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such as continuous glucose, lactate, and ketones to help users   6.  United States Government  Accountability Office. GAO-22-
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          Limitations                                           2023. https://www.gao.gov/assets/gao-22-104486.pdf
          A key limitation of this study is continued adherence to the   7.  United States Government Accountability Office. GAO-23-105644:
          mobile application and study tasks. Keeping users engaged   Special Operations Forces: Actions Needed to Assess Performance
          over time is a limitation of most app-based health and human   of the Preservation of the Force and Family Program. Report to
          performance studies and consumer apps. User-rated content   Congressional Committees. Updated April 27, 2023. Accessed May
          and app feature use help drive continued adherence, as will the   1, 2023. https://www.gao.gov/assets/gao-23-105644.pdf
          addition of BYOD.                                   8.  Wickwire EM, Albrecht JS, Capaldi VF 2nd, et al. Trajectories
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          create gaps in the otherwise continuous data collection. This   9.  Werner JK, Shahim P, Pucci JU, et al. Poor sleep correlates with
          restriction can limit the ability of the app and the individual   biomarkers of neurodegeneration in mild traumatic brain injury
          to follow their progress accurately in real time. However, new   patients: a CENC study. Sleep. 2021;44(6):zsaa272. doi:10.1093/
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          AI and machine learning algorithms can improve the strength   10.  Saxon L, DiPaula B, Fox GR, et al. Continuous measurement of
          and accuracy of insights provided by the app to the individual,   reconnaissance marines in training with custom smartphone app
          which can drive engagement and help overcome gaps in data   and watch: observational cohort study. JMIR Mhealth Uhealth.
          collection through probabilistic analytic methods. 28  2020;8(6):e14116. doi:10.2196/14116
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                                                             12.  Saxon L, Faulk RT, Barrett T, McLelland S, Boberg J. A novel
          The data collected from Servicemembers in this study is more   digital research methodology for continuous health assessment of
          inclusive of the totality of mental and physical load experi-  the special operations warfighter: the Digital cORA Study. J Spec
          enced by each Servicemember than infrequent in-person check-  Oper Med. 2022;22(4):78–82. doi:10.55460/4SSJ-AHIB
          ins. This approach can more accurately assess overall health   13.  ResearchKit. Active Tasks. Updated August 30, 2018. Accessed
          and preserve mental and physical health and readiness. The   April 27, 2023. https://researchkit.org/docs/docs/ActiveTasks/Ac-
                                                                tiveTasks.html
          ability for individuals to see negative trends in performance   14.  Koffel E, Kramer MD, Arbisi PA, Erbes CR, Kaler M, Polusny
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          Author Contributions                                  doi:10.1017/S0033291715001798
          LS conceived the study concept, obtained funding, and wrote   15.  Morais CHB, Barini Filho U, Martins MR. In: Proceedings of the
          the first draft. RF made intellectual contributions. TB analyzed   ASME 2020 39th International Conference on Ocean, Offshore
          the data and created the tables. SM designed and created the   and Arctic  Engineering. American Society of Mechanical Engi-
          app and research platform. JB made intellectual and editorial   neers; 2020.
          contributions.                                     16.  Price L. Texas State University – DISC Personality System Valida-
                                                                tion Study. In: DISC Technical Supplement. Institute for Motiva-
                                                                tional Living; 2018.
          Disclosures                                        17.  Prochaska F, Sampayo J, Carter B. DISC Factors. SSRN. 2015.
          The authors have indicated they have no financial relation-  doi:http://dx.doi.org/10.2139/ssrn.2686882
          ships relevant to this article to disclose.        18.  Summerlin RMC. Personality Styles of Student Naval Aviators:
                                                                An Analysis of Disc Styles in Flight Training and Attrition Rates.
          Funding                                               Southeastern Baptist Theological Seminary; 2012.
          This work was supported by the Military Operational Medi-  19.  Jang S, Kitchen PJ, Kim J. The effects of gamified customer bene-
                                                                fits and characteristics on behavioral engagement and purchase:
          cine Research Program.                                Evidence from mobile exercise application uses. Journal of Busi-
                                                                ness Research. 2018;92:250–259. doi:https://doi.org/10.1016/j.
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