Military Readiness Research Articles

Virtual Reality in Military Training to Maintain Indonesian Military Readiness in The Era of Covid-19 Pandemic

During the COVID-19 pandemic, there have been many changes to human activities, not to mention Indonesia's military armed forces (TNI). Despite the COVID-19 pandemic, threats to national security still exist. There are even some potential threats that developed during the COVID-19 pandemic and could explode at any time. This article is written based on a qualitative method and used a literature study approach of various literature that related to the topic. The author wants to show the importance of maintaining Indonesian Military Armed Force (TNI) readiness by continuing military education and training with some adjustments. Virtual Reality has become the solution to this problem. With fully immersive system technology, VR can provide an experience that is closest to reality. So that even in a pandemic condition with a policy of restricting human activities, military readiness can still be maintained.

Use of electronic cigarettes among U.S. Military service members – prevalence and associated risk factors

Background Decreased physical fitness, loss of vision and hearing, and increased risk of chronic diseases are significant primary and secondary implications associated with the health of U.S. Military Service members who use tobacco, including electronic cigarettes. Despite the medical and non-medical costs to the U.S. Department of Defense and potential adverse health effects to Service members, electronic cigarette use is on the rise. Methods U.S. Military Service members who completed their Periodic Health Assessment, a standardized, electronic, logic-based tool, from July 2018 to July 2019 were eligible. This exploratory study examines the prevalence and significant risk factors associated with self-reported use of electronic cigarettes, as well as determines if tobacco use varies by sex and Service branch, through use of Chi-square analysis and logistic regression. Results U.S. Military Service members 17–70 years old were included in this study (N = 1.12 M), with 80% of study participants being male and 20% female. Exposure to secondhand smoke (OR: 2.12, 95% CI: 2.15–2.22) and screening positive for hazardous drinking (OR: 2.70, 95% CI: 2.64–2.76) were found to show the greatest increase in odds of using electronic cigarettes, with similar findings after stratification by sex and Service branch. Stratification by Service branch revealed further differences in the association between electronic cigarette use and various demographic, military, lifestyle, and health characteristics. Conclusion Electronic cigarette use is increasing across the United States. U.S. Service members have unique risk factors and patterns of tobacco use. Despite tobacco use having potential adverse effects on military readiness, its use remains prevalent in this population. Our findings identify opportunities for the U.S. Department of Defense to review tobacco policy and availability and accessibility of cessation services to promote quitting tobacco, especially electronic cigarettes.

Русы и венгры на Нижнем Дунае в 943 г.

Russian chronicles give different dates of Igor's second campaign against Byzantium. Researchers adhere to the dating of The Tale of Bygone Years (Povest' vremennykh let) - 944; however, 943 seems to be the most possible, since Igor's contract with the Greeks was preceded by difficult, and therefore long negotiations, which resulted in Igor's agreement with the Greeks in 944. Earlier in 943, the Hungarians passed through Bulgaria, having confirmed the agreement on the tribute by the “empire of the Romans.” Those who support that Igor's second campaign against the Greeks shoud be dated 943 try to link it with the military action of the Hungarians, having no serious grounds for this. Until 970, the Hungarian leaders did not enter into military alliances with the Kievan princes, since their robber raids were directed mainly to the west, while their invasions of the Balkans became more frequent after their defeat in Germany in 955. Nevertheless, setting off in a raid on Byzantium in the spring of 943, the Hungarians learnt about Igor's military preparations from the Eastern Slavs from Transcarpathia, who had close contacts with the Tivertsy, Igor's allies in his summer campaign of 943. To achieve their goals, the Hungarians skillfully took advantage of the news that a more significant army had been assembled in Russia to march to the Balkans. In his turn, Igor benefited from the fact that the Hungarians had already sown fear in Byzantine society before his arrival on the Lower Danube, saying that Bulgaria did not prevent “northern barbarians” from passing through its territory.

