nation. This chapter describes some of the research, along with some of the advantages and limitations, of self-assessment.

The ultimate goal of collecting data on biomarkers that measure or predict the status of physiological and cognitive function of military personnel is to assess any change in these functions that could compromise an individual’s health and ability to perform mission tasks. The usual approach to the interpretation of these data is to compare them with the range of values determined to support normal physiological and cognitive function. If the data are outside this range, then there is a risk that the health of the individual and/or the mission success will be compromised. Corrective actions should be available to bring the physiological or cognitive function back to the normal range or to save the individual and accomplish the mission objective.

To implement such a system, several steps must be accomplished. First, there must be devices for continuously or intermittingly monitoring the biomarkers. Second, there must be some system for transmitting the data to a command and control unit or to the individual so that corrective action can be taken. Third, there must be baseline or reference data (normal range) that can be used to interpret the data. (The development of devices for measuring biomarkers and the system for transmission of data is beyond the scope of this report.)

For practical reasons it is likely that the data-monitoring system will be able to calculate and screen the incoming data so only those data that require action will be brought to the attention of the individual and/or the command and control unit. This means that the standard used in the analysis (the baseline data) becomes important. It is widely recognized that many individuals have biomarker values that may fall outside the normal range for some physiological or cognitive functions (Sargent and Weinman, 1966). Although the normal range is useful in the practice of clinical medicine because there are other opportunities to make judgments about a patient’s condition, a more rigorous approach may be needed for a system monitoring the vital functions of a combat service member.

A biomarker is a surrogate marker for an important outcome and therefore the choice of biomarkers will have a significant impact on the types and design of the devices and systems that will be needed. Major issues that must be considered are related to the validation of the biomarker, such as reliability and the potential for false positive or false negative results. Therefore, prior to implementing performance testing to assess “readiness to perform,” careful planning is necessary. Test development and validation can be a rather daunting and complex problem. For instance, even when a given measure has good reliability and validity under laboratory conditions, the efficacy of the procedure may not generalize to field settings. At the most basic level, it is first necessary to de-

Front Matter (R1-R18)

Executive Summary (1-14)

1 Rationale for Military Interest and Current Capabilities in Monitoring Metabolism (15-36)

2 The Study of Individual Differences: Statistical Approaches to Inter- and Intraindividual Variability (37-52)

3 Monitoring Overall Physical Status to Predict Performance (53-84)

4 Physiological Biomarkers for Predicting Performance (85-158)

5 Strategies for Monitoring Cognitive Performance (159-194)

6 Conclusions and Recommendations (195-208)

Appendix A: Examples of Physiological and Cognitive Markers of Performance (209-218)

Appendix B: Metabolic Monitoring at the National Aeronautics and Space Administration: A Concept for the Military (219-232)

Appendix C: Workshop Agenda (233-236)

Appendix D: Workshop Manuscripts (237-434)

Appendix E: Biographical Sketches of Workshop Speakers (435-444)

Appendix F: Biographical Sketches of Committee Members (445-450)