Military Readiness Research Articles

Prevalence Of Unplanned Readmissions Among Patients Of Military Treatment Facilities.

Understanding readmissions within the Military Health System (MHS) provides important insights to better understand and improve health outcomes for military personnel and their families. We assessed all-cause seven- and thirty-day readmission rates in military treatment facilities by treatment service for patients ages 18-64 for fiscal years 2011-18 using inpatient data from the MHS and the private sector. We compared unplanned readmission rates for the obstetric, medical, and surgical product lines. Readmission rates differed by product line. Seven-day readmission rates ranged from 1.5percent to 3.3percent by product line, and thirty-day rates ranged from 3.2percent to 8.8percent. The obstetric line had the greatest number of readmissions (391,463) but the lowest seven-day readmission rate (1.5percent). Readmission rates were lower for the military population than for people in other insurance groups, but military readiness is disrupted by unplanned readmissions. Product-line differences in readmission rates in the MHS suggest opportunities for improvement.

Post-Deployment Screening In The Military Health System: An Opportunity To Intervene For Possible Alcohol Use Disorder.

Unhealthy alcohol use in the military remains a serious threat to health and military readiness and raises the question of how to improve detection that facilitates diagnosis and treatment. Army active duty soldiers are routinely screened for possible alcohol use disorder in pre- and post-deployment health surveillance surveys. We examined the likelihood of having a follow-up behavioral health visit or receiving an alcohol use disorder diagnosis among soldiers returning from deployments associated with the Afghanistan or Iraq operations in fiscal years 2008-13, based on their post-deployment screening results. After we controlled for demographic and military treatment facility characteristics, military history, and comorbidities, we found that people who screened positive for possible alcohol use disorder were significantly more likely to have such a visit and receive such a diagnosis. Routine post-deployment alcohol screening represents an opportunity for timely intervention by the Military Health System for military members whose results indicate elevated risk for alcohol use disorder.

Design for a cohort-randomized trial of an acceptance and commitment therapy-enhanced weight management and fitness program for Navy personnel

Overweight/obesity and inadequate fitness in active duty personnel impact the wellbeing of service members and have significant costs for military readiness and budget. ShipShape (SS), the Navy's weight management program, was designed to promote nutritional, behavioral, and exercise education to service members. Although SS is an evidence-based program, about half of those who complete the program pass the Body Composition Assessment (BCA), one part of the Navy's comprehensive Physical Fitness Assessment (PFA). SS may not fully address underlying behavioral, psychological, and emotional barriers that influence poor eating and exercise habits. A novel solution to improve outcomes is to incorporate acceptance and commitment therapy (ACT) to promote mindful awareness of present moment experiences, improve psychological flexibility, and support commitment to behavior change. This paper describes a cohort-randomized controlled trial of ACT-enhanced SS (ACT + SS) compared to the standard SS-only program. Active duty service members referred to the SS program are randomized to receive 8-weekly ACT + SS or SS-only group interventions. Our aims are to: 1) determine the effectiveness of ACT + SS compared to SS-only; 2) examine psychological flexibility as a mechanism underlying intervention response; and 3) explore potential moderators of intervention response. The primary outcome is weight, one of the key components of the BCA; secondary outcomes include Body Mass Index (BMI), body fat %, self-reported BCA results, physical activity, problematic eating, and quality of life. We have designed a cohort-randomized trial with interventions that are pragmatically implemented in a real-life military setting, and outcomes that are immediately relevant to service members and leadership.

Measuring Reliability In The Wartime Transport of Provisions: The Case of Mao Yuanyi (1594–1641)

A military strategist and advisor, Mao Yuanyi (1594–1641) was one of the most prolific writers of the late Ming period on military matters and participated in the Ming war against the Jurchen in Liaodong in the early seventeenth century. In his seminal study on the conduct of war, the Records of Military Preparedness (Wubeizhi), he exhaustively discussed the costs and benefits of the transport methods available at the time, including carts, pack animals, and water transport. Among all the transport methods that he considered, Mao clearly favored what he called “human transport” (renyun), which exclusively relied on the labor of human bearers. By drawing on Mao’s writings on the transport of provisions, this study analyzes his forceful argument in favor of employing human labor and illuminates the practices of organizing wartime logistics. It also sheds light on the manner in which the costs and benefits of transport methods were being evaluated and how the notions of efficiency and reliability came into play in calculations concerning transport in the late Ming period.

