Drill Sergeant Research Articles

Physical Injuries, Treatment-Seeking, and Perceived Barriers to Treatment in U.S. Army Drill Sergeants.

Drill sergeants work under mentally and physically challenging conditions. The current study examined self-reported rates of physical injuries in drill sergeants; rates of treatment-seeking for injuries; perceived barriers toward treatment-seeking; and associated demographic and environmental factors. Drill sergeants from across all Army basic training locations completed self-report surveys from September to November of 2018. In total, 726 drill sergeants were included in analyses. Drill sergeants indicated whether they had acquired an injury during their time in the drill sergeant role and whether they had sought treatment for all such injuries. Furthermore, drill sergeants rated their agreement with a number of possible perceived barriers to treatment-seeking for physical injuries. Regression models examining each phenomenon included hours of sleep obtained per day; general- and health-specific leadership behaviors of the company command teams; unit cohesion; time as a drill sergeant; duty location; gender; military operational specialty; years in the military; previous combat deployments; and route of assignment. The study was approved by the Walter Reed Army Institute of Research Institutional Review Board. In total, 38% of respondents reported acquiring an injury during their time as drill sergeants. Of those who had acquired an injury, 61% reported seeking medical help for all injuries acquired. Injuries were more likely in females (49%) than in males (34%) and less likely in drill sergeants reporting at least 6 hours of sleep (27%) versus those reporting 5 hours (40%) and 4 hours or less (43%). Reported comparisons were significant after controlling for demographic and environmental variables in regression models. The most strongly endorsed perceived barriers to treatment-seeking were "Seeking help would place too much burden on the other drill sergeants" (69%) and "Seeking help would interfere with my ability to train the recruits" (60%). Both of these perceived barriers were significantly associated with reduced treatment-seeking in injured drill sergeants, after controlling for demographic and environmental variables. This study is the first to examine injury occurrence, treatment-seeking, and perceived barriers to treatment-seeking in U.S. Army drill sergeants. Building on previous studies that showed the negative effects of sleep deprivation on the safety and behavioral health of drill sergeants, the current study gives further evidence of the negative effects of such sleep deprivation, this time in the domain of physical injuries. The results suggest that pursuing strategies that allow for healthier sleep duration may contribute to injury reduction.

Resilience Training Efficacy by Instructor Specialization: A Program Evaluation with Army Recruits

A growing recognition of the importance of resilience skills for psychological health and optimal performance has led to the development of a wide array of resilience trainings. Across the military, resilience training has been implemented by military personnel and training experts. To date, no direct assessment of the comparative efficacy of instructor type on training outcomes has been conducted. To that end, we conducted a program evaluation that examined differences in the efficacy of a two-hour resilience training course for new recruits in Basic Combat Training on resilience-focused knowledge and skills as a function of instructor specialization. Soldiers (n = 401) received training from either a training specialist or a drill sergeant. Findings revealed that soldiers’ knowledge and perceived resilience skills improved regardless of instructor type. Soldiers preferred training specialists to drill sergeants; however, soldiers who received training from drill sergeants had greater improvements in knowledge as compared to soldiers instructed by training specialists. Soldiers with high levels of pre-training resilience who received training from drill sergeants showed the greatest improvements in knowledge. We conclude that drill sergeants, when provided with train-the-trainer preparation by subject matter experts, can efficaciously provide resilience training to new Army recruits during Basic Combat Training.

US Army Drill Sergeants: Stressors, Behavioral Health, and Mitigating Factors.

