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Enabling the Global Response Force : access strategies for the 82nd Airborne Division
\"The Global Response Force (GRF) is built for rapid response to unforeseen or, more specifically, unplanned operations. Selected Army airborne forces provide a large portion of the GRF and are dependent on joint concepts for deployment and access. This study illustrates a method for determining the best access strategies given constraints in aircraft, intermediate staging bases, operational capabilities, and other factors. The study applies this method to each geographic combatant command and develops specific, tailored strategies for each. The access strategies are built from multiple analytic techniques: historical aircraft data and platform specifications to determine capabilities and limitations of the air fleet; several airfield databases, site reports, and expert judgments to determine probable intermediate staging base locations and their likely capabilities; multiple deployment concepts for access to minimize operational risks; and detailed geographic and operational analysis to determine global coverage and reach. In the end, we were able to deduce a preferred strategy for each of the combatant commands. Global access for the GRF is provided partially through the use of well-established staging bases but will necessarily rely on austere basing and complex deployment concepts for particular locations in multiple combatant commands. The study concludes with several recommendations to close those risks, which span the services, combatant commands, and joint staff\"--Back cover.
BOOK
Figuring Violence
In the United States, the early years of the war on terror were marked by the primacy of affects like fear and insecurity. These aligned neatly with the state's drive toward intensive securitization and an aggressive foreign policy. But for the broader citizenry, such affects were tolerable at best and unbearable at worst; they were not sustainable. Figuring Violence catalogs the affects that define the latter stages of this war and the imaginative work that underpins them. These affects—apprehension, affection, admiration, gratitude, pity, and righteous anger—are far more subtle and durable than their predecessors, rendering them deeply compatible with the ambitions of a state embroiling itself in a perpetual and unwinnable war.Surveying the cultural landscape of this sprawling conflict, Figuring Violence reveals the varied mechanisms by which these affects have been militarized. Rebecca Adelman tracks their convergences around six types of beings: civilian children, military children, military spouses, veterans with PTSD and TBI, Guantánamo detainees, and military dogs. All of these groups have become preferred objects of sentiment in wartime public culture, but they also have in common their status as political subjects who are partially or fully unknowable. They become visible to outsiders through a range of mediated and imaginative practices that are ostensibly motivated by concern or compassion. However, these practices actually function to reduce these beings to abstracted figures, silencing their political subjectivities and obscuring their suffering. As a result, they are erased and rendered hypervisible at once. Figuring Violence demonstrates that this dynamic ultimately propagates the very militarism that begets their victimization.
eBook
Pre-deployment insomnia is associated with post-deployment post-traumatic stress disorder and suicidal ideation in US Army soldiers
Insomnia is prevalent among military personnel and may increase risk of mental disorders and suicidal ideation. This study examined associations of pre-deployment insomnia with post-deployment post-traumatic stress disorder (PTSD) and suicidal ideation among US Army soldiers.
Soldiers from three Brigade Combat Teams completed surveys 1-2 months before deploying to Afghanistan in 2012 (T0), on return from deployment (T1), 3 months later (T2), and 9 months later (T3). Logistic regression was performed to estimate associations of pre-deployment (T0) insomnia with post-deployment (T2 or T3) PTSD and suicidal ideation among respondents who completed surveys at all waves (n = 4645). A hierarchy of models incorporated, increasing controls for pre-deployment risk factors and deployment experiences.
Pre-deployment insomnia was associated with increased risk of post-deployment PTSD (adjusted odds ratio [AOR] = 3.14, 95% confidence interval [CI] = 2.58% to 3.82%, p < .0005) and suicidal ideation (AOR = 2.78, 95% CI = 2.07% to 3.74%, p < .0005) in models adjusting for sociodemographic characteristics and prior deployment history. Adjustment for other pre-deployment risk factors and deployment experiences attenuated these associations; however, insomnia remained significantly associated with post-deployment PTSD (AOR = 1.50, 95% CI = 1.19% to 1.89%, p = .001) and suicidal ideation (AOR = 1.43, 95% CI = 1.04% to 1.95%, p = .027). Subgroup models showed that pre-deployment insomnia was associated with incident PTSD (AOR = 1.55, 95% CI = 1.17% to 2.07%, p = .003) and suicidal ideation (AOR = 1.67, 95% CI = 1.16% to 2.40%, p = .006) among soldiers with no pre-deployment history of these problems.
