In 2020, homicides in the United States saw a record single-year increase, with firearm injuries becoming the leading cause of death for children, adolescents, and young adults. It is critical to understand the magnitude of this crisis to formulate an effective response. To evaluate whether young adult males living in parts of 4 major US cities faced a firearm-related death and injury risk comparable with risks encountered during recent wartime service in Iraq and Afghanistan. In this cross-sectional study of young adult males aged 18 to 29 years living in the top 10% most violent zip codes in each domestic setting (as measured by fatal shooting rates), fatal and nonfatal shooting data for 2020 and 2021 were aggregated at the zip code level for 4 of the largest US cities (Chicago, Illinois; Los Angeles, California; New York, New York; and Philadelphia, Pennsylvania). Wartime mortality and combat injury rates for the conflicts in Iraq and Afghanistan were used to assess relative risk. The relative risk of firearm-related death and nonfatal shootings in each setting as compared with combat death and injury in the comparator setting. Of 129 826 young adult males aged 18 to 29 years living in the top 10% most violent zip codes in the 4 cities studied, 45 725 (35.2%) were Black, 71 005 (54.7%) were Hispanic, and 40 355 (31.1%) were White. Among this population, there were 470 homicides and 1684 firearm-related injuries. Young adult males living in the most violent zip code of Chicago (2585 individuals aged 20-29 y) and Philadelphia (2448 individuals aged 18-29 y) faced a higher risk of firearm-related homicide than US soldiers who were deployed to Afghanistan, with risk ratios of 3.23 (95% CI, 2.47-4.68) and 1.91 (95% CI, 1.32-3.46), respectively. In expanding the analysis to the top 10% of the cities' most violent zip codes, the risks in Chicago likewise exceeded those of combat death faced by military service members, with a risk ratio of 2.10 (95% CI, 1.82-2.46), and the risks in Philadelphia were comparable with those of deployment to war 1.15 (95% CI, 0.98-1.39). Nonfatal shooting risks were comparable with, or exceeded, the injury risk of combat in Iraq, producing a combined annual firearm risk of 5.8% in Chicago and 3.2% in Philadelphia. However, these findings were not observed in the most violent zip codes of Los Angeles and New York City, where young men faced a 70% to 91% lower risk than soldiers in the Afghanistan war across fatal and nonfatal categories (eg, fatal shooting in most violent zip code in Los Angeles: risk ratio, 0.30; 95% CI, 0.26-0.34; nonfatal shooting in top 10% most violent zip codes in New York: risk ratio, 0.09; 95% CI, 0.08-0.10). The risk of violent death and injury observed in the zip codes studied was almost entirely borne by individuals from minoritized racial and ethnic groups: Black and Hispanic males represented 96.2% of those who were fatally shot (452 individuals) and 97.3% of those who experienced nonfatal injury (1636 individuals) across the 4 settings studied. In this cross-sectional study, for young adult men in several of the communities studied, firearm violence carried morbidity and mortality risks that exceeded those of war. Health equity requires prioritizing effective responses.

The level of security in Afghanistan has started to deteriorate since American military activities began. This is because the fight between the United States and the Taliban organization is causing an increasing number of civilian deaths. The United Nations (UN) is now involved in settling the conflict in Afghanistan as a result of the escalating conflict conditions there. In addition to deploying troops from member nation contingents, the UN also enlists the aid of a Private Military Company (PMC) to help carry out the peace mission in Afghanistan. However, International organization role theory and rational choice theory are both used in this Article.
 Keyword : UN, PMC, Afganistan

The sensitivity of chest X-ray (CXR) for the detection of significant thoracic injury in children exposed to blast

