This study aims to analyze the influence of education and training, personnel innovation, service orientation, and reward-punishment system on the implementation of reform in the Indonesian National Police (Polri). Institutional transformation requires strengthening the capacity of officers through systematic education and training, fostering innovation in policing tasks, focusing on public service orientation, and implementing fair reward and punishment mechanisms. The study employs a literature review method, reviewing 50 scholarly articles, national and international journals, and official Polri reports over the last ten years (2015–2025). The findings indicate that continuous education and training enhance technical and managerial competence, while personnel innovation promotes creativity and operational efficiency. Service orientation reinforces an organizational culture that is responsive to public needs, and the reward-punishment system ensures compliance with procedural and ethical standards. The integration of these four variables contributes significantly to the success of reform implementation. The literature emphasizes the need for education planning based on organizational needs, fostering operational innovation, enhancing service orientation, and applying a transparent and fair reward-punishment system. These findings provide a foundation for policymakers to design more effective, adaptive, and sustainable reform strategies, improving professionalism, accountability, and public trust in the institution.

Longitudinal associations between service member problematic anger and marital dysfunction in U.S. military couples: Findings from the Millennium Cohort Program

Examination of changes in suicide cognitions during an intensive treatment program for posttraumatic stress disorder.

Objective: To investigate the current status of sleep quality and its relationship with attributional style and resilience among military personnel stationed in a certain plateau area. Methods: A questionnaire survey was conducted among military personnel stationed at a specific location in a certain plateau area using a self-designed general information questionnaire, the Attributional Style Questionnaire, the Connor-Davidson Resilience Scale, and the Pittsburgh Sleep Quality Index. Results: Participants scored 36.19±12.71 for negative event attributional style, 76.45±17.83 for resilience, and 2.85±2.28 for sleep quality. Attributional style scores were positively correlated with sleep quality scores (r=0.132, P<0.01), whereas resilience scores were negatively correlated with sleep quality scores (r=-0.313, P<0.01). Age, educational level, marital status, duration of stay in the certain plateau area, altitude of station, attributional style, and resilience were all identified as influencing factors for sleep quality. Conclusion: The sleep quality of military personnel stationed in the certain plateau area appears to be relatively good. The study suggests that maladaptive attributional styles and lower levels of resilience may be contributing factors to poorer sleep quality. Future mental health management interventions could target attributional styles and resilience to improve the sleep quality and overall psychological well-being of military personnel in the certain plateau area.

Medial Tibial Stress Syndrome (MTSS) is an overuse pathological condition, characterized by pain and tenderness along the posteromedial border of the tibia. The duration and severity of symptoms, in some cases, may lead to marked functional impairment and undermine athletic performance.There is a lack of consensus across literature regarding several aspects of MTSS. The purpose of this narrative review is to synthesize current evidence and highlight key elements related to MTSS.Findings indicate that MTSS is a multifactorial condition involving periosteal traction, bone overload and impaired remodeling. Epidemiological data are heterogeneous, but MTSS remains prevalent among athletes and military personnel. Multiple intrinsic and extrinsic risk factors contribute to its onset. Diagnosis is primarily clinical, supported by imaging. Conservative management, consisting of rest, anti-inflammatory medications and physiotherapy, remains the cornerstone, while the evidence for surgical intervention is limited and methodologically weak.

Female service members experience higher rates of injury compared to males, due to physiological differences, poorly fitted equipment, and female-specific health issues. They are also at greater risk of posttraumatic stress disorder and military sexual trauma. As more women transition to civilian life, many encounter difficulties accessing appropriate care, compounded by lack of military cultural competence among civilian healthcare providers and limited understanding of available services. This study aims to explore the impact of chronic pain on female Australian Defence Force (ADF) veterans, their experiences in obtaining optimal healthcare, and their perceptions of healthcare needs. Qualitative data were collected from 23 Queensland-based ex-serving female ADF members with chronic pain (M = 52 years of age), through six focus groups (four online, two in-person). Participants had served in the Army (44%), Navy (30%), or Air Force (26%) for an average of 10.2 years, with pain duration ranging from four to 60 years. Data were analysed via an inductive thematic approach. Four main themes were developed, with corresponding sub-themes. Findings reveal how military culture, systemic healthcare barriers, and perceived poor provider understanding contribute to delayed diagnoses and below evidence-based standard care. Participants called for improved clinician training in military cultural awareness, trauma-informed care, and greater awareness of available services, emphasising the urgent need for gender- and veteran-informed approaches to support the health and wellbeing of female veterans. Recommendations will inform the development of an education module for primary care providers, with the goal of improving chronic pain outcomes for female veterans in Australia.

