{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,13]],"date-time":"2026-05-13T13:28:26Z","timestamp":1778678906631,"version":"3.51.4"},"reference-count":35,"publisher":"Oxford University Press (OUP)","issue":"Supplement_6","license":[{"start":{"date-parts":[[2023,11,1]],"date-time":"2023-11-01T00:00:00Z","timestamp":1698796800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Although existing auditory injury prevention standards benefit warfighters, the Department of Defense could do more to understand and address auditory injuries (e.g., hearing loss, tinnitus, and central processing deficits) among service members. The Blast Injury Prevention Standards Recommendation (BIPSR) Process is designed to address the needs of all the Military Services for biomedically valid Military Health System (MHS) Blast Injury Prevention Standards.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Materials and Methods<\/jats:title>\n                  <jats:p>Through the BIPSR Process, stakeholders provided their intended uses and requested functionalities for an MHS Blast Injury Prevention Standard. The BIPSR Process established a broad-based, non-advocacy panel of auditory injury Subject Matter Expert (SME) Panel with members drawn from industry, academia, and government. The SME Panel selected evaluation factors, weighted priorities, and then evaluated the resulting candidate MHS Auditory Blast Injury Prevention Standards against the evaluation criteria. The SME Panel members provided rationales for their decisions, documented discussions, and used iterative rounds of feedback to promote consensus building among members. The BIPSR Process used multi-attribute utility theory to combine members\u2019 evaluations and compare the candidate standards.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>The SME Panel identified and collated information about existing auditory injury datasets to identify gaps and promote data sharing and comprehensive evaluations of standards for preventing auditory blast injury. The panel evaluated the candidate standards and developed recommendations for an MHS Blast Injury Prevention Standard.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>The BIPSR Process illuminated important characteristics, capabilities, and limitations of candidate standards and existing datasets (e.g., limited human exposure data to evaluate the validity of injury prediction) for auditory blast injury prevention. The evaluation resulted in the recommendation to use the 8-hour Equivalent Level (LAeq8hr) as the interim MHS Auditory Blast Injury Prevention Standard while the community performs additional research to fill critical knowledge gaps.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usad078","type":"journal-article","created":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T15:01:08Z","timestamp":1699628468000},"page":"176-184","source":"Crossref","is-referenced-by-count":4,"title":["Recommendations for a Military Health System Auditory Blast Injury Prevention Standard"],"prefix":"10.1093","volume":"188","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5183-2550","authenticated-orcid":false,"given":"Elizabeth B","family":"Brokaw","sequence":"first","affiliation":[{"name":"The MITRE Corporation , McLean, VA 22102, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Douglas","family":"S. Brungart","sequence":"additional","affiliation":[{"name":"Walter Reed National Military Medical Center , Bethesda, MD 20814, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan","family":"M. Byrne","sequence":"additional","affiliation":[{"name":"The MITRE Corporation , McLean, VA 22102, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Greg","family":"A. Flamme","sequence":"additional","affiliation":[{"name":"Stephenson and Stephenson Research and Consulting, LLC , Forest Grove, OR 97116, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raj","family":"Gupta","sequence":"additional","affiliation":[{"name":"U.S. Army Medical Research and Development Command , Frederick, MD 21702-501, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Charles R","family":"Jokel","sequence":"additional","affiliation":[{"name":"Defense