Conflict In Afghanistan Research Articles

The battalion aid station (BAS) has historically served as the first stop during which combat casualties would receive care beyond a combat medic. Since the conflicts in Iraq and Afghanistan, many combat casualties have bypassed the BAS for treatment facilities capable of surgery. We describe the care provided at these treatment facilities during 2007-2020. This is a secondary analysis of previously described data from the Department of Defense Trauma Registry. We included encounters with the documentation of an assessment or intervention at a BAS or forward operating base from January 1, 2007 to March 17, 2020. We utilized descriptive statistics to characterize these encounters. There were 28,950 encounters in our original dataset, of which 3.1% (884) had the documentation of a prehospital visit to a BAS. The BAS cohort was older (25 vs. 24, P < .001) The non-BAS cohort saw a larger portion of pediatric (<18 years) patients (10.7% vs. 5.7%, P < .001). A higher proportion of BAS patients had nonbattle injuries (40% vs. 20.7%, P < .001). The mean injury severity score was higher in the non-BAS cohort (9 vs. 5, P < .001). A higher proportion of the non-BAS cohort had more serious extremity injuries (25.1% vs. 18.4%, P < .001), although the non-BAS cohort had a trend toward serious injuries to the abdomen (P = .051) and thorax (P = .069). There was no difference in survival. The BAS was once a critical point in casualty evacuation and treatment. Within our dataset, the overall number of encounters that involved a stop at a BAS facility was low. For both the asymmetric battlefield and multidomain operations/large-scale combat operations, the current model would benefit from a more robust capability to include storage of blood, ventilators, and monitoring and hold patients for an undetermined amount of time.

The present paper aims to quantify how human-made changes in the upstream exacerbate climate change impacts on water birds’ habitat in the downstream. To reduce climate change effects and design adaptation policies, it is important to identify whether human activities understate or overstate the effects of climate change in a region on its inhabitants. This paper also shows how human activities may magnify climate change impacts both locally and regionally. Land-use/land-cover change as the important sign of human-made destruction in an ecosystem was detected in the upstream of the Helmand basin over 40 years. Owing to conflicts in Afghanistan, studies on this basin are rare. The water bird’s habitat suitability maps during the study period were created using the maximum entropy model and the multi-criteria evaluation method. The post-classification method was applied to show the land-use/land-cover change over 40 years. These results were compared to the area of suitable habitat for water birds. The findings of these analyses indicated that the irrigated farming was expanded in the upstream despite climate change and water limitation, while the water birds’ habitat in the downstream was declined. These results revealed that the unsustainable pattern of farming and blocking water behind dams in the upstream exacerbated the negative effects of climate change on water birds’ habitat in the downstream. The significance of this study is to demonstrate the role of human in exacerbating climate change impacts both locally and regionally.

This paper aims to present the role of intelligence services in the American foreign policy using as a case study the Afghan conflict from 1979-1989. Thus, this paper underlines the actions (or inactions) of the American intelligence services, highlighting their limitations from this period. It is important to describe the context that contributed to the start of the soviet invasion in Afghanistan and the two perspectives (American and Soviet) over the conflict. In this regard, we considered necessary an analysis on the Soviet point of view regarding the conflict and, most importantly, concerning the American involvement, having in mind the purpose of objectiveness while presenting the context and events. Using the relevant documents, testimonies and statements of former CIA officials from that period, the paper underlines the way foreign policy decisions were taken by the Administrations from Washington, during the Soviet-Afghan war, and how American intelligence services influenced the foreign policy decision-making process and the evolution of the conflict.

