Navy Service Research Articles

Posttraumatic Stress Disorder and Weight Loss in Male and Female Active-duty Service Members: A Weight Management Study.

Overweight and obesity are critical public health concerns with relevance to U.S. military personnel, as active duty service members must meet physical fitness and body composition standards. Biological sex and posttraumatic stress disorder (PTSD) diagnosis may affect service members' weight management efforts, but it is unclear what contribution each of these factors independently or in combination have on weight loss. Addressing this gap in knowledge, the current study used multilevel models to examine the effects of sex and self-reported PTSD diagnosis on change in weight of active duty Navy service members (n = 178, 61% female, 24% PTSD) over the course of and after a behavioral weight management intervention. On average, participants' weights decreased significantly during the intervention (P < .001), and there was a significant sex-by-PTSD interaction effect such that male participants without a self-reported PTSD diagnosis and female participants with a self-reported PTSD diagnosis lost significantly more weight during the intervention than their counterparts (P = .015). The main effects of sex and self-reported PTSD diagnosis on weight change during the intervention were nonsignificant (P's ≥ .24). While weight remained stable on average during the follow-up period (P = .28), female sex marginally predicted weight loss during the follow-up period (P = .07), whereas self-reported PTSD diagnosis and the sex-by-PTSD interaction were not significant (P's ≥ .16). These results highlight the importance of considering both sex and PTSD diagnosis as factors that together may influence the efficacy of behavioral weight management programs for active duty service members. NCT01757847.

Osteoarthritis Across Joint Sites in the Million Veteran Program Cohort: Insights From Electronic Health Records and Military Service History.

To characterize the relationship between the frequency of idiopathic osteoarthritis (OA) and characteristics including demographics, comorbidities, military service history, and physical health in a veteran population. We performed a cohort study in the Million Veteran Program (MVP) using International Classification of Diseases, 9th and 10th revision codes to define the frequency of site-specific OA across 3 joints or unspecified OA in veterans with respect to demographics (eg, age, sex, race and ethnicity), military service data, detailed electronic health records, military branch, and war era. We validated previous reports of sex- and age-dependent differences in OA frequency, and we identified that unspecified OA was associated with a higher frequency of 16 Deyo-Charlson comorbidities. These associations generally persisted within each isolated joint site-specific OA. Depending on military branch, prior military engagement was differentially associated with the frequency of OA. Prior United States Army and Navy service were associated with higher and lower risk, respectively, of OA across all joint sites; however, multivariable-adjusted models adjusting for a range of covariates, including age, sex, and ancestry, reversed the apparent protective effect of prior Navy service. These findings highlight the breadth of factors associated with OA in the MVP veteran population and suggest that physical status may be a modifiable risk factor for OA. This work may help in the design of strategies to optimize appropriate detection, intervention, treatment, and even rehabilitation for OA in veterans and the general population.

Sexual Assault Research in the Military: Is Oversampling Necessary for Representativeness?

Sexual assault in the U.S. Military is a serious concern. Recruiting representative samples of service members to participate in sexual assault research is essential for understanding the scope of the problem and generating data that can inform prevention and intervention efforts. Accordingly, the current study aims to examine response and completion rates of an anonymous survey of sexual assault and alcohol use among active duty sailors aged 18 to 24 with the overarching goal of achieving a representative sample and informing future recruitment efforts. This study was approved by the Institutional Review Board at the Naval Health Research Center. The study involved an anonymous survey of sexual assault and alcohol use among 612 active duty sailors aged 18 to 24. Since 79.6% of Navy service members are men and 20.4% are women, women were oversampled to achieve sufficient representation. Survey invitations were emailed to 12,031 active duty sailors: 64.3% (n = 7,738) men and 35.7% (n = 4,293) women. Response rates were disproportionate, with 3.0% (n = 234) of male and 8.8% (n = 377) of female sailors responding to the study invitation. Survey completion rates, however, were similar between male and female sailors (81.2% and 80.1% for male and female personnel, respectively). Results demonstrated that female sailors were significantly more likely than male sailors to participate in a study of sexual assault and alcohol use. However, once enrolled in the study, male and female sailors completed the 234-item questionnaire at a similar rate. Study findings highlight the challenges of engaging male service members in sexual assault-related research. Despite the disproportionately high representation of men in the military, sexual assault researchers may need to sample according to the overall distribution of gender in the military or perhaps even oversample men to achieve a representative sample.