Femoral neck stress fractures (FNSFs) are a potentially devastating injury to a service member's livelihood and quality of life if improperly managed. The purpose of this study was to determine the population-level incidence and risk factors associated with FNSF in the US military. The Defence Medical Epidemiology Database was used to identify all distinct FNSF cases in both active and reserve military service members from 2006 to 2015 (International Classification of Diseases, ninth revision, clinical modification code 733.96). The associations of sex and occupation, age, rank and service branch with FNSF outcomes were evaluated. Relative risk (RR) of injury was also calculated based on risk factors of sex, age, rank and branch. The overall incidence of FNSFs was 0.23/1000 person-years, with rates of 0.27/1000 person-years in enlisted service members (male: 0.18/1000 person-years; female: 0.92/1000 person-years) and 0.07/1000 person-years in officers (male: 0.04/1000 person-years; female: 0.23/1000 person-years). For most occupations, female service members were at significantly greater risk (RR 3.66-11.25). Compared with enlisted infantry members, Special Operations Forces, mechanised/armour, aviation, maintenance and administration were at significantly decreased risk for FNSFs (RR 0.12-0.82). Aviation was the only officer occupation at a significantly decreased risk (RR 0.45) of FNSFs compared with ground and naval gunfire officers. In the multivariable assessment, female sex (RR: 6.02), age <20 years (RR 1.22-2.00), junior enlisted rank (RR 2.63-7.14) and service in the Marine Corps (RR 1.46) were significant risk factors for FNSF outcomes. Female sex, younger age and junior enlisted rank were salient risk factors for FNSFs. There were also several occupations that showed an increased risk. Although FNSFs are rare, the likelihood of permanent disability is high when the pathology is not recognised early. Understanding the factors with the greater risk can be used during medical planning and when training clinicians to provide preventive and prompt care.

Operational experience from the Russo-Ukrainian War revealed frequent use of tourniquets that were not medically indicated and an increase in ischemic complications from prolonged tourniquet application as a consequence of extended evacuation times. In response to this, the Committee on Tactical Combat Casualty Care (CoTCCC) convened a working group to evaluate whether tourniquet reassessment and conversion practices should extend to the All Service Member (ASM) level. With input from NATO and partner nations, the Working Group developed a standardized, time-based algorithm that provides plain language guidance for reassessment, repositioning, and conversion. The proposed change replaces the term replacement with repositioning, affirms a reassessment window within 2 hours for nonmedical personnel, and limits conversion beyond 2 hours to medical personnel. These updates will expand lifesaving capability to nonmedical responders, reduce preventable morbidity and mortality from tourniquet use, and align TCCC principles with current operational realities.

Military personnel and veterans exposed to blast overpressure waves frequently report vestibular symptoms, including dizziness, vertigo, and imbalance. Although blast exposure is known to disrupt vestibular function, how vestibular deficits develop over time, particularly at the level of vestibular afferent signaling, remains unclear. In this study, we used an ear-blast model to investigate the early injury responses and progression of vestibular deficits following a single, moderate-intensity blast exposure (20 PSI) in male and female Long-Evans rats. Vestibular function was assessed using single-unit recordings from vestibular afferents and vestibulo-ocular reflex (VOR) testing. Blast exposure produced progressive changes in vestibular afferent activity in both male and female rats. In males, spontaneous firing rates remained unchanged, whereas females showed a reduction at 1day and 14days post-blast. In both sexes, firing irregularity increased, and a greater proportion of afferents became less responsive to head rotation and translation. Although gains and phases of the remaining canal and otolith afferents were preserved, response distortion increased following blast exposure, indicating reduced precision of vestibular afferents' encoding of head movement. Despite the impairments in vestibular nerve activity, steady-state rotational and translational VOR gains remained largely unchanged, with only moderate phase changes up to 56days post-blast. However, a subset of animals exhibited reduced step rotationalVOR gains and earlier quick phase responses following blast exposure. Morphological analysis revealed stereocilia damage, significant loss of saccular hair cells, and astrocytic activation in the central vestibular nuclei. Together, these findings indicate that blast-induced vestibular injury involves both peripheral and central components, with progressive changes in vestibular afferent activity that could influence sensory inputs to the CNS.