The role of the drill sergeant is one of the most challenging within the US Army, involving unusually long hours and little time off, for a minimum of 2 years. The current study sought to examine the behavioral health of this population and identify risk factors that might be addressed by policy changes. In total, 856 drill sergeants across all Army basic training sites completed surveys from September to November of 2018. Drill sergeants identified factors that had caused stress or worry during their assignment. Rates were measured for behavioral health outcomes including depression, insomnia, anxiety, burnout, functional impairment, alcohol misuse, aggression, and low morale. Potential risk and resilience factors included time as a drill sergeant, sleep, route of assignment, general leadership, health-promoting leadership, and drill sergeant camaraderie. The study was approved by the Walter Reed Army Institute of Research Institutional Review Board. The most commonly experienced stressors were finding time to exercise, lack of sleep, and long work hours. Percentages of drill sergeants meeting behavioral health screening criteria were 19% for depression, 27% for moderate-to-severe insomnia, 14% for generalized anxiety disorder, 48% for high burnout, 32% for functional impairment, 35% for moderate alcohol misuse, 32% for off-duty aggression, and 25% for low morale. Rates for most outcomes were associated with time spent as a drill sergeant, with behavioral health issues peaking during 13-18 months. Poorer outcomes were also associated with fewer hours of sleep and initial unhappiness regarding involuntary assignment to the role of drill sergeant, while better outcomes were associated with higher ratings of general leadership, health-promoting leadership, and drill sergeant camaraderie. This study is the first to examine behavioral health and morale of drill sergeants and to identify risk and resilience factors. Suggestions for policy changes include increasing the number of drill sergeants to decrease workload and allow sufficient time for recovery and sleep.

How can we partner with electronic health record vendors on the complex journey to safer health care?

The Office of the National Coordinator for Health Information Technology released the Safety Assurance Factors for EHR Resilience (SAFER) guides in 2014. Our group developed these guides covering key facets of both electronic health record (EHR) infrastructure (eg, system configuration, contingency planning for downtime, and system-to-system interfaces) and clinical processes (eg, computer-based provider order entry with clinical decision support, test result reporting, patient identification, and clinician-to-clinician communication). The SAFER guides encourage healthy relationships between EHR vendors and users. We conducted a qualitative study over 12 months. We visited 9 health care organizations ranging in size from 1-doctor outpatient clinics to large, multisite, multihospital integrated delivery networks. We interviewed and observed clinicians, IT professionals, and administrators. From the interview transcripts and observation field notes, we identified overarching themes: technical functionality, usability, standards, testing, workflow processes, personnel to support implementation and use, infrastructure, and clinical content. In addition, we identified health care organization-EHR vendor working relationships: marine drill sergeant, mentor, development partner, seller, and parasite. We encourage health care organizations and EHR vendors to develop healthy working relationships to help address the tasks required to design, develop, implement, and maintain EHRs required to achieve safer and higher quality health care.

Sleep deprivation and hazardous unintended sleep in US army drill sergeants

ObjectivesSleep deprivation is an occupational hazard for members of the armed forces, and has potential consequences not only for the sleep-deprived individuals, but also for the people around them. Perhaps the most consistently sleep-deprived population in the US Army are drill sergeants, who lead intense cycles of initial training for new soldiers. In the first systematic assessment of drill sergeants, the current study examined sleep deprivation and its relationship to falling asleep in two hazardous contexts: while driving, and while co-supervising recruit trainings. DesignIn total 856 drill sergeants across all Army basic training sites completed surveys. Sleep-related items measured sleep quantity, sleep problems, exhaustion, and stress due to lack of sleep. ResultsDrill sergeants reported working long hours (M = 14.74 hours, SD = 2.53), and being at work 6.42 (SD = 0.6) days per week, while obtaining low levels of sleep (75% reported five hours or less per night). Many (27%) met criteria for moderate or severe clinical insomnia. A substantial proportion (42%) reported having fallen asleep at the wheel at least once during their time as a drill sergeant. Further, the likelihood of this occurring was associated with obtaining low amounts of sleep and with meeting criteria for clinical insomnia. Similar rates of occurrence and associations with sleep issues were observed for falling asleep during recruit trainings. ConclusionsResults highlight the importance of ensuring drill sergeants acquire adequate sleep in order to reduce the risk of accidents involving this population and those in their care.

