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It is well known that less than 1% of the population achieves ideal cardiovascular health, and 65% of patients do not have their conventional risk biomarkers under control. Military service has its own particularities that may contribute to cardiovascular risk.To define the preventive strategy goals, we analysed the prevalence of traditional cardiovascular risk factors for coronary artery disease and elevated fibrinogen among active military personnel in the Republic of Serbia.The cross-sectional study included 738 individuals older than 20 years, mostly between 31 and 40 years old. The mean value of SBP for the whole group was 122.39± 9.42 mmHg, and for the DBP, it was 79.94±6.56 mmHg. Among active military personnel, 72.7% (533) had prehypertension, and 13.8% (101) was hypertensive. Both body mass and BMI index among the observed age subgroups were found to increase with the age of the patients and cholesterol values. HDL cholesterol values also differed statistically significantly between age subgroups, with the proportion of individuals with HDL less than 1.5 mmol/L in all subgroups being about 85%, the only in the 41-50 age group was lower, 76.4%. LDL cholesterol and the proportion of individuals who had LDL 3.5 increases with the age of patients, and an identical trend was recorded with triglycerides. With ageing, fibrinogen levels increased.Those findings considering cardio and cerebrovascular risk factors would help create a new approach for primary prevention for these categories of individuals.Dobro je poznato da manje od 1% populacije ima idealno kardiovaskularno zdravlje, kao i da 65% pacijenata nema kontrolu nad konvencionalnim biomarkerima rizika. Vojna služba ima svoje osobitosti koje mogu doprineti kardiovaskularnom riziku.Da bismo definisali ciljeve preventivne strategije, analizirali smo prevalenciju tradicionalnih kardiovaskularnih faktora rizika za koronarnu arterijsku bolest i povišenog fibrinogena među aktivnim vojnim licima vojske Republike Srbije.Studija preseka je obuhvatila 738 osoba starijih od 20 godina, uglavnom između 31 i 40 godina. Srednja vrednost SBP-a za celu grupu bila je 122,39 ± 9,42 mmHg, a za DBP 79,94 ± 6,56 mmHg. Među ispitivanom populacijom 72.7% (533) je imalo prehipertenziju, a 13,8% (101) hipertenziju. Utvrđeno je da se i telesna masa i indeks telesne mase među posmatranim starosnim podgrupama povećavaju sa godinama pacijenata, kao i vrednosti ukupnog holesterola. Vrednosti HDL holesterola su se takođe statistički značajno razlikovale među starosnim podgrupama, pri čemu je udeo pojedinaca sa HDL-om manjim od 1,5 mmol/L u svim podgrupama bio oko 85%, dok je jedino u starosnoj grupi od 41-50 godina bio niži, 76,4%. LDL holesterol, kao i udeo pojedinaca koji su imali LDL ³ 3,5, raste sa starenjem pacijenata, a identičan trend je zabeležen i kod triglicerida. Sa starenjem, nivo fibrinogena se povećava.Dobijeni rezultati koji se odnose na kardio i cerebrovaskularne faktore rizika bi mogli doprineti stvaranju novog pristupa u primarnoj prevenciji kod ovih kategorija bolesnika.

Figueiredo, PS, Looney, DP, Pryor, JL, Doughty, EM, McClung, HL, Vangala, SV, Santee, WR, Beidleman, BA, and Potter, AW. Verification of maximal oxygen uptake in active military personnel during treadmill running. J Strength Cond Res XX(X): 000-000, 2021-It is unclear whether verification tests are required to confirm "true" maximal oxygen uptake (V[Combining Dot Above]O2max) in modern warfighter populations. Our study investigated the prevalence of V[Combining Dot Above]O2max attainment in U.S. Army soldiers performing a traditional incremental running test. In addition, we examined the utility of supramaximal verification testing as well as repeated trials for familiarization for accurate V[Combining Dot Above]O2max assessment. Sixteen U.S. Army soldiers (1 woman, 15 men; age, 21 ± 2 years; height, 1.73 ± 0.06 m; body mass, 71.6 ± 10.1 kg) completed 2 laboratory visits, each with an incremental running test (modified Astrand protocol) and a verification test (110% maximal incremental test speed) on a motorized treadmill. We evaluated V[Combining Dot Above]O2max attainment during incremental testing by testing for the definitive V[Combining Dot Above]O2 plateau using a linear least-squares regression approach. Peak oxygen uptake (V[Combining Dot Above]O2peak) was considered statistically equivalent between tests if the 90% confidence interval around the mean difference was within ±2.1 ml·kg-1·min-1. Oxygen uptake plateaus were identified in 14 of 16 volunteers for visit 1 (87.5%) and all 16 volunteers for visit 2 (100%). Peak oxygen uptake was not statistically equivalent, apparent from the mean difference in V[Combining Dot Above]O2peak measures between the incremental test and verification test on visit 1 (2.3 ml·kg-1·min-1, [1.3-3.2]) or visit 2 (1.1 ml·kg-1·min-1 [0.2-2.1]). Interestingly, V[Combining Dot Above]O2peak was equivalent, apparent from the mean difference in V[Combining Dot Above]O2peak measures between visits for the incremental tests (0.0 ml·kg-1·min-1 [-0.8 to 0.9]) but not the verification tests (-1.2 ml·kg-1·min-1 [-2.2 to -0.2]). Modern U.S. Army soldiers can attain V[Combining Dot Above]O2max by performing a modified Astrand treadmill running test. Additional familiarization and verification tests for confirming V[Combining Dot Above]O2max in healthy active military personnel may be unnecessary.