As the combat operational tempo of the military conflicts in Iraq and Afghanistan has declined over the last decade, there has been a decrease in the number of patients requiring acute limb salvage. In their place, a growing population of patients with persistent functional deficits, pain, and inadequate soft tissue coverage stemming from prior limb salvage strategies have returned to our institution seeking revision surgery. Herein, we examine our institution's evolving surgical approach to extremity reconstruction from 2011 through 2019, culminating in the development of our limb restoration concept. We also discuss the impact of this orthoplastic approach on the acute management of complex extremity trauma and its role in providing sustained surgical readiness during interwar years. We retrospectively reviewed all limb reconstructive procedures performed at our tertiary care military treatment facility between September 1, 2011 to December 31, 2019 to characterize the trends in extremity reconstruction procedures performed at our institution. Cases were identified as limb restoration procedures if they involved secondary/revision reconstructive procedures designed to optimize function, treat pain, or improve the durability of the injured extremity following initial reconstruction efforts. Nearly 500 limb restoration procedures were performed during the study period. These procedures steadily increased since 2011, reaching a maximum of 120 in 2018. Orthoplastic procedures such as osseointegration, targeted muscle reinnervation, regenerative peripheral nerve interface, agonist-antagonist myoneural interface, and soft tissue resurfacing flap reconstruction accounted for the rise in secondary/revision reconstruction performed during this time period. Limb restoration is a collaborative orthoplastic approach that utilizes state-of-the-art surgical techniques for treating complex extremity trauma. Although limb restoration originally developed in response to managing the long-term sequelae of combat extremity trauma, the concept can be adapted to the acute management setting. Moreover, limb restoration provides military surgeons with a means for maintaining critical war-time surgical skills during the current low casualty rate era. Level of Evidence: V, therapeutic.

Predictors of Cognitive Functioning Among Veterans with Mild Traumatic Brain Injury

Increased emphasis on stability operations, counterinsurgency, and security cooperation during the conflicts in Afghanistan and Iraq resulted in programs to train and educate U.S. military personnel in foreign cultures and intercultural competence. Now, with the shift to great power competition, the Services have reduced or eliminated cultural training and education requirements. Documenting the approaches and lessons from these programs is important to maintain an institutional record for the future, if and when the United States sees the need to better understand the foreign cultures with which and in which its military operates. The present study applied a framework for qualitatively evaluating military cross-cultural training programs based on training science.

Public awareness of traumatic brain injury (TBI) in the military increased recently because of the conflicts in Iraq and Afghanistan where blast injury was the most common mechanism of injury. Besides overt injuries, concerns also exist over the potential adverse consequences of subclinical blast exposures, which are common for many service members. A TBI is a risk factor for the later development of neurodegenerative diseases, including Alzheimer disease (AD)-like disorders. Studies of acute TBI in humans and animals have suggested that increased processing of the amyloid precursor protein (APP) toward the amyloid beta protein (Aβ) may explain the epidemiological associations with AD. In a previous study, however, we found in both rat and mouse models of blast overpressure exposure that rather than increasing, rodent brain Aβ42 levels were decreased after acute blast exposure. Here we subjected APP/presenilin 1 transgenic mice (APP/PS1 Tg) to an extended sequence of repetitive low-level blast exposures (34.5 kPa) administered three times per week over eight weeks. If initiated at 20 weeks of age, these repetitive exposures, which were designed to mimic human subclinical blast exposures, reduced anxiety and improved cognition as well as social interactions in APP/PS1 Tg mice, returning many behavioral parameters in APP/PS1 Tg mice to levels of non-transgenic wild type mice. Repetitive low-level blast exposure was less effective at improving behavioral deficits in APP/PS1 Tg mice when begun at 36 weeks of age. While amyloid plaque loads were unchanged, Aβ 42 levels and Aβ oligomers were reduced in the brain of mice exposed to repetitive low-level blast exposures initiated at 20 weeks of age, although levels did not directly correlate with behavioral parameters in individual animals. These results have implications for understanding the nature of blast effects on the brain and their relationship to human neurodegenerative diseases.

ABSTRACTThis article focuses on Julie Paucker and Robert Schuster's ‘MALALAI – Die afghanische Jungfrau von Orléans’ (2017), paying special attention to the constructions and contestations of gender and nation in this recent re‐working of Schiller's Die Jungfrau von Orleans (1801). Paucker radically re‐configures Schiller's play, whose engagement with the concept of nation allowed subsequent interpretations to view it as a nationalist text depicting a symbolic figure for a German nation that did not as yet exist, by centring on nineteenth‐century Afghan folk hero Malalai of Maiwand and placing her in dialogue with her Franco‐German counterpart. Set against past and present conflict in Afghanistan, migration to Europe, and the ‘refugee crisis’ in Germany, ‘MALALAI’ engages two geographically and culturally disparate myths. Whilst Paucker's version of Schiller's text elaborates an intertextual negotiation with the past, her transnational adaptation of a national narrative undermines and transcends the nationalism and Eurocentrism which have marked much of modern Jeanne d'Arc‐reception to date. Through its multilingual and multinational politics of performance, ‘MALALAI’ resists re‐writing Schiller's Jungfrau as an example of a major literature, positing instead a centre/periphery shift as a way of attending to historical and political development on a global level.