The aim of the current research is to investigate how the responsiveness, reliability, and empathy affect the level of public service satisfaction, in which the perceived service quality is an intermediate variable at the Mapilli Community Health Center. A quantitative style was used and a survey methodology was used to conduct the study by employing the users of community health services. The data were collected through closed-ended questionnaires, non-participatory observation and additional documentation. The methods of analysis included the structure equation modeling that can be varied to evaluate the direct and indirect relationships between the variables. The results showed that responsiveness, reliability, and empathy affected the perceived service quality in a statistically significant positive effect. Responsiveness and empathy also exhibited a statistically significant positive direct impact on the public service satisfaction. Additionally, the perceived service quality showed that it had a strong positive impact on the public service satisfaction. The mediation analysis showed that perceived service quality was a major mediator of the impacts of responsiveness, reliability and empathy on satisfaction with public service. These findings indicate that improving the responsiveness, reliability, and empathy of the health service personnel can strengthen the perceptions of service quality and therefore, improve the satisfaction of the populace. Finally, the paper confirms that perceived service quality is a strategic factor in enhancing the influence of the service quality dimension on the public service satisfaction in the primary health care setting.

Artificial intelligence (AI) is pivotal in shaping the future technological landscape. Multi-Agent Reinforcement Learning (MARL) has emerged as a significant AI technology for simulating complex dynamics across various domains, enabling novel potentials for advanced strategic planning and coordination among autonomous agents. However, its practical deployment in sensitive military contexts is constrained by the lack of explainability: a critical factor for reliability, safety, strategic validation, and human-machine interaction. This paper reviews the latest advancements in explainability within MARL and presents novel use cases, emphasizing its indispensability for examining agents’ decision-making processes. Existing techniques are critically assessed and associated with the domain of military strategies, focusing on simulated air combat scenarios. The concept of a novel information-theoretic explainability descriptor to analyse the cooperation capabilities of agents is then introduced. The aim of this research is to highlight the necessity of precisely understanding AI decisions and aligning these artificially generated tactics with human understanding and strategic military doctrines, thereby enhancing the transparency and reliability of AI systems. By illuminating the crucial importance of explainability in advancing MARL for operational defence, this work supports not only strategic planning but also the training of military personnel with insightful and comprehensible analyses.

Given their unique psychosocial milieu, military-dependent youth (children of service members) may be vulnerable to excess weight gain, adverse cardiometabolic health, and binge eating. This study aimed to test the effects of group interpersonal psychotherapy (IPT), relative to a standard-of-care health education (HE) group, on these outcomes in adolescent military-dependents. Military-dependent 12 to 17-year-olds with BMI ≥ 85th percentile and elevated anxiety and/or recent loss-of-control-eating participated in a multisite cluster randomized controlled trial comparing 12 weeks of adapted group IPT, targeting psychosocial problems, to a HE group. BMI, cardiometabolic health, and binge eating were assessed at baseline, posttreatment, and 1-year follow-up. BMI and cardiometabolic variables were measured or retrieved from electronic medical records at 2- and 3-year follow-ups. We were not able to recruit a fully powered trial; however, we analyzed data from 153 adolescent military-dependents (43.8% boys) with LOC-eating and/or high anxiety. There were no group differences between IPT and HE on outcomes. Some improvements in BMI indices, glucose regulation, and binge eating (p < 0.001) were observed across both groups. Group-based interventions may positively impact weight trajectories and cardiometabolic health among adolescent military-dependents. Future studies should elucidate potential moderators and mechanisms of interventions on outcomes in this important population. ClinicalTrials.gov identifier NCT02671292.

