Overseas Deployment Research Articles

S2726 No Biopsy Saves Life! Rare Incidence of Liver Transplantation for Unknown T-Cell Lymphoma-Induced Acute Liver Failure

INTRODUCTION: Acute liver failure (ALF) is a rare condition characterized by acute hepatic injury causing rapid onset of coagulopathy and encephalopathy. Without prompt treatment, ALF carries an exceptionally high morbidity and mortality, and prognosis is particularly poor when ALF is attributed to malignant infiltration. We present a case of ALF of initially unknown etiology that required expedited liver transplantation. The patient was subsequently diagnosed with hepatic T-cell lymphoma, which is a potentially transplant disqualifying condition. Post-transplant, the patient completed chemotherapy and made a full recovery. CASE DESCRIPTION/METHODS: A 21-year-old male soldier without prior medical history was evacuated from an overseas deployment for 2 weeks of headaches, fatigue, nausea, and vomiting. Scleral icterus had developed in conjunction with diminished hepatic synthetic function (INR 2.8 not responsive to Vitamin K), hyperbilirubinemia (total bilirubin 12.4 mg/dL), and elevated transaminase levels (ALT/AST 1000/705 U/L). Upon stateside evaluation, he developed asterixis and progressive encephalopathy. The history obtained from the patient was reliably negative for toxic ingestions or suspect environmental exposures. The workup for vascular causes, viral and autoimmune hepatitis, Wilson disease, hemochromatosis, and alpha-1-antitrypsin deficiency was negative. An empiric treatment with n-acetylcysteine was ineffective. Per the ALF Study Group estimation, the patient had a 9% 21-day transplant free survival, and was promptly transferred to a transplant center. A liver biopsy was deferred given coagulopathy and rapid decompensation that required vasopressors and intracranial pressure reduction as a bridge to transplant. His explant demonstrated T-cell rich lymphoma with no hyper-metabolic lesions on PET scan. The patient fully recovered from surgery, completed chemotherapy, and remains in clinical remission on his immunosuppressive regimen. DISCUSSION: Less than 40 cases of ALF from hepatic lymphoma have been reported in the literature, with a majority diagnosed post-mortem. Prognosis is generally poor, and rapid clinical deterioration prompts difficult and swift decisions often based on an incomplete data set. As described with this young patient with ALF of initially unknown etiology, proceeding with liver transplant was the only life-saving option. This case demonstrates that a consideration must be made to transplant potentially disqualifying conditions that have effective established therapies.Figure 1.: Diagnostic CD3 stain for T-cell rich lymphoma.Figure 2.: Diagnostic CD20 stain for T-cell rich lymphoma.

The Mediating Role of Alexithymia in the Association Between Adverse Childhood Experiences and Postdeployment Mental Health in Canadian Armed Forces Personnel.

Recent studies showing an association between adverse childhood experiences and the development of alexithymia in military personnel have generated interest regarding the role of alexithymia in the pathway linking childhood trauma exposure to mental health disorders. Accordingly, the current study was conducted to (a) examine the associations among adverse childhood experiences, alexithymia, and symptoms of depression and posttraumatic stress disorder (PTSD) among recently deployed Canadian military personnel and (b) assess the mediating role of alexithymia in these associations. Data collected from 2,927 members of the Canadian Armed Forces at baseline and after their return from an overseas deployment were subjected to a prospective path analysis. The results of the path analysis, R2 = .35, pointed to a significant direct effect of childhood adversity on postdeployment mental health symptoms. Contrary to our expectations, the results also pointed to a negative indirect effect of childhood neglect, suggesting that childhood neglect contributed to lower levels of postdeployment depression and PTSD symptoms through the dimension of alexithymia related to difficulty in describing feelings. These patterns of associations, for the most part, persisted even when accounting for combat exposure during recent deployments, R2 = .42. The present results are discussed in light of study limitations and methodological considerations, and policy and clinical implications are noted.

Landscapes of intelligence in the Third Reich: visualising Abwehr operations during the Second World War

ABSTRACT The German military-intelligence service (the Abwehr) was a macrospatial organisation whose clandestine operational activities were significantly affected by such factors as place and space. As the Second World War progressed, the Abwehr’s covert spaces expanded and contracted dynamically, producing some challenging operational environments. The service responded in various ways to a changing landscape engendered by military occupation, overseas deployment, geographical distance, enemy activity, and imminent defeat. In response to the recent spatial turn in the theory and methodology of other disciplines, intelligence historians should now consider incorporating geospatial viewpoints more often into their textual accounts and perhaps even publishing dynamic online visualisations with the aid of historical geographic information systems (HGIS).