A-16 Impact of Modifiable Mood and Health Factors on Cognitive Functioning among Veterans with History of Mild Traumatic Brain Injury

The Afghan conflict, which has lasted for more than three decades, at the turn of 2011-2012 went through a new cycle of its evolution. In June 2011, it was announced that the withdrawal from countries of American troops and at the same time - about the start of direct US talks with the Taliban. Observers agreed that the complete conclusion US troops in 2014 will not end conflict, but can contribute to its new round. Few assumed that in the mid-1970s began one of the longest-running and most internationalized modern regional conflicts. By its complexity it is comparable to the situation on the Korean Peninsula and the Middle East conflict. It is noteworthy that none of external participants in the Afghan situation could not completely turn off, even with the withdrawal of troops, Afghanistan gave rise to and showed the limits for many international endeavors.

Hearing loss and insomnia emerged as preeminent sources of morbidity among military service members and veterans who served in the recent Iraq and Afghanistan conflicts. Significant threshold shift (STS), an early indicator of hearing loss, has not been studied in relation to insomnia. This study's objective was to examine the co-occurrence of STS and insomnia among U.S. military personnel with blast-related injury. A total of 652 service members who were blast-injured during military operations in Iraq or Afghanistan between 2004 and 2012 were identified from the Blast-Related Auditory Injury Database. Pre- and post-injury audiometric data were used to ascertain new-onset STS, defined as 30 dB or greater increase for the sum of thresholds at 2,000, 3,000, and 4,000 Hz for either ear. Insomnia diagnosed within 2 years post-injury was abstracted from electronic medical records. Multivariable logistic regression analysis examined the relationship between STS and insomnia, while adjusting for age, year of injury, occupation, injury severity, tinnitus and concussion diagnosed in-theater, and PTSD. A majority of the study sample was aged 18-25 years (79.9%) and sustained mild-to-moderate injuries (92.2%). STS was present in 21.1% of service members. Cumulative incidence of diagnosed insomnia was 22.3% and 11.1% for those with and without STS, respectively. After adjusting for covariates, those with STS had nearly 2-times higher odds of insomnia (odds ratio (OR) = 1.91, 95% CI = 1.12-3.24) compared with those without STS. In multivariable modeling, the strongest association was between PTSD and insomnia (OR = 5.57, 95% CI = 3.35-9.26). A secondary finding of note was that military personnel with STS had a significantly higher frequency of PTSD compared with those without STS (28.1% vs. 15.2%). Hearing threshold shift was associated with insomnia in military personnel with blast-related injury and could be used to identify service members at risk. Multidisciplinary care is needed to manage the co-occurrence of both conditions during the post-deployment rehabilitation phase. Future research should evaluate the specific mechanisms involved in this relationship and further explore the association between hearing threshold shift and PTSD.

Post-traumatic stress disorder (PTSD) is a common condition in post-deployment service members (SM). SMs of the conflicts in Iraq and Afghanistan also frequently experience traumatic brain injury (TBI) and exposure to blasts during deployments. This study evaluated the effect of these conditions and experiences on functional brain connectomes in post-deployment, combat-exposed veterans. Functional brain connectomes were created using 5-min resting-state magnetoencephalography data. Well-established clinical interviews determined current PTSD diagnosis, as well as deployment-acquired mild TBI and history of exposure to blast. Linear regression examined the effect of these conditions on functional brain connectomes beyond covariates. There were significant interactions between blast-related mild TBI and PTSD after correction for multiple comparisons including number of nodes (non-standardized parameter estimate [PE] = -12.47), average degree (PE = 0.05), and connection strength (PE = 0.05). A main effect of blast-related mild TBI was observed on the threshold level. These results demonstrate a distinct functional connectome presentation associated with the presence of both blast-related mild TBI and PTSD. These findings suggest the possibility that blast-related mild TBI alterations in functional brain connectomes affect the presentation or progression of recovery from PTSD. The current results offer mixed support for hyper-connectivity in the chronic phase of deployment TBI.