Personality testing: enhancing in-service selection of mid-career soldiers

ABSTRACTNoncognitive attributes – notably personality – consistently predict important job-related outcomes for the Army (e.g., attrition, performance, disciplinary incidents) during Soldiers’ first term of enlistment. Recently, the U.S. Army Research Institute for the Behavioral and Social Sciences (ARI) has conducted research suggesting that personality measures can be used to improve person-job match and enhance performance beyond first term of enlistment. This paper summarizes recent research on the relationship between personality assessments and in-service job performance. This research is important because the duties of many Army in-service job assignments (e.g., Recruiter, Drill Sergeant, non-commissioned officer [NCO] Instructor, Special Operations) differ substantially from the type of work performed by the NCOs prior to such assignments, which renders moot the truism “the best predictor of future performance is past performance.” The paper also offers a conceptual framework for future research, which can add value to multiple types of in-service assignment decisions.

Role of Drill Sergeants in Nutrition Behaviors of Soldiers in Basic Combat Training

BackgroundIn the US Army, soldiers’ nutrition behaviors have a direct impact on their performance. The emphasis in basic combat training is on “soldierization” (transforming a civilian into a soldier), and drill sergeants are instrumental in this process. Limited information about how drill sergeants use their influence to have an impact on nutrition behaviors of new soldiers is available. ObjectiveThis study aimed to determine nutrition attitudes, beliefs, and knowledge of drill sergeants; the ways drill sergeants instill new soldiers with an army identity (eg, warrior athlete, army strong); and how healthy eating is perceived to fit with this new identity. DesignThis qualitative, phenomenological study used in-depth interviews conducted with army drill sergeants at two southeast US Army posts between July and August 2011 (n=30). Main outcome measuresInterviews emphasized drill sergeants’ perceptions of the eating environment during basic training, the drill sergeant role, and drill sergeants' main duties. Data analysisAn iterative process of group coding using a constant comparative method was used to find distinct themes. Data were analyzed using qualitative data analysis software. ResultsDrill sergeants described their main duty as training new soldiers. Drill sergeants identified the ideal soldier as lean and physically fit but did not identify training soldiers how to eat to become the ideal soldier as part of their duties. Confusion about nutrition concepts was common. Overall, drill sergeants recognized that what soldiers eat affects their physical performance and appearance, but they did not see helping soldiers establish healthy eating behaviors as one of their duties or responsibilities during basic combat training. ConclusionsDrill sergeants are key individuals in the process by which new recruits develop a soldier identity. Additional resources are necessary to help drill sergeants emphasize nutrition and health during basic combat training and help them guide soldiers toward adopting healthy eating as part of their soldier identity to improve weight management, health, and performance.

Line 2: Faces

Line 2: Faces Terrance Hayes (bio) During the first weeks of my freshman year in college, I shared some of what looked like poems with my new English professor, Dr. John Thatcher French. It was the only way I could think of impressing him. My teammates—I was on a basketball scholarship—warned me he was a hard ass. He’d failed students for as little as a comma splice, they said. He’d been a naval intelligence officer during the Vietnam War, he was a horse trainer, a Faulkner scholar, a chain smoker, and lapsed Yankee. Dark haired and square jawed with an abrupt baritone, he had the look and bearing of R. Lee Ermey, the actor who played the infamous drill sergeant in Full Metal Jacket. I don’t remember an especially enthusiastic response when I showed Dr. French my poems, but when a poet named Fran Quinn visited campus that October, he set up a poetry conference for the two of us. It was the first time I met someone who lived as a poet. I knew poets roamed the earth. I’d heard rumors, growing up, that the poet James Dickey ran fat, drunk, and naked through some woods not far from my house, but I never saw him or met anyone who saw him. And in any case, no one I knew would have been impressed to meet a poet. No one in my family knew I was writing poems. I didn’t know what to make of Fran Quinn. He was probably in his forties at the time. In the light of certain memories his hair was silvery blonde, other times I remember it as a yellowish silver; he had a round face with a mild bewildered look or he had a saggy face with a quizzical sadness. It may have been the blue baseball cap he wore that skewed his age and demeanor. He didn’t seem especially poetic. He wasn’t Beatnikish, professorial, or hung over. We sat alone in Dr. French’s office. Dr. French had smoked probably three cartons of cigarettes a day over a span of twenty years in that office. Fran Quinn shuffled through a stack of fifty or so pages bound by a large binder clip, reading his poems to me. He shared his own work perhaps as a way to disarm me, but it didn’t comfort me. I thought it was strange that he didn’t have a book. I showed him the best of my altogether terrible poems. He must have offered encouragement. Quinn asked if I’d heard of Robert Bly. I hadn’t. I told him I liked Gwendolyn Brooks. I asked what he thought of James Dickey. Not much. While Quinn spoke—maybe he was talking about Robert Bly again—I scanned Dr. French’s wall of books. As best as I could tell, the measure of an educated man was what he’d read, not what he’d written. French had read all of William Faulkner plus lots of books about Faulkner; all of Mark Twain plus lots of books about Twain; most of Herman Melville, Nathaniel Hawthorne: dead white writers. He taught what he knew to us. Once in the middle of reading Molly Bloom’s sprawling soliloquy in Ulysses, he began to weep right there in front of our class. That’s still among the most shocking and lovely moments in all of my college education. Another time in [End Page 811] my sophomore or junior year, when he was too hung over to teach a chapter of Toni Morrison’s Beloved, he lay his rumpled head down on his desk and asked me to teach it. I don’t know that I would call the moment a boy decides he will become a teacher a coming of age story. There’s no drama to it. I was the first in my family, the first of all my grandmother’s children and grandchildren to go to college. I did not go into the army as both my father and stepfather had. I was tall enough to get a basketball scholarship to a small liberal arts college surrounded by...