One Health and veterans' post-deployment health.

Since 2001, more than 3.3million US service members have been deployed to operations Iraqi Freedom, Enduring Freedom, New Dawn, Inherent Resolve and Freedom's Sentinel. Visible and invisible war wounds from direct combat experiences, coupled with environmental exposures to harmful substances, can complicate veterans' health throughout their lifespan. While promoting a holistic view of health, health professionals should be attentive for potential risks associated with environmental or animal exposures (One Health concept). During deployment, infectious and non-infectious environmental exposures and harmful substances in the air, on the land and in the water may result in immediate- or long-term health effects. Veterans can also face psychosocial health risks when home that may impact their concentration, emotional responses and social interactions. To strengthen health professions education, the authors recommend that curricula incorporate a comprehensive overview of veterans' physical and psychosocial health risks as a result of their deployment. They describe four specific curriculum topics, competencies and didactic methods that can reinforce veteran-specific content for clinical education and training. By applying the One Health concept, health professionals can document harmful environmental exposures during deployment, report gaps in clinical practice, and provide support for veterans' physical and psychosocial health needs when returning to civilian life.

Pregnancy and Abortion: Experiences and Attitudes of Deployed U.S. Servicewomen.

More U.S. servicewomen than civilian women experience unintended pregnancies, which can impact their health, well-being, and careers. Despite this, federal policy limits abortion access and coverage for military personnel to cases of rape, incest, and life endangerment. This study aimed to document servicewomen's experiences with unintended pregnancy and abortion during deployment, and their knowledge and opinions of military policies related to sexual activity, pregnancy, and abortion. Between June 2016 and July 2017, we conducted a cross-sectional online survey among a convenience sample of current and former U.S. Military, National Guard, and Reserves members whose last deployment ended in 2010 or later. We asked open- and closed-ended questions about demographics, experiences with pregnancy and abortion during deployment, and knowledge and opinions of military policies related to sexual activity, pregnancy, and abortion. We ran descriptive statistics on closed-ended questions and inductively coded open-ended question responses. This study was approved by the Allendale Investigational Review Board. A total of 319 participants were included. The majority said that servicewomen are reprimanded for sexual activity and becoming pregnant during deployment in all or some circumstances. Among these respondents, one-third said that fear of reprimand for sexual activity affects deployed servicewomen's use of contraception. Twenty respondents became pregnant or discovered that they were pregnant during deployment; twelve were unable to access the pregnancy- and/or abortion-related services they wanted or needed. Among those whose last deployment ended in 2013 or later (n=141), when federal policy expanded abortion coverage for servicemembers to include cases of rape and incest, the minority knew the correct coverage or provision policies for abortion in cases of rape and incest or life endangerment. The majority believed that the military should cover and provide abortion in cases of rape, incest, or life endangerment and for unwanted pregnancies. Among this convenience sample of current and former servicewomen with an overseas deployment that ended in 2010 or later, 6% became pregnant or discovered that they were pregnant during deployment, and most of these respondents reported being unable to access the pregnancy- and/or abortion-related services they wanted or needed. The majority reported lack of knowledge of military abortion policies and that servicewomen are reprimanded for pregnancy and/or sexual activity in some or all circumstances, with many noting this reprimand as a barrier to contraceptive use for some servicewomen. Predeployment health visits may be one intervention point for disseminating the military's abortion policies; commanding officers should also be well versed in these policies so that they are able to provide effective leadership to junior military members.

Transition From Military Prehospital Medicine to Civilian EMS.