O objetivo desta pesquisa foi analisar o esgotamento profissional de policiais militares que trabalham no serviço administrativo, em relação aos aspectos referentes a Síndrome de Burnout. Para a obtenção dos resultados expostos, adotou-se uma metodologia quantitativa, de natureza descritiva, do tipo survey, utilizando para a coleta de dados o instrumento Maslach Burnout Inventory (MBI). A amostra foi composta por 112 policiais militares da ativa, que trabalham em setores administrativos da Polícia Militar do Estado do Pará. No geral a síndrome de Burnout costuma ser identificada entre profissionais que desenvolvem suas atividades diretamente ligadas com outras pessoas, como é o caso dos policiais. Nos resultados da pesquisa identificamos predominantemente profissionais do sexo masculino, no geral casados, com a média de um filho, e nível superior completo. Na mensuração dos níveis da síndrome, surge um alerta, pois, ainda que, eles apresentem níveis comedidos, exige-se atenção por parte dos gestores, uma vez que, a síndrome é invisível, segundo Lindblom et al. (2006) está associado a outros tipos de distúrbios psicológicos, como depressão, ansiedade e insônia. Contudo, constatou-se que apesar de tudo, boa parte dos policiais estão satisfeitos com sua profissão.

A Magyar Honvédség számára kiemelten fontos az utánpótlás szempontjából azon fiatal generáció vizsgálata, amelyet Z generációnak hívunk, mivel ők az aktív szolgálatot teljesítő állomány legfiatalabb tagjai, és mert a tiszt- és altisztképzés bázisát is ők jelentik. Az írás a hazai és nemzetközi szakirodalom alapján próbál átfogó képet adni az éppen 14–25 éves korosztály képzési és tanulási sajátosságairól.

Background Many United States veterans and active military with a history of traumatic brain injury (TBI) also experience challenges from comorbid posttraumatic stress disorder (PTSD), yet the additional burden of PTSD is not clear. Purpose To address this knowledge gap, this study examined the relationship of PTSD to cognitive, social, and physical functioning and depressive symptoms in veterans recently diagnosed with TBI. Methods Veterans were recruited from a VA rehabilitation clinic. The Patient Competency Rating Scale and Center for Epidemiologic Studies Depression Scale measured functioning and depression, respectively. Chart review captured PTSD diagnosis. Findings In the sample of 83 veterans, 65% had a current PTSD diagnosis. After controlling for sociodemographic variables and TBI severity, PTSD was a significant predictor of lower cognitive, social, and physical functioning and higher depressive symptomatology. Discussion Clinicians should incorporate PTSD assessment in their work with veterans with TBI. Integrated behavioral health and rehabilitation interventions that provide strategies for veterans to manage TBI symptoms and PTSD are critical.