BackgroundIn the structure of military traumatism, the number of multiple and combined wounds and injuries has increased significantly due to the increase in the destructive properties of modern weapons. Most blast wounds are characterized by multiple damage to blood vessels and nerve fibers and significant defragmentation of muscles and skin. All such wounds are considered initially infected, which is an additional aggravating factor. The establishment of a correct rehabilitation diagnosis and subsequent stage-by-stage assessment of the results of rehabilitation therapy should be based on adequate functional assessment tools. The FIM is one such tool that had not been previously recommended for use in any Ukrainian guideline.ObjectiveThe aim of the study was to investigate the possibility of using the Functional Independence Measure as an additional tool for assessing the effectiveness of rehabilitation of military personnel in Ukraine with combined injuries over a long period of time.Material and MethodsA retrospective study was conducted of 807 wounded Ukrainian servicemen with complex injuries of varying severity. Examination included a meticulous analysis of medical records, a comprehensive physical examination, and a survey using the FIM scale. Due to the nature of the injuries, the servicemen were provided with standard rehabilitation programs.ResultsAll patients were classified as lightly injured and moderately injured according to the Abbreviated Injury Scale. The examined wounded had an initial assessment of more than 6 points on the FIM scale. Initial data in the assessment of functioning on the FIM scale allowed the identification of two different subgroups of patients: one with a predominance of motor function impairment, and the other, predominant cognitive impairment. Reliable positive changes of the total FIM indicator were observed in all patient groups. The primary improvement in the groups with traumatic brain injury (TBI) was attributed to enhancements in cognitive abilities. Patients with the lowest initial motor abilities (combined upper and lower extremity trauma group) demonstrated the highest increase in this area.ConclusionsInclusion of the FIM scale in the recommended toolkit for assessing the effectiveness of rehabilitation will allow for additional objectification of rehabilitation care and the formulation of individual recommendations for achieving the best rehabilitation results.

Tuberculosis (TB) remains a force health protection threat to the U.S. military, particularly in crucial populations at increased risk of exposure or re-activation. This analysis examined TB testing trends and the prevalence of latent tuberculosis infection (LTBI) among U.S. Army active component soldiers from 2014 through 2023, the first decade following a major policy shift to targeted testing. Defense Medical Surveillance System data indicate that a total of 339,465 TB tests were administered, primarily (81.0%) tuberculin skin tests. Of those tests, 22,762 (6.7%) were positive, leading to the identification of 18,018 (5.3%) LTBI diagnoses. Asian/Pacific Islander soldiers demonstrated the highest LTBI diagnosis proportion (10.2%), followed by non-Hispanic Black (8.6%), Hispanic (5.6%), and Non-Hispanic White (2.9%) soldiers; the data also include 'other' (6.8%) and 'unknown/missing' (3.6%) categories. Recruits exhibited a significantly higher LTBI diagnosis proportion (11.0%) than non-recruits (3.6%), highlighting a high prevalence of LTBI among incoming personnel at time of accession. A marked decline in testing volume-a 72% decrease from 2014 to 2023 in the annual numbers of tests administered-followed the 2013 U.S. Army Medical Command policy shift. The substantially higher average proportion (6.7%) of positive tests from 2014 to 2023 compared to the average from the pre-policy era (1.3%) of universal screening demonstrates the successful concentration of testing resources on those most at risk, thereby improving diagnostic yield within a low-prevalence military force. This analysis's findings describe the epidemiological outcomes of the Army's targeted testing policy and underscore the importance of ongoing, targeted surveillance to mitigate TB risks in military settings. The 2013 policy that successfully transitioned the U.S. Army from universal tuberculosis screening to a targeted, risk-based strategy reduced testing volume by 72% over the next decade. The decline in tuberculosis testing volume coincided with a substantial increase in diagnostic yield, with the overall positivity proportion rising from 1.3% in the pre-policy era to 6.7% in 2023. The 2013 policy revision to a targeted, risk-based tuberculosis testing strategy succeeded in focusing valuable public health resources on high-risk groups. The high prevalence (14.0%) of latent tuberculosis infection that has been identified in recruits confirms that accession is the most critical juncture for tuberculosis control within the Army. Slight but notable differences in testing type positivity suggests opportunity for further policy refinement.