Jihadi Culture: The Art and Social Practices of Militant Islamists

Jihadi Culture: The Art and Social Practices of Militant Islamists

The Change of Joseon-Japan Relationship in the Late 17th Century and Tsushima-han

Kōrinteishō that due to the waning of Japan s might, the relationship between Joseon and Japan changed. Reconsidering this intriguing record, this article attempts to clarify the trends in Joseon-Japan relationship during the late 17th century. Already before Tsunayoshi, the Bakufu abandoned diplomacy that relied on martial prestige. However, it is particularly noteworthy that the Tsunayoshi regime mentioned this explicitly as the diplomatic stance during its reception of the Tongsinsa. In this period, the Bakufu had given more weight on Joseon relations and, in turn, officially approved the role of Tsushima-han as Chōsen-goyō, who were the mediators between the two countries. However, in the Ulleung-do incident, while the Tsushima attempted to claim Japanese sovereignty over Ulleung-do, the Bakufu avoided this, prioritizing a stable diplomatic relation with Joseon. This indicates a marked difference in diplomatic attitude towards Joseon between the Bakufu and Tsushima. Furthermore, in this period, a shift occurred in Joseon-Tsushima relations. Kashima Hyōsuke, a vassal of Tsushima-han, records that Joseon had lost their patience and have been more unyielding to the increasingly demanding Tsushima. Indeed, Joseon started to be more assertive towards Tsushima by signing the Gyehae-yakjo to control the Waegwan. Ostensibly, Tsushima complied to Joseon s restriction on private-trade, but simultaneously, devised a way to benefit from private-trade directly. Thus, patronized merchants called Motogatayaku were newly sent to the Waegwan to increase the financial profit of the han. Finally, the notion of Tsushima as the frontline of military readiness against foreign countries was another significant historical development in late 17th century. This notion was refined further in terms of narrative and logic and became a rational explanation for the role of Tsushima within the Baku-Han state.

Heterogeneity in Military Trauma Casualty Care.

Military combat casualty care is at the forefront of military medical readiness, but there is little data on current proficiency of deployed personnel. A previous study identified a potential performance gap in military trauma teams. This study aims to evaluate a subsequent team to determine if heterogeneity of teams exists and to determine if this level of efficiency persists or can be improved. Military trauma teams at the Role 3 hospital in Bagram, Afghanistan, were evaluated over the course of a single deployment between April and October 2018. Trauma teams were directly observed and performance of the ATLS primary trauma survey timed. These results were compared to previously published times from Kandahar and Bagram Role 3 sites from Oct 2016 to Apr 2017. Time to completion of the primary survey in 2018 was statistically faster than the times reported from the Role 3 sites from Oct 2016 to Apr 2017 (344.75 s vs. 482.8 s, p < 0.05). The greatest improvements of efficiency were in the time periods between assessing the airway and breathing, evaluating the patient's circulation, and completing of the primary survey. Trauma teams can vary significantly in their efficiency in evaluating trauma patients. Whether this is clinically significant is currently debatable, but it highlights a possible readiness gap for deploying military personnel and the heterogeneity of military combat casualty care.

A prospective field study of U.S. Army trainees to identify the physiological bases and key factors influencing musculoskeletal injuries: a study protocol

BackgroundMusculoskeletal injuries (MSKIs) are common in military trainees and present a considerable threat to occupational fitness, deployability, and overall military readiness. Despite the negative effects of MSKIs on military readiness, comprehensive evaluations of the key known and possible risk factors for MSKIs are lacking. The U.S. Army Research Institute of Environmental Medicine (ARIEM) is initiating a large-scale research effort, the ARIEM Reduction in Musculoskeletal Injury (ARMI) Study, to better understand the interrelationships among a wide range of potential MSKI risk factors in U.S. Army trainees in order to identify those risk factors that most contribute to MSKI and may be best targeted for effective mitigation strategies.MethodsThis prospective study aims to enroll approximately 4000 (2000 male and 2000 female) U.S. Army trainees undergoing Basic Combat Training (BCT). Comprehensive in-person assessments will be completed at both the beginning and end of BCT. Participants will be asked to complete surveys of personal background information, medical history, physical activity, sleep behaviors, and personality traits. Physical measurements will be performed to assess anthropometrics, tibial microarchitecture and whole body bone mineral density, muscle cross-sectional area, body composition, and muscle function. Blood sampling will be also be conducted to assess musculoskeletal, genetic, and nutritional biomarkers of risk. In addition, participants will complete weekly surveys during BCT that examine MSKI events, lost training time, and discrete risk factors for injury. Participants’ medical records will be tracked for the 2 years following graduation from training to identify MSKI events and related information. Research hypotheses focus on the development of a multivariate prediction model for MSKI.DiscussionResults from this study are expected to inform current understanding of known and potential risk factors for MSKIs that can be incorporated into solutions that optimize Soldier health and enhance military readiness.

ВИКЛАДАЧІ СПЕЦІАЛЬНИХ ДИСЦИПЛІН ВВНЗ: СТАН ПІДГОТОВЛЕНОСТІ ТА НАПРЯМИ ЇЇ УДОСКОНАЛЕННЯ

Introduction: There is a task before the national higher military educational institutions – to prepare the scientific pedagogical specialists, who could unite the deep fundamental military professional knowledge, practical experience and pedagogical excellence with constantly increasing challenges of modern society to the Armed Forces of Ukraine and military higher education system in their military activities. The pedagogical qualification system improvement stipulates the research of military teachers readiness for the pedagogical work modern state. The purpose is to highlight the actual state, problematic issues and directions of improvement of higher military educational institutions special subjects lecturers preparedness. Methods : theoreical: analysis of the theoretical: scientific researches and normative and legal documents, which determines the demands to the higher military school lecturers preparedness; views and facts comparison concerning the investigated topic in historical context with modern state ; prognosis to determine the conditions and directions of effective implementation of the system of principles, rules, demands, which directs lecturers cognitive activities. Empirical: questionnaires, conversation, direct and indirect observation, experts assessment method, self-assessment, testing – were used with the aim of determining the level of higher military educational institutions special subjects lecturers professional competence formedness. Results: The statistical data, obtained as a result of the research, permitted to determine the priority directions to improve the scientific pedagogical personnel postgraduate education system. These are: lecturers familiarization with modern education conceptions, theories, approaches, scientific investigation preparation and pedagogical diagnosing. Originality: The complex investigation of the higher military educational institutions special subjects lecturers preparedness allowed to determine some drawbacks in their preparation, also as some suggestions concerning the directions of pedagogical qualification improvement and the problems in proper organization and pedagogical conditions provision of pedagogical activities in higher military educational institutions. Conclusion : The problem of professional development of higher military educational institutions lecturers, the solving of which is seen in the professional development in the postgraduate education system by involving the teachers to the pedagogical qualification development courses and distance learning.

Use of Traditional and Modified Functional Movement Screening to Predict Balance with Military Load