Mental Health Treatment Rates During Pregnancy and Post Partum in US Military Service Members

Although new parents' mental health is known to decline, less is known about changes in therapy attendance, especially among military service members. To investigate changes in therapy attendance among new parents and by parental leave length. This cohort study of US Army and Navy service members from January 1, 2013, to December 31, 2019, compared parents' monthly therapy attendance with matched nonparents' across childbirth and compared mothers' weekly therapy attendance before vs after returning to work. Eligible monthly sample members included service members with first births from January 1, 2014, to December 31, 2017, and 12 months of data before to 24 months after birth and nonparents with 36 months of data. Eligible weekly sample members included mothers with first births from January 1, 2013, to June 30, 2019, and data from 12 months before to 6 months after birth and nonparents with 18 months of data. Data analysis was performed from July 1, 2023, to January 15, 2024. Those exposed to parenthood had no prior children, acquired a dependent younger than 1 year, and, for mothers, had an inpatient birth. Unexposed matches did not add a dependent younger than 1 year. Monthly counts of mental health therapy sessions and any therapy sessions (weekly). The monthly sample included 15 554 193 person-month observations, representing 321 200 parents and matches, including 10 193 mothers (3.2%; mean [SD] age, 25.0 [4.9] years), 50 865 nonmother matches (15.8%; mean [SD] age, 25.0 [5.0] years), 43 365 fathers (13.5%; mean [SD] age, 26.4 [4.8] years), and 216 777 nonfather matches (67.5%; mean [SD] age, 26.4 [4.8] years). The weekly sample included 17 464 mothers. Mothers went to 0.0712 fewer sessions at 1 month post partum (95% CI, -0.0846 to -0.0579) compared with 10 months before birth. Fathers went to 0.0154 fewer sessions in the month of birth (95% CI, -0.0194 to -0.0114) compared with 10 months before. Parents with preexisting treatment needs had larger decreases in treatment. Weekly therapy attendance increased by 0.555 percentage points (95% CI, 0.257-0.852) when mothers returned to work from 6 weeks of leave and 0.953 percentage points (95% CI, 0.610-1.297) after 12 weeks of leave. In this cohort study of new parents, therapy attendance decreased around childbirth, especially among parents with prior mental health needs and mothers with longer maternity leaves. These findings suggest that more accessible treatment, including home visits or telehealth appointments, is needed.

External Validation and Updating of a Statistical Civilian-Based Suicide Risk Model in US Naval Primary Care