Abstract In Abdulrazak Gurnah’s novels set in German East Africa, German colonialism is portrayed as violent, with administrators, military personnel, plantation overseers, and missionaries all engaging in acts of violence towards East Africans. Of these groups, the figure of the missionary is the most ambivalent, given that Christianity had both protective as well as culturally damaging functions in colonial spaces. This article provides a historical contextualisation of German missionary presence in German East Africa around 1900 and thereby productively complicates the role of missionaries and places them within the broader context of colonial violence in German East Africa. It examines the use of German within mission schools to contextualise the use of the German language in the novel as well as the ways in which missionaries were engaged in epistemic violence. In a third section, the article examines some of the ways in which German missionary societies contributed to the colonial revisionist movement – a movement that is described in the last chapter of Afterlives . This article reflects on how German missionary groups tried to keep their legacies alive in post-war Germany by creating memories of the former German colonies and thus provides context for the transnational and multilingual entanglements of the novel Afterlives .

ABSTRACT Environmental, social, and governance (ESG) performance has become an important component of firms' long‐term sustainability strategies. This study examines the influence of military‐connected board members on ESG outcomes in Thai listed firms from 2000 to 2022. We find that the presence of military‐connected board members has a positive effect on overall ESG scores, particularly on the environmental component. Economically, a one standard deviation increase in the proportion of military‐connected board members and high‐ranking military board members is associated with 7.1% and 8.2% increases in the environmental score, respectively. Our findings support strategic leadership skills, ethical standards, and disciplined decision‐making hypothesis such that boards with a high ratio of military experience personnel, especially at the general level, are associated with stronger ESG performance. We also find that ESG performance improves significantly when military‐connected boards operate under a military‐affiliated government. Although the study focuses on Thailand, the findings offer broader insights into how board composition and leadership background may influence sustainability across different geographies. Overall, the findings highlight board‐level military experience as a strategic governance resource for advancing ESG performance.

Background: Retirement represents a critical transitional phase for members of the Indonesian military and civil servants, often accompanied by post-power syndrome and retirement depression, which adversely affect psychological stability, musculoskeletal function, and social participation. This study aimed to empirically analyze the effectiveness of physiotherapy interventions based on physical activity combined with psychosocial support in mitigating post power syndrome and retirement depression, while also assessing their alignment with the job demands-resources model and the successful aging theory. Methods: This study employed a quantitative analytical survey involving 200 retired Indonesian military personnel and civil servants (≥1 year post-retirement) selected through simple random sampling. Data were collected using structured Likert-scale questionnaires covering physiotherapy interventions, post-power syndrome symptoms, and mental health indicators. Validity and reliability were confirmed through pilot testing. Data were analyzed using structural equation modelling with partial least squares (SEM-PLS 4) to assess relationships and model fit through outer and inner model evaluations. Results: The results indicate that all constructs met the criteria for validity and reliability (outer loading &gt; 0.70; AVE &gt; 0.50; CR &gt; 0.80; HTMT &lt; 0.85). Physiotherapy interventions demonstrated a significant effect in reducing PPS (β = -0.62; t = 8.522; p &lt; 0.001) and retirement depression (β = -0.67; t = 7.274; p &lt; 0.001), with musculoskeletal function and physical activity engagement acting as significant partial mediators (t = 5.275; p &lt; 0.001). These findings affirmed that integrated physiotherapy interventions enhance retirees’ physical resilience and psychosocial well-being, while also holding strategic relevance for national health policies and strengthening the role of retirees as supportive components within the national defense and security system. Conclusion: This research contributes to advancing physical and mental well-being among the elderly through integrated physiotherapy interventions; however, its cross-sectional design presents a limitation, suggesting future studies adopt longitudinal approaches with broader contextual variables.

Unpredictability in the child's environment has recently emerged as a significant and unique form of early life adversity (ELA). Cross-sectional studies have linked childhood unpredictability with increased post-traumatic stress disorder (PTSD) symptoms in adults; however, no prospective studies have tested the link between childhood unpredictability and PTSD risk in later life, nor what processes, such as increased anhedonia symptoms, might mediate such risk. Here, we leveraged three distinct prospective, longitudinal cohorts to test the hypothesis that unpredictability during childhood contributes to adult PTSD via worsening anhedonia symptoms. Participants were male service members (n=314), adult females (n=170), and adolescents (n=137) recruited for separate longitudinal investigations. All completed dimensional assessments of anhedonia symptoms and PTSD; childhood trauma and childhood unpredictability were measured by the Questionnaire for Unpredictability in Childhood (QUIC). Pearson correlations tested relations between QUIC, anhedonia symptoms, and PTSD symptoms. Mediational models tested whether the link between childhood unpredictability and PTSD is mediated by increased anhedonia symptoms by estimating indirect effects via bootstrapped path analysis. Childhood unpredictability was associated with increased adult PTSD symptoms in all three cohorts (rs>.19, ps<.016). Further, in all three cohorts, the relationship was partially mediated by higher anhedonia symptoms (bs>0.046, 95% confidence intervals = 0.01-0.12). All effects remained significant when controlling for levels of childhood trauma and removing anhedonia-related PTSD items. Unpredictability during childhood may confer risk for adult PTSD, and this increased risk may occur via alterations in anhedonia symptoms. Efforts to increase predictability during childhood could enhance resilience to later traumatic events.

In 2007, the Office of the Assistant Secretary of Defense issued guidance to routinely monitor post concussive symptoms following mild traumatic brain injury (mTBI). Subsequent clinical practice guidelines published as early as 2009 further underscored the importance of routine symptom monitoring following mTBI using standardized assessments such as the Neurobehavioral Symptom Inventory (NSI), though the NSI was not specifically recommended until 2015. The study objective was to describe the frequency of NSI administration, as documented in the Military Health System (MHS) electronic medical record (EMR), within one year after mTBI diagnosis among post-9/11 Active-Duty Service Members. Data for this effort were extracted from the Military Health System (MHS) Data Repository and used to identify Service Members whose first mTBI (i.e., index) was documented between Fiscal Years 2002 and 2021 (index TBI; n = 150,976). Members were excluded from the cohort for a history of a more severe TBI (n = 128,253) and/or a catastrophic injury (e.g., spinal cord injury; n = 3,805). Members were matched with data from completion of the NSI that was contained within the DoD TBI portal. The cohort was further evaluated to determine the frequency of documented NSI administration within one year of the index mTBI date. Among those with an index mTBI meeting inclusion criteria, 3,351 (2.2%) Service Members had an NSI documented within the EMR. When filtered to NSI surveys completed within 1 year of the index mTBI date, 1,182 (0.78%) NSIs were recorded. The prevalence of a matched NSI increased as time went on, with the highest number administered in 2019. Findings suggest relatively infrequent administration and documentation of the NSI following mTBI. System- and individual-level barriers may have played a role in this. Increased understanding regarding barriers and facilitators to administering and documenting the NSI within the EMR are needed to inform future implementation efforts to further measurement-based care among Service Members.

Adequate provision and equitable utilization of HIV preexposure prophylaxis (PrEP) is crucial to reducing HIV incidence. Nearly all new HIV infections among active duty services members occur among males; Black men are disproportionately affected (>40% of new infections). We investigated the effect of the Coronavirus disease-19 (COVID-19) pandemic on oral PrEP use among beneficiaries of the Military Health System. We analyzed demographic and PrEP prescription data from approximately 4.5 million TRICARE Prime beneficiaries aged 18-64 years during the pre-COVID-19 (October 1, 2016-February 28, 2020) and COVID-19 periods (March 1, 2020-September 30, 2022). We compared the characteristics of beneficiaries that initiated PrEP during the pre-COVID to COVID-19 periods. Overall, 89,761 PrEP prescriptions were issued among 15,658 enrollees out of which 56,779 prescriptions (18.7% of which were new prescriptions) were issued in the pre-COVID-19 period while 32,982 prescriptions (10.8% of which were new prescriptions) were issued during the COVID-19 period. Black beneficiaries represented 20% of PrEP initiations. Percentage of beneficiaries who initiated PrEP (0.25% vs 0.10%) (P < .001) and reductions in PrEP initiation were noted across all demographic stratifications for race, rank, and sex (P < .001). Overall, beneficiaries were 65% less likely to initiate PrEP during the COVID-19 period after adjusting for covariates (adjusted odds ratio (aOR) 0.35; CI 0.33-0.38), potentially because of changes in access, behaviors, or perceived risk. In addition, the cumulative length of PrEP prescriptions (210 days vs 90) (P < .001) declined from pre-pandemic to pandemic period. Continual efforts to identify those at greatest risk for acquiring HIV, including men who have sex with men, are needed to ensure adequate provision of PrEP to those at greatest risk.