Use of Traditional and Modified Functional Movement Screening to Predict Balance with Military Load Eric M. Scudamore 1, Sandra L. Stevens 2, Dana K. Fuller 2, John M. Coons 2, Don W. Morgan2, FACSM 1Arkansas State University, Jonesboro, AR; 2Middle Tennessee State University, Murfreesboro, TN PURPOSE: To determine if Functional Movement Screen (FMS) or modified Functional Movement Screen (mFMS) item scores predict dynamic balance scores of potential military recruits who wore a 24.2 kg military load. METHODS: Thirty physically-active males and females who displayed anthropometric and physical fitness characteristics typical of military recruits entering basic training completed FMS and mFMS. Torso-loaded balance was assessed as loaded composite reach distance (LCR) and loaded overall stability indices (LOSI) measured using the Y Balance test and Biodex Balance System, respectively. RESULTS: FMS composite scores exhibited the strongest relationship with LCR and participants with higher FMS composite scores (>15) displayed higher LCR values compared to those with lower FMS composite scores (<14). Analysis of FMS subscores using penalized regression indicated that an in-line lunge score of 1 predicted a shorter LCR (Coef for score of 2 = 6.86 (95% CI = 2.88, 10.93)); Coef for score of 3 = 8.36 (95% CI = 3.96, 13.70)) and a shoulder mobility score of 3 predicted better LOSI (Coef = -2.38 (95% CI = -3.56, -0.57)). Loaded shoulder mobility (Coef = -2.11 (95% CI = -4.12, -0.26)) and trunk stability push-up (95% CI = Coef = 1.61 (0.08, 3.13) scores of 3 also predicted better and worse LOSI, respectively. CONCLUSION: The in-line lunge item score from the FMS may be the best predictor of torso-loaded balance and the FMS may be more appropriate than items from a torso-loaded FMS battery in predicting torso-loaded balance in military recruits. Use of the FMS by clinicians may aid in mitigating musculoskeletal injuries in service members, thus minimizing losses that contribute to decreased military readiness.

The Impact of Aeroallergens on Military Readiness: A Case Report

Seasonal aeroallergens commonly cause allergic conjunctivitis, rhinorrhea, sinusitis, and cough in sensitized individuals. These clinical symptoms are the result of IgE-mediated type I hypersensitivity reactions, which trigger the degranulaton of mast cells and basophils. In contrast, aeroallergens are not common precipitants of urticarial dermatitis, which is driven by a cell-mediated type IV hypersensitivity reaction. In this case report, we describe an Active Duty Air Force member stationed in San Antonio, TX, who presented to the dermatology clinic with a three year history of recalcitrant urticarial dermatitis found to be directly related to exposure to the pollen from the Juniperus ashei tree, also referred to as Mountain Cedar. While laboratory findings confirmed a high level of circulating IgE antibody to Mountain Cedar, the patient had no upper respiratory symptoms consistent with a typical allergic reaction. Further, his skin disease rapidly cleared within 24 hours of leaving southern Texas. Because of the recalcitrant nature of his condition upon returning home, he was considered unfit for further military service. This case not only highlights the growing link between IgE and chronic skin disease, but also the impact aeroallergens can have on the medical readiness and world-wide deployability of Airmen, Sailors, Soldiers, and Marines.

The kindness of strangers: soldiers, surgeons, civilians, and conflict intimacies in the American Civil War

ABSTRACT America’s Civil War is often identified as the instigator of a new, industrial discipline that replaced the individualism of the antebellum era. Its traditional narrative trajectory is one of consolidation and cooperation that emphasizes the emergence of order from the chaos of conflict and the ordering of idealized, individual masculine bodies in the service of an equally glorified national body. This article complicates contemporary assumptions pertaining to gender, martial manhood, and national health in a wartime context. Juxtaposing the reports produced by Draft Board doctors in the later years of the conflict against a selection of nursing memoirs, it examines the ways in which elite assumptions about national health and military preparedness were challenged by the intimate realities of the war. It explores the tensions revealed through the federal draft between voluntarism and coercion, and the resultant shift from intimacy to estrangement in the later years of the conflict. It reveals that the points of intimacy between strangers effected by the Civil War were not always positive or supportive. Too often they were controlling confrontations that challenge the national narrative that has for so long pertained in the case of America’s mid-nineteenth century civil conflict.

Improving Military Readiness and Reducing Suicide Risk: The Role Between Positive TBI Screens, Severe Insomnia, and Suicidal Outcomes

This study examined how insomnia severity and a positive traumatic brain injury (TBI) screen relate to suicidal outcomes across military branches. Data were compiled from 1,635 participants across seven studies. A series of analyses were conducted by military branch to identify which significantly differed on the variables of interest. A series of multiple regression analyses were conducted to explore whether insomnia severity and a positive TBI screen predicted suicidal outcomes and whether the effect varied as a function of military branch. Insomnia severity and a positive TBI screen each had independent relationships with the suicide risk outcomes. The relationship between insomnia and suicide risk varied by military branch. However, a positive TBI screen had a significant effect on suicidal behavior and thoughts and the effect was similar across the four groups. Efforts to identify and intervene on insomnia and TBI sequelae may improve quality of care for service members at risk of suicide. Insomnia and post-TBI symptoms are important targets of intervention as they are often less stigmatized and can be easily assessed by brief self-report measures.