Suicide remains an ongoing concern in the US military. Statistical models have not been broadly disseminated for US Navy service members. To externally validate and update a statistical suicide risk model initially developed in a civilian setting with an emphasis on primary care. This retrospective cohort study used data collected from 2007 through 2017 among active-duty US Navy service members. The external civilian model was applied to every visit at Naval Medical Center Portsmouth (NMCP), its NMCP Naval Branch Health Clinics (NBHCs), and TRICARE Prime Clinics (TPCs) that fall within the NMCP area. The model was retrained and recalibrated using visits to NBHCs and TPCs and updated using Department of Defense (DoD)-specific billing codes and demographic characteristics, including expanded race and ethnicity categories. Domain and temporal analyses were performed with bootstrap validation. Data analysis was performed from September 2020 to December 2022. Visit to US NMCP. Recorded suicidal behavior on the day of or within 30 days of a visit. Performance was assessed using area under the receiver operating curve (AUROC), area under the precision recall curve (AUPRC), Brier score, and Spiegelhalter z-test statistic. Of the 260 583 service members, 6529 (2.5%) had a recorded suicidal behavior, 206 412 (79.2%) were male; 104 835 (40.2%) were aged 20 to 24 years; and 9458 (3.6%) were Asian, 56 715 (21.8%) were Black or African American, and 158 277 (60.7%) were White. Applying the civilian-trained model resulted in an AUROC of 0.77 (95% CI, 0.74-0.79) and an AUPRC of 0.004 (95% CI, 0.003-0.005) at NBHCs with poor calibration (Spiegelhalter P < .001). Retraining the algorithm improved AUROC to 0.92 (95% CI, 0.91-0.93) and AUPRC to 0.66 (95% CI, 0.63-0.68). Number needed to screen in the top risk tiers was 366 for the external model and 200 for the retrained model; the lower number indicates better performance. Domain validation showed AUROC of 0.90 (95% CI, 0.90-0.91) and AUPRC of 0.01 (95% CI, 0.01-0.01), and temporal validation showed AUROC of 0.75 (95% CI, 0.72-0.78) and AUPRC of 0.003 (95% CI, 0.003-0.005). In this cohort study of active-duty Navy service members, a civilian suicide attempt risk model was externally validated. Retraining and updating with DoD-specific variables improved performance. Domain and temporal validation results were similar to external validation, suggesting that implementing an external model in US Navy primary care clinics may bypass the need for costly internal development and expedite the automation of suicide prevention in these clinics.

The Association of Skin Cancer Prevention Knowledge, Sun-Protective Attitudes, and Sun-Protective Behaviors in a Navy Population.

U.S. Navy service members are primarily between the ages of 18 and 30 years and often required to be outside for extended periods of time in geographical locations with increased and often unfamiliar ultraviolet indexes that collectively increase their risk for skin cancer. Skin cancer is the country's most common form of cancer, yet there is a paucity of skin cancer prevention literature, especially within the U.S. Navy. The purpose of this study was to describe skin cancer risk and skin cancer prevention "cues-to-action" and to determine if skin cancer prevention knowledge was associated with sun-protective attitudes (e.g., prevention perceptions, benefits, threats, barriers, and sun-protective behavior self-efficacy) and sun-protective behaviors (e.g., wearing long sleeve shirts and using sunscreen and not deliberately exposing skin for a tan) in a Navy population. A cross-sectional, descriptive, correlational design was utilized, and the study approval was obtained by the Naval Medical Center Portsmouth Institutional Review Board. Two-hundred twenty-nine active duty Navy service members aged 18-30 years who presented to primary care for their periodic health assessment completed the Brief Skin Cancer Risk Assessment and the Skin Cancer Survey. Descriptive statistics were utilized to assess service members' perceptions and knowledge regarding skin cancer prevention along with sociodemographic characteristics. The Spearman rank-order correlation and the Mann-Whitney U test were used to assess associations. P-values <.05 were used to determine statistical significance. Skin cancer prevention knowledge was significantly related to sun-protective behavior self-efficacy (r = 0.218, P = .001), benefits (r = 0.271, P ≤ .001), sun protection behaviors (r = 0.152, P = .024), skin cancer risk (r = 0.256, P = .001), current frequency of high-risk sun behavior (r = 0.183, P = .006), past frequency of high-risk sun behavior (r = 0.219, P = .001), sun exposure (U = 4,813.50, P = .005), tanning bed use (U = 3,154.50, P = .031), and training (U = 4,099.50, P = .005). Integrating skin cancer education into primary care visits (i.e., periodic health assessments) may improve Navy service members' modifiable sun-protective attitudes and behaviors and may contribute to lowering future skin cancer rates.

