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Although interest is high in addressing suicide mortality after the transition from military to civilian life, little is known about the risk factors associated with this transition. To support the ongoing suicide surveillance work of the US Department of Veterans Affairs (VA) Office of Mental Health and Suicide Prevention, examining these factors is important for targeting suicide prevention efforts. To examine the prevalence, patterns, and associated characteristics of suicide mortality among US service members after separation from military active status. This retrospective population-based cohort study obtained demographic and military service data from the VA/Department of Defense Identity Repository. Individuals who served on active duty in the US Army, Navy, Air Force, Marine Corps, or Coast Guard after September 11, 2001, and who separated from active status between January 1, 2010, and December 31, 2017, were included in the cohort. Data analyses were conducted from September 9, 2019, to April 1, 2020. Suicide mortality within 6 years after separation from military service. A total of 1 868 970 service members (1 572 523 men [84.1%]; mean [SD] age at separation, 30.9 [9.9] years) separated from the military during the study period. Through the end of the study period (December 31, 2017), 3030 suicides (2860 men and 170 women) were identified as having occurred within 6 years of separation from the military. Statistically significant differences in suicide risk were found by demographic and military service characteristics. Suicide rates after separation were time dependent, generally peaking 6 to 12 months after separation and declining only modestly over the study period. Male service members had a statistically significantly higher hazard of suicide than their female counterparts (hazard ratio [HR], 3.13; 95% CI, 2.68-3.69). Younger individuals (aged 17-19 years; HR, 4.46 [95% CI, 3.71-5.36]) had suicide hazard rates that were approximately 4.5 times higher than those who transitioned at an older age (≥40 years). Service branch remained a risk factor for suicide even 6 years after separation; those who separated from the Marine Corps (HR, 1.55; 95% CI, 1.36-1.78) and the Army (HR, 1.48; 95% CI, 1.31-1.67) had a higher hazard than those who transitioned from the Air Force. The hazard for those who separated from the active component was higher than for those who separated from the reserve component (HR, 1.29; 95% CI, 1.18-1.42). Service members with a shorter length of service had a higher hazard (HR, 1.26; 95% CI, 1.11-1.42) than those with a longer service history. Results of this study show that not all service members who recently transitioned from military life had the same risk of suicide. The data suggest that awareness of military service and demographic characteristics can help identify those most at risk for suicide to target prevention efforts.

Objectives. We conducted a longitudinal assessment of tobacco pricing in military retail outlets, including trends within each service branch. Methods. We determined the price of a single pack of Marlboro Red cigarettes at military retail stores located in the continental United States, Alaska, and Hawaii and at their nearest Walmarts in spring 2011 and 2013 (n = 128 for pairs available at both assessments). Results. The average difference between cigarettes sold in military retail outlets and Walmarts decreased from 24.5% in 2011 to 12.5% in 2013. The decrease was partially attributable to significant price decreases at Walmarts. The largest increases in cigarette prices occurred on naval installations. Potential savings at stores on several installations remained substantial in 2013; the largest approached $6 per pack. Stores on 17 military installations decreased cigarette prices during the study period. Conclusions. Tobacco can be purchased in military retail stores at substantial savings over civilian stores. If tobacco pricing is to cease to be an incentive for use among personnel, a revised military tobacco pricing policy is needed.

The military airbase plays a crucial role in national defense, particularly in air defense. One of the most critical facilities at a military airbase for supporting air operations is the runway that serves as the area where fighter aircraft take off and land; hence. If such an event occurs, the Air Force’s capability, specifically the ability of fighter aircraft to take off and land, would be compromised, disrupting air operations. Therefore, the rapid damage runway repair (RADARR) method, aligned with the rigid pavement construction approach, is essential. The foundation of the construction implementation involves creating a Work Breakdown Structure (WBS) as a reference for RADARR operation planning. This study aims to develop a WBS as the basis for RADARR operation time planning. The research method employed is a mixed-method approach with descriptive analysis. The variables under investigation include work packages, construction methods, work activities, and the duration of operations. This study comprises expert judgment, pilot surveys, respondent surveys, and focus group discussion (FGD) followed by the development of RADARR WBS, measure the operational time of RADARR through respondent surveys. These findings serve as a valuable reference for executing RADARR construction work within the military context.