EnglishThis article seeks to understand the relation between situations of indebtedness of the military of the Brazilian Navy and the military habitus. From interviews carried out with indebted military personnel, commanders, and professionals working in the area, as well as through participant observation and documentary analysis, we sought to understand how characteristics of military life are entangled with economic practices developed by agents in this field. This fact was evidenced in different moments in the lives of these subjects, such as marriage still at the beginning of their military career, together with all the financial obligations resulting from it, active military duty travel and expenses related to entertainment and purchase of gifts as rewards for the prolonged absence from families, transfers to hard to reach access locations as well as the acquisition of payroll-linked loans to clear debts arising from these situations and to respond to social expectations inherent to the profession. The findings of the study identified that at the heart of this association between indebtedness and military habitus there were answers to moral imperatives and emotional issues, which expanded from the military field, modulating the economic activities of these subjects. portuguesEste artigo busca entender a relacao entre o endividamento dos militares da Marinha do Brasil e o habitus militar. A partir de entrevistas realizadas com militares endividados, comandantes e profissionais que atuam na area, bem como por meio da observacao participante e analise documental, buscou-se compreender como caracteristicas da vida militar estao enredadas com praticas economicas desenvolvidas por agentes desse campo. Tal fato foi evidenciado em momentos diferenciados na vida desses sujeitos, como o casamento, ainda no inicio da carreira militar, e as obrigacoes financeiras advindas, as viagens a servico e os gastos realizados com diversoes e presentes como recompensas pela ausencia prolongada, as transferencias para locais de dificil acesso, bem como a aquisicao de emprestimos consignados para sanar dividas oriundas dessas situacoes e para responder as expectativas sociais inerentes a profissao. Os resultados do estudo identificaram que no cerne da associacao entre endividamento e habitus militar se encontravam presentes respostas a imperativos morais e a questoes emocionais, que se expandiam do campo militar, modulando a acao economica desses sujeitos.

The lack of information on active military pilots has led to the present study, which aimed to analyze the sense of aviation-associated spatial disorientation and the incidence of visual illusions ...

The use of performance and image enhancing drugs (PIEDs) among active mili-tary personnel and veterans presents a public health concern. Deeper understanding of PIEDs use in those populations is necessary to understand what underpins their use and provide information to help shape interventions with the aim of reducing impacts on individuals’ health, wellbeing, social circumstances, public perception and, in serving personnel, any wider military performance. A contemporary review was conducted using five academic journal databases, citation searching, and hand searching. Studies were excluded if published prior to 2000 or did not specify PIEDs use. Following this search, 20 studies were identified for review. Findings suggest that anabolic steroids and weight-loss supplements were the most used PIEDs. Image enhancement was mentioned the most as a reason for PIEDs use followed by keeping up with the physical and emotional demands of active duty. Additionally, findings suggested that young, male non-commissioned Army personnel were most likely to use PIEDs. There were clear gaps in the current literature surrounding PIEDs use, as well as an understanding of when service personnel began using PIEDs. Further research should aim to answer these questions.

Since the events of 9/11, the United States has experienced a resurgence of patriotism. Society actively applauds the service and sacrifice made by veterans and active military personnel. The Post-...

What explains the level of commitment within an international military alliance? Specifically, when do alliances choose to adopt active military support for offensive uses of force versus lower levels of commitment? Drawing on the rational design of international institutions literature, this paper argues that the choice of commitment is a conscious effort to address two competing problems. The first is the potential for entrapment. Allies worry that commitments may lead other member states to act in a risky fashion, creating unnecessary conflict. The other problem is the need to demonstrate commitment in order to maximize the bargaining power of the member states. The former problem leads allies to choose lower levels of commitment like defense pacts in order to signal to alliance members what types of behaviors are acceptable. Conversely, the latter problem encourages states to make broader obligations about when they will use force. Empirically, concern for moral hazard should be more likely when there are power disparities amongst members within an alliance. Greater levels of threat facing alliance members should lead states to favor maximizing their commitments. These two arguments are tested empirically on all alliances from 1816-1992 with results supporting both conjectures.

Background High rates of musculoskeletal injuries such as plantar fasciitis and stress fractures have been observed among physically active military personnel. During service time, infantry soldiers use issued boots daily that should fit well and provide comfort to prevent injuries and decrease lower extremity pain effectively. The association of military boot comfort with overuse injuries remains unclear. This study investigates the relationship between the chosen military boot size, perceived boot comfort and lower leg overuse injury. Methods During the cross-sectional study, 227 (males, n = 213; females, n = 14) active-duty infantry soldiers at a mean age of 29.5 years old, and with an average service time of 7.2 years were assessed for a history of overuse injury, footprint length, appropriate shoe size, and footwear comfort. Males with a history of overuse injury (n = 32) and non-injured age-matched controls (n = 34) were selected for detailed testing and establishing the possible relationship between footwear comfort and lower leg overuse injury. Results No relationship was found between footwear comfort and a history of lower leg overuse injury. N = 38 (57.6%) of study subjects were wearing an inappropriate shoe size daily. Inappropriate shoe size usage affected footwear comfort ratings significantly. Conclusions Study results showed that improper boot size was significantly related to comfort ratings but was not associated with a history of lower leg overuse injury.