Improvised Explosives Devices (IEDs) are a lethal threat to soldiers in hostilities. Until now, their use has been characteristic of the military conflict in Iraq and Afghanistan. Currently, IEDs are also used in the war in Ukraine. Their popularity is mainly due to easy access to explosives and pyrotechnics (e.g. from unexploded bombs), and chemical reagents, as well as specialistic knowledge that can be obtained online. These factors contribute to creation of effective means of combat, capable of destroying manpower and enemy's military equipment at a minimal cost and amount of work. Currently, problem of improvised explosives is particularly serious due to the fact that virtually everyone is able to make high-energy materials at home, using commercially available chemical reagents or obtaining them from unexploded explosives, and using simple tools. The matter is further complicated by the fact that, as a result of experiments, newer and newer explosives are created in "home laboratories". Those explosives are not yet widely known and tested, which increases the risk associated with IED. In this article, explosives used by terrorist groups and amateurs of pyrotechnics have been analyzed and characterized. The problem of universal access to knowledge and materials necessary to construct explosives was also discussed.

Management and outcomes of military penetrating neck injuries: An eleven-year retrospective case note review

Women in Conflict and Post-conflict Situations: An Anthology of Cases from Iraq, Iran, Syria, and Other Countries

The emergence of the Afghan Arabs phenomena is the by-product of the Afghan ‘jihad’. The Arabs that mostly came to Afghanistan sought to fulfil a ‘religious’ duty in the form of jihad. This migration process from the Arab countries to the Af-Pak region was in line with the USA, Pakistan, Afghan mujahideen, Arab countries’ policies and volunteering fighters’ personal beliefs. The Afghan Arabs were not a homogeneous group; they were ideologically and strategically fragmented and had different groups and views. Hence, all Afghan Arabs did not end up in Al-Qaeda. Despite this fragmentation, Afghan Arabs played an essential role in the Afghan conflict, from raising funds to providing volunteer fighters and coverage of ‘jihad’ through their media sources. They also intervened in the affairs of Afghan mujahideen groups. They either sided with the opposing jihadi factions (and later with the Taliban) during the Afghan Civil War or remained silent. In the post-2001 period, their role was limited to technical support and fighting against the ‘common enemy’. In this period, the Taliban’s policy towards Al-Qaeda was to not condemn, not cut ties, to regularise them while officially rejecting their presence.

Medical service activity in organizing medical equipment provisions to a limited contingent of Soviet troops (forces) during the armed conflict in Afghanistan (19791989) was presented. It was established that thanks to the medical supply specialists competent work in the most difficult conditions in the shortest possible time during the creation and build-up of Soviet troops (forces) grouping, a medical supply system adapted to the specific conditions of activity was formed, functioning in three, largely isolated areas. The work medical supply units and institutions to provide troops (forces) with medical equipment during the armed conflict is shown, as well as the problematic issues of their functioning, which were successfully resolved thanks to the involvement of students from the faculty of Military Medical Academy named after S.M. Kirov. It reflects the priority tasks facing the medical supply system during the withdrawal period of a group of Soviet troops (forces) from Afghanistan, including providing local population assistance and its armed forces by transferring not only buildings, structures, medical service units, but also part of the medical property. The features of certain drug provision for the medical evacuation and military hospitals stages were presented, particularly injection and infusion solutions, as well as medical oxygen. The operational experience of the troops (forces) medical supply system during the armed conflict in Afghanistan was analyzed, and a number of contradictions were identified, which were later successfully eliminated. The medical supply specialists role was emphasized, whose professionalism and dedication made it was possible to solve all the tasks facing them in providing troops (forces) with medical equipment. In general, military units and military medical organizations that were part of a limited contingent of Soviet troops were provided with medical equipment within their actual need, which contributed to the timely provision of medical care and treatment of the wounded and sick, as well as maintaining a high level of the troops (forces) combat capability.