Developing water resiliency solutions at military installations

Climate change, along with rising human water demands, has been projected to raise the vulnerability of available water resources and poses further risks to global water security. A challenge of this century will be to secure enough fresh water for the world’s increasing population. U.S. Army installations provide critical support to Army’s mission. Army facilities face many risks which must be overcome to ensure that vital missions continue. Installation Energy and Water Plans (IEWPs) comprise one pivotal effort to ensure that facilities maintain access to the resources they need and can meet resilient solutions to maintain water supplies to sustain the people and environment. An essential component of the IEWP is the development of potential solutions, or courses of action (COAs) to address deficiencies that can improve an installation’s baseline condition, ensuring energy and water (E&W) security and resiliency. The undertaking seeks to improve security and resiliency by considering the varied threats of disruption within installations and providing measures for adaptable recovery. These disruptions include environmental events, droughts and climatic events, spills, and water security threats. Increasing energy and water resiliency aims to maintain that Army’s mission is successfully carried even if sources of water are cut off or compromised. The objective of this paper is to document water resiliency improvements in military installations by applying priority facilities demand estimation planning tools and reviewing courses of action and also providing lessons learned and tools that could be utilized for planned communities or city-based water management efforts. The IEWP process empowers stakeholders to improve military readiness through state-of-the-art solutions for enhanced security, resiliency, and mission assurance. These methods and use of standardized data sets could be pursued to be applied towards a broader scope of stakeholders to improve water resiliency for cities, communities, and industries outside of the military.

The Dorjéling Armoury in the Potala According to the Fifth Dalai Lama’s gsung ’bum

Although the government established through the alliance of the Gélukpa (Dge lugs pa) and the Khoshud in 1642 took its appellation from the Ganden Palace (Dga’ ldan pho brang/Ganden Phodrang) at Drepung (’Bras spung), the symbolic seat of power of this government was the Potala, at the same time fortress, administrative centre, earthly copy of the celestial palace of Avalokiteśvara, and official residence of the Fifth Dalai Lama. Less known, however, is that the Potala also came to symbolise military readiness. It acquired this new martial function in 1667, when an armoury, called Dorjéling (Rdo rje gling), was set up at the base of the White Palace. The Fifth Dalai Lama memorialised its establishment with a poetic text, which is included in volume nineteen (ma) of his collected works. This paper examines this text, which provides information both on the contents of the armoury and on the logic employed to justify the creation of spaces dedicated to military preparedness within a palace that was fast becoming one of the most revered sites in the Tibetan sphere.

Movement behaviors associated with mental health among US military service members

ABSTRACT Compared to the general adult population, military service members experience an excess burden of mental health problems (e.g., posttraumatic stress disorder, PTSD). Physical activity, screen time, and sleep (i.e., movement behaviors) are independently associated with mental health, but their combined effects are poorly understood, particularly in military populations. We analyzed data from active component service members in the national 2018 Health Related Behaviors Survey (N = 17,166). Weighted gender-stratified logistic regression models examined the associations of meeting recommended/healthy levels of moderate-to vigorous physical activity (MVPA), screen time, and sleep duration – separately and in combination (none, some, all) – with PTSD, suicide ideation, and serious psychological distress. In both men and women, meeting sleep recommendations was associated with reduced odds of each outcome. Meeting MVPA recommendations was associated with lower odds of serious psychological distress only in men (OR = 0.76, 95% CI: 0.58–1.00). No/low screen time was associated with lower odds of suicide ideation only in women (OR = 0.66, 95% CI: 0.45–0.95). The odds of all three outcomes were lower in those who reported some or all (vs. none) recommended/healthy movement behaviors, with the lowest odds found in the “all” group, suggesting a possible dose-response relationship. Findings can help inform multiple behavior change interventions to improve service members’ psychological fitness and military readiness.

Development of a Risk Prediction Model for Assessing Dental Readiness in the Canadian Armed Forces.

The establishment and sustainment of a high state of dental readiness in the Canadian Armed Forces (CAF) are the primary missions of the Royal Canadian Dental Corps. The objective of this study was to develop a risk prediction tool to estimate dental readiness in active CAF personnel. The prediction model was developed to predict the classification of non-deployable (yes/no) within 12 months (primary) and 18 months (secondary) using both dental history data (including dental attendance, restorations, root canals, and third molar status) and demographic information. Two cohorts were used for development: a recruit cohort who enrolled between April 2016 and March 2017 and a longer-serving member (LSM) cohort who had their recall dental exam between May 2014 and October 2014. Each group was followed until April 26, 2018. Elastic net logistic regression models were used to create the models. Model performance was evaluated using area under the curve, F1, and the Brier score. The recruit cohort included 2,828 individuals and the LSM cohort included 2,398 individuals. Overall, the classification of non-deployable occurred in 5.1% of the study population within 12 months and 9.6% of the population within 18 months. The models predicted the outcome with an area under the receiver operating curve of 0.77 in recruits and 0.70 in LSMs. The prediction model shows potential but its performance and usability could be further improved through the consistent collection of high quality, discretely entered, epidemiological data following standardized diagnostic terminology and coding. A recalibrated and automated version of this model could assist in decision making, resource allocation, and the enhancement of military dental readiness.

Carlopolis: Sketches of Everyday Life of A Swedish Cossack Camp on the Frontier (1709 – 1713)

The purpose of this article is to highlight the daily life of the inhabitants of the camp of the Swedish King Charles (Carl) XII and his Ukrainian allies, in the vicinity of the Turkish fortress Bender on the Dniester River (now the territory of the Republic of Moldova), between 1709 and 1713. The sequence and time of Swedes and Cossacks’ staying in three alternating locations, their conveniences and disadvantages, the influence of the nature of development and the degree of comfort of buildings on the sanitary and epidemiological situation were specified. In the course of the study, the methods of providing food to the population of the camps, the differences in the diet of ordinary soldiers and senior officers, and their relationship with moral and military combat readiness were studied. Also, the influence of the border situation under the conditions of the ongoing war and the unusualness of landscape and climate for the Swedes, on the occurrence of rumours and phobias, and the general mental perception of the steppe region to them was found out.

Features of medical support of physical training and mass sports events in the Armed Forces of the Russian Federation

Introduction. Physical training is the most important element of the combat readiness of the troops, its goals and objectives are defined by the Manual on Physical Training in the Armed Forces of the Russian Federation. The solution of these tasks should contribute to the formation of military personnel's readiness to endure extreme physical and mental stress during the preparation and conduct of combat operations. Comprehensive provision of physical training in the troops requires the hard work of various services, including the medical service.The purpose of the study. Identify problematic issues of medical support for physical training and sports events in the Armed Forces of the Russian Federation and identify ways to solve them.Materials and methods. The article uses the materials of the work of medical and nursing teams in the medical provision of physical training of units of the Southern Military District from 2016 to 2019. Additionally, the data of an in-depth medical examination of the personnel of some units of the district subordination for 2018 were used.Results and discussion. When analyzing the work of visiting medical and nursing teams during the medical support of passing the standards for physical training, a number of problematic issues were identified. First, there are always military personnel who regularly do not engage in physical training and during the delivery of standards make excessive efforts and work at the limit of their capabilities. Secondly, some exercises are very dangerous, either in terms of injuries or the likelihood of developing complications from the cardiovascular system. All this applies to the medical support of the competition. As an example, the championship of the Armed Forces of the Russian Federation in fire and rescue sports, held from 3 to 6 September 2019 in Rostov-on-Don on the territory of the garrison fire brigade, is given. The program of the competition included passing the obstacle course, climbing the training tower, extinguishing the fire, etc., all very traumatic. Therefore, for the medical support of these competitions, a medical and nursing team of the resuscitation profile was allocated on a reanimobile with specialized stowage, respiratory and oxygen equipment.Conclusion. It is necessary to strictly monitor the correctness of the definition of the group of physical training and the gradual increase in physical activity in order to avoid complications and further progression of diseases or even deaths in military personnel. It is impossible to approach formally the conduct of an in-depth medical examination of military personnel.