Physical Education, Exercise, Fitness and Sports: Early PM&R Leaders Build a Strong Foundation

Physical Education, Exercise, Fitness and Sports: Early PM&R Leaders Build a Strong Foundation

Depression And Anxiety Risk Among U.s. Army Drill Sergeant Candidates

Depression And Anxiety Risk Among U.s. Army Drill Sergeant Candidates

Substance Use and Sleep Quality Among U.S. Army Drill Sergeant Candidates

Substance Use and Sleep Quality Among U.S. Army Drill Sergeant Candidates

Trainee Perceptions of Drill Sergeant Qualities During Basic Combat Training

Basic combat training plays an important role in military service with approximately 72,000 soldiers participating in the United States annually. Although Drill Sergeant qualities have been widely portrayed in popular media, there is very little empirical research that documents the characteristics of Drill Sergeants and the impact these characteristics may have on trainees. In this study we evaluated a measure of perceived Drill Sergeant qualities and the degree to which these qualities related to mental health symptoms and job-related outcomes of trainees. Three types of perceived Drill Sergeant qualities were found from factor analyses: motivation, respect, and toughness. Using latent growth curve analyses, higher initial scores on motivation and respect, but not toughness, were associated with greater decreases in mental health symptoms over time. Further, changes in perceived Drill Sergeant qualities related to changes in depressive symptoms, unit cohesion, and citizen behaviors assessed over the course of basic combat training.

The Ever-Changing Nature of the Sea: Whitman's Absorption of Maximilian Schele de Vere