Currently, there is a disconnection between veteran military medics and the civilian Emergency Medical Services (EMS) workforce. This project aimed to characterize the rate of civilian certification among military medics, both active duty and retired, and identify perceived barriers to continuing a career in EMS after military separation. The National Association of Emergency Medical Technicians (EMTs) administered a 21-question online survey to participants. Individuals were recruited through the National Association of EMTs membership communications, Military Relations Committee members, and social media. All responses were anonymous and no identifiable information was collected. Survey questions were compiled and reported as a percentage of respondents. Free-text responses were categorized based on broad themes identified by the authors and are reported as a percentage of respondents. Results included 456 veteran and active duty respondents, of whom 304 (70.7%) had prehospital experience while in the military and 250 (58.1%) had emergency department experience. Over 60% of respondents participated in combat-related duty with 37% having at least 18months of overseas deployment. Civilian EMT certification was held by 164 (36.7%) survey participants and 170 held paramedic certification (38.1%), while 65 (14.6%) held no EMS certification. There were 119 (28.1%) respondents who stated that they did not plan to work in civilian EMS. Top selected reasons for not pursuing civilian EMS careers included: pursuing a medical career that was not prehospital (28.5%), pay disparity (18.1%), and no interest in civilian prehospital medicine (16.4%). Write in responses indicated general frustration with maintaining certification and a desire for advanced certification (AEMT, paramedic) to be supplied by the military prior to transitioning to a civilian workforce as many respondents felt their military-endowed skills and experiences were better aligned with these advanced EMS licenses. The majority of survey respondents held an EMS certification of some kind and suggests that recent efforts to supply military medics with civilian certifications have been largely successful. However, there is still a large portion that remains noncertified or expresses disinterest with entering the civilian workforce. Generally, many of those certified feel their military scope of practice exceeded civilian EMT certification and requested AEMT or paramedic licensure opportunities while still active duty military.

Contributions from Japan to gastrointestinal endoscopy training and development: Special report.

Contributions from Japan to gastrointestinal endoscopy training and development: Special report.

Contraceptive use and access among deployed US servicewomen: findings from an online survey

Background/introductionThis study aimed to survey US servicewomen on their contraceptive access and use during deployment.MethodsBetween June 2016 and July 2017, we conducted a cross-sectional online survey among a convenience sample...

Overseas Deployment of the JMSDF and Operational Maritime Law: In the Case of Counter-Piracy Operations off the Coast of Somalia and the Gulf of Aden

Overseas Deployment of the JMSDF and Operational Maritime Law: In the Case of Counter-Piracy Operations off the Coast of Somalia and the Gulf of Aden

Abortion Need among U.S. Servicewomen: Evidence from an Internet Service.

U.S. servicewomen have high rates of unintended pregnancy, but federal policy prohibits abortion provision at military treatment facilities and military insurance coverage of abortion, except in cases of rape, incest, or a life-endangering pregnancy. Such restrictions pose challenges to abortion access for servicemembers, particularly during deployment. We aimed to explore the experiences of U.S. servicewomen when accessing abortion during overseas tours and deployment. We reviewed de-identified data from email inquiries and online consultation forms from U.S. servicewomen or military spouses seeking medication abortion from the telemedicine service Women on Web between January 2010 and December 2017. We used descriptive statistics and inductively coded textual responses to describe client characteristics, circumstances of pregnancy, reasons for abortion, and barriers to abortion care. Our sample included data for 323 individuals. Reasons for abortion related to military service included disruption of deployment, fear of military reprimand, and potential career impacts. Additionally, servicemembers faced barriers to abortion access related to overseas military deployment or tour, including a lack of legal abortion in-country, limited financial resources, language barriers, travel restrictions, and a lack of confidentiality. U.S. military servicewomen stationed in countries where safe, legal abortion is restricted or unavailable face deployment-related barriers to abortion care, which compound those barriers they may face regardless of deployment status. Removal of federal bans on the provision and coverage of abortion care and improved education about existing regulations could improve access to timely abortion care and in some cases allow servicewomen who wish to obtain abortion care to remain deployed.

The supply chain of violence

Every year, more people are killed defending the environment than are soldiers from the United Kingdom and Australia on overseas deployments in war zones combined. During the last 15 years, the number of both deaths of environmental defenders, and the countries where they occur, have increased. Recorded deaths have increased from two per week to four per week over this period. These deaths are primarily related to conflict over natural resources, across a range of sectors. Of 683 total deaths, >230 were related to mining and agribusiness between 2014 and 2017. We find that rule of law and corruption indices are closely linked to patterns of killings. Using spatial data, we investigate the drivers of these conflicts and violence and seek to identify who may be most at risk and why. We argue that businesses, investors and national governments at both ends of the chain of violence need to be more accountable.