Effect of Service-Branch on Contraception Use and Childbirth Rates Among United States Military Recruits [6H

INTRODUCTION: Unintentional pregnancy is a common problem among US servicewomen, particularly junior enlisted, with negative effects on the mother, infant, and military readiness. METHODS: Secondary analysis of insurance records from 92,072 servicewomen, who attended basic training between 2013 and 2017, examining differences between service-branches in prescription contraception use after 6 months on active duty and childbirth in the first 24 months of active duty using Kaplan-Meier and Cox Regression Analyses. IRB approved. RESULTS: Rates of prescription contraception use after 6-months on active duty varied significantly between branches [Army (18.1%), Air Force (27.4%), Navy (37.6%), and Marines (26.5%); (P<.001)] as did the proportion of women on prescription contraception using longer-acting methods (Depot-medroxyprogesterone, Implant, or Intrauterine) [Army (15.2%), Air Force (17.5%), Navy (54.7%), and Marines (49.8%); P<.001)]. There were significant (P<.001) differences in the rate of childbirth in the first 24 months on active duty between all of the services except the Air Force and Navy (P=.057) [(Army: 11.1% (95% Confidence Interval 10.7-11.5), Air Force 6.0% (5.6-6.4), Navy 6.7% (6.3-7.1), and Marines 8.4% (7.8-9.0)). In multivariable analysis accounting for age and contraception use, there were significant (P<.001) differences between services in the risk of childbirth. For example, the Navy (Hazard Ratio 1.24 (95% Confidence Interval 1.13-1.35)), Marines (1.48 (1.33-1.65)), and Army (1.86 (1.71-2.01)) all had a higher risk than the Air Force. CONCLUSION: Despite access to an identical medical benefit, including free contraception, contraceptive use and pregnancy rates among junior enlisted vary significantly across services. Further study is needed to determine the etiology of these differences.

Survey of Sexual Function and Pornography.

We aimed to explore and describe the pornography habits of young men and women. Given recent upward trends in pornography use and erectile dysfunction, along with a plausible pathophysiology, we hypothesized that pornography use would correlate with sexual dysfunction. Institutional Review Board approval was obtained. Surveys were distributed to 20-40 year old men and women presenting to a urology clinic. Information was collected on demographics and medical history. Sexual function was evaluated with the International Index of Erectile Function (IIEF) in men and the Female Sexual Function Index in women. Extent of potential addiction to pornography was measured with the pornography craving questionnaire and the obsessive passion scale. Pornography use was measured based on both frequency and duration, and analyzed relative to sexual dysfunction. Men used pornography significantly more frequently than women (81.1% vs. 39%). Computer and cellular phone image viewing were the most popular modalities in both sexes. There was no association between IIEF and craving for, or obsessive passion for, pornography. Preference for pornography with masturbation was found to be significantly associated with erectile dysfunction (p = 0.001). Rates of erectile dysfunction were lowest in those preferring partnered sex without pornography (22.3%) and increased significantly when pornography was preferred over partnered sex (78%). No correlation was found between any variables and female sexual dysfunction. Pornography and sexual dysfunction are common among young people. No clear relationship exists between extent of addiction to pornography and sexual dysfunction in either gender. However, men who prefer masturbation with pornography to partnered sex have a significantly increased risk of sexual dysfunction. Given sexual dysfunction may be associated with mental health concerns, further evaluation of its causes and impact on military operational readiness are warranted.

Emerging Infectious Diseases and Antimicrobial Resistance (EIDAR).