Lean Six Sigma (LSS) is a process improvement methodology developed in the manufacturing industry to increase process efficiency while maintaining product quality. The efficacy of LSS application to the health care setting has not been adequately studied. This article presents a quality improvement project at the U.S. Naval Academy that uses LSS to improve the mass immunizations process for Midshipmen during in-processing. The process was standardized to give all vaccinations at one station instead of giving a different vaccination at each station. After project implementation, the average immunizations lead time decreased by 79% and staffing decreased by 10%. The process was shown to be in control with a capability index of 1.18 and performance index of 1.10, resulting in a defect rate of 0.04%. This project demonstrates that the LSS methodology can be applied successfully to the health care setting to make sustainable process improvements if used correctly and completely.

The main tasks of the Training Air Base concern the practical training of cadets in piloting techniques as well as maintaining and improving the piloting skills of the instructors. It is essential to maintain the infrastructure of the airfield and the Base as a whole ready for operation. This allows for fulfilling the fundamental mission of such military units, which is to provide effective operations for the defence of the state. Therefore, measures to support and improve the operation of such military facilities are extremely important and also became the genesis of this article. It analyses and evaluates the number of flights carried out over seven years (2016–2022) at the studied training base using mathematical modelling, allowing to assess the variability of the studied series. The phase trends method was used for this purpose, preceded by a seasonality study. It allowed the identification of periods in which the number of flights performed varies significantly. Such knowledge enables better regulation of the airport’s operation, adjustment of activities to the needs, and the determination of further directions for airport development and the justification of potential investments. An additional value of the article is the presentation of a mathematical modelling method specifically designed for seasonal time series, along with their diagnostics. It also provides an opportunity for other institutions to carry out tasks while upholding the highest standards.

Persistent organochlorine chemicals (OCs), including chlordane compounds (CHLs), DDTs, PCBs, and chlorinated dioxins and related compounds (DRCs), were examined in the adipose tissue and liver from 33 specimens of habu ( Protobothrops flavoviridis ), a species of venomous pit viper endemic to the Japanese Southwest Islands. The median concentrations of CHLs, DDTs, and PCBs in adipose tissue of 22 habus collected from an urban area were 4400 ng g −1 lipid weight (lw), 610 ng g −1 lw, and 1600 ng g −1 lw, respectively. Their DDT and PCB concentrations were higher in comparison with the specimens from a rural area. Liver of 10 specimens from the urban area were subjected to DRCs analysis, and PCDDs, PCDFs, and DL-PCBs were detected with median values of 1300, 350, and 150,000 pg g −1 lw, respectively. Among PCDD/F congeners, octa-CDD was detected at the highest concentrations in seven liver samples, but considerable concentrations of penta- and hexa-CDD/Fs were found in two samples. Relatively higher concentrations of PCB, DDTs, and PCDD/Fs were found in habus collected within 1 km of the boundary of military facilities, suggesting that OCs from some unknown sources of these OCs inside and/or around some of the facilities accumulated in habus.