Mapping of SARS-CoV-2 IgM and IgG in gingival crevicular fluid: Antibody dynamics and linkage to severity of COVID-19 in hospital inpatients

Mapping of SARS-CoV-2 IgM and IgG in gingival crevicular fluid: Antibody dynamics and linkage to severity of COVID-19 in hospital inpatients

Low-dose ionizing radiation and cancer mortality among enlisted men stationed on nuclear-powered submarines in the United States Navy

Background Men stationed on nuclear-powered submarines are occupationally exposed to external ionizing radiation at very low levels and radiation dose for each individual is closely monitored. Little is known about ionizing radiation (IR) risks of cancer mortality for populations with levels of cumulative ionizing radiation exposure this low. Materials and methods This historical cohort study followed 85,033 enlisted men who had served on a nuclear-powered submarine in the U.S. Navy between 1969 and 1982 to determine patterns of cancer mortality. Occupational radiation doses were measured by badge dosimeters for each individual for all periods of Navy service potentially involving radiation exposure. Deaths were ascertained through 1995 by searches of multiple national mortality databases. Within-cohort dose-response relationships for cancer mortality were estimated using linear Poisson regression models. Individual-level smoking status was not available so cancer risks were estimated separately for cancers with and without previously published evidence of consistently moderate or strong associations with smoking. Results A total of 584 cancer deaths occurred during a follow-up period of up to 27 years. The mean and median cumulative occupational radiation doses received while in the Navy were 5.7 and 1.1 milliSieverts (mSv), respectively, range 0–242 mSv. Mortality Excess Relative Risks (ERRs) per 10 mSv and 95% confidence intervals (CI) were 0.053 (CI −0.03, 0.17) for all cancers, 0.052 (CI −0.03, 0.18) for all solid cancers, and 0.003 (CI −0.29, 0.30) for leukemias excluding chronic lymphocytic leukemia. The ERRs per 10 mSv were 0.052 (CI −0.07, 0.17) for cancers previously associated with smoking and 0.012 (CI −0.10, 0.12) for cancers that were not. Conclusions The ERR point estimates for solid cancers and leukemia were statistically compatible with those reported in previously published studies of other ionizing radiation-exposed and monitored cohorts, albeit with wide confidence intervals. This study, with high-quality measurements of in-Navy occupational external IR doses, high follow-up proportion, and detailed IR dose-response analyses, is consistent with the premise of small excess cancer risks from low-dose IR.

Fishermen Empowerment Strategy as a Solution against Hybrid Threats in Indonesia

Indonesia is the largest archipelagic country in the world which has the potential to become the World Maritime Axis. As a maritime country, Indonesia has several problems with threats at sea. In this study, the researcher aims to analyze the empowerment of fishing communities as a form of mitigating hybrid threats in Indonesia. This study is qualitative research. The researchers used data collection techniques through a literature study. The data were collected according to the concept proposed by Miles and Hubberman. One of the obstacles that affect the empowerment of fishermen is the lack of budget, lack of human resources and supervision, and Fraud of fishermen. Air strengths that can support and cover the lesser quantity of Alutsista. Fishermen Empowerment Strategy is carried out by setting goals (winning war with fishery mobilization), availability of facilities (place, information, communication), and methods (Indonesian Navy Service, Regional Defense Development, and Social Communication).

Health conditions among Navy divers at end of service: a retrospective cohort study

Purpose: To identify the most prevalent health conditions among divers during their last year of Navy service. Methods: For this retrospective descriptive study we used data from the Dive Jump Reporting System to identify 4,623 active-duty divers who separated between 2008 and 2018. Medical records, dive histories, and personnel files were merged, linked and analyzed at the individual level. Results: On average, 420 divers separated each year. Among the separating divers, 99% were male, 26% were aged 25 to 29 years old with a mean age of 35 (SD = 9, range 18 to 65). The major medical categories with the highest numbers of divers affected were: musculoskeletal system diseases (prevalence rate (PR) = 515.2 per 1,000 divers/year); nervous system (PR = 411.9); injury and poisonings (PR = 249.8); and mental disorders (PR = 237.3). Of the 50 specific conditions that affected the most divers the top four were joint disorders (PR = 34.5), disorders of refraction and accommodation (PR = 30.1), back disorders (PR = 26.8) and organic sleep disorders (PR = 21.6). Compared to divers with fewer than 29 dives, divers with 49-plus dives were about twice as likely to have diagnoses related to symptoms involving head and neck. Conclusions: The study found high rates of conditions such as musculoskeletal disorders, joint and back disorders, and some mental health related disorders. Special warfare divers have high rates of hearing loss, and other disorders of ear. The results show the need and to develop and implement group-specific mitigation programs.