IntroductionThe Infectious Disease Clinical Research Program’s (IDCRP) Emerging Infectious Diseases and Antimicrobial Resistance (EIDAR) Research Area is a Department of Defense (DoD) clinical research capability that is responsive and adaptive to emerging infectious disease (EID) threats to US military readiness. Among active-duty and other Military Health System (MHS) beneficiaries, EIDAR research is largely focused on evaluating the incidence, risk factors, and acute- and long-term health effects of military-relevant EIDs, especially those caused by high-consequence pathogens or are responsible for outbreaks among US military populations. The EIDAR efforts also address Force Health Protection concerns associated with antimicrobial resistance and antimicrobial stewardship practices within the MHS.MethodsThe EIDAR studies utilize the approach of: (1) Preparing for emergent conditions to systematically collect clinical specimens and data and conduct clinical trials to assist the military with a scientifically appropriate response; and (2) Evaluating burden of emergent military-relevant infectious diseases and assessing risks for exposure and development of post-infectious complications and overall impact on military readiness.ResultsIn response to the Ebola virus epidemic in West Africa, the IDCRP partnered with the National Institutes of Health in developing a multicenter, randomized safety and efficacy study of investigational therapeutics in Ebola patients. Subsequently, the EIDAR team developed a protocol to serve as a contingency plan (EpICC-EID) to allow clinical research activities to occur during future outbreaks of viral hemorrhagic fever and severe acute respiratory infections among MHS patients. The EIDAR portfolio recently expanded to include studies to understand exposure risks and impact on military readiness for a diversity of EIDs, such as seroincidence of non-Lyme disease borreliosis and Coccidioides fungal infections among high-risk military populations. The team also launched a new prospective study in response to the recent Zika epidemic to conduct surveillance for Zika and other related viruses among MHS beneficiaries in Puerto Rico. Another new study will prospectively follow U.S. Marines via an online health assessment survey to assess long-term health effects following the largest DoD Shiga Toxin-Producing Escherichia coli outbreak at the U.S. Marine Corps Recruit Depot-San Diego. In cooperation with the Trauma-Related Infections Research Area, the EIDAR Research Area is also involved with the Multidrug-Resistant and Virulent Organisms Trauma Infections Initiative, which is a collaborative effort across DoD laboratories to characterize bacterial and fungal isolates infecting combat-related extremity wounds and link lab findings to clinical outcomes. Furthermore, the EIDAR team has developed an Antimicrobial Resistance and Stewardship Collaborative Clinical Research Consortium, comprised of Infectious Disease and Pharmacy specialists.ConclusionsThe EIDAR Research Area is responsive to military-relevant infectious disease threats that are also frequently global public health concerns. Several new EIDAR efforts are underway that will provide Combatant Command Surgeons, Infectious Diseases Service Chiefs, and other Force Health Protection stakeholders with epidemiological information to mitigate the impact of EIDs and antimicrobial resistance on the health of U.S. military service members and their dependents.

An Editorial Review of Mobile Health: Implications for the US Military Health System.

The United States Military Health System provides healthcare to a diverse patient population throughout the world. There are three distinct challenges that the Military Health System faces. (1) Providers have varying degrees of clinical training expertise and may be called upon to practice outside their usual scope of care. (2) There is geographic isolation of patients and providers with limited resources while stationed overseas. (3) Patients are at higher risk of breaks in continuity of care because of permanent change of duty stations, deployments, and retirement. In this article we review the history of mobile health in both the civilian and military sectors, and how mobile health may be used to address the challenges unique to the United States Military Health System. There are many good initiatives in military mobile health, however they are decentralized and different across the services and military treatment facilities. We describe some military specific success stories with improving patient access to care and disease specific mobile health applications implemented. Mobile health is a powerful platform which can help deliver standardized care in missions around the world and improve access to care for patients at military treatment facilities in the United States. The United States Military Health System would benefit greatly from creating universal mobile health applications to assist providers in patient access to care, military mission readiness, and disease specific modules. Future resources should be dedicated to the development of a mobile health application pool that is universally implemented across services to improve quality of care delivered at home and in theater by military providers.

Discontinuation Rates of Antidepressant Use by Dutch Soldiers.