Insomnia, whether short-term or chronic, is a common condition. It has a negative impact on vulnerable patient groups, including active military personnel and veterans, patients with coexisting psychiatric and medical disorders, those in life transitions such as menopause, and elderly persons. Although cognitive behavioral therapy for insomnia (CBTI) is first-line treatment for insomnia, its high cost and a lack of trained providers has prevented widespread uptake. Now, digital CBTI (dCBTI) is emerging as a scalable option with the potential to overcome these barriers in managed care. The first part of this article reviews the epidemiology and pathophysiology of insomnia with a focus on vulnerable patient groups. The second part explores the rapidly evolving landscape of nondrug therapy for insomnia. The underlying concepts and supporting evidence for CBTI and dCBTI are presented, including their utility in vulnerable patient groups.

IntroductionMilitary surgery requires skills that in general cannot be easily learnt in civilian training. Participation in a fellowship abroad adapted to the particular operating conditions of the foreign deployment is one route that might secure the necessary supplementary training. We therefore assessed the relevance of such a fellowship in the preparedness of young military surgeons in their first deployment.MethodsThis study included all active military surgeons who had completed a fellowship abroad during their initial training from 2004 to 2017 in Tchad or Senegal or Djibouti. The collection of data was performed using a questionnaire. The main judgement criterion was the rate of positive answers awarded to the relevance of this fellowship in the preparedness of respondents’ first foreign deployment.ResultsSixty-nine of 73 surgeons answered. Sixty-one estimated the fellowship had allowed them to feel more operational during their first mission, with 83.61% rating this feeling as important. Also, 61 recommended the use of a fellowship for war surgery training. The grade assigned to the surgical benefit was 8.48/10.ConclusionA fellowship abroad permits one to become familiar with surgical practice under austere circumstances and the particularities of the surgical structures at the front. Current trainees’ feedback confirms its relevance.

Background Chronic pain (CP) and mental disorders are common among active military personnel (AMP) due to their potential exposure to various physical and psychological stressors. Aim The aim of this study was to evaluate pain perception and beliefs regarding their pain among AMP suffering from CP using self-reported measures, and to understand the development and persistence of pain in AMP. Methods Sixty male AMP outpatients suffering CP were included. All participants completed the following forms and questionnaires: Oswestry Disability Index(ODI), Visual Analogue Scale(VAS), Neck Disability Index(NDI), Bournemouth Questionnaire for neck(BQN), International Physical Activity Questionnaire(IPAQ), Hospital Anxiety and Depression Index(HADS), 36-item Short Form Survey(SF-36), Automatic Thoughts Questionnaire(ATQ), and Pain Belief Questionnaire(PBQ). Results The mean age of the participants was 22.85±3.50 years, the median duration and frequency of pain were 12 months and 14.5 days in a month, respectively. The median of ODI scores was 26; three of patients were evaluated as crippled while 8 patients had severe disability. The HADS and PBQ-psychological scores were high in the patient group. Positive correlations were found between pain frequency and the ODI, VAS, NDI and PBQ-psychological scores. Relationships were also shown between PBQ-psychological and the VAS and ATQ scores. Correlations between ODI scores and ATQ scores were also revealed. Conclusions Our results suggest that, in addition to the organic basis of pain, there is strong evidence for significant contribution from the psychological characteristics and pain-related beliefs of the patients. Physicians may choose a multi-dimensional perspective in the diagnosis and treatment of pain, especially in patients suffering from CP.