Sun Exposure Prevention Practices Within U.S. Naval Aviation.

Occupational exposure to ultraviolet radiation is a critical concern for those serving in the U.S. Military. Work and mission requirements predispose members to significant sun exposure, while sun-protective behavior often comes second to mission accomplishment. Prior research implicated institutional practices and constraints as preventing the routine use of sun protection modalities, but no large-scale studies have assessed service members' perceptions regarding sun protection modalities available to them in their work environment or their daily sun protection practices. The study employed a cross-sectional survey distributed to active duty (AD) U.S. Navy service members assigned to 1 of 19 aircraft squadrons based in Southern California and deployed on missions across the Pacific theater of operations. The intent was to evaluate rates of sunburn, sun-protective practices, and perceptions regarding sun exposure and prevention practices in their workplace. The study and survey tool received approval from the Naval Medical Center San Diego Institutional Review Board. Statistical analysis of survey answers was performed to assess for trends in response rates overall and response rates within sociodemographic groups. Pearson's chi-squared tests were utilized to assess for significance where appropriate. P-values <.05 were used to determine statistically significant trends in response rates. One thousand surveys were distributed, of which 896 surveys were completed. The response rate was 89.6%. Eight hundred and eighty-eight surveys were included in the analysis. The surveyed population was consistent with the demographics of the U.S. Navy as a whole. 55.1% of survey respondents reported sunburn within the past year, higher than the rate reported in a previously surveyed civilian population. Reports of sunburn within the past year were not significantly different in regard to gender (P = .88), age (P = .53), and years of AD (P = .48). Increasing rank did show a significant correlation with reports of sunburn (P = .0) (Table S1). 62.2% of those surveyed reported frequent/routine use of some form of sun protection. This was lower than the rate reported in a previously surveyed civilian population. A large majority of service members surveyed (75.9%) reported using sunscreen with a sun protection factor >15.29.1% of survey respondents reported working in direct sunlight always/almost always. This was lower than the rates reported in a previously surveyed U.S. Air Force population of aviation maintainers. Low rates of respondents reported frequent reminders to use sun protection (18.9%), and fewer reported the routine or frequent use of sunscreen while at work (12.3%). A higher percentage reported regular use of sunscreen during outdoor leisure activities (36.5%), suggesting a barrier to use in the workplace. U.S. Military personnel report higher rates of sunburn and lower rates of routine use of sun protection practices compared to a previously surveyed civilian population. The overall rates of sun protection use while in the work setting are low both overall and compared to reports of routine use during outdoor leisure activities. Reported rates of reminders to use sunscreen are low, suggesting that increased education regarding the risk of excessive sun exposure and tools for effective sun protection are still needed.

Regional timber supply for shipbuilding and maintenance of war fleets in Cadiz: methods, agents and phases (1717-1736)

In the period of 1717-1736, the southern peninsular forests became a new resource frontier at the service of the Spanish Navy, in the context of the Bourbon Reforms. The timber supply for shipbuilding and maintenance of war fleets in Cádiz was made through four methods: direct administration by commissioned services; purchase from regional middlemen merchants; articulation between contractors and direct administration; articulation with the Royal Exchequer. The rhythm of supply was the reflex of different needs and constraints in three phases: maintenance of fleets during the period of consolidation of Cádiz as a naval and commercial center (1717-1727); the first shipbuilding series (1728-1731); the impact of the 30’s Mediterranean campaigns and the shipbuilding production of Ciprian Autran (1731-1736).