Analysis of Surgical Volume in Military Medical Treatment Facilities and Clinical Combat Readiness of US Military Surgeons

Low surgical volume in the US Military Health System (MHS) has been identified as a challenge to military surgeon readiness. The Uniformed Services University of Health Sciences, in partnership with the American College of Surgeons, developed the Knowledge, Skills, and Abilities (KSA) Clinical Readiness Program that includes a tool for quantifying the clinical readiness value of surgeon workload, known as the KSA metric. To describe changes in US military general surgeon procedural volume and readiness using the KSA metric. This cohort study analyzed general surgery workload performed across the MHS, including military and civilian facilities, between fiscal year 2015 and 2019 and the calculated KSA metric value. The surgeon-level readiness among military general surgeons was calculated based on the KSA metric readiness threshold. Data were obtained from TRICARE, the US Department of Defense health insurance product. The main outcomes were general surgery procedural volumes and the KSA metric point value of those procedures across the MHS as well as the number of military general surgeons meeting the KSA metric readiness threshold. Aggregate facility and regional market-level claims data were used to calculate the procedural volumes and KSA metric readiness value of those procedures. Annual adjusted KSA metric points earned were used to determine the number of individual US military general surgeons meeting the readiness threshold. The number of general surgery procedures generating KSAs in military hospitals decreased 25.6%, from 128 377 in 2015 to 95 461 in 2019, with a 19.1% decrease in the number of general surgeon KSA points (from 7 155 563 to 5 790 001). From 2015 to 2019, there was a 3.2% increase in both the number of procedures (from 419 980 to 433 495) and KSA points (from 21 071 033 to 21 748 984) in civilian care settings. The proportion of military general surgeons meeting the KSA metric readiness threshold decreased from 16.7% (n = 97) in 2015 to 10.1% (n = 68) in 2019. This study noted that the number of KSA metric points and procedural volume in military hospitals has been decreasing since 2015, whereas both measures have increased in civilian facilities. The findings suggest that loss of surgical workload has resulted in further decreases in military surgeon readiness and may require substantial changes in patient care flow in the MHS to reverse the change.

HPV-Related Cancers: A Growing Threat to U.S. Military Health and Readiness.

The incidence of human papillomavirus (HPV) related cancers is growing in the United States. Active duty service members (ADSM) have higher rates of HPV infection than civilians and are therefore at greater risk of developing HPV-related cancers. The purpose of this commentary is to examine the burden of HPV-related cancers in ADSM. The current HPV vaccination and cervical cancer screening uptake rates of U.S. ADSM are presented, including a literature review of military-focused studies on HPV vaccination and cervical cancer screenings. We provide directions for future research, interventions, and policy recommendations to improve HPV-related cancer prevention among ADSM.

Knowledgeability and Identification: Explaining Military Interprofessional Healthcare Teams' Excellence and Readiness.

ABSTRACTThe importance of successful interprofessional collaboration for effective patient care is generally acknowledged. Research into interprofessional collaboration has thus far been mainly situated in the civilian context and has mostly indicated barriers that prevent successful interprofessional collaboration. However, military interprofessional healthcare teams (MIHTs) seem to be exceptionally successful. Building on the overarching finding of the studies within this special edition—i.e., that MIHTs’ readiness and excellence are in part due to healthcare professionals’ “shared understanding” of what is needed to effectively serve on an MIHT—this commentary uses the theory of Landscape of Practice as a lens to further explain the processes through which healthcare professionals attain this shared understanding. Used within the fields of Health Professions Education and workplace learning, Landscapes of Practice (LoP) helps to explain how learning occurs within practice. It highlights how, by engaging within the various working environments belonging to a profession, social interactions between the various professionals within that environment form the conduit for learning. LoP highlights that the outcome of this learning process is “knowledgeability,” i.e., understanding of how to engage within the field and with its players, resulting in being an acknowledged member of the field. Fostered through a process called “identification,” professionals learn to see how their professional practice aligns with that of others and how to effectively collaborate with others. The commentary explains how the findings of the separate studies within this special edition strongly resonate with knowledgeability and identification. It is concluded that civilian interprofessional healthcare teams may benefit from incorporating characteristics of MIHTs in their training programs.

Severe Drug-Induced Liver Injury in the Military: A Retrospective Review.