Centers for Public Health-Aberdeen , Aberdeen Proving Ground, MD 21010-5403, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon G","family":"Kujawa","sequence":"additional","affiliation":[{"name":"Massachusetts Eye and Ear , Boston, MA 02114, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa","family":"Lalis","sequence":"additional","affiliation":[{"name":"The MITRE Corporation , McLean, VA 22102, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Richard","family":"L. McKinley","sequence":"additional","affiliation":[{"name":"U.S. Air Force Research Laboratory , Wright-Patterson AFB, OH 45433, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"William J","family":"Murphy","sequence":"additional","affiliation":[{"name":"Stephenson and Stephenson Research and Consulting, LLC , Forest Grove, OR 97116, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel","family":"W. Spencer","sequence":"additional","affiliation":[{"name":"The MITRE Corporation , McLean, VA 22102, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher","family":"J. Smalt","sequence":"additional","affiliation":[{"name":"Massachusetts Institute of Technology Lincoln Laboratory , 244 Wood St, Lexington, Massachusetts 02421, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brissi","family":"F. Zagadou","sequence":"additional","affiliation":[{"name":"L3 Harris Technologies, Inc. , San Diego, CA 92121, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,11,8]]},"reference":[{"key":"2023111014354077100_R1","article-title":"2022 Annual Benefits Report","author":"U.S. Department of Veterans Affairs","year":"2023"},{"key":"2023111014354077100_R2","volume-title":"American Institute of Biological Sciences Peer Review of Injury Prevention and Reduction","author":"Wightman","year":"2010"},{"issue":"2","key":"2023111014354077100_R3","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1287\/deca.1060.0071","article-title":"Should We Protect Commercial Airplanes Against Surface-to-Air Missile Attacks by Terrorists?","volume":"3","author":"von Winterfeldt","year":"2006","journal-title":"Decis Anal"},{"issue":"5","key":"2023111014354077100_R4","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1097\/MOO.0000000000000083","article-title":"Noise-induced hearing loss: a military perspective","volume":"22","author":"Pfannenstiel","year":"2014","journal-title":"Curr Opin Otolaryngol Head Neck Surg"},{"issue":"3","key":"2023111014354077100_R5","doi-asserted-by":"publisher","first-page":"71","DOI":"10.1093\/epirev\/mxu005","article-title":"Hearing impairment and tinnitus: prevalence, risk factors, and outcomes in US service members and veterans deployed to the Iraq and Afghanistan wars","volume":"37","author":"Theodoroff","year":"2015","journal-title":"Epidemiol Rev"},{"issue":"6","key":"2023111014354077100_R6","doi-asserted-by":"publisher","first-page":"797","DOI":"10.1682\/JRRD.2008.09.0118","article-title":"Auditory and vestibular dysfunction associated with blast-related traumatic brain injury","volume":"46","author":"Fausti","year":"2009","journal-title":"J Rehabil Res Dev"},{"issue":"Suppl 1","key":"2023111014354077100_R7","doi-asserted-by":"publisher","first-page":"S42","DOI":"10.1080\/14992027.2017.1416189","article-title":"Acoustic reflexes are common but not pervasive: evidence using a diagnostic middle ear analyser","volume":"57","author":"McGregor","year":"2018","journal-title":"Int J Audiol"},{"key":"2023111014354077100_R8","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.heares.2018.11.006","article-title":"Human middle-ear muscles rarely contract in anticipation of acoustic impulses: implications for hearing risk assessments","volume":"378","author":"Jones","year":"2019","journal-title":"Hear Res"},{"key":"2023111014354077100_R9","article-title":"Pervasiveness of Early Middle Ear Muscle Contractions USAARL-TECH-TR\u20132021-05","author":"Flamme","year":"2021"},{"issue":"45","key":"2023111014354077100_R10","doi-asserted-by":"publisher","first-page":"14077","DOI":"10.1523\/JNEUROSCI.2845-09.2009","article-title":"Adding insult to injury: cochlear nerve degeneration after \u201ctemporary\u201d noise-induced