In recent yearS, Betty Barrett and Ted Genoways have discovered that Whitman lifted entire images and phrases from newspaper articles and rearranged them into some of his Civil War poems.1 This aspect of Whitman's poetry is not, however, confined to the Whitman of the Civil War era. Instead it began earlier and stemmed from a long-lasting fascination with a fellow writer whose influence on Leaves of Grass remains largely overlooked: Maximilian Schele De Vere, author of Stray Leaves from the Book of Nature,2 which appeared 1855, sharing with Whitman's first edition of Leaves not only a publication date but a green cover blind-stamped with flower y orna- ments and sporting a golden title. Stray Leaves has so far found its way into Whitman scholarship as nothing more than a curious footnote,3 though Schele De Vere himself has been increasingly gaining critical notice.But even though it is unlikely that this book influenced the 1855 Leaves of Grass (Stray Leaves would have been published at most only a few months before the first edition of Leaves of Grass) and the striking physical similarities between the books do appear to be coincidental, such is not the case with the 1856 and (especially) the 1860 editions of Leaves, which are significantly influenced by Schele De Vere's thinking, and which include an almost word-by-word copy of a whole paragraph from Stray Leaves-the first known instance of W hitman copying and rearranging somebody else's words into his own poetry.Born in a grim old mountain castle4 Sweden and raised Prussia, baron Maximilian Schele De Vere (1820-1898) emigrated to the United States his early twenties after receiving a degree philosophy from Berlin's Friedrich Wilhelm Universitat. In 1844, he became the youngest faculty member the histor y of the University of Virginia, where he taught a variety of subjects and even volunteered as a drill sergeant during the Civil War. He published several books on natural science, comparative literature, American histor y, and linguistics, and he translated French and German works of fiction into English. While Schele De Vere's upbringing, education, and social status could not have been more different from Whitman's, their philosophical interests overlapped on a striking number of topics. Both shared a keen interest the American idiom (Schele de Vere was the first academic to teach classes on it), were fascinated by Eastern mythology,5 admired Darwin, Humboldt, and the heroes of the American Revolution, and tried to fuse a strict belief natural law with spirituality.6 (See Figure 1.)Whitman presumably discovered the scholar first through Outlines of Comparative Philology, a book Schele De Vere published through G. P. Putnam & Co. 1853. According to C. Carroll Hollis, Whitman borrowed the book from his acquaintance William Swinton sometime between 1856 and 18597 and took notes on it.8 In the only academic treatment of Schele De Vere and Whitman to date, James Perrin Warren identifies striking similarities both authors' optimistic understanding of language9 and strongly suggests that Whitman studied Schele De Vere's book. Whether Whitman came upon Schele De Vere's later writ- ings, such as Stray Leaves, by actively searching for them or through a chance encounter remains uncertain. Considering that Whitman most likely read the periodicals Schele De Vere published on a regular ba- sis, it seems almost inevitable that the well-read Whitman would have rediscovered the well-published Swede at some point.One very likely place for Whitman to have re-encountered Schele De Vere is Putnam's Monthly Magazine of American Literature, Science and Art, a periodical issued by G. P. Putnam, the publisher of both Swin- ton's and Schele De Vere's books. The poet would have read Swinton's Rambles over the Realms of Verbs and Substantives10 published two parts the periodical late 1854, as well as a review of Leaves 1855- one of the few that, besides his self-reviews, had anything positive to say about his book. …

Military Probes Epidemic of Suicide

WITH 3 DEPLOYMENTS UNDER his belt and a slot waiting for him in the US Army’s Drill Sergeant School, a 33-year-old sergeant first class stepped up his alcohol consumption and reported to friends and colleagues that he was having nightmares, slept with a gun under his pillow, and was depressed. About a month after he was supposed to have left for the training, he was found dead in his apartment from a gunshot wound to the head. This vignette was one of many included in a July Army report on suicide prevention that described how a multitude of interacting factors— such as job and personal stress, psychiatric conditions, and brain injuries— are contributing to a continuing epidemic of suicide among returning soldiers (http://usarmy.vo.llnwd.net/e1 /HPRRSP/HP-RR-SPReport2010_v00 .pdf). The report calls for a variety of interventions, including increased discipline and accountability by military leaders, efforts to reduce the stigma of seeking mental health care, and a more robust primary care effort to identify and treat these patients. The report is one of a number of efforts to examine this issue. Other recent reports by military scientists probe the high prevalence of conditions such as posttraumatic stress disorder (PTSD), mild traumatic brain injury (MTBI), and comorbidities and behavioral problems that may contribute to suicide in veteran and military populations and highlight barriers to affected soldiers accessing care. Since 2008, the rate of suicide in Army personnel, about 20 per 10 000, has exceeded that of the general population, which is about 19 per 10 000. Despite