As former U.S. Army Surgeon General Horoho points out, a large fraction of what determines the health and readiness of our military families does not occur during appointments with professionals, but rather within the \"Lifespace-where health really happens...\" Indeed, when children of military families experience psychosocial difficulties, such stress impacts the service members' personal well-being and ability to focus at work, impairing their capacity to attend to the mission. As such, the Department of Defense (DoD) has instituted a family readiness system to bolster resiliency within military families, including children, e.g., by linking families with support networks. Bolstering military family resiliency, including the prevention of and effective intervention for child psychosocial problems, is an important issue at all levels of the DoD. Service members, leaders, and policy makers have a vested interest in promoting mission readiness and a healthy force. Research can play an important role in shaping decision-making by consolidating what is currently known and not known about a particular expertise area. To date, there has been no consolidation of research regarding outcomes associated with military community support and the programs that currently exist to bolster child and family resiliency. Given the importance of military families to mission readiness, a review of the relevant research is warranted. This commentary article reviews the literature on community support for military children, provides an overview of currently available resources, discusses concerns with the current provision of support services to military families, and offers recommendations for future research, policy, and implementation of military community support programs. Although there is a dearth of research on available support programs, there appears to be no lack of services available to military families. However, several steps could be taken to make these resources into a more supportive system. Family members must be able to identify what support services exist, distinguish which service is most suitable for their needs, and be able to readily access these services in a resource-conserving manner. Considerable overlap in support services seems to suggest limited coordination between organizations and service providers, particularly in regard to the government/civilian interface, which inherently lies outside of DoD control. This overlap suggests a redundancy, which may not be efficient economically or in regard to accessing support. There also may be some confusion over which support service is most suitable for the consumer's need. Although some overlap is useful, such as the provision of different services to different populations (e.g., having separate programs for the Army, Navy, Air Force, and Marine subcultures), limited organization and parsimonious provision of services makes it particularly difficult for spouses and family members to navigate resources. Initial attempts are being made to organize and consolidate resources in both the government and civilian sectors. However, it is clear that these initiatives have not completely solved problems related to resource access, redundancy, and lack of research-supported efficacy.

BackgroundLocal authorities and other service providers need data on their local ex-military communities to be able to plan services. However, published research and data may not be applicable to the local population. Qualitative research offers a relatively low-cost way to get insights into the needs of local ex-military communities.MethodsA pilot study using in-depth interviews with a small convenience sample of former ex-Army residents of Tameside. Framework analysis was used to identify and group themes arising from the data. This study was conducted using the Consolidated Criteria for Reporting Qualitative Research.ResultsWhile participants saw mental health as a particular challenge, they felt that it tends to get disproportionate attention relative to other needs. The study identified potential barriers to accessing health services that arise from an interaction between aspects of military and civilian healthcare culture and practices. Participants also said that military service could affect the health of both partners and children and that these effects might be more pronounced at key times, such as during adolescence.ConclusionParticipants’ perceptions of the health of former members of the Armed forces reflect the published epidemiological literature. This suggests that qualitative data can be valid for understanding the health needs of local ex-military communities. Further research is needed to test the findings here with a broader group of ex-military personnel, to explore the barriers faced in accessing healthcare and to understand the health needs of the families of ex-service personnel.

As part of a Military Emergency Medical Services (EMS) system process improvement initiative, the authors sought to objectively evaluate the U.S. military EMS system for the island of Okinawa. They applied a program evaluation tool currently utilized by the U.S. National Park Service (NPS). A comprehensive needs assessment was conducted to evaluate the current Military EMS system in Okinawa, Japan. The NPS EMS Program Audit Worksheet was used to get an overall \"score\" of our assessment. After all the data had been collected, a joint committee of Military EMS physicians reviewed the findings and made formal recommendations. From 2011 to 2014, U.S. military EMS on Okinawa averaged 1,345 ± 137 patient transports annually. An advanced life support (ALS) provider would have been dispatched on 558 EMS runs (38%) based on chief complaint in 2014 had they been available. Over 36,000 man-hours were expended during this period to provide National Registry Emergency Medical Technician (EMT)-accredited instruction to certify 141 Navy Corpsman as EMT Basics. The NPS EMS Program Audit Worksheet was used and the program scored a total of 31, suggesting the program is well planned and operating within standards. This evaluation of the Military EMS system on Okinawa using the NPS program assessment and audit worksheet demonstrates the NPS evaluation instruments may offer a useful assessment tool for the evaluation of Military EMS systems.

The US Military Health System (MHS) is a unique federal health care system with a critical mission: ensuring that America's military personnel are healthy; maintaining a ready medical force in support of operational forces around the world; and delivering a medical benefit to approximately 9.5 million beneficiaries. This article provides an overview of how the MHS relies upon the TRIcARE program to deliver both direct care (delivered in military treatment facilities) and purchased care (delivered by network providers). The article also describes the history and evolution of the TRICARE program, presents information on the populations served and the volume and type of care rendered, and examines access and quality issues. Furthermore, it describes recent policy and operational changes that have influenced how the MHS delivers health care, placing these changes in the context of other challenges facing the US health care system.