hearing loss","volume":"29","author":"Kujawa","year":"2009","journal-title":"J Neurosci Res"},{"issue":"1","key":"2023111014354077100_R11","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1016\/j.heares.2017.01.003","article-title":"Cochlear synaptopathy in acquired sensorineural hearing loss: manifestations and mechanisms","volume":"349","author":"Liberman","year":"2017","journal-title":"Hear Res"},{"key":"2023111014354077100_R12","doi-asserted-by":"publisher","first-page":"627","DOI":"10.1016\/j.freeradbiomed.2017.04.343","article-title":"Antioxidants reduce neurodegeneration and accumulation of pathologic Tau proteins in the auditory system after blast exposure","volume":"108","author":"Du","year":"2017","journal-title":"Free Radic Biol Med"},{"issue":"7","key":"2023111014354077100_R13","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1371\/journal.pone.0067618","article-title":"Mechanisms of hearing loss after blast injury to the ear","volume":"8","author":"Cho","year":"2013","journal-title":"PLoS One"},{"issue":"1","key":"2023111014354077100_R14","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41598-018-28924-7","article-title":"Blast-induced cochlear synaptopathy in chinchillas","volume":"8","author":"Hickman","year":"2018","journal-title":"Sci Rep"},{"key":"2023111014354077100_R15","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.neuroscience.2018.07.053","article-title":"Primary neural degeneration in the human cochlea: evidence for hidden hearing loss in the aging ear","volume":"407","author":"Wu","year":"2019","journal-title":"Neuroscience"},{"issue":"20","key":"2023111014354077100_R16","doi-asserted-by":"publisher","first-page":"4439","DOI":"10.1523\/JNEUROSCI.3238-20.2021","article-title":"Primary neural degeneration in noise-exposed human cochleas: correlations with outer hair cell loss and word-discrimination scores","volume":"41","author":"Wu","year":"2021","journal-title":"J Neurosci"},{"issue":"3","key":"2023111014354077100_R17","doi-asserted-by":"publisher","first-page":"834","DOI":"10.1044\/2019_JSLHR-19-00293","article-title":"Acquired central auditory processing disorder in service members and veterans","volume":"63","author":"Tepe","year":"2020","journal-title":"J Speech Lang Hear Res"},{"key":"2023111014354077100_R18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fneur.2020.00613","article-title":"Objective and subjective auditory effects of traumatic brain injury and blast exposure in service members and veterans","volume":"11","author":"Kuchinsky","year":"2020","journal-title":"Front Neurol"},{"issue":"6","key":"2023111014354077100_R19","doi-asserted-by":"publisher","first-page":"1615","DOI":"10.1097\/AUD.0000000000001067","article-title":"Estimated prevalence of functional hearing difficulties in blast-exposed service members with normal to near\u2013normal-hearing thresholds","volume":"42","author":"Grant","year":"2021","journal-title":"Ear Hear"},{"key":"2023111014354077100_R20","first-page":"1","article-title":"Field assessment of acute auditory responses to environmental exposures in close quarters tactics training","volume":"24","author":"Kulinski","year":"2022","journal-title":"Int J Audiol"},{"issue":"3","key":"2023111014354077100_R21","doi-asserted-by":"publisher","first-page":"457","DOI":"10.1097\/AUD.0000000000000517","article-title":"Effect of blast injury on auditory localization in military service members","volume":"39","author":"Kubli","year":"2018","journal-title":"Ear Hear"},{"key":"2023111014354077100_R22","article-title":"Evaluation of Low-Gain Hearing Aids as Treatment for Auditory Processing Deficits in Service Members with Normal Hearing Thresholds and History of mTBI","author":"Kokx-Ryan","year":"2020"},{"issue":"4","key":"2023111014354077100_R23","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1001\/jamanetworkopen.2021.6445","article-title":"Neurotrauma biomarker levels and adverse symptoms among military and law enforcement personnel exposed to occupational overpressure without diagnosed traumatic brain injury","volume":"4","author":"Boutt\u00e9","year":"2021","journal-title":"JAMA Netw