Noon

48 Noon Tony Hoagland Noon at the gym, and work-ethic Nichole is giving a class called Tight Butt for women who fear their husbands are losing interest, and others who are part of the Husband Recycling Program. Fifty serious minutes of sweat, repetitive step and thigh burn, a techno & trance drill sergeant— There will always be some who motivate by flattery, but Nichole is a punisher. I am watching the guy on the rowing machine who is stroking across a cardiovascular ocean while watching the backside of a redheaded woman who is using her lunch break to catch up on furniture catalogues. Did he who made the lamb make the three or four of us? and what was he thinking, when he fastened our pieces together? snapped on the plastic back and set us in motion? I myself am not a pretty sight, with my red face and little belly running through a mirror toward my grave but perhaps I am an advertisement for not trying to improve; 49 49 Tony Hoagland or an advertisement for trying in spite of certain failure, or an advertisement for joining the conspiracy that seems to exist between us to never, ever stop craving. ...

It's Kind of a Funny Story (review)

Reviewed by: It's Kind of a Funny Story Loretta Gaffney Vizzini, Ned It's Kind of a Funny Story. Miramax/Hyperion, 2006 [448p] ISBN 0-7868-5196-1$16.95 Reviewed from galleys Ad Gr. 9-12 Craig's anxiety about academic performance at his prestigious Manhattan high school slowly transforms him into a shadowy observer of life; he stops eating, contemplates suicide, and eventually checks himself into the psychiatric ward of a nearby hospital. Because the adolescent unit is under construction, fifteen-year-old Craig is hospitalized among a motley crew of mostly adult patients, whose comparatively grimmer problems make him appreciate the relative privilege and ease of his own existence. After he rediscovers a childhood activity of drawing maps of imaginary landscapes and falls for Noelle, a beautiful girl who has scarred her own face, Craig decides upon release to apply to an arts high school and embrace life fully. Though the book follows a predictable trajectory of fairly standard crisis-to-therapy-to-recovery, narrator Craig is a character with enough complexity to give a familiar story some twists. Passive and sweetly naïve in a manner reminiscent of Charlie in Stephen Chbosky's Perks of Being a Wallflower, Craig is generous with other people but not with himself—a mental drill sergeant of his own imagining periodically shames him into eating or berates him for a poor performance, adding to the stream-of-consciousness thread of authenticity. The other psychiatric patients, though, are stock fare, veering dangerously close to caricature—Craig's roommate Muqtada, the melancholy Egyptian, and Noelle, the troubled beauty, are more stepping stones to Craig's recovery than fully realized characters. Though Kaysen's Girl Interrupted offers a more vivid and original explanation of the psych ward, Craig's triumph over depression through the discovery of his latent artistic ability will appeal to fans of therapy and recovery literature. Copyright © 2006 The Board of Trustees of the University of Illinois