EXPERIENCE IN MEDICAL SUPPORT OF SHIPS AND UNITS OF FOREIGN ARMIES DURING THE NEW CORONAVIRUS PANDEMIC

The pandemic of a new coronavirus infection (COVID-19) threatened the combat readiness of the Armed Forces (AF) and required the urgent development and implementation of its own measures to limit the spread of the disease. Wide-spread principles to combat this disease, including social distancing, isolation of patients and quarantine of contact persons, are difficult to comply with Navy service. Given the features of habitability, autonomy and distance from the main locations, the experience gained and the measures taken during the outbreak of COVID-19 on the US Navy nuclear aircraft carrier «Theodore Roosevelt» are of great interest. It was important that at the time of diagnosis COVID-19 77% of crew members had no signs of disease, and 43% of them remained completely asymptomatic. The incidence among officers was significantly less than in ordinary and sergeant personnel. None of the officers were hospitalized. People of the white race predominated among the diseased and hospitalized (42,7 per cent and 30,4 per cent, respectively), as well as those associated with reactor operation, weapons and support personnel (27,9 per cent in total). At the same time, those servicemen who strictly followed non-specific preventive measures had a reliably lower infection rate.

A Methodology for Estimating the Cost of Educating Military Physicians at the Uniformed Services University.

The Department of Defense (DoD) operates a large, multi-channeled physician accession pipeline to maintain a professional workforce of over 10,000 active duty physicians. The Uniformed Services University (USU) operates the nation's only federal medical school providing trained doctors to the Army, Navy, Air Force, and Public Health Service. Although the school serves an essential purpose, policymakers question the cost of operating the University's medical school. One challenge is to develop reproducible and transparent costing methods that can be used to evaluate the University's value and efficiency. This work proposes a replicable methodology for estimating the cost per student-year at USU. Using detailed data from USU encompassing facility use, budgeting and expenditures, and faculty and student rosters, we break out and attribute costs to the University's component schools. Using faculty and staff time-use surveys, we further break out education-related personnel costs from other University activities such as research and service. We can then calculate the School of Medicine's annual cost to educate a uniformed physician. In Fiscal Year 2017, it cost the DoD approximately $253,000 per year (more than $1 million dollars total over a 4-year curriculum) to directly educate a physician though the USU School of Medicine. Data from the following Fiscal Year show that education costs grew a modest 2.1% per student-year. This work provides a foundational framework and approach to estimate the costs of accessioning a physician at USU. This methodology can be replicated for subsequent value analyses of physician accession and retention as budgetary pressures change to match the DoD operating environment. Uniformed Services University's costs should be periodically reassessed against those of alternative accession sources.

Toward a "Dashboard" Indicator of Retention in U.S. Navy Personnel.

Retention is a top priority for the U.S. Navy. However, our understanding of factors influencing retention of Navy personnel is limited. Current research implies that poor mental health, low appraisals of unit cohesion, low leadership satisfaction, and low social support may adversely affect retention. There is a need to understand how these and other factors influence retention in U.S. Navy personnel. We evaluated a broad range of factors influencing job satisfaction and career intentions (proxies of retention) in a large sample of Navy service members. Seven hundred and ninety-eight U.S. Navy men and women participated in this study as part of the Naval Unit Behavioral Health Needs Survey (NHRC.2014.0006). Independent variables included personal and unit morale, unit cohesion, affective organizational commitment, social support, behavioral health, sleep, leadership satisfaction, and perceived stress. Dependent variables include job satisfaction and career intentions. Separate multivariate regression models examined the unique and combined associations of independent and demographic variables with each dependent variable, respectively. Regression models accounted for 48% of variance in job satisfaction and 55% of variance in career intentions, respectively. The most robust predictors of job satisfaction were affective organizational commitment (i.e., one's emotional attachment to, identification with, and involvement in an organization), depressive symptoms, unit cohesion, and perceived stress; primary predictors of career intentions included affective organizational commitment, years of military service, marital status, and race/ethnicity. In this study, we identified diverse predictors of job satisfaction and career intentions of Navy men and women, with overall models accounting for substantial variance in both outcomes. This study informs evidence-based policies, programs, practices, and processes designed to influence job satisfaction, career intentions, and retention in U.S. Navy service members. These study findings also inform the development of a dashboard indicator of retention of U.S. Navy men and women.