Open"},{"issue":"7","key":"2023111014354077100_R24","doi-asserted-by":"publisher","first-page":"1059","DOI":"10.1682\/JRRD.2010.09.0166","article-title":"Implications of blast exposure for central auditory function: a review","volume":"49","author":"Gallun","year":"2012","journal-title":"J Rehabil Res Dev"},{"issue":"3","key":"2023111014354077100_R25","doi-asserted-by":"publisher","first-page":"699","DOI":"10.1523\/JNEUROSCI.2226-04.2005","article-title":"Enriched acoustic environment after noise trauma reduces hearing loss and prevents cortical map reorganization","volume":"25","author":"Norena","year":"2005","journal-title":"J Neurosci Res"},{"issue":"7","key":"2023111014354077100_R26","doi-asserted-by":"publisher","first-page":"2115","DOI":"10.1523\/JNEUROSCI.4985-05.2006","article-title":"Acceleration of age-related hearing loss by early noise exposure: evidence of a misspent youth","volume":"26","author":"Kujawa","year":"2006","journal-title":"J Neurosci Res"},{"issue":"19","key":"2023111014354077100_R27","doi-asserted-by":"publisher","first-page":"7509","DOI":"10.1523\/JNEUROSCI.5138-14.2015","article-title":"Aging after noise exposure: acceleration of cochlear synaptopathy in \u201crecovered\u201d ears","volume":"35","author":"Fernandez","year":"2015","journal-title":"J Neurosci Res"},{"issue":"3","key":"2023111014354077100_R28","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1007\/s00420-015-1083-5","article-title":"Occupational noise exposure and hearing: a systematic review","volume":"89","author":"Lie","year":"2015","journal-title":"Int Arch Occup Environ Health"},{"issue":"45","key":"2023111014354077100_R29","doi-asserted-by":"publisher","first-page":"14972","DOI":"10.1523\/JNEUROSCI.4028-10.2010","article-title":"Ringing ears: the neuroscience of tinnitus","volume":"30","author":"Roberts","year":"2010","journal-title":"J Neurosci Res"},{"issue":"10","key":"2023111014354077100_R30","doi-asserted-by":"publisher","first-page":"1825","DOI":"10.1097\/MAO.0000000000000616","article-title":"Otologic outcomes after blast injury: The Boston Marathon experience","volume":"35","author":"Remenschneider","year":"2014","journal-title":"Otol Neurotol"},{"issue":"3","key":"2023111014354077100_R31","first-page":"355","article-title":"Sound-evoked activity in primary afferent neurons of a mammalian vestibular system","volume":"18","author":"McCue","year":"1997","journal-title":"Am J Otol"},{"issue":"10","key":"2023111014354077100_R32","doi-asserted-by":"publisher","first-page":"2155","DOI":"10.1089\/neu.2010.1532","article-title":"Rodent model of direct cranial blast injury","volume":"28","author":"Kuehn","year":"2011","journal-title":"J Neurotrauma"},{"key":"2023111014354077100_R33","first-page":"1","article-title":"The vestibular effects of repeated low-level blasts","volume":"11","author":"Littlefield","year":"2015","journal-title":"J Neurotrauma"},{"issue":"3","key":"2023111014354077100_R34","first-page":"190","article-title":"The effects of noise on the vestibular system","volume":"22","author":"Golz","year":"2001","journal-title":"Am J Otolaryngol -Head Neck Med Surg"},{"issue":"4","key":"2023111014354077100_R35","doi-asserted-by":"publisher","first-page":"1955","DOI":"10.1121\/1.1605415","article-title":"Hearing protection: surpassing the limits to attenuation imposed by the bone-conduction pathways","volume":"114","author":"Berger","year":"2003","journal-title":"J Acoust Soc Am"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/188\/Supplement_6\/176\/53075609\/usad078.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/article-pdf\/188\/Supplement_6\/176\/53075609\/usad078.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T15:01:14Z","timestamp":1699628474000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/article\/188\/Supplement_6\/176\/7388250"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,1]]},"references-count":35,"journal-issue":{"issue":"Supplement_6","published-online":{"date-parts":[[2023,11,8]]},"published-print":{"date-parts":[[2023,11,8]]}},"URL":"https:\/\/doi.org\/10.1093\/milmed\/usad078","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2023,11,1]]},"published":{"date-parts":[[2023,11,1]]}}}