Drug-induced liver injury (DILI) is a significant cause of morbidity and mortality. Establishing a diagnosis is challenging due to the broad differential diagnosis of liver injury. We retrospectively reviewed patients with severe idiosyncratic DILI at Walter Reed National Military Medical Center in order to define the scope and patterns of injury in the military population. Using the military health database, we identified a total of 110 patients who had an International Classification of Disease (ICD)-10 code for toxic liver injury in the electronic medical record at Walter Reed National Military Medical Center between 2016 and 2019. Each patient record was reviewed, and all pertinent data for included patients were recorded into a database for analysis. Twenty-seven out of 110 patients with a diagnostic code for toxic liver injury met inclusion criteria for severe idiosyncratic DILI. Nine cases were caused by supplements, including 5 active duty service members using synthetic anabolic steroids or preworkout supplements. The majority of patients were men and one-third were serving on active duty. The ranges of liver enzyme elevation and patterns of liver injury widely varied. Military service members are at particularly high risk for DILI given the frequent use of over-the-counter and other unregulated strength- and performance-enhancing supplements. These injuries not only have significant medical consequences but can profoundly impact military readiness and mission capability. Diagnosis of DILI among active duty service members requires a strong index of suspicion, and inquiry regarding all ingestions is crucial. Educating physicians, providers, and policy makers on the risks of supplement-induced liver injury among service members is crucial. These data will facilitate additional studies exploring susceptibility to severe idiosyncratic DILI among the military population.

The Bioethical Problems in Applying the Defense Production Act to Pharmaceuticals

The Bioethical Problems in Applying the Defense Production Act to Pharmaceuticals

Military Transportation in State Freight and Defense Community Plans

The US Department of Defense (DoD) makes extensive use of the US multimodal transportation network to move material for operational support, keep facilities supplied, and move personnel. Federal agencies, especially the US Department of Transportation, work closely with the DoD. States and localities also play a critical role in defense infrastructure. This research examines state freight and defense community plans to identify how the transportation needs of the DoD are being addressed in state planning. The findings are 72% of the 50 state freight plans mention defense transportation, while 34% considered defense transportation needs in-depth. About 6 of 19 identified state defense community plans mention transportation, but only 3 have specific defense transportation goals. Nationally, the DoD and federal agencies work closely together to maintain the nation’s defense transportation network, but at the local and state level closer cooperation on transportation issues should be developed. Military readiness remains high, but efficiencies in the system can be improved.

The Potential Role of Functional Motor Competence to Promote Physical Military Readiness: A Developmental Perspective.

Decreased physical fitness in military recruiting populations is problematic for the development of physical military readiness (PMR) and presents a threat to national security. The demonstration of low levels of fitness may be an indicator of a more foundational problem in the physical development of military recruits. We propose the development of functional motor competence (FMC) across childhood and adolescence as a necessary antecedent to advanced PMR training and military-specific tasks (i.e., rucking and obstacle course navigation) and as an integral part of sustained PMR. The development of FMC supports increases in cardiovascular and muscular endurance through repeated efforts performed during practice and in sport, as well as muscular power as many FMC movements mimic plyometrics in a strength in conditioning sense. We posit that an inadequate foundation in FMC will serve as a barrier to achieving sufficient PMR and combat success of the fighting force. We propose three possible solutions to ensure sufficient PMR levels through the implementation of developmentally appropriate FMC-based training. First would be promoting FMC-based training in junior reserve officer training corp and ROTC programs. Second would be a more global approach, on the scale of the National Defense Education Act, specifically focusing on promoting quality daily physical education that could reach millions of children. Third, individual branches could begin promoting the tenets of foundational FMC training concepts in their physical training manuals, which ideally would address FMC before and throughout basic training, as well as subsequent active duty training.

CORR Insights®: Institutional Experience and Orthoplastic Collaboration Associated with Improved Flap-based Limb Salvage Outcomes.

CORR Insights®: Institutional Experience and Orthoplastic Collaboration Associated with Improved Flap-based Limb Salvage Outcomes.

Viral Hepatitis C-Related Care in Active Duty and Reserve Service Members: A Retrospective Review.