‘Sufficient Reinforcements Overseas’: British PostWar Troops' Recruiting Policy in Nigeria, 1945–53

This article critically examines Britain's postwar recruitment policy in Nigeria, 1945–53. It is a subject that has not been studied by scholars. As the Second World War drew to a close, the Nigerian colonial military had declared that it had sufficient illiterate, ‘pagan’ infantrymen of northern Nigerian ‘tribal,’ including Tiv, origin to meet any but unforeseen demands of troops for service in the South East Asia Command (SEAC). Yet, recruitment of the same category of infantrymen, as well as ex-servicemen, was resumed after the war. The critical/analytic historical method is deployed to interrogate Nigerian and British archival sources on the subject. The study shows that, unlike the case of the High Commission Territories Corps (HCTC), Nigeria's postwar recruitment was not meant for overseas deployment. It was primarily driven by Britain's objectives of restoring the army to its pre-war role of enforcing colonial law and order in furtherance of its resolve to maintain its colonial state in Nigeria despite postwar militant nationalism.

Longitudinal survey of condom use across a US Navy and Marine Corps shipboard deployment

ObjectivesCondoms are highly effective in preventing sexually transmitted infections (STIs) but implementation is often inconsistent with use rarely examined across travel transition periods. We examined the prevalence of condom use...

Pay Attention, Carter Jones by Gary D. Schmidt

Reviewed by: Pay Attention, Carter Jones by Gary D. Schmidt Elizabeth Bush Schmidt, Gary D. Pay Attention, Carter Jones. Clarion, 2019 [224p] Trade ed. ISBN 978-0-544-79085-8 $16.99 E-book ed. ISBN 978-1-328-52691-5 $9.99 Reviewed from galleys R Gr. 4-6 Carter’s father, Captain Jackson Jones, is on yet another overseas deployment, leaving his wife and four children to manage on their own with little communication from him. When Mr. Bowles-Fitzpatrick, butler extraordinaire, arrives at their doorstep, explaining that his previous employer, Captain Jones’ father, “has left a most generous endowment to support my continuing service to his family,” they accept without question. The butler quickly wrangles them into shape, cooking healthier meals, overseeing homework, taking the kids to cultural events, chauffeuring them to and from school in his very cool Bentley, which he even teaches sixth-grade narrator Carter to drive. Carter’s social capital rises even further when the butler organizes a cricket team, which is promptly coopted by eighth-graders, who graciously allow Carter and his buddy to join “by invitation only.” If American readers are by now inured to the baseball-as-metaphor-for-life trope, cricket and its labyrinthine rules, traditions, and jargon will come as an unexpected treat as well as an apt device for exploring the Jones family backstory, which involves a sibling’s death and Captain Jones’ domestic failures and abandonment. Readers will easily spot the Mary Poppins theme, as the wise, mysterious domestic helper arrives just in time to help both children and parents through trying times; the book is [End Page 221] also peppered with literary callouts to everyone from the Brontës to prominent contemporary YA authors. Beyond that, though, is a story with weight and heart, and Schmidt fans will be glad to see him back on the pitch. Copyright © 2019 The Board of Trustees of the University of Illinois

The Conditions and Possibilities of Overseas Deployment of “Community Development Education”: Through the Experiences of Coperative Researches for Comparative Analysis between the UK, South Korea and Japan

The Conditions and Possibilities of Overseas Deployment of “Community Development Education”: Through the Experiences of Coperative Researches for Comparative Analysis between the UK, South Korea and Japan

Sleep, resilience, and psychological distress in United States military Veterans

ABSTRACTSleep problems are prevalent among Veterans. Left untreated, such problems may elevate psychological distress and increase risk of subsequent mental health disorders. Psychological resilience may buffer against negative psychological outcomes, yet the relationship between sleep and resilience has not been studied. This study explored poor sleep, resilience, and psychological distress using questionnaires collected as part of the Study of Post-Deployment Mental Health. Participants (N = 1,118) had served in the US military since September 11, 2001, had one or more overseas deployments, and were free from a past-month DSM-defined mental health disorder. Hierarchical linear regression was used to examine the association between poor sleep quality (Pittsburgh Sleep Quality Index total score) and psychological distress (Global Symptom Index; Symptom Checklist-90-R), controlling for demographic and health characteristics. Moderation analyses tested for a potential buffering effect of resilience (Connor-Davidson Resilience Scale). Poor sleeping Veterans had worse physical and psychological health, lower resilience, and endorsed more lifetime traumatic events. Poor sleep was associated with greater psychological distress controlling for health and demographic characteristics. Both resilience factors—adaptability and self-efficacy—had significant buffering effects on the relationship between poor sleep and psychological distress, suggesting that resilience may protect against negative outcomes in poor sleepers. Additional research is warranted to better understand the relationships between sleep, resilience, and psychological distress. Such research may inform pertinent prevention efforts, including interventions that improve sleep, enhance resilience, and protect against incident mental health diagnoses.