Background The Instability Severity Index (ISI) score is a preoperative risk stratification tool used to identify patients at heightened risk of recurrent anterior instability after an arthroscopic Bankart procedure. The primary objective of this study was to validate the utility of the ISI score in predicting failure of primary arthroscopic Bankart surgery in an active-duty military population. Methods A retrospective study was performed to compare all military service members undergoing primary arthroscopic Bankart repairs at a single military treatment facility between 2007 and 2014. The primary outcome of interest was surgical failure due to recurrent instability. The ISI framework was used to stratify each patient for recurrence, and multivariate analysis was performed to evaluate the composite ISI score and individual domains between patients with and patients without failed Bankart repairs. Results A total of 131 patients were identified, with a mean patient age of 26.8 years (range, 19-47 years), among whom 42 patients (32%) were identified as having a higher-demand military occupation. At a minimum 2-year follow-up, 34 patients (26%) sustained recurrent anterior shoulder instability. The mean ISI score of patients in the failed Bankart repair group was not statistically different than that of patients with a successful repair (3.41 vs 3.5, P = .74), and no individual ISI domains were identified as independent risk factors for subsequent surgical failure or revision stabilization. Conclusion Contrary to the findings of previous validation studies, the composite ISI score and its individual risk factors were not predictive of subsequent surgical failure after primary arthroscopic Bankart repair in an active military population.

In this paper, I reflect upon my experience of working with active military officerscum-research brokers in research on the Congolese (DRC) armed forces. Drawing upon the traditions of autoethnography and Narrative International Relations, I recount the story of an evolving relationship between one particular military broker and myself. It highlights how military research brokers, while frequently cast not only as capable of handling their own security, but as prime sources of insecurity, often share the general (civilian) research broker's predicaments of insecurity. In doing so, the narrative also challenges dominant gendered, as well as racialized, ideas of who is at risk when conducting research in conflict settings.

The presented study discusses the use of analgesics by medical personnel in the colonies and at field hospitals located in the urban capitals of the colonies was an important aspect of providing immediate care to Roman veterans after injuries or other causes of chronic pain. Upon completion of twenty years or more of active military service, Roman legionnaires received financial benefits from the Roman State and free plots of land in Italy or Roman conquered lands. These outposts in Roman conquered territory served as a buffer between the Roman State and potential Roman enemies, helped to suppress insurrections in the territories they occupied and helped to Romanize these territories. The coloniae varied in size and population from a few hundred to several thousand people. Adequate medical care is indispensable to the survival and prosperity of any community of people. The larger coloniae had hospitals and health care professionals to support the colonists living there. Smaller colonies had a medical clinic with a smaller staff. Managing chronic pain suffered by ranchers and farmers was a major concern for the medici (physicians) who lived and worked in the coloniae. The veterans and their families sometimes required pain management for their functionality and quality of life.

The article provides an assessment of the patriotic education of S. Amanzholov's soldiers during the Great Patriotic War. A comprehensive analysis of S. Amanzholov's activities as a political leader is presented. The article provides new data on the use of heroic deeds of Kazakh batyrs by scientists to raise the military spirit of soldiers. During the Great Patriotic War, patriotism became the most important value in Soviet society. Selfless devotion to their Motherland manifested itself among millions of Soviet citizens and became a source of unprecedented mass heroism. From February 1942 to June 1946 S. Amanzholov was on active military service in the ranks of the Soviet Army. He conducted political and educational work among soldiers of non-Russian nationality, published in the Kazakh language the "Notebook of the Red Army Agitator" and leaflets about the heroes of the Soviet Union.

Military service is associated with increased risk of mental health problems. Previous reviews have pointed to under-utilization of mental health services in military populations. Building on the most recent systematic review, our narrative, critical review takes a complementary approach and considers research across the Five-Eyes nations from the past six years to update and broaden the discussion on pathways to mental healthcare in military populations. We find that at a broad population level, there is improvement in several indicators of mental health care access, with greater gains in initial engagement, time to first treatment contact, and subjective satisfaction with care, and smaller gains in objective indicators of adequacy of care. Among individual-level barriers to care-seeking, there is progress in improving recognition of need for care and reducing stigma concerns. Among organizational-level barriers, there are advances in availability of services and cultural acceptance of care-seeking. Other barriers, such as concerns around confidentiality, career impact, and deployability persist, however, and may account for some remaining unmet need. To address these barriers, new initiatives that are more evidence-based, theoretically-driven, and culturally-sensitive, are therefore needed, and must be rigorously evaluated to ensure they bring about additional improvements in pathways to care.

