Secretary Of Defense Research Articles

The Suicide Prevention and Response Independent Review Committee (SPRIRC): Translating Recommendations Into Actions.

A number of reports over the past 2 decades have provided recommendations for reducing the rate of suicide in the U.S. Armed Forces. Notwithstanding their veracity, few of these recommendations have been fully implemented. At the direction of the Secretary of Defense and the U.S. Congress, a Suicide Prevention and Response Independent Review Committee was formed in 2022, with the mission of reviewing all policies and procedures regarding suicide within the DoD. The Suicide Prevention and Response Independent Review Committee considered over 400 specific recommendations garnered from component offices, military installation visits, and service member focus groups, ultimately making 127 recommendations. The Secretary of Defense then directed the formation of an implementation working group, which assessed these 127 recommendations for feasibility, impact, and required resourcing. After being assessed by the implementation working group, DoD leadership approved 111 total actions to move forward for resource consideration in the formal budget process. These actions aligned to 5 lines of effort focused on reducing suicide behavior throughout the military. Resourcing decisions then determined that 83 of these recommendations would be funded beginning in fiscal year 2025. From an implementation science perspective, broader agency concerns throughout the DoD often are primary barriers to implementing system-wide changes. By making deliberate decisions about prioritizing the most impactful actions, resourcing processes can be informed directly by relevant data. Implementation of recommendations to reduce suicide deaths in the military must go through several deliberative steps in order to be prioritized, funded, and ultimately adopted by the military. As researchers and external stakeholders become more familiar with this process, recommendations for future prevention activities can better overcome barriers to implementation.

Unlocking What Makes Military Behavioral Health Interventions Work, Stumble, or Fade Away.

The Office of the Secretary of Defense and each of the services have made an unprecedented commitment to the prevention of sexual assault and related behavioral health phenomena. Indeed, the Department of Air Force has selected, in some cases tailored, and disseminated a wide array of evidence-based preventative programs, policies, and practices (EBPs) over the last few decades. However, many of these efforts seem to follow a predictable life course. EBPs are initially implemented with great enthusiasm, supported for a few years, then fall out of favor, and are replaced by a different effort. This research effort aims to build on the existing civilian implementation science research to (1) offer a military-specific model of sustained, high-quality implementation and (2) test this model in a series of interconnected studies. New York University's Institutional Review Board approved the study protocols, and the Army's Human Research Protection Office provided permission to collect data. We conducted interviews first with prevention leaders in the services and at the Office of the Secretary of Defense level regarding factors that they thought helped or hurt the sustainment of EBPs. We used these interviews to identify EBPs currently implemented in Department of Air Force and selected four EBPs out of the 25 identified for intensive study. We then interviewed implementers of those four EBPs regarding what they thought helped or hurt the sustainment of that EBP. We also gathered information about the 25 currently implemented EBPs themselves and gathered policy and guidance, as well as leadership communication about those EBPs and the target problems they focus on. We coded this information to allow us to test EBP parameters and policy and leader communication that predict sustained high-quality implementation. We conducted over 100 observations of the 4 EBPs we are studying intensively and have collected quantitative data from implementers and participants to help us test factors related to sustained high-quality implementation within each of those 4 EBPs and across the EBPs. Several military-specific factors were nominated for inclusion in the military-specific model of implementation sustainment. The implementation of even highly standardized EBPs varies greatly. Implementers and participants are generally highly engaged, but implementers vary in the extent to which they understand the mechanisms of action for the EBP they are implementing. We recommend training implementers in the mechanisms of action in the EBPs they are expected to implement and including quality assurance as a component of prevention efforts in a manner more similar to how the military addresses aspects of the operational mission. By moving beyond counting classes and attendance, and specifying how to engage participants in the EBPs in the manner that produces the key outcomes, it is likely that EBPs will have more robust implementations that can be better sustained over time.