This article aims to describe the ideology and movement of the Taliban in Afghanistan. The question posed in this article revolves around what is the ideology of the Taliban? How did the term Taliban come from? Why is it easy for the Taliban to establish cooperation with al-Qaeda and ISIS? Therefore, by describing the transformation of the Taliban jihad movement since the era of the Soviet-Afghan war to the birth of the Taliban Regime, this article provides a conclusion that local conflicts in Afghanistan gave birth to the landscape of the global terrorism movement that had an impact on the development of terrorism in Indonesia.

ABSTRACT While tobacco product (such as combustible cigarettes and nicotine vaping products) and cannabis use rates remain high in the general United States (U.S.) population, veterans from the conflicts in Iraq and Afghanistan (i.e., OEF/OIF veterans) are at high risk of high rates of cannabis and tobacco use. Co-use of tobacco and cannabis (i.e., using both substances within a specified period of time or combining the drugs within the same device for use) is of growing prevalence in the U.S. However, little is understood about the prevalence rates of tobacco and cannabis co-use among U.S. veterans and its associations with mental health symptomatology. The current study conducted a preliminary analysis of co-use patterns of tobacco and cannabis and associated mental health outcomes among a sample of OEF/OIF veterans (N = 1,230). Results indicated high rates of lifetime and past 30-day use of both substances. Past 30-day co-users endorsed significantly higher levels of stress, PTSD, depression, and anxiety compared to singular product users. Results suggest that the addition of cannabis use in conjunction with tobacco use may be associated with greater mental health symptoms among veterans. Findings indicate veteran tobacco and cannabis co-users may benefit from mental health care to help mitigate poor mental health symptoms.

Purpose:Traumatic heterotopic ossification (tHO) has become a signature pathology affecting wounded military personnel who have sustained blast-associated traumatic amputations during the recent conflicts in Iraq and Afghanistan. Heterotopic ossification is characterized by the abnormal development of mature bone depositions in extra-skeletal sites such muscle, tendon, and soft tissues, leading to impaired wound healing, pain, reduced range of motion, and limited use of prostheses. While many factors influence the formation of tHO, the extended use of tourniquets to limit catastrophic hemorrhage during prolonged field care (PFC) has not been explored. Herein, we investigate the impact of tourniquet use following blast-related injury on ectopic bone formation.Methods:Utilizing an established pre-clinical model of blast-associated complex lower limb injury and traumatic amputation, we evaluated the effects of extended tourniquet use on tHO formation. Male rats (11-12-week-old) were subjected to blast overpressure exposure, femur fracture, and soft tissue crush injury. A pneumatic tourniquet (250-300mmHg) was applied to the injured limbs for either 90- and 150-minutes followed by trans-femoral amputation. Limbs were assessed for HO formation using microCT. Analysis of muscle/soft-tissue osteogenesis-related gene transcripts and multiple serum inflammatory mediators were measured by using qRT-PCR and Luminex multiplex assays, respectively.Results:At 12 weeks, volumetric analysis with microCT imaging revealed an 70% increase in total bone formation (P=0.007, n=11) near the site of injury in rats subjected to 150-minutes of tourniquet time compared to rats with no tourniquet time in the setting of blast-injuries. Rats subjected to 150-minute tourniquet usage and blast injury had increased expression of osteochondrogenic genes including Bmp2 (5.4-fold increase, P=0.01) as early as 6 hours post-injury while Hif1α (4.2-fold increase, P<0.01), Sox9 (2.8-fold increase, P<0.01), Runx2 (8.2-fold increase), and Bmp2 (7.7-fold increase, P<0.02) remained elevated for 7 days. Analysis of cytokines and chemokines in the serum demonstrated increased expression of key analytes in the tourniquet group above that induced by traumatic amputation alone in the control group in factors including IL-1 (22-44%, P<0.005) and IL-6 (13-69% p<0.03) between 6 hrs and POD7.Conclusions:These findings suggest that extended tourniquet time leads to both significant increases in key transcription factors associated with early endochondral bone formation, as well as increased systemic inflammatory mediators. Increased expression of Hif1α with prolonged tourniquet use also demonstrates the importance of tissue hypoxia and Hif1α signaling in combat applicable tHO and the potential development of targets for therapeutic inhibition. This data supports mechanisms by which extended tourniquet times under PFC conditions could result in increased local neuromuscular dysfunction and systemic inflammation, resulting in increased local tissue injury and potential further functional loss secondary to tHO in wounded military personnel.