The impact of the armed conflict in Afghanistan on vegetation dynamics

US service members injured in the recent conflicts in Iraq and Afghanistan were more likely to survive than those in previous conflicts because of advances in medicine and protective gear. However, there is limited research examining the long-term impact of injuries while deployed on physical and mental quality of life (QOL) among service members. We used data from two time-points with an average follow-up period of 4.27 years (SD = 2.13; n = 118,054) to prospectively examine the association between deployment and injury status with QOL. Data were derived from the Millennium Cohort Study surveys (2001 to 2016) and linked with the Department of Defense Trauma Registry (DoD-TR) among a cohort of US service members from all branches and components. The primary predictor (a combination of deployment and injury status) was comprised of the following four categories: 1) not deployed, 2) deployed and not injured, 3) deployed and non-battle injured, and 4) deployed and battle injured. Demographic, military, psychological and behavioral health, and life stress factors were adjusted for in multivariable models. Outcomes of interest were physical and mental QOL from the Short-Form Health Survey for Veterans (VR-36) measured at ~4 year follow-up. Between group comparisons indicated that those deployed and battle-injured had the greatest decline in both mental (-3.82) and physical (-10.13) QOL scores over time (p < .05). While deployment and injury status were associated with poorer mental and physical QOL in adjusted models; only the association between deployment and injury status with physical QOL was clinically meaningful (more than 2.5). In adjusted models, Time 1 mental and physical QOL explained most of the variance (23–25%) in Time 2 mental and physical health QOL as compared to other covariates (e.g., injury and deployment, and other sociodemographic factors increased variance by ~5%). Time 1 QOL was the most significant predictor of later QOL, but those injured while deployed experienced significant and meaningful decrements to long-term physical QOL. This suggests that prevention and rehabilitation interventions should focus on improving physical health among injured service members to avoid long-term adverse effects.

Energized ballistic fragments from improvised explosive devices were the most common cause of injury to coalition service personnel during conflicts in Iraq and Afghanistan. Surgical excision of retained fragments is not routinely performed unless there is a concern for injury to vital structures. However, no clear guidelines dictate when or if a fragment should be removed, reflecting a lack of objective evidence of their long-term effects. Using a porcine model, we aimed to evaluate changes to the carotid artery produced by retained fragments over time. Institutional Animal Care and Use Committee approval for all experiments was obtained before commencement of the study. Eighteen female swine (mean mass 62.0 ± 3.4 kg) were randomized into three study groups corresponding to the time of survival after implantation of ballistic fragments: 1, 6, and 12 weeks. Two animals from each group were randomly assigned to have one of the three different fragments implanted within the right carotid sheath in zones 1-3 of the neck. The left carotid served as the control. The vascular flow rate and arterial diameter were measured at each level before implantation and again after the survival interval. Baseline and interval angiograms were performed to identify gross vascular changes. No abnormalities were identified on baseline or interval angiograms. No significant difference was found when the baseline was compared to interval measurements or when compared to the control side for all gross and physiological measures at 1 and 6 weeks (P = .053-.855). After 12 weeks, the flow and diameter changed significantly (P < .001-.03), but this significant change was found in both the control and affected carotid. The lack of significant gross anatomical and physiological changes at 6 weeks postimplantation lends evidence toward the current policy that early removal of retained ballistic fragments around cervical vessels is not required. Changes were significant after 12 weeks which suggest that surveillance may be required; however, such changes could be explained by physiological animal growth.