Pre-deployment insomnia contributed to prediction of post-deployment PTSD and suicidal ideation in Army soldiers, suggesting that detection of insomnia could facilitate targeting of risk mitigation programs. Future studies should investigate whether treatment of insomnia helps prevent PTSD and suicidal ideation among deployed service members.
Journal Article
How Wartime Military Service Affects Children and Families
How are children's lives altered when a parent goes off to war? What aspects of combat deployment are most likely to put children at risk for psychological and other problems, and what resources for resilience can they tap to overcome such hardships and thrive? To answer these questions, Patricia Lester and Lieutenant Colonel Eric Flake first examine the deployment cycle, a multistage process that begins with a period of anxious preparation after a family receives notice that a parent will be sent into combat. Perhaps surprisingly, for many families, they write, the most stressful part of the deployment cycle is not the long months of separation that follow but the postdeployment period, when service members, having come home from war, must be reintegrated into families whose internal rhythms have changed and where children have taken on new roles. Lester and Flake then walk us through a range of theoretical perspectives that help us understand the interconnected environments in which military children live their lives, from the dynamics of the family system itself to the external contexts of the communities where they live and the military culture that helps form their identity. The authors conclude that policy makers can help military-connected children and their families cope with deployment by, among other things, strengthening community support services and adopting public health education measures that are designed to reduce the stigma of seeking treatment for psychological distress. They warn, however, that much recent research on military children's response to deployment is flawed in various ways, and they call for better-designed, longer-term studies as well as more rigorous evaluation of existing and future support programs.
Journal Article
Feasibility of large-scale deployment of multiple wearable sensors in Parkinson's disease
Wearable devices can capture objective day-to-day data about Parkinson's Disease (PD). This study aims to assess the feasibility of implementing wearable technology to collect data from multiple sensors during the daily lives of PD patients. The Parkinson@home study is an observational, two-cohort (North America, NAM; The Netherlands, NL) study. To recruit participants, different strategies were used between sites. Main enrolment criteria were self-reported diagnosis of PD, possession of a smartphone and age≥18 years. Participants used the Fox Wearable Companion app on a smartwatch and smartphone for a minimum of 6 weeks (NAM) or 13 weeks (NL). Sensor-derived measures estimated information about movement. Additionally, medication intake and symptoms were collected via self-reports in the app. A total of 953 participants were included (NL: 304, NAM: 649). Enrolment rate was 88% in the NL (n = 304) and 51% (n = 649) in NAM. Overall, 84% (n = 805) of participants contributed sensor data. Participants were compliant for 68% (16.3 hours/participant/day) of the study period in NL and for 62% (14.8 hours/participant/day) in NAM. Daily accelerometer data collection decreased 23% in the NL after 13 weeks, and 27% in NAM after 6 weeks. Data contribution was not affected by demographics, clinical characteristics or attitude towards technology, but was by the platform usability score in the NL (χ2 (2) = 32.014, p<0.001), and self-reported depression in NAM (χ2(2) = 6.397, p = .04). The Parkinson@home study shows that it is feasible to collect objective data using multiple wearable sensors in PD during daily life in a large cohort.
Journal Article
Marriage and divorce after military deployment to Afghanistan: A matched cohort study from Sweden
To investigate the probability of marriage and divorce among Swedish military veterans deployed to Afghanistan relative to non-deployed matched comparators.
Matched cohort study in Sweden.
Military veterans were identified through Swedish military personnel registers regarding foreign deployments, and comparators from the Military Service Conscription Register (1969-2013). Of 1,882,411 eligible conscripts, 7041 had served in Afghanistan at some point in time between 2002 and 2013. To each military veteran, up to 5 non-deployed comparators who underwent conscription were matched by age, sex, psychological assessment, cognitive ability, psychiatric history and social characteristics. After matching there were 4896 (82%) unmarried and 1069 (18%) married deployed military veterans. The main outcome was marriage or divorce after deployment to Afghanistan. Data on marital status were retrieved from Statistics Sweden until December 31, 2014.