Deployment and Psychological Correlates of Suicide Ideation: A Prospective, Longitudinal Study of Risk and Resilience Among Combat Veterans.

Suicide rates among military personnel have risen in part due to war zone deployments. Yet, the degree to which deployment-related stressors, in combination with preexisting and co-occurring psychiatric symptoms and individual resilience factors, contribute to suicide ideation (SI) remains unclear. The current study leverages prospective, longitudinal data to examine both risk and protective factors associated with SI in deployed service members. Participants were 1,805 active duty enlisted Marines and Navy service members assessed before and after a 7-month deployment for SI, preexisting and concurrent symptoms of depression, post-traumatic stress disorder (PTSD), alcohol consumption, as well as prior and deployment-related traumatic brain injury (TBI). Current self-reported psychological resilience and social support were analyzed as potential protective factors. Rates of SI were 7.3% and 3.9% before and after deployment, respectively. Of those with post-deployment SI, 68.6% were new-onset cases. Multivariate regression revealed that concurrent mild depression was the strongest risk factor (odds ratio [OR] = 10.03, 95% CI 5.28-19.07). Other significant risk factors included prior SI (OR = 3.36, 95% CI 1.60-7.05), prior subthreshold PTSD (OR = 2.10, 95% CI 1.10-3.99), and deployment TBI (OR = 1.84, 95% CI 1.03-3.28). Controlling for clinical symptoms and TBI, the risk of SI was reduced for those with moderate (OR = 0.50, 95% CI 0.27-0.93) and high psychological resilience scores (OR = 0.25, 95% CI 0.08-0.79) after deployment. Results indicate that even mild symptoms of depression and PTSD may increase the risk of SI. Screening for subthreshold clinical symptoms and TBI while incorporating psychological resilience training would allow for a more multidimensional approach to suicide risk assessment.

SARS-CoV-2 Infections and Serologic Responses from a Sample of U.S. Navy Service Members - USS Theodore Roosevelt, April 2020.

Compared with the volume of data on coronavirus disease 2019 (COVID-19) outbreaks among older adults, relatively few data are available concerning COVID-19 in younger, healthy persons in the United States (1,2). In late March 2020, the aircraft carrier USS Theodore Roosevelt arrived at port in Guam after numerous U.S. service members onboard developed COVID-19. In April, the U.S. Navy and CDC investigated this outbreak, and the demographic, epidemiologic, and laboratory findings among a convenience sample of 382 service members serving aboard the aircraft carrier are reported in this study. The outbreak was characterized by widespread transmission with relatively mild symptoms and asymptomatic infection among this sample of mostly young, healthy adults with close, congregate exposures. Service members who reported taking preventive measures had a lower infection rate than did those who did not report taking these measures (e.g., wearing a face covering, 55.8% versus 80.8%; avoiding common areas, 53.8% versus 67.5%; and observing social distancing, 54.7% versus 70.0%, respectively). The presence of neutralizing antibodies, which represent antibodies that inhibit SARS-CoV-2, among the majority (59.2%) of those with antibody responses is a promising indicator of at least short-term immunity. This report improves the understanding of COVID-19 in the U.S. military and among young adults in congregate settings and reinforces the importance of preventive measures to lower risk for infection in similar environments.

Non-clinical Drivers of Variation in Preoperative MRI Utilization for Breast Cancer.