US service members injured in the recent conflicts in Iraq and Afghanistan were more likely to survive than those in previous conflicts because of advances in medicine and protective gear. However, there is limited research examining the long-term impact of injuries while deployed on physical and mental quality of life (QOL) among service members. We used data from two time-points with an average follow-up period of 4.27 years (SD = 2.13; n = 118,054) to prospectively examine the association between deployment and injury status with QOL. Data were derived from the Millennium Cohort Study surveys (2001 to 2016) and linked with the Department of Defense Trauma Registry (DoD-TR) among a cohort of US service members from all branches and components. The primary predictor (a combination of deployment and injury status) was comprised of the following four categories: 1) not deployed, 2) deployed and not injured, 3) deployed and non-battle injured, and 4) deployed and battle injured. Demographic, military, psychological and behavioral health, and life stress factors were adjusted for in multivariable models. Outcomes of interest were physical and mental QOL from the Short-Form Health Survey for Veterans (VR-36) measured at ~4 year follow-up. Between group comparisons indicated that those deployed and battle-injured had the greatest decline in both mental (-3.82) and physical (-10.13) QOL scores over time (p < .05). While deployment and injury status were associated with poorer mental and physical QOL in adjusted models; only the association between deployment and injury status with physical QOL was clinically meaningful (more than 2.5). In adjusted models, Time 1 mental and physical QOL explained most of the variance (23-25%) in Time 2 mental and physical health QOL as compared to other covariates (e.g., injury and deployment, and other sociodemographic factors increased variance by ~5%). Time 1 QOL was the most significant predictor of later QOL, but those injured while deployed experienced significant and meaningful decrements to long-term physical QOL. This suggests that prevention and rehabilitation interventions should focus on improving physical health among injured service members to avoid long-term adverse effects.

Previous research has shown that injuries to the head and neck were prevalent in 73% of all mounted fatalities of underbody blast. The mechanisms that cause such injuries to the central nervous system (CNS) are not yet known. The aim of this study was to identify the head and spinal injuries in fatalities due to underbody blast (UBB) and then develop hypotheses on the causative mechanisms. All U.K. military fatalities from UBB with an associated head injury that occurred during 2007-2013 in the Iraq and Afghanistan conflicts were identified retrospectively. Computed tomography post-mortems (CTPMs) were interrogated for injuries to the head, neck, and spine. All injuries were documented and classified using a radiology classification. Pearson's chi-square and Fisher's exact tests were used to show a relationship between variables and form a hypothesis for injury mechanisms. There were 50 fatalities from UBB with an associated head injury. Of these, 46 had complete CTPMs available for analysis. Chi-square and Fisher's exact tests showed a relationship between lateral ventricle blood and injuries to the abdomen and thorax. Five partially overlapping injury constellations were identified: 1.multiple-level spinal injury with skull fracture and brainstem injury, 2.peri-mesencephalic hemorrhage, 3.spinal and brainstem injury, 4.parenchymal contusions with injury to C0-C1, and 5.an "eggshell" pattern of fractures from direct impact. These injury constellations can now be used to propose injury mechanisms to develop mitigation strategies or clinical treatments.

BackgroundTraumatic heterotopic ossification (tHO) is characterized by ectopic bone formation in extra-skeletal sites leading to impaired wound healing, entrapment of neurovascular structures, pain, and reduced range of motion. HO has become a signature pathology affecting wounded military personnel who have sustained blast-associated traumatic amputations during the recent conflicts in Iraq and Afghanistan and can compound recovery by causing difficulty with prosthesis limb wearing. Tourniquet use to control catastrophic limb hemorrhage prior to surgery has become almost ubiquitous during this time, with the recognition the prolonged use may risk an ischemia reperfusion injury and associated complications. While many factors influence the formation of tHO, the extended use of tourniquets to limit catastrophic hemorrhage during prolonged field care has not been explored.MethodsUtilizing an established pre-clinical model of blast-associated complex lower limb injury and traumatic amputation, we evaluated the effects of tourniquet use on tHO formation. Adult male rats were subjected to blast overpressure exposure, femur fracture, and soft tissue crush injury. Pneumatic tourniquet (250–300 mmHg) applied proximal to the injured limb for 150-min was compared to a control group without tourniquet, before a trans-femoral amputation was performed. Outcome measures were volume to tHO formation at 12 weeks and changes in proteomic and genomic markers of early tHO formation between groups.ResultsAt 12 weeks, volumetric analysis with microCT imaging revealed a 70% increase in total bone formation (p = 0.007) near the site of injury compared to rats with no tourniquet time in the setting of blast-injuries. Rats subjected to tourniquet usage had increased expression of danger-associated molecular patterns (DAMPs) and end organ damage as early as 6 h and as late as 7 days post injury. The expressions of pro-inflammatory cytokines and chemokines and osteochondrogenic genes using quantitative RT-PCR similarly revealed increased expression as early as 6 h post injury, and these genes along with hypoxia associated genes remained elevated for 7 days compared to no tourniquet use.ConclusionThese findings suggest that tourniquet induced ischemia leads to significant increases in key transcription factors associated with early endochondral bone formation, systemic inflammatory and hypoxia, resulting in increased HO formation.