During a median follow-up of 4.1 years after deployment of married individuals, 124 divorces were observed among deployed military veterans and 399 in the matched non-deployed comparator cohort (277 vs. 178 per 10,000 person-years; adjusted hazard ratio 1.61, 95%CI 1.31-1.97). During a median follow-up of 4.7 years after deployment in the unmarried cohort, 827 new marriages were observed among deployed military veterans and 4363 in the matched non-deployed comparators cohort (399 vs. 444 per 10,000 person-years; adjusted hazard ratio 0.89, 95%CI 0.83-0.96).
Military veterans were more likely to divorce and less likely to marry after deployment compared with matched non-deployed comparators.
Journal Article
Epidemiology and associated microbiota changes in deployed military personnel at high risk of traveler's diarrhea
Travelers' diarrhea (TD) is the most prevalent illness encountered by deployed military personnel and has a major impact on military operations, from reduced job performance to lost duty days. Frequently, the etiology of TD is unknown and, with underreporting of cases, it is difficult to accurately assess its impact. An increasing number of ailments include an altered or aberrant gut microbiome. To better understand the relationships between long-term deployments and TD, we studied military personnel during two nine-month deployment cycles in 2015-2016 to Honduras. To collect data on the prevalence of diarrhea and impact on duty, a total of 1173 personnel completed questionnaires at the end of their deployment. 56.7% reported reduced performance and 21.1% reported lost duty days. We conducted a passive surveillance study of all cases of diarrhea reporting to the medical unit with 152 total cases and a similar pattern of etiology. Enteroaggregative E. coli (EAEC, 52/152), enterotoxigenic E. coli (ETEC, 50/152), and enteropathogenic E. coli (EPEC, 35/152) were the most prevalent pathogens detected. An active longitudinal surveillance of 67 subjects also identified diarrheagenic E. coli as the primary etiology (7/16 EPEC, 7/16 EAEC, and 6/16 ETEC). Eleven subjects were recruited into a nested longitudinal substudy to examine gut microbiome changes associated with deployment. A 16S rRNA amplicon survey of fecal samples showed differentially abundant baseline taxa for subjects who contracted TD versus those who did not, as well as detection of taxa positively associated with self-reported gastrointestinal distress. Disrupted microbiota was also qualitatively observable for weeks preceding and following the incidents of TD. These findings illustrate the complex etiology of diarrhea amongst military personnel in deployed settings and its impacts on job performance. Potential factors of resistance or susceptibility can provide a foundation for future clinical trials to evaluate prevention and treatment strategies.
Journal Article
Anesthesia during deployment of a military forward surgical unit in low income countries: A register study of 1547 anesthesia cases
Military anesthesia meets unique logistical, technical, tactical, and human constraints, but to date limited data have been published on anesthesia management during military operations.
This study aimed to describe and analyze French anesthetic activity in a deployed military setting.
Between October 2015 and February 2018, all patients managed by Sainte-Anne Military Hospital anesthesiologists deployed in mission were included. Anesthesia management was described and compared with the same surgical procedures in France performed by the same anesthesia team (hernia repair, lower and upper limb surgeries). Demographics, type of surgical procedure, and surgical activity were also described. The primary endpoint was to describe anesthesia management during the deployment of forward surgical teams (FST). The secondary endpoint was to compare anesthesia modalities during FST deployment with those usually used in a military teaching hospital.
During the study period, 1547 instances of anesthesia were performed by 11 anesthesiologists during 20 missions, totaling 1237 days of deployment in nine different theaters. The majority consisted of regional anesthesia, alone (43.5%) or associated with general anesthesia (21%). Compared with France, there was a statistically significant increase in the use of regional anesthesia in hernia repair, lower and upper limb surgeries during deployment. The majority of patients were civilians as part of medical support to populations.
In the context of an austere environment, the use of regional anesthesia techniques predominated when possible. These results show that the training of military anesthetists must be complete, including anesthesia, intensive care, pediatrics, and regional anesthesia.
Journal Article