An Accurate and Rapidly Calibrating Speech Neuroprosthesis

BackgroundBrain–computer interfaces can enable communication for people with paralysis by transforming cortical activity associated with attempted speech into text on a computer screen. Communication with brain–computer interfaces has been restricted by extensive training requirements and limited accuracy.MethodsA 45-year-old man with amyotrophic lateral sclerosis (ALS) with tetraparesis and severe dysarthria underwent surgical implantation of four microelectrode arrays into his left ventral precentral gyrus 5 years after the onset of the illness; these arrays recorded neural activity from 256 intracortical electrodes. We report the results of decoding his cortical neural activity as he attempted to speak in both prompted and unstructured conversational contexts. Decoded words were displayed on a screen and then vocalized with the use of text-to-speech software designed to sound like his pre-ALS voice.ResultsOn the first day of use (25 days after surgery), the neuroprosthesis achieved 99.6% accuracy with a 50-word vocabulary. Calibration of the neuroprosthesis required 30 minutes of cortical recordings while the participant attempted to speak, followed by subsequent processing. On the second day, after 1.4 additional hours of system training, the neuroprosthesis achieved 90.2% accuracy using a 125,000-word vocabulary. With further training data, the neuroprosthesis sustained 97.5% accuracy over a period of 8.4 months after surgical implantation, and the participant used it to communicate in self-paced conversations at a rate of approximately 32 words per minute for more than 248 cumulative hours.ConclusionsIn a person with ALS and severe dysarthria, an intracortical speech neuroprosthesis reached a level of performance suitable to restore conversational communication after brief training. (Funded by the Office of the Assistant Secretary of Defense for Health Affairs and others; BrainGate2 ClinicalTrials.gov number, NCT00912041.)

Darth Vader's Secret Weapon: Implementing Mission Engineering with UAF

AbstractWhen planning and conducting a Mission Engineering (ME) study, it is important to have a complete, correct, and coherent model of the mission architecture. The Unified Architecture Framework (UAF) has been found to be effective for this purpose. The OUSD (R&E) Mission Integration office is exploring how to use UAF for their ME architectures. This paper will explore some of the required modeling features and constructs that will enable this to occur. The paper “Implementing Mission Engineering with UAF” was presented at a previous conference and this paper will expand on that presentation and will discuss additional work that has been accomplished since then. This paper will also explore the proposed extensions for UAF to better support ME. We created a prototype model using the Battle of Hoth from Star Wars as a proof of concept for these modeling extensions and used the process and ME concepts defined in the Mission Engineering Guide (MEG). Since then there have been several concepts that were explored such as compatibility with the Model‐Based Acquisition (MBAcq) approach, recent initiatives from the Office of the Assistant Secretary of Defense for Mission Capabilities, Enterprise Systems Engineering (ESE) process and methods, detailed resource engagement, use of different modeling languages (e.g., Systems Modeling Language (SysML), SysML v2 and UAF v2), Effects and Outcomes, variety of measures, additional attributes/stereotypes such as differentiation between enemy/friendly/neutral ‐ Blue Force, Red Force, etc., provenance/confidence of enemy resources, and so forth. This paper will summarize the research and modeling done to date and explore these additional concepts as well as new ideas introduced in the MEG v2.

Power implicit in language: A case of the Sri Lankan Government’s securitization of the COVID-19 pandemic

This is an attempt to uncover the ways in which the Government of Sri Lanka (GoSL) securitized its response to the COVID-19 pandemic in 2020, and how that process of securitization functioned in furthering its overall approach to its legitimacy and governance. Regarding this, the article focuses on the language which characterizes the discourse and the references made to the Sri Lankan armed conflict. Using Critical Discourse Analysis (CDA), written and audio-visual texts from government media outlets, private media outlets, and English news articles are assessed in this article as primary data. The discourse on the studied corpus reveals how the State securitized its response to COVID-19 as one befitting a military threat rather than a public health risk. In militarizing the securitizing process, the police and triforces were deployed as first respondents. References made to their experience in defeating the Liberation Tigers of Tamil Eelam (LTTE), as well as to former President Gotabaya Rajapaksa’s role as Defence Secretary in the armed conflict against the LTTE, were used in legitimizing the process of securitization. References made to the “sacrifices” made by the State, and the military, by extension, were used in instilling a sense of responsibility among the public to show their support for the government in its attempt to grapple with the pandemic. The public were also asked to act in unison which included an implied demand for discarding their diverse identities. This article further reveals a novel form of religious securitization emerging from the studied corpus in relation to GoSL’s response to the COVID-19 pandemic.

Pentingnya Badan Intelijen Pertahanan dalam Non-Combat Military Mission: Instrumen Perhatian Khusus untuk Peningkatan Kapasitas dan Kapabilitas Pertahanan

This research will focus on the importance of Defense Intelligence Agencies in Non-Combat Military Missions. This research method will use a qualitative approach with case studies to explore the importance of the Defense Intelligence Agency in Non-Combat Military Missions. The data will be collected through in-depth interviews with defense experts, intelligence analysts, and military personnel involved in non-combat missions, as well as through analysis of related documents and official reports. As a result, Military Intelligence has a vital role to play in defense policymaking by providing information to anticipate and confront potential threats, enabling comprehensive threat assessment, and supporting defense diplomacy with accurate intelligence. The establishment of the Defense Intelligence Agency under the Secretary of Defense was proposed because it could coordinate intelligence with military operations, speed up decision-making, and support non-combat missions with strategic intelligence. The agency also strengthens Indonesia's defense diplomacy by providing information for strategic planning and supporting collaboration with the local defense industry, which contributes to enhanced national defense capabilities and economic growth. To be effective, the intelligence function of the Defense Intelligence Agency must synergize with the existing intelligence community, to support Indonesia's mission to become an Asian Tiger.

Sending the B team: The impact of lesser signals of resolve

When signaling resolve, is it necessary to go ‘all-in’ and send the strongest possible signal or can sending a lesser signal be effective? Prior research suggests that sending a lesser signal is an admission of irresolution, akin to sending no signal. We make the novel claim that lesser signals of resolve can actually be worse for credibility than sending no signal, particularly in general deterrence situations. We theorize that while the absence of a signal may go unnoticed, a lesser signal puts a spotlight on irresolution. Building on prior findings that high-level visits can function as signals of extended deterrence commitment, we test our theory using new data on visits abroad by the US president, vice president, secretary of state, and secretary of defense. We find that only presidential visits are effective at deterring military challenges against the country visited. Visits by lesser officials, whom we dub the ‘B Team’, actually increase the risk of deterrence failure.

Enhancing Sarcolemmal Membrane Repair Using a Novel Protein Therapeutic Approach can Improve Membrane Integrity in Duchenne Muscular Dystrophy Cells and Mouse Models

Duchenne Muscular Dystrophy (DMD) is a fatal neuromuscular disease involving progressive cardiac and skeletal myocyte cell death and subsequent muscle degeneration. DMD and Becker muscular dystrophy (BMD) result from mutations in the dystrophin gene that compromise the structural integrity of the sarcolemma. While there has been important recent progress in the treatment of DMD, the currently available therapeutics have significant limitations. Thus, novel therapies that address the compromised sarcolemmal membrane integrity are an unmet medical need. Tripartite motif protein 72, or mitsugumin 53 (TRIM72/MG53), facilitates the sarcolemma repair response after disruption of the membrane. Loss of TRIM72/MG53 function in mice leads to a progressive myopathy. Exogenous delivery of recombinant human MG53 protein (rhMG53) can increase sarcolemmal membrane repair in many different cell types and ameliorate pathology in models of DMD and multiple limb girdle muscular dystrophies. Despite the promise of rhMG53 as a therapeutic invention the development of this protein to treat DMD has been complicated by findings showing that high levels of the protein correlate with metabolic dysfunction in animal models and some human patients. Deletion analysis of the major domains of the rhMG53 protein allowed us to design an improved version of rhMG53 called MyoTRIM. MyoTRIM contains amino acid replacements to eliminate metabolic effects and improve solubility while maintaining membrane repair effects. One set of modifications inactivate the E3 ligase activity of the protein, which revealed this function is dispensable for subcellular localization of the protein. TRIM72/MG53 is reported to mediate this effect by binding phosphatidylserine (PS) at membrane injury sites, so we demonstrate that MyoTRIM can bind PS-coated beads to illustrate that carboxy-terminal domains are required for effcient PS binding rather than the E3 ligase function. External application of MyoTRIM can increase membrane repair capacity in a variety of cell-based assays using DMD and BMD patient myoblasts and myotubes. We also establish that MyoTRIM can increase membrane repair and prevent eccentric contraction induced injury in a dystrophin deficient mouse model. Taken together, these results provide mechanistic insight into rhMG53 function and indicate that MyoTRIM can recapitulate the therapeutic effects on sarcolemmal membrane repair while eliminating E3 ligase activity and associated side effects. This work was supported by the Offce of the Assistant Secretary of Defense for Health Affairs through the Duchenne Muscular Dystrophy Research Program (DMDRP) under Translational Research Award HT9425-23-1-0940. The opinions, interpretations, conclusions, and recommendations are those of the author and are not necessarily endorsed by the Department of Defense. This is the full abstract presented at the American Physiology Summit 2024 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Court rules against former college intern