Introduction: COVID-19, caused by the betacoronavirus SARS-CoV-2, has overwhelmed the world’s health systems. Objective: To describe the epidemiological characteristics of patients treated in a tertiary care hospital. Methods: A retrospective cohort study of patients diagnosed with or suspected of having COVID-19 from March 23 to July 31, 2020 was conducted. Results: 4,401 patients were hospitalized at the Central Military Hospital, out of which 35 % were beneficiaries, 26 % civilians, 28 % active military, and only 11%, retired military. Male gender predominated, both in hospitalized patients and in those who died, as well as the O+ group and absence of comorbidities; among the observed comorbidities, the main ones were overweight and diabetes. Hospitalized patients’ median age was 49 years, while median age of those who died was 62 years; women older than 51 years had a higher risk of dying. Adjusted case fatality rate was 18.5 %; 50 % died within the first six days. Conclusions: In this study, the epidemiological characteristics and main comorbidities in Mexican patients with SARS-CoV-2 infection were identified.

BACKGROUND: Anterior instability has consistently been shown to be the most common type of glenohumeral instability. Recent studies have demonstrated a higher percentage of posterior and combined (anterior and posterior) instability than had previously been reported; however, this work has not been replicated recently in a particularly young military population, which may be representative of an especially athletic or high-demand group. QUESTION/PURPOSE: What proportion of arthroscopic shoulder stabilization procedures are performed to address isolated anterior instability, isolated posterior instability, and combined instability in a young, military population? METHODS: Between August 2009 and January 2020, two sports medicine fellowship–trained surgeons performed arthroscopic shoulder surgery on 543 patients at a single institution. During that time, the indication to be treated with arthroscopic stabilization surgery was symptomatic glenohumeral instability, as diagnosed by the operative surgeon, that restricted patients from carrying out their military duties. Of those, 82% (443 of 543) could be evaluated in this retrospective study, while 18% (100 of 543) were excluded due to either incomplete data or because the procedure performed was not to address instability. No patient underwent an open stabilization procedure during this period. Of the 443 patients investigated, the mean age was 22 ± 4 years, and 88% (392 of 443 patients) were men. Instability type was characterized as isolated anterior, isolated posterior, or combined (anterior and posterior) according to the physician’s diagnosis as listed in the patient’s clinical records and operative reports after the particular capsulolabral pathology was identified and addressed. RESULTS: Isolated anterior instability occurred in 47% of patients (210 of 443). Isolated posterior instability happened in 18% of patients (80 of 443), while combined anteroposterior instability occurred in 35% of patients (153 of 443). CONCLUSION: Shoulder instability is common in the military population. Although anterior instability occurred most frequently, these findings demonstrate higher proportions of posterior and combined instability than have been previously reported. Surgeons should have a heightened suspicion for posterior and combined anteroposterior labral pathology when performing arthroscopic stabilization procedures to ensure that these instability patterns are recognized and treated appropriately. The current investigation examines a unique cohort of young and active individuals who are at particularly high risk for instability and whose findings may represent a good surrogate for other active populations that a surgeon may encounter. Level of Evidence Level III; therapeutic study.

Background: Although studies are available on high-energy Lisfranc injuries, the evidence for increasingly reported low-energy Lisfranc injuries in active individuals, including athletes and military personnel, remains scarce and mostly retrospective. Purpose: This meta-analysis aimed to review the return-to-play (RTP) and return-to-duty (RTD) rates with regard to the anatomic type and the management of low-energy Lisfranc injuries in a high-demand, active population. Study Design: Systematic review; Level of evidence, 4. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched the MEDLINE (PubMed), EMBASE, Google Scholar, and Cochrane databases through June 2019 to identify studies on low-energy Lisfranc injuries in athletes and military personnel. The primary outcomes were RTP/RTD rates and time to RTP/RTD, and the secondary outcomes were time missed from practice, games missed, time to full recovery, midfoot arthritis rate, and reoperation rate. Results: Overall, 15 studies (N = 441 patients) were included in the meta-analysis. Of these, 6 studies were of level 3 evidence, 8 studies were level 4 (case series), and 1 study was level 5. Of the 441 subjects, 380 (86.17%) were able to RTP and RTD. There was no statistically significant difference in RTP rates for operative versus nonoperative treatment, ORIF versus PA, or bony versus ligamentous injuries. The mean time missed from practice/duty for operative versus nonoperative treatment was 58.02 days (95% CI, 13.6-102.4 days; I 2 = 98.03%) and 116.4 days (95% CI, 62.4-170.4 days; I 2 = 99.45%), respectively. The mean time missed from practice/duty for bony versus ligamentous injury was 98.9 days (95% CI, 6.1-191.7 days; I 2 = 99.82%) and 76.5 days (95% CI, 37.9-115.02 days; I 2 = 99.83%), respectively, with no statistically significant differences (standardized mean difference = 3.62 days [95% CI: –5.7 to 13 days]; I 2 = 83.17%). Conclusion: This review indicated an overall excellent RTP/RTD rate for low-energy Lisfranc injuries in high-demand individuals. The time missed from athletic participation/military duty was not affected by injury treatment type, the bony versus ligamentous nature of the injury, or athlete player position. However, the low evidence levels and significant heterogeneity of the included studies precludes making conclusions regarding length of time missed or optimal management. Higher-quality studies on low-energy Lisfranc injuries are needed.