How do foreign powers disengage from a conflict? We study this issue by examining the recent, large-scale security transition from international troops to local forces in the ongoing civil conflict in Afghanistan. We construct a new dataset that combines information on this transition process with declassified conflict outcomes and previously unreleased quarterly survey data of residents’ perceptions of local security. Our empirical design leverages the staggered roll-out of the transition, and employs a novel instrumental variables approach to estimate the impact. We find a significant, sharp, and timely decline of insurgent violence in the initial phase: the security transfer to Afghan forces. We find that this is followed by a significant surge in violence in the second phase: the actual physical withdrawal of foreign troops. We argue that this pattern is consistent with a signaling model, in which the insurgents reduce violence strategically to facilitate the foreign military withdrawal to capitalize on the reduced foreign military presence afterward. Our findings clarify the destabilizing consequences of withdrawal in one of the costliest conflicts in modern history, and yield potentially actionable insights for designing future security transitions. (JEL D74, F51, F52, O17)

U.S. and Taliban signed a peace deal on 29thFebruary2020 which brought an end to the decades-old Afghan conflict. 9/11 Attacks changed the situation of the world as the U.S. used its preemptive right of self-defense and started the global war on terror to eliminate the threat of terrorism. This research paper has discussed in detail the war on terror and events that led to the peace deal between the U.S. and the Taliban. Defensive realism theory has been used to analyze the unilateral decision of the U.S. to start the war on terror and the Liberalperspective has been used to analyze the peace deal between the U.S. and the Taliban. Peace in Afghanistan is very important for the peace and stability of South Asia. This paper has discussed how Afghanistan can increase its economic growth and stability by inclusion in CPEC. The inclusion of Afghanistan in CPEC will bring economic stability and prosperity in the South Asian region.

This article examines the historical development of Uzbekistan's stance on the situation in Afghanistan, outlines its main stages, achievements and challenges, investigates the major initiatives of Tashkent on solving conflict in the neighbouring country before and after 2016, the major priorities of its contemporary foreign policy towards the Afghan conflict, and the Uzbek government's expectations from the upcoming developments in Afghanistan.

Religion is two blades which one side can be a tool to legitimize stabbing humans, but on the other hand can be a source of hope. Religion in the Afghanistan conflict is not only a justification for jihadist acts, but also a hidden cause of conflict between religious communities there which gave birth to ethnic and religious group disintegration. This is compounded by the absence of structural institutions that accommodate national unity. The difficulty of reconciliation carried out by state actors and international organizations in the resolution of the Afghanistan conflict has led to the use of second-track diplomacy to help resolve this never-ending revolution. The appointment of Nahdlatul Ulama (NU) which is a religious-based civil society organization as a mediator by Indonesia in supporting reconciliation efforts is the turning point of the conflict transformation effort in Afghanistan. NU has a vision to create positive peace that aims to mitigate religious teachings in contributing to the conflict and eliminate the justification of religion as a tool to perpetuate civil conflict. In the context of public diplomacy, NU uses a model of religious diplomacy that can be defined as "the use of religion to communicate with the global public as a way to overcome the Afghan conflict”. This paper seeks to explain how NU uses religious diplomacy in conflict transformation efforts in Afghanistan.

Evidence on experiences and perceptions of care in pregnancy and childbirth in conflict-affected settings is limited. We interviewed 561 maternity care providers and observed 413 antenatal care consultations, 671 births, and 393 postnatal care consultations at public health facilities across Afghanistan. We found that healthcare providers work under stressed conditions with insufficient support, and most women receive mixed quality care. Understanding socio-cultural and contextual factors underpinning acceptance of mistreatment in childbirth, related to conflict, insecurity, gender and power dynamics, is critical for improving the quality of maternity care in Afghanistan and similar fragile and conflict affected settings.