Case name: Griffin v. Secretary of Defense, No. 23‐3220 (6th Cir. 12/05/23).

Defining the "Cyber-Pearl Harbor" - Validation of the DSLP-framework in "Offensive Cyberspace Operations Targeting Ukraine: A Cyber Pearl-Harbor"

The use of cyberattacks against organizations, health care and individuals have increased along with the constant digitalisation. Nations have also fallen victim to cyberattacks, often combined with other means of war. A Cyber-Pearl Harbor (further shortened as CPH) is a term mentioned by the former United States Secretary of Defense, Mr. Leon Panetta, who described it as “combined attacks that result in human death and physical destruction and that paralyzes an entire nation”. Gazmend Huskaj used Panetta's definition in order to create a framework (herein the “DSLP-framework”) for classifying an event as a CPH. This study strives to see if the DSLP-framework can be validated since the term has been widely used for the last 25 years. However, a universal definition of the term seems to be missing, therefore it is not certain that the criteria presented in the framework is accurate. A qualitative case study was conducted through a literature review regarding the term CPH and semi structured interviews with three experts were done, which were later analysed through a thematic analysis. The framework was applied to three real life cases: a public health sector in Costa Rica, a TV-tower in Kyiv, Ukraine and the grocery company Coop in Sweden. The result from applying the DSLP-framework to each case was that only the case of TV-tower in Kiev, Ukraine, could be classified as a CPH. The following conclusions were drawn in this study: 1) The framework could not be validated due to lack of data, and 2) The interviewees views differed from the framework making it hard to find common ground.

Court rules against former college intern

Case name: Griffin v. Secretary of Defense, No. 23‐3220 (6th Cir. 12/05/23).

Fiscal Year 2018 National Defense Authorization Act, Section734, Weapon Systems Line ofInquiry: Overview andBlast Overpressure Tool-A Module forHuman Body Blast Wave Exposure forSafer Weapons Training.

Experiences by service members in recent conflicts and training environments illuminate concerns about the possible effects of blast overpressure (BOP) exposure on brain health. Section734 of the National Defense Authorization Act for Fiscal Year (FY) 2018 (Public Law 115-91) requires that the Secretary of Defense conducts a longitudinal medical study on blast pressure exposure of members of the Armed Forces during combat and training, and the Assistant Secretary of Defense for Health Affairs was assigned responsibility for fulfilling requirements. The study's goal is to improve DoD's understanding of the impact of BOP exposure from weapon systems on service members' brain health and inform policy for risk mitigation, unit readiness, and health care decisions. This article focuses on the activities of the Weapon Systems Line of Inquiry (LOI) and the development of a prototype BOP Tool. The DoD established the Section734 Workgroup, which developed a program structure with five LOIs. The Weapon Systems LOI coordinated, collated, and analyzed information on BOP resulting from heavy weapons and blast events to inform strategies, and accounted for emerging research on health effects and performance. Ongoing research was leveraged to develop a BOP Tool as a standalone module and for integration into the Range Managers Toolkit. The effort identified opportunities for the DoD to improve the clarity of communications about BOP exposure, risk, and safety; establish methods to leverage emerging research; and develop a prototype BOP Tool to predict exposure loads when firing heavy weapons in training. It is recommended that the DoD revises requirements and policy to improve and standardize safety guidance throughout research, development, testing, and evaluation; acquisition; and training. The validated BOP Tool allows users to generate a scenario to predict BOP exposure and allows service members to modify them during planning for safer training.

FRANCES HESSELBEIN: A DEEP SOURCE OF WISDOM, INSPIRATION, AND ENCOURAGEMENT

AbstractThe author, the 28th U.S. Secretary of Defense, writes about his long history with “my trusted mentor Frances Hesselbein.” As he notes, “Every one of Frances’s 107 years was a gift. And as I continue to mourn her passing, I also continue to draw inspiration from her life and her service. Of course, to Frances, there was never a distinction between the two. As she would say, To serve is to live.” He recalls that he “first met Frances in 2003 when, as the Commanding General of the 10th Mountain Division, I attended a leadership seminar for senior leaders at West Point.” In a roomful of generals, “Frances articulated something profound and true. Character is what counts. And before you can talk to anyone about values like bravery, integrity, and respect for all, you have to live those values. I’ve seen this lesson play out many times over my career. When you live and lead with character, your teammates will follow your example.”

Tropical cyclones’ acoustic reconnaissance

Acoustic reconnaissance of tropical cyclones with underwater gliders is an emerging approach for a comprehensive understanding of the oceanic conditions leading to the formation and intensification of cyclones and for aiding in wind speed forecasting. Shaw et al. (1978) showed that the underwater sound pressure level is in the linear relationship to the logarithm of the moderate local wind speed. Wilson and Makris (2006) proposed an acoustic surface source model for hurricane wind speeds. The model requires a parameterization of the winds’ contribution. The inversion of the acoustic data leads to estimation of the local wind speeds. The Gulf of Mexico acoustic dataset, collected by the bottom-anchored monitoring system during the passage of storm Barry (2019), is analyzed and correlated with the high-resolution wind speed data generated by the Weather Research and Forecast model. The efficacy of gliders outfitted with acoustic system to provide the real-time reporting of the local wind speeds is also discussed based on the flights’ recorded soundscapes. Acoustic glider reconnaissance offers a safe and cost-efficient way of contributing new type data to NOAA and US NAVY weather forecasting models. [Work supported by the Office of the Under Secretary of Defense for Research and Engineering, award# FA9550-21-1-0215.]

Classical Realism and the Rise of Sino-American Antagonism: A Review Essay

Abstract Has the United States been trying to contain China? If so, why now? Still, proponents of Chinese containment have been critical of the United States' continued fixation with Russia - a declining state - arguing that this diversion undermines a focused Chinacentric strategy. This is not the first time that U.S. strategic attention has been diverted from China. Back in 2001, U.S. Secretary of Defense, Donald Rumsfeld, embarked on an ambitious endeavor to revise U.S. grand strategy and focus on China which was perceived as the sole state capable of becoming a peer rival to the United States. However, following the tragic events of 11 September 2001, the Bush administration redirected its focus away from great power antagonism with China towards the Global War on Terror. Could any political scientist, speculating upon the direction of American grand strategy in the summer of 2001, by any accounts have foreseen that the United States would waste significant strategic capital in pursuing terrorists in Afghanistan and promoting democracy in the Middle East over the next decade? Nowadays, could any political theorist in December 2021 have foreseen that the United States would drive Russia into the open arms of China and create Mackinder's Eurasian nightmare? Classical realism may have the best answers. Jonathan Kirshner's latest treatise explains why past is more than prologue and how classical realism is superior to other “realisms” in providing the most authoritative insights about the complex strategic behavior of states.

Known Unknowns: The Inevitability of Cyber Attacks

As described by Former U.S. Secretary of Defense, Donald Rumsfeld in his 2011 book, Known and Unknown, “there are many things of which we are completely unaware—in fact, there are things of which we are so unaware, we don’t even know we are unaware of them. Throughout history the world has faced numerous catastrophic events that were not foreseen but in hindsight were discoverable including the devastating effects of Pearl Harbor, and the September 11 terrorist attacks. More recently, the potential for catastrophic loss has been magnified in the 2020 Solar Winds and 2021 Colonial Pipeline cyber-attacks. We may not know when or how these events will occur or how much damage or destruction will occur, but we do know that these events are possible. The literature differentiates between events that occur totally by surprise, and outcomes or events that actors have identified as possibly existing but do not know whether they will take place or not. The aim of this paper is to provide insight, based on an empirical review of selected attacks both within and outside the cyber space literature to uncover the underlying risk, uncertainty, and complexity that may have been known but not seriously considered by those who had the knowledge and capability to investigate the warning signs. Based on the case study analysis, this paper will present the reasons for inaction and how we can learn from these experiences. The following two theories – institutionalization and rationalization have been found to provide some reasons for the occurrence of behaviors which increase the possibility of unobserved risks. In this paper we explore these theories through case study analysis and propose a framework consisting of four concepts for increasing awareness of these situations.

The Illusion of Neutralism: The Indigenous Third Force and the Filipino Republic from the Late 1940s to the 1950s

Abstract It often has been an illusion that Filipinos lack indigeneity due to the ties with the United States since 1898. Lost in these mists were the indigenous agendas that lay underneath the official narratives. The article presents a background and then examines the administration of Elpidio Quirino, president of the Philippines from 1948 to 1953, particularly his neutralist Pacific Pact initiative and the failed use of military force against the Huks. It concludes with a discussion of the rise of Ramón Magsaysay. It then examines Magsaysay, Philippine president from 1953 to 1957, beginning as defense secretary, support from the United States, the Magsaysay myth, his counterinsurgency campaign against the Huks, his election as president, international leadership, and legacies after his death. The study will show how the top-down policies of Quirino reliant on military force gave way to the unifying, reformist, inclusive, and inspirational leadership of Magsaysay, which became a kind of third force apart from the oligarchy and the Communists.

0630 For Whom the Bell Tolls: Empirical Clustering of Insomnia and Suicidal Ideation

Abstract Introduction Insomnia is associated with risk for suicidal thoughts and behaviors. It is unclear if insomnia drives risk equivalently across all individuals, or whether there are subgroups of high-risk individuals for whom insomnia is more relevant. This exploratory archival analysis examined the relationship between insomnia and current suicidal ideation among subgroups of individuals with lifetime suicidal ideation. Methods Data were acquired from the Military Suicide Research Consortium on 2,617 individuals without missingness on measures of suicidal thoughts and behaviors, anxiety, insomnia, thwarted belongingness, traumatic brain injury, risky alcohol use, and symptoms of post-traumatic stress. Medoid (k-means) clustering algorithms identified subgroups. Robust Poisson models tested interactions between insomnia and cluster identity in association with current suicidal ideation. Models were unadjusted, adjusted for demographic factors, and adjusted for clinical characteristics. Results Clustering identified two subgroups: Cluster 1 (N=1,141) and Cluster 2 (N=1,494). Cluster 1 had fewer individuals with current suicidal ideation (29.2% vs. 66.6%) and in general had less severe symptoms of anxiety, PTSD, insomnia, traumatic brain injury, and suicidal thoughts and behaviors. Across clusters, insomnia severity was associated with risk for current suicidal ideation (PRR: 1.09 [1.03-1.14]). Although individuals in Cluster 1 were less likely to have current suicidal ideation (PRR 0.51 [0.44-0.58]), greater severity of insomnia was associated with greater risk (PRR: 1.11 [1.04-1.18]). By contrast, individuals in Cluster 2 had a greater risk of current suicidal ideation (PRR: 1.68 [1.51-1.88]) and greater severity of insomnia was associated with a diminished risk of current ideation (PRR 0.92 [0.88-0.97]). Conclusion In this exploratory study, individuals with less severe psychopathology were more likely to report current suicidal ideation with worsening insomnia, while those with severe psychopathology were less likely to report suicidal ideation with worsening insomnia. Insomnia may disproportionately increase suicide risk among lower risk individuals. Support (if any) This work was in part supported by the Military Suicide Research Consortium (MSRC), an effort supported by the Office of the Assistant Secretary of Defense for Health Affairs under Award No. (W81XWH-16-2-0003). Opinions, interpretations, conclusions, and recommendations are those of the author and are not endorsed by the MSRC or the Department of Defense.