This study aims to identify the determinants of trust in other countries, focusing on US citizens’ trust in Japan. The analysis of the data of the national Pew Research Center survey conducted in 2015 examines the determining influence of theoretical correlates, which draw from extant studies of international trust, including national images, goal compatibility, issue awareness, and historical memories. Images of the Japanese people as honest, inventive, and hardworking increase trust in Japan. US perceptions of historically inimical events in US-Japan relations do not influence current trust, and the comprehensive regression of trust in Japan on diverse correlates does not demonstrate a predicted cross-generational difference due to experiential distance from such events. A higher level of trust in Japan is observed among US citizens who think that Japan, despite its declining economy, should play a more active military role in the Asia-Pacific region. These US citizens tend to see Japan as a trustworthy partner, given the economic and military rise of China and the resulting goal compatibility (due to dealing with a common threat) between the United States and Japan.

The purpose of this paper is to discuss issues related to the use of media as a tool of information warfare: analysis of randomly selected episodes of the Russia-1 headline news show in terms of publications related to the conflict in the eastern Ukraine. Russia was selected, because of the fact that its mass media for many years have been engaged in shaping anti Ukrainian attitudes not only within their own country but also abroad. The importance of information has changed. Some time ago, it was a tool supporting the implementation of active military operations, but now it could be used as a main force, which sets the direction and determines the effects of the war. This paper attempts to answer the question of what role the Russian state television plays in conducting information warfare against Ukraine, supporting military operations in the east of the country. The object of the study was the Russian state television, namely the headline news show, summarizing the day called “Vesti at 20:00” in the period from 14 July 2014 until 14 May 2015.

We respond to the commentary by Gray, Nash, and Litz (this issue) regarding the use of cognitive processing therapy (CPT) to address moral injury as described in our previous publication (Wachen et al., 2016). In their commentary, Gray et al. posit that CPT is inappropriate when applied to the treatment of war-related traumas involving “real moral and ethical transgressions” (i.e., moral injuries). However, Gray and colleagues’ assertions are centered on a premise that is incorrect, namely that CPT is based on the idea that “self-blame and guilt are inherently illogical or inaccurate,” and that CPT assumes that all beliefs associated with moral injury are erroneous. On the contrary, we acknowledge that self-blame and guilt may be accurate responses to warzone trauma, yet disagree that CPT is not suitable in these situations. This response serves to clarify some of the inaccurate interpretations of the treatment as stated by Gray and colleagues, and reiterates the position of CPT on many of the issues that were raised. Specifically, we discuss the use of Socratic questioning within CPT to address the issue of moral injury. Furthermore, we highlight the strong evidence base for the use of CPT in treating veterans and active military. Until it has been determined through empirical study, it is premature to assert that CPT is insufficient in addressing moral injury in combat personnel.

Fleet Readiness Center Southwest (FRC SW) is the largest aerospace industrial complex in the U.S. Navy. The FRC SW conducts maintenance, repair and overhaul (MRO) activities on five major airframes with many of them being more than 20 years old. With demand for the aircraft in the field high, management at FRC SW were under enormous pressure to shorten the turn-around times of aircraft – the time between an aircraft being inducted for overhaul and the time it was returned to the warfighter for use in active military operations. Leadership at FRC SW requested the development of a simulation model that would incorporate all the important aspects of the complex and variable operating environment of their MRO facility and lend insight into how various factors and changes could affect the throughput time of aircraft across the facility. This research describes how the development and use of a simulation model uncovered several significant opportunities for management at FRC SW to increase turn-around t...