Battlefield pain management changed markedly during the first 20 years of the Global War on Terror. Morphine, long the mainstay of combat analgesia, diminished in favor of fentanyl and ketamine for military pain control, but the options are not hemodynamically or psychologically equivalent. Understanding patterns of prehospital analgesia may reveal further opportunities for combat casualty care improvement. Using Department of Defense Trauma Registry data for the Afghanistan conflict from 2005 to 2018, we examined 2,402 records of prehospital analgesia administration to assess temporal trends in medication choice and proportions receiving analgesia, including subanalysis of a cohort screened for an indication with minimal contraindication for analgesia. We further employed frequency matching to explore the presence of disparities in analgesia by casualty affiliation. Proportions of documented analgesia increased throughout the study period, from 0% in 2005 to 70.6% in 2018. Afghan casualties had the highest proportion of documented analgesia (53.0%), versus U.S. military (31.9%), civilian/other (23.3%), and non-U.S. military (19.3%). Fentanyl surpassed morphine in the frequency of administration in 2012. The median age of those receiving ketamine was higher (30 years) than those receiving fentanyl (26 years) or nonsteroidal anti-inflammatory drugs (23 years). Among the frequency-matched subanalysis, the odds ratio for ketamine administration with Afghan casualties was 1.84 (95% CI, 1.30-2.61). We observed heterogeneity of prehospital patient care across patient affiliation groups, suggesting possible opportunities for improvement toward an overall best practice system. General increase in documented prehospital pain management likely reflects efforts toward complete documentation, as well as improved options for analgesia. Current combat casualty care documentation does not include any standardized pain scale.

Background: Hypertension increases the risk of cardiovascular disease. Literature describing associations between depression and blood pressure is inconsistent, potentially due to differing associations by sex. Veterans have high burdens of both depression and hypertension, respectively, and thus are a critical population in which to understand possible individual differences. Thus, among Veterans, we estimated the association between depression and hypertension and determined if this differs by sex. Methods: We used 2001-2017 nationwide Veterans Health Administration data from Veterans who served in support of conflicts in Afghanistan and Iraq. Major depressive disorder (MDD), mild depression, or no depression (reference group) were defined based on ICD-9/ICD-10-CM codes. Multivariable logistic regression models tested if depression status (independent variable) affected the risk of hypertension (dependent variable; defined as ≥2 blood pressure readings ≥140 systolic or ≥90 diastolic), controlling for sociodemographic factors, smoking, and comorbid mental health conditions. The adjusted model was also stratified by sex. Results: Among 761,627 Veterans (13.0% women; median age [interquartile range]= 29.5 [25.2-39.2] years), 24.1% had MDD, 18.8% mild depression, and 57.1% no depression. MDD was more prevalent for women than men (32.4% vs. 22.8%; p &lt;0.001). Hypertension was more common among Veterans with MDD (48.6%), compared to those with mild depression (40.7%) or no depression (28.0%; p &lt;0.001). In adjusted analyses, those with MDD had a 2.46xgreater risk of hypertension (95% CI, 2.43-2.49) and those with mild depression had 1.76xgreater risk (95% CI, 1.73-1.78) vs. those with no depression. In sex-stratified analyses, adjusted odds ratios were similar for women and men (MDD: 2.43 for women, 2.46 for men; mild depression: 1.74 for women, 1.75 for men). Conclusion: Both major and minor depression are associated with an increased risk of hypertension, with similar risk observed for women and men. Given the high burden of both depression and hypertension in this younger population, the potential long-term health implications of these conditions may warrant targeted intervention to prevent cardiovascular disease.