Hepatitis C Virus (HCV) infection is a leading cause of chronic liver disease and hepatocellular carcinoma, and universal screening of all adults is recommended. Treatment with new direct antiviral agents are well tolerated and highly effective and decrease morbidity and mortality from HCV. The timely treatment of active-duty Service members (SMs) is essential to prevent complications of HCV and to ensure medical readiness and safety of the Department of Defense blood supply. We performed a retrospective review of the quality of care of Navy Active Duty (AD) and reserve SMs diagnosed with HCV to assess rates of successful treatment and compliance with national guideline recommendations and identify potential challenges to receiving curative HCV therapy. A retrospective chart review was completed on the health records of 54 AD and reserve US Navy SMs diagnosed with HCV. The records were reviewed for timeliness of subspecialty evaluation, achievement of sustained virologic response (SVR), and documentation of the completion of HCV-associated recommendations from national organizations and guidelines. Challenges and barriers to care were identified. Ninety-eight percent of AD and reserve Navy SMs diagnosed with HCV were prescribed treatment, 81% achieved an SVR after completing initial treatment, which reached 92% after initial nonresponders underwent a second round of treatment. Fifty percent of SMs experienced a delay in care due mostly to military-related obligations and patient noncompliance or both. There was a small number of delays in care as a result of prolonged notification of results and referral time. As HCV screening recommendations expand to include all adults, more HCV infections will be identified in both the active and reserve components. Modern HCV therapies are both relatively short in duration as well as curative, allowing for the restoration of medical readiness and military service retention. Despite these advantages, we identified challenges of effecting HCV cures in a mobile military population. We recommend centralized compliance monitoring of not only HCV force screening but also HCV treatment to ensure maximized military medical readiness.

Adjustment Disorders in U.S. Active Duty Military Women: A Scoping Review for the Years 2000 to 2018.

Adjustment disorder (AD) is the most common mental health diagnosis in the U.S. military and is more than twice as likely to be diagnosed in active duty servicewomen as compared with male servicemembers. The literature on ADs, particularly in female servicemembers, has not been reviewed yet. We conducted a scoping review of the literature to explore the degree of research activity and summarize current literature gaps. We created a PRISMA-ScR checklist and prospectively registered it in Open Science Framework. The literature search included articles (including studies and reports) published between 2000 and 2018 in either the grey literature or the following databases: Ovid Medline, CINAHL, Embase, PsycINFO, Web of Science, and Ovid Cochrane. We used DistillerSR to conduct title and abstracts screening, full-text screening, and data charting. The social ecological model for military women's health framework was used to organize the results. After screening 1,304 records, 29 were included for data charting. Most frequently, studies were descriptive (cross-sectional) (25%), with no randomized controlled studies. The studies primarily focused on ADs' risk factors in servicewomen (76%), followed by military readiness (38%). Only 14% addressed recommendations for treatments based on expert opinion, although they did not directly test interventions, and 7% focused on health outcomes. ADs affect the health of U.S. military women and military readiness, yet little is known about their successful treatment or health outcomes. Additional research in those areas is warranted.

A Scoping Review of Cervical Cancer Risk Factors, Prevention, Diagnosis, and Treatment in U.S. Active Duty Military Women.

Maintaining military readiness requires integration and delivery of appropriate sex-specific health care services for active duty servicewomen (ADSW). Cervical cancer screening (CCS) provides early detection, intervention, and treatment, allowing for reductions in human papillomavirus (HPV) infections and cervical cancer cases. This scoping review examines existing cervical cancer evidence related to ADSW and identifies research gaps, leverage points, and policy recommendations within the context of the social ecological model for military women's health. We conducted a scoping literature search using both indexed databases and nonindexed sources. We managed retrieved records from 2000 to 2018 with Endnote reference and DistillerSR systematic review software. Of 1,006 records from indexed databases and 208 records from nonindexed resources retrieved, 40 publications met the inclusion criteria. Cervical cancer research addressing ADSW is limited. Servicewomen have high rates of known cancer risk factors and face challenges related to deployments and change of duty station that affect continuity of health care and timely follow-up for abnormal CCS. Multimodal interventions with stakeholder support can encourage CCS adherence and increase HPV vaccination rates. Maintaining military readiness among ADSW requires robust evidence-based prevention efforts to address risk factors that are reportedly higher among servicewomen, as well as challenges to continuity in health care delivery that may increase the likelihood of cervical cancer incidence. Recognizing the role of HPV vaccination as cancer prevention, collaborations and partnerships, research, best practices, and creative solutions to close ADSW's sex-specific health gaps will help to ensure a fit and ready force.