Estimating the effects of ramp-up and learning from cost performance data

Emergency medicine research on the front lines

This Viewpoint discusses the updated 2023 clinical practice guidelines issued by the US Department of Veterans Affairs and the US Department of Defense regarding treatment approaches for posttraumatic stress disorder.

FCE to demo DFC300 system at US Army base in California

US Department of Defense contributions to malaria surveillance

Testosterone Supplementation Enhances Lean Body Mass But Not Lower-Body Muscular Strength and Endurance During Severe Exercise- and Diet-Induced Energy Deficit

Response

IntroductionThis study aims to evaluate US Department of Defense hospital efficiency.MethodsDrawing on the American Hospital Association’s annual survey data, the study employs data envelopment analysis, slack analysis, and the Malmquist Productivity Index to identify the differences in hospital efficiency between Air Force, Army, and Navy hospitals as well as the trends of their efficiency from 2010 to 2021.ResultsUS Department of Defense hospitals operated inefficiently from 2010 to 2021, although the average technical efficiency of all DOD hospitals increased slightly during this period. The inefficiency of all US Department of Defense hospitals may be due to the lack of pure technical efficiency rather than the suboptimal scale. However, as the efficiency trends in Navy hospitals differ from those in Army and Air Force hospitals, we should be careful in addressing the inefficiency of each type of US Department of Defense hospital.ConclusionInformed by the findings, this study enhances our understanding of US Department of Defense hospital efficiency and the policy implications, offering practical advice to healthcare policymakers, hospital executives, and managers on managing military hospitals.

The US Army offers English-language instruction and socio-cultural training to foreign-born personnel, and current US law allows some immigrants to apply for expedited citizenship through military service. The US Army, thus, offers a compelling context in which to explore how such institutional factors might facilitate immigrant incorporation, yet we know little about the experience of foreign-born soldiers because most surveys exclude active-duty personnel. Using novel data obtained from the US Department of Defense that are not available to the public, this research note describes the integrative nature of the US Army, and contrasts foreign-born and native-born soldiers in relation to what we know about selectivity and immigrant job outcomes elsewhere. We examine rank, promotion likelihood, and retention of newly enlisted citizen and noncitizen immigrant soldiers compared to their native-born counterparts who joined the US Army between 2002 and 2009. We show that immigrants perform equally well or better than native-born soldiers.

: The international mobilization to save the Republic of Korea (ROK) in June 1950 brought the Canadian Army into its first major sustained contact with the US Army. The experience proved generally positive and laid the foundation for cooperation for hemispheric and European defense during the Cold War. The relationship of the 25th Canadian Infantry Brigade Group (CIBG) in Korea and its rear echelon in Japan to the US Army was, however, occasionally strained. The major clash of military cultures between Canadians and Americans occurred in the Japanese domain of the US Far East Command (FECOM) and US Army Forces Far East, not in the US Eighth Army. The result was grudging accommodation and wary compromises that kept alive the Canadian and American partnership. When the United Nations called for its member nations to provide ground forces to fight the North Korean Army, the US Department of Defense tried to set the terms by which FECOM would accept foreign troops for the Eighth Army. The basic criteria were reasonable enough. The forces should be of brigade or regimental size and of proven effectiveness. The forces should be supportable by their national armies and the US Army. The logistical support agreements should be negotiated for cost sharing, to be paid later. The existing military aid programs would remain in place. The Joint Chiefs of Staff (JCS) knew which armies met the criteria: Great Britain, Australia, New Zealand, Pakistan, and Canada.

In 1973, the US Department of Defense (DoD) began development of the Navstar global positioning system (GPS) and embarked on a journey that would take radio navigation and positioning to what were then unimagined levels of performance. From its inception, GPS was viewed as a revolutionary technology that would enhance the positioning capability of US and allied military forces throughout the world. The DoD has continued to upgrade and improve all of the components of the system to keep pace with technology advances and the requirements of an ever-expanding user community. The GPS user community includes an increasing number of civil, scientific, and commercial applications, ranging from precision scanning to pinpointing disruptions in electric power distribution networks. However, this dual military and civil aspect of GPS has posed significant challenges for the US government and DoD policy makers. Since the inception of GPS, the DoD has been confronted with the need to balance a wide range of different and sometimes competing national security, civil, foreign policy, commercial and scientific interests. The challenge has been to exploit the full civil utility of the system without jeopoardizing national security interests in the process. This challenge will become even more formidable for military leaders as US and allied forces become increasingly reliant on GPS for all types of military operations, and as the applications of the worldwide civil user community continue to expand.