Learning to Discipline

At the start of her teaching career, Ms. Metzger confesses, she ricocheted between being a drill sergeant and Mary Poppins. Here she shares with new teachers the many lessons she's learned along the way about classroom discipline and classroom management. Dear New Teachers, No one is born knowing how to 125 adolescents for five hours a day and teach the curriculum at the same time. Learning to discipline takes years. Mostly, it's trial and error. Nothing works all the time, and what works well in one class has no effect on another. However, over time, our repertoire of responses grows; we learn what we can tolerate; we gain a sense of timing; we make alliances within a school. Trust me, you will improve. When I began teaching, I struggled to my classes. I did not yet understand the difference between classroom discipline and classroom management. So let me start at the beginning. A Confession I still wince at my early attempts to control my classes. Here's what I painfully remember about myself as a young teacher, trying in vain to classes. * On the first day, I told a huge football player to change seats. I was stunned when he obeyed. * I identified emotionally with the students rather than the teachers. * I pretended competence, certainty, and adulthood - though I didn't feel any. I was still working out my own issues with authority figures, so it was hard to be one. * I ricocheted between being a drill sergeant and Mary Poppins. * Kids liked challenging me, and it was fun for them to see me squirm. Kids attacked my most vulnerable character flaws, and they could undo my self-esteem in a matter of minutes. * One critical comment could haunt me for days. * I thought everything was my fault. * The kids who behaved worst got all my attention. * Desperate, I used the curriculum, grades, and my own education to coerce (bully?) students. * I was so afraid to admit failure that I didn't ask for help. * The very idea of discipline exhausted me. I hated it. * I felt terminally vulnerable. Some Progress I hated disciplining adolescents. If I was going to stay in education, I knew I had to get past the discipline issues. I tried to write down all my mistakes in order to find a pattern and not repeat them. That didn't help. I just kept making the same mistakes over and over. More helpful was remembering my own recent high school and college experience. I wrote down what I liked and hated about my own teachers, so I could at least pretend to be someone who knew what she was doing. I remembered how much I wanted the teachers I adored to like or notice me; I remembered how criticism bruised my fragile academic ego; I remembered how I resented teacher power plays. Mostly, I remembered how much I hated the infantilizing nature of high school. Those memories got me through the first years of teaching. I reminded myself that I already knew a lot - just from the student side of the desk. If I could keep remembering, I could convey genuine empathy and have honest interactions. My mother, an outstanding teacher, was the best help. She listened patiently that first year as I complained - or cried - that my classes never went as I planned. Finally, my mother said, Look, you can't expect to know how to teach instantly. You wouldn't expect to do brain surgery in your first year of medical school. If you think you can learn this in one year, you degrade my profession. Now, let's look at your failures. First, you need to see failures as opportunities for you to learn. You need a theory for each problem. Why is it a problem? What do you bring to the situation? What could you have done differently? What other lens could you use to understand the situation? …

Cases from the Osler Medical Service at Johns Hopkins University

Presenting featuresA 26-year-old man with human immunodeficiency virus infection (CD4 count, 3/μL) was admitted for evaluation of a 2-month history of fevers and fatigue and a 1-week history of nausea and abdominal pain. He had no previous history of opportunistic infections. His physical examination was notable for a temperature of 39°C and mild hepatomegaly without significant tenderness. There were no heart murmurs, and he did not have splenomegaly, lymphadenopathy, skin rash, or neurological changes. His white blood cell count was 2.9/μL, his platelet count was 132,000/μL, and his hematocrit was 22.4%. His alkaline phosphatase level was slightly elevated at 152 U/L, but his aminotransferase and bilirubin levels were normal. Evaluation included negative hepatitis serologies, negative blood and mycobacterial cultures, negative toxoplasmosis immunoglobulin (Ig) M and IgG, a nonreactive rapid plasma reagin, a negative purified protein derivative skin test, and negative serum cryptococcal and urine histoplasmosis antigens. A computed tomographic scan of the abdomen (Figure 1) revealed hepatomegaly with a patchy enhancing pattern, periportal edema, and multiple small lesions in the spleen.Upon further questioning, the patient reported that he had traveled extensively in Italy, France, and Spain while in the military, during which had he consumed unpasteurized milk products. He was currently working as a drill sergeant at a prison. He also had a pet cat and had recent contact with a friend’s kitten.What is the diagnosis?

Case in Health Care Management: “The Drill Sergeant”

Case in Health Care Management: “The Drill Sergeant”

Emotional Metaphors, Socialization, and Roles of Drill Sergeants

. . . the society exercises a moral pressure over its members, to put their sentiments in harmony with the situation. [Durkheim 1961:445] Drill sergeants in the United States Army play a crucial role in the behavioral and emotional socialization of new soldiers. This is a study of the relationships among drill sergeants' emotional metaphors, their socialization, and their role performance as drill sergeants. It postulates some dynamics by which the transmission and interpretation of emotional metaphors may be adaptive for particular kinds of roles, in this case as junior military leaders. The data are based on ethnographic research at an American Army basic-training post, Fort Michael.2 Thirty-two drill sergeants and their spouses were studied from the time they arrived at the post, attended Drill Sergeant School, and participated in drill sergeant roles during their two-year tours. The sample included eight female drill sergeants and included a representative sample of blacks, whites, and Hispanics.3 In the course of ethnographic research into the effects of drill sergeants' job stress on their family life, it became apparent that the