Single-Item Measures for Detecting Sleep Problems in United States Military Veterans.

As many as two-thirds of post-9/11 military veterans complain of sleep problems, including insomnia-like symptoms. Left untreated, chronic sleep problems increase the risk for a range of negative outcomes, including incident mental health disorders. However, sleep problems remain overlooked in primary care settings. To date, no brief sleep screeners have been developed or validated. Items assessing insomnia and poor sleep are often embedded into commonly used psychological assessments, and may serve as a viable first step in screening. The objective of this study was to examine the utility of three single items (i.e., trouble falling asleep, awakening in the early morning, and sleep that is restless or disturbed) embedded into the Symptom Checklist-90-Revised (SCL) for identifying two outcomes of interest, poor sleep and probable insomnia. Data were drawn from the cross-sectional Post-Deployment Mental Health Study, hosted by the Mid-Atlantic VA Mental Illness Research, Education, and Clinical Center. Item performance was evaluated using sensitivity, specificity, and predictive value calculations, along with receiver operating characteristic (ROC) curves. Post-9/11U.S. military veterans with one or more overseas deployments and with no current DSM Axis I mental health disorder (N = 1118). An in-person health and sleep questionnaire, including the Pittsburgh Sleep Quality Index (PSQI) and the Symptom Checklist (SCL). Using an item response of 1, all three items demonstrated moderate sensitivity (0.70-0.78) and acceptable rates of false positives and false negatives (0.23-0.48 and 0.11-0.42, respectively) in predicting both outcomes, poor sleep and probable insomnia. Our initial findings suggest that existing items in the SCL may serve as a first step in screening for sleep problems. Early detection and treatment of sleep problems might prevent or ameliorate several negative outcomes, including incident mental health disorders.

Pakistan’s Foreign Policy Motivations in Sending Troops Abroad


 
 
 Ever since the establishment of the United Nations Organization (UNO), international community has resorted to peacekeeping operations to bring about peace in global conflict zones. The UN does not have a standing army and therefore it relies on troop contributions from member states for peacekeeping operations. Pakistan has been sending its troops abroad to participate in UN peacekeeping operations since 1960. The decisions to undertake such dangerous assignments are influenced inter alia by factors such as nation’s foreign policy, availability of troops, security concerns, public opinion and the sense of fulfilling international obligations. Arguably, foreign policy motivations in most cases dominate the Pakistani state’s decision to send its soldiers abroad. The underlying strategic decision making process remains the preserve of the official bureaucracy, both civilian and military. Decision making is easy for military governments; difficult in times of weak political governments and an assertive military; and long winded and chaotic when the matter is referred to the parliament. This paper promulgates Pakistan’s foreign policy motivations for providing troops for overseas deployments and reinforces the thesis that states like Pakistan lend their forces for international ventures, when they foresee clear cut strategic advantages.
 
 

Tungiasis: Outbreak investigation of a zoonosis during overseas deployment

BackgroundTungiasis is an ectoparasitosis caused by the sand flea Tunga penetrans. It is endemic in the under privileged communities of Latin America, the Caribbean and Sub Saharan Africa with geographic and seasonal variations even within endemic areas. We describe investigation of an outbreak of Tungiasis in troops deployed as part of UN peacekeeping force in Central Africa. MethodsTungiasis was diagnosed in an unusually large number of cases of severely pruritic boils over feet in soldiers of a UN peacekeeping battalion. An outbreak investigation was carried out and the outbreak was described in time, place and person distribution. A retrospective cohort study was done to ascertain the associated risk factors. ResultsA total of 36 cases were identified of which 33 had laboratory confirmation. Of the 36 cases, 10(27.77%) had only Fortaleza Stage II lesions, 22 (61.11%) a combination of Fortaleza Stage II and III lesions and four (11.11%) cases had a combination of Stage, II, III and IV lesions. Secondary bacterial infection was seen in 25 (69.44%) cases. Epidemiological analysis revealed that it was a common source single exposure outbreak traced to a temporary campsite along one of the patrolling routes. ConclusionIn a Military setting an integrated approach combining health education and environmental control is required to prevent such outbreaks.

Hardly Full Metal Jacket: What We Can Learn From a Military Learning Environment.

Hardly Full Metal Jacket: What We Can Learn From a Military Learning Environment.