Soldiers have a higher risk for developing psychiatric disorders that require treatment; often with antidepressants. However, antidepressants as well as the psychiatric disorder, may influence military readiness in several ways. In the general population, early discontinuation of antidepressant treatment is often seen. It is yet unknown whether this occurs to a similar extent in soldiers. The objective of this study was to evaluate discontinuation of antidepressant use by Dutch soldiers in the first 12 months after start and determinants thereof. Data were obtained from the military pharmacy. All Dutch soldiers who started using an antidepressant between 2000 and 2014 were included. Kaplan-Meier curves were constructed to estimate the discontinuation rate over time and the influence of each determinant on discontinuation rate was estimated using Cox regression. About 25.9% of de 2479 starters had discontinued their antidepressant use after 1 month; after 3 and 6 months this number increased to 52.7% and 70.3%, respectively. Early discontinuation was higher in soldiers who received their first prescription from a neurologist or rehabilitation specialist (HR 1.85, 95% CI 1.55-2.21, HR 2.66 95% CI 1.97-3.58) compared to soldiers with a first prescription from a general practitioner. In addition, early discontinuation was lower in soldiers who were prescribed serotonin reuptake inhibitors and other antidepressants (HR 0.57, 95% CI 0.51-0.60, HR 0.63, 95% CI 0.55-0.73) and in soldiers between 40 and 50 years of age (HR 0.79, 95% CI 0.70-0.89). More than half of the soldiers discontinued their prescribed antidepressant within 3 months and after 6 months, only 30% were still on antidepressants.

What Explains the Abandonment of Yezidi People by the Kurdish Forces in 2014? Foreign Support or Internal Factors

In 2014, the genocide of Yezidi people in Shingal by the Islamic State of Iraq and Levant (ISIL) attracted the world’s attention and triggered a military intervention by the United States. The Kurdistan Democratic Party (KDP) has been accused of allowing the genocide to occur because it had been in military and security control of the area, but abandoned the local population to its horrific fate when ISIL attacked. As such, the KDP’s rival parties regard the withdrawal of KDP Peshmerga forces as a betrayal of the Yezidi people that raises troubling questions about the party’s motivations for doing so. This article offers six possible factors that may have contributed to the fall of Shingal: moral hazard based on genocide, moral hazard based on risk-taking on the Kurdistan Region’s capital of Erbil, military preparedness, bureaucratic and partisan obstacles, and lack of strong leadership and morale. The article tests these hypotheses and concludes that moral hazard does not account for the abandonment. Instead, the article argues that Kurdish forces could not defend the town because of a lack of military preparedness, bureaucratic and partisan obstacles, and lack of strong leadership and morale.

ПРOФЕСIO-ПСИХOГРAМA (IНФOРМAЦIЙНO-КOМУНIКAЦIЙНИЙ AСПЕКТ) ПРOФЕСIЙНOЇ ПIДГOТOВКИ МAЙБУТНIХ OФIЦЕРIВ ЗБРOЙНИХ СИЛ УКРAЇНИ

The structure of a professional specialist is considered in the article. The structure of the professional specialist is a system-forming factor in building a process for the training of future officers of the Armed Forces of Ukraine. Psychophysiological aspect of any professional activity of a person (including an officer of the Armed Forces) is disclosed through the description of requirements. These requirements are put forward to the military to provide military capability and combat readiness of the military subdivision.The professional qualification (aspect of information and communication competence) of the future officer of the Armed Forces of Ukraine is aimed at creating an information, motivational basis for the future officer’s officer in the conditions of the military conflict in the east of the state. The goal is also to reform and modernize the Armed Forces of Ukraine.The main functions performed by a professional officer are deeply analyzed: informational, diagnostic, predictive, forming.It is determined that the psychogram is the basis for constructing a psychological portrait of the officer’s face. Principles of constructing a psychological portrait of an officer should be used both in the process of professional removal of future military, and in the official characteristics of the officerf.As a result of expert research, the psychic characteristics of an officer were determined. These characteristics are formed during the learning process. The officer’s psychogram is created (psychological portrait). Also, the role of various professionally important qualities of the future activity of the soldier is revealed. The characteristic (psychological portrait of a person) can be a reliable basis for an adequate assessment of an officer and prediction of his professional efficiency and possible projected career growth.