0666 Need a novel method to reduce anger after combat? Treat sleep apnea

Abstract Introduction Dysregulated anger can result in devastating health and interpersonal consequences for individuals, families, and communities. Compared to civilians, combat veterans and service members (C-V/SM) report higher levels of anger and often have risk factors for anger including posttraumatic stress disorder (PTSD), traumatic brain injury (TBI), pain, alcohol use, and impaired sleep. Methods The current study examined the relative contributions of established variables associated with anger (e.g., combat exposure, current PTSD symptoms, history of TBI, pain interference, and hazardous alcohol use) in 1,263 C-V/SM. Sleep impairments, represented by poor sleep quality and obstructive sleep apnea (OSA) risk, were also evaluated as potential mediators of the relationships between established risk factors and anger, and therefore potential modifiable treatment targets. Results Multiple regression model results revealed that PTSD symptoms (β = 0.517, p < .001), OSA risk (β = 0.057, p = .016), pain interference (β = 0.214, p < .001), and hazardous alcohol use (β = 0.054, p = .009) were significantly associated with anger. Results of the mediation models revealed that OSA risk accounted for associations between PTSD and pain interference with anger. Conclusion Treating OSA may be a novel way to reduce anger in C-V/SM who have PTSD and/or pain interference. The current study extends previous literature by simultaneously examining factors associated with anger using a multivariable model in a large sample of C-V/SM. Support (if any) This work was supported by the Assistant Secretary of Defense for Health Affairs endorsed by the Department of Defense, through the Psychological Health/Traumatic Brain Injury Research Program Long-Term Impact of Military-Relevant Brain Injury Consortium (LIMBIC) Award/W81XWH-18-PH/TBIRP-LIMBIC and with resources and the use of facilities at the James A. Haley Veterans’ Hospital. The views expressed in this abstract are those of the authors and do not necessarily represent the official policy or position of the Defense Health Agency, Department of Defense, or any other U.S. government agency. For more information, please contact dha.TBICOEinfo@mail.mil. UNCLASSIFIED

Increasing Maternity Leave and Decreasing Attrition Rates of U.S. Active Duty Women in the Prenatal and Immediate Postpartum Period.

The USA currently does not have a national parental leave policy. In 2016, the Secretary of Defense increased the allotted maternity leave for active duty U.S. military members from 6 to 12 weeks. The purpose of this study was to understand the potential impact of this change on attrition rates of active duty women in the Army, Air Force, Navy, and Marines from their initial prenatal visit through the first year postpartum. All active duty women who had a confirmed pregnancy in the electronic health record from 2011 to 2019 were included for consideration in the study. A total of 67,281 women met the inclusion criteria. These women were followed from their initial documented prenatal visit for 21 months (9 months gestation and 12 months postpartum) for removal from the Defense Eligibility and Enrollment Reporting System signaling attrition from service presumably related to pregnancy or childbirth. Logistic regression models were used to assess the association between maternity leave policy and attrition adjusting for covariates. Overall, women who were allotted 6 weeks of maternity leave were associated with higher attrition relative to women provided 12 weeks of maternity leave (odds ratio = 1.36; 95% CI, 1.31-1.42; P < .0001), representing a 22% decrease in attrition rates of women given 12 weeks vs. 6 weeks of leave. This impact of attrition rate was the greatest among members who were of lower rank (6 weeks vs. 12 weeks of leave: junior enlisted (E1-E3), 29.2% vs. 22.0%, P < .0001 and non-commissioned officer (E4-E6), 24.3% vs. 19.4%, P < .0001) and who served in the Army (28.0% vs. 21.2%, P < .0001) and Navy (20.0% and 14.9%, P < .0001). Family-friendly health policy appears to have the intended outcome of retaining talent in the military workforce. The impact of health policy on this population can provide a glimpse into the influence of similar policies should they be implemented nationwide.