Two of the most common and costly mental health diagnoses among military veterans who served in the post-9/11 conflicts in Afghanistan and Iraq are posttraumatic stress disorder (PTSD) and depression, but over half of veterans who screen positive for these problems do not seek treatment. A key barrier is self-stigma of mental illness. Mindfulness has shown promise as an explanatory variable in the context of mental health symptoms and self-stigma, but these associations are underexplored in the veterans' literature. This study examines direct and indirect effects among mindfulness, PTSD and depression, and self-stigma in post-9/11-era military veterans. A sample of 577 veterans from 3 large American cities completed surveys capturing mindfulness, symptoms of PTSD and depression, and self-stigma. A structural equation modeling approach was used to examine direct and indirect effects among study variables. Mindfulness was associated with less PTSD and depression and indirectly with less self-stigma through the PTSD pathway. PTSD was associated with more depression and self-stigma, and depression was not significantly associated with self-stigma. PTSD is strongly associated with self-stigma in military veterans, many of whom do not seek mental health treatment. Findings show that mindfulness is a promising intervention target for reducing symptoms of PTSD directly and reducing associated self-stigma of mental illness indirectly. Additional investigation of links between mindfulness, PTSD and depressive symptoms, and self-stigma in military veterans is warranted. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Significant advancements in the treatment of spinal cord injury (SCI) were developed in the setting of military conflicts, partly due to the large numbers of injuries sustained by service members. No effective SCI treatment options existed into the early 20th century, and soldiers who sustained these injuries were usually considered untreatable. Extensive progress was made in SCI treatment during and after World War II, as physical therapy was increasingly encouraged for patients with SCI, multidisciplinary teams oversaw care, pathophysiology was better understood, and strategies were devised to prevent wound infection and pressure sores. Recent conflicts in Iraq and Afghanistan have caused a substantial rise in the proportion of SCIs among causes of casualties and wounds, largely due to new forms of war and weapons, such as improvised explosive devices. Modern military SCIs resulting from blast mechanisms are substantively different from traumatic SCIs sustained by civilians. The treatment paradigms developed over the past 100 years have increased survival rates and outcomes of soldiers with SCI. In this paper, the authors review the role of military conflicts in the development of therapeutic interventions for SCI and discuss how these interventions have improved outcomes for soldiers and civilians alike.

ABSTRACT Using data from its national university entrance exam, we examined the relationship between armed conflict and student achievement in Afghanistan. Exploiting the province-year variation in exposure to conflict intensity, we estimated the relationship between conflict and exam results generally and by gender for all test takers from 2014–2019. Findings show that a one standard deviation increase in conflict intensity at the province-year level was associated with a 2.9 percentage point reduction in the probability of passing the exam, a 0.096 score point reduction in total exam scores, and a greater detrimental impact on women’s exam results.

Afghanistan experienced an extraordinary situation in 2021, marked by intensified conflict, the Covid-19 pandemic, and prolonged drought. This article reflects on the research method and approaches employed to investigate these overlapping crises, and the applications of this approach to assess the livelihoods impacts of the pandemic in the context of conflict and climate change in Afghanistan. It relies primarily on field qualitative data collection and analysis from Kandahar and Herat provinces supported by further insights from the quantitative analysis of household survey data in 2019/20, part of which overlaps with the onset of the pandemic. Reflections on the methodology reveal the importance of longitudinal qualitative methods of analysis to understand the pathways through which layered crises can affect people’s lives and livelihoods. These research findings are used to develop implications for coherent development of policies and programming to better support poor and vulnerable Afghan people in the context of overlapping crises.