Chapter 2 - US Department of Defense launch safety standards

This article analyzes the complex problems associated with the operations and staffing of the US Army's junior officers during the Republican administration of Richard Nixon. The second half of the 1960s and first half of the 1970s were marked by prevailing anti-war sentiment in the US public opinion, which contributed to a crisis in the US Army's officer corps staffing system. A combination of social, economic, and other preferences led to military service in general, and officer careers in particular, becoming unattractive to younger generations. Recognizing the scale of the problems, the Nixon administration and the US Department of Defense took a number of measures to address the overall crisis in the US Army staffing system, the effectiveness of which remains a subject of debate.

Brief cognitive behavioral therapy (BCBT) is a clinically effective intervention for reducing risk of suicide attempts among suicidal US Army soldiers. However, because specialized treatments can be resource intensive, more information is needed on costs and benefits of BCBT compared with existing treatments. To evaluate the cost-effectiveness of BCBT compared with treatment as usual for suicidal soldiers in the US Army. A decision analytic model compared effects and costs of BCBT vs treatment as usual from a US Department of Defense (DoD) perspective. Model input data were drawn from epidemiologic data sets and a clinical trial among suicidal soldiers conducted from January 31, 2011, to April 3, 2014. Data were analyzed from July 3, 2018, to March 25, 2019. The strategies compared were treatment as usual alone vs treatment as usual plus 12 individual BCBT sessions. Treatment as usual could include a range of pharmacologic and psychological treatment options. Costs in 2017 US dollars, suicide attempts averted (self-directed behavior with intent to die, but with nonfatal outcome), suicide deaths averted, and incremental cost-effectiveness ratios, assuming a 2-year time horizon for treatment differences but including lifetime costs. In the base-case analysis, BCBT was expected to avert approximately 23 to 25 more suicide attempts and 1 to 3 more suicide deaths per 100 patients treated than treatment as usual. Sensitivity analyses assuming a range of treatment effects showed BCBT to be cost saving in most scenarios. Using the federal discount rate, the DoD was estimated to save from $15 000 to $16 630 per patient with BCBT vs treatment as usual. In a worst-case scenario (ie, assuming the weakest plausible BCBT effect sizes), BCBT cost an additional $1910 to $2250 per patient compared with treatment as usual. Results suggest BCBT may be a cost-saving intervention for suicidal active-duty soldiers. The costs of ensuring treatment fidelity would also need to be considered when assessing the implications of disseminating BCBT across the entire DoD.

The US Department of Defense, including the Army, Air Force, Navy, and Defense Advanced Research Projects Agency (DARPA) has engaged in cognitive enhancement research and development for over a century, exploring novel pharmaceutical, dietary, neuroscientific, instructional, technological, and sleep-related enhancement strategies. The overall objective of this work is to identify safe, reliable, and robust strategies and technologies to help military personnel achieve dominance through enhanced skill acquisition, vigilance and threat detection, situation awareness, decision-making, teamwork, and emotional control. The present review provides an introductory overview of recent and current US Army research examining several approaches to cognitive enhancement. These include approaches aimed at specifically targeting neural mechanisms and processes directly responsible for enhanced task performance and include transcranial electrical stimulation (tES), augmented reality (AR), and targeted skills training. Also considered are approaches targeting nth-order mechanisms and processes that relatively indirectly affect perception, cognition, and/or emotion and include nutritional and dietary intervention, resilience, cognitive and teamwork training, peripheral nerve stimulation, and sleep modification. We detail several promising approaches and provide an overview of forward-looking research objectives pursued by the US Army. Finally, we provide an overview of some of the ethical, regulatory, methodological, technological, doctrinal, and reliability challenges facing cognitive enhancement research and constraining its immediate application to military training and operations.

This article updates new developments in the evolution of the US Army's controversial Human Terrain System program (HTS). Building upon the recent report on the HTS program by the American Anthropological Association's Commission on the Engagement of Anthropology with the Security and Intelligence Communities, this article discusses how HTS‐type arrangements are becoming part of the US Department of Defense's (DoD's) newest Combatant Command for the continent of Africa, or AFRICOM. Of particular note is the way “human terrain” no longer refers simply to the HTS program, but has acquired expanded reference to describe a broader array of approaches to the leveraging of socio‐cultural knowledge within DoD. Most notably for AFRICOM, this includes moving beyond rapid assessment ethnography to incorporate cultural data into the predictive work of cultural modelling, as this informs the implementation both of counterinsurgency doctrine as well as military humanitarianism in Africa and elsewhere. This article explores the ethical, practical and cultural implications of such a turn.