Preoperative magnetic resonance imaging (MRI) utilization in breast cancer treatment has increased significantly over the past 2 decades, but its use continues to have interprovider variability and disputed clinical indications. The aim of this study was to evaluate non-clinical factors associated with preoperative breast MRI utilization. This study utilized TRICARE claims data from 2006 to 2015. TRICARE provides health benefits for active duty service members, retirees, and their dependents at both military (direct care with salaried physicians) and civilian (purchased care under fee-for-service structure) facilities. We studied patients aged 25-64years with a breast cancer diagnosis who had undergone mammogram/ultrasound (MMG/US) alone or with subsequent breast MRI prior to surgery. Facility characteristics included urban-rural location according to the National Center for Health Statistics classification. Adjusted multivariable logistic regression tests were used to identify independent factors associated with preoperative breast MRI utilization. Of the 25,392 identified patients, 64.7% (n = 16,428) received preoperative MMG/US alone, while 35.3% (n = 8964) underwent additional MRI. Younger age, Charlson Comorbidity Index score ≥ 2, active duty or retired beneficiary category, officer rank (surrogate for socioeconomic status), Air Force service branch, metropolitan location, and purchased care were associated with an increased likelihood of preoperative MRI utilization. Non-metropolitan location and Navy service branch were associated with decreased MRI use. After controlling for expected clinical risk factors, patients were more likely to receive additional MRI when treated at metropolitan facilities or through the fee-for-service system. Both associations may point toward non-clinical incentives to perform MRI in the treatment of breast cancer.

THE EFFECT OF SUPPLY AUTOMATION SYSTEMS TECHNICAL OPERATIONS READINESS OF INDONESIAN WARSHIP (CASE STUDY: DOPUSBEKTIM)

In the system of guiding material for the Navy the spare parts are supporting material because of their nature as a provision that supports the maintenance of the main material so that it is always maintained and maintained its quality. The Eastern Region Procurement Center Depot or Dopusbektim is the Technical Implementation Unit (UPT) of Head quarter of Indonesian Navy Service, which has the duty and responsibility to receive, store, maintain and distribute provisions to the user unit or user unit including of Indonesian Warship In especially those located in the Koarmatim region or currently is Second Fleet of Indonesian Navy (Koarmada II). In supporting its duties and functions as a storage and distribution facility, Dopusbektim has a structured and implemented supply pattern supported by an automated system that uses special applications so that the distribution process can be carried out better in supporting technical operations readiness of Indonesian Warship. However, in carrying out the Dopusbektim debriefing, it was felt that it was not optimal although it was supported by infrastructure because there were still obstacles and obstacles. This results in Dopusbektim's duties and functions, one of which is providing services in order to support technical operations readiness of Indonesian Warship has not been maximized. Therefore it is necessary to analyze which effects need to be improved in optimally supporting technical operations readiness of Indonesian Warship .Keywords: Supplies Pattern, Automation System, Indonesian Warship Technical Operational Readiness, Multiple Regression analysis.

Virologic Suppression in U.S. Navy Personnel Living with HIV Infection and Serving in Operational Assignments.

Current United States Navy policy supports the continuation of duty for active duty (AD) service members living with HIV infection. The creation of this policy is instrumental to prevent exclusion and to promote career expansion and promotional opportunities for AD service members infected with HIV. The established instruction parallels the HIV care continuum, a widely accepted public health model. No studies have been done to determine whether allowing service members to fill operational and Outside the Continental United States (OCONUS) assignments disrupts this continuum of care. This retrospective study aims to evaluate how an operational or OCONUS assignment impacts the ability of an HIV AD service members to receive the standard of care HIV medical treatment and maintain viral suppression. A retrospective chart review was performed on the health records of 20 United States AD Navy service members with HIV who were placed in OCONUS or large ship assignments per current U.S. Navy policy. Health records were reviewed during the service member's assignment. Viral loads were documented immediately prior and at 6 months after starting their new assignment. Changes to anti-retroviral medications and the medical treatment facility, including the specialty of the treating provider were recorded. The results demonstrate no significant change in the service member's viral load during the first 6 months in an operational or OCONUS assignment. Members still had access to care including medications and specialty providers based on the locality. All service members within this review were able to maintain viral suppression despite the location of their assignments. This limited study suggests that care is accessible and the standard HIV care continuum is maintained while deployed or stationed overseas.