Background:Shoulder instability is a topic of significant interest within the sports medicine literature, particularly regarding recurrence rates and the ideal treatment indications and techniques. Little has been published specifically addressing the occupational implications of symptomatic recurrent shoulder instability.Hypothesis:Previous arthroscopic repair will continue to be a significant predisposing factor for recurrent instability in a young, active population, and that recurrent instability may have a negative effect on college graduation and postgraduate occupational selection.Study Design:Case series.Level of Evidence:Level 4.Methods:We conducted a retrospective review of approved medical waivers for surgical treatment of anterior shoulder dislocation or instability prior to matriculation at the US Military Academy or the US Naval Academy for the graduating classes of 2010 to 2013. Statistical analysis was performed to determine the incidence and risk factors for recurrence and to determine the impact on graduation rate and occupation selection.Results:Fifty-nine patients were evaluated; 34% developed recurrent anterior instability. Patients with previous arthroscopic repair had a significantly higher incidence of recurrence (38%, P = 0.044). Recurrent shoulder instability did not significantly affect graduation rates or self-selected occupation ( P ≥ 0.05).Conclusion:There is a significant rate of recurrent shoulder instability after primary surgical repair, particularly among young, active individuals. In addition, arthroscopic repair resulted in a significantly higher recurrence rate compared with open repair in our population. Surgical repair for shoulder instability should not necessarily preclude young individuals from pursuing (or being considered for) occupations that may place them at greater risk of recurrence.Clinical Relevance:The risk of recurrent instability is greater than the rate typically described, which may suggest that some subpopulations are at greater risk than others. A unique data point regarding instability is the effect on occupation selection.

Lyme disease is a continuing threat to military personnel operating in arboriferous and mountainous environments. Here we present the case of a 24-year-old Second Lieutenant, a recent graduate from the United States Military Academy, with a history of Lyme disease who developed recurrent knee effusions following surgery to correct a hip impingement. Although gonococcal arthritis was initially suspected from preliminary laboratory results, a comprehensive evaluation contradicted this diagnosis. Despite antibiotic therapy, aspiration of the effusions, and steroid treatment to control inflammation, the condition of the patient deteriorated to the point where he was found to be unfit for duty and subsequently discharged from active military service. This case illustrates the profound effect that latent Lyme disease can have on the quality of life and the career of an active duty military member. It highlights the need for increased surveillance for Borrelia burgdorferi (B. burgdorferi) in military training areas and for the early and aggressive diagnosis and treatment of military personnel who present with the symptoms of acute Lyme disease.

Primary Objective: Research focused on mild traumatic brain injury in active military and veteran populations details the psychological, neurological and functional outcomes of mTBI, in a primarily...

Veterans’ Voices is a unique space for the contributions of veterans, active military, and military family members to voice their perspectives and experiences with areas of military or veteran life of interest to Journal of Veterans Studies readership and veterans studies scholars. Authors connect their experiences or perspectives with issues (explored or not yet explored) in applicable research, academic, or teaching fields. Veterans’ Voices submissions are vetted by members of the Journal of Veterans Studies editorial board.

Background: Research has shown that number of and blast-related Traumatic Brain Injuries (TBI) are associated with higher levels of service-connected disability (SCD) among US veterans. This study builds and tests a prediction model of SCD based on combat and training exposures experienced during active military service.Methods: Based on 492 US service member and veteran data collected at four Department of Veterans Affairs (VA) sites, traditional and Machine Learning algorithms were used to identify a best set of predictors and model type for predicting %SCD ≥50, the cut-point that allows for veteran access to 0% co-pay for VA health-care services.Results: The final model of predicting %SCD ≥50 in veterans revealed that the best blast/injury exposure-related predictors while deployed or non-deployed were: 1) number of controlled detonations experienced, 2) total number of blast exposures (including controlled and uncontrolled), and 3) the total number of uncontrolled blast and impact exposures.Conclusions and Relevance: We found that the highest blast/injury exposure predictor of %SCD ≥50 was number of controlled detonations, followed by total blasts, controlled or uncontrolled, and occurring in deployment or non-deployment settings. Further research confirming repetitive controlled blast exposure as a mechanism of chronic brain insult should be considered.

Both negative posttraumatic cognitions and posttraumatic stress disorder (PTSD) symptoms decrease over the course of cognitive-behavior therapy for PTSD; however, further research is needed to determine whether cognitive change precedes and predicts symptom change. The present study examined whether weekly changes in blame predicted subsequent changes in PTSD symptoms over the course of cognitive processing therapy (CPT). Participants consisted of 321 active duty U.S. Army soldiers with PTSD who received CPT in one of two clinical trials. Symptoms of PTSD and blame were assessed at baