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training period, suggests that any effects may manifest over a 12. Carr W, Stone JR, Walilko T, et al. Repeated low-level blast ex-
long time. On the other hand, those studies that specifically posure: a descriptive human subjects study. Mil Med. 2016;181(5
assessed breachers over a long time, using within and be- suppl):28–39.
tween-subjects designs, did not find any effect of blast. None of 13. Carr W, Yarnell AM, Ong R, et al. Ubiquitin carboxy-terminal
the studies addressed the possibility that exposure to repetitive hydrolase-l1 as a serum neurotrauma biomarker for exposure to
occupational low-level blast. Front Neurol. 2015;6:49.
blast may hasten or cause neurodegeneration over time. Re- 14. Shamseer L, Moher D, Clarke M, et al. Preferred reporting items
search with larger sample sizes is needed, as well as career-long for systematic review and meta-analysis protocols (PRISMA-P)
objective monitoring. The sheer volume of data produced by 2015: elaboration and explanation. BMJ. 2015;349:g7647.
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such efforts will benefit from computational modeling and 15. Blennow K, Jonsson M, Andreasen N, et al. No neurochemical
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automated algorithms that correct for sensor dynamics. evidence of brain injury after blast overpressure by repeated ex-
plosions or firing heavy weapons. Acta Neurol Scand. 2011;123
(4):245–251.
Funding 16. Tate CM, Wang KK, Eonta S, et al. Serum brain biomarker level,
This research was supported by the Department of Defense neurocognitive performance, and self-reported symptom changes
(DoD) and 9 Line LLC. Additional support was provided by in soldiers repeatedly exposed to low-level blast: a breacher pilot
the Defense and Veterans Brain Injury Center (DVBIC; grant study. J Neurotrauma. 2013;30(19):1620–1630.
no. MDA 905-03-2-0003). 17. Gill J, Motamedi V, Osier N, et al. Moderate blast exposure re-
sults in increased IL-6 and TNFalpha in peripheral blood. Brain
Behav Immun. 2017;65:90–94.
Disclaimer 18. Gill J, Cashion A, Osier N, et al. Moderate blast exposure alters
The views expressed herein are those of the authors and do gene expression and levels of amyloid precursor protein. Neurol
not necessarily reflect the views of the Department of Health Genet. 2017;3(5):e186.
Affairs, the DoD, or DVBIC. 19. Baker AJ, Topolovec-Vranic J, Michalak A, et al. Controlled blast
exposure during forced explosive entry training and mild trau-
matic brain injury. J Trauma. 2011;71(5 suppl 1):S472–477.
Disclosures 20. Kamimori GH, LaValle CR, Eonta SE, et al. Longitudinal in-
The authors have indicated they have no financial relation- vestigation of neurotrauma serum biomarkers, behavioral char-
ships relevant to this article to disclose. acterization, and brain imaging in soldiers following repeated
low-level blast exposure (New Zealand Breacher Study). Mil
Author Contributions Med. 2018;183(suppl_1):28–33.
HB conceived the study concept and wrote the first draft. FB 21. Thiel KJ, Dretsch MN, Ahroon WA. The effects of low-level re-
and EY provided conceptual and editorial input, and all au- petitive blasts on neuropsychological functioning. USAARL Re-
port No 2016-06. 2015;December:1–28.
thors read and approved the final manuscript. 22. Rhea CK, Kuznetsov NA, Ross SE, et al. Development of a por-
table tool for screening neuromotor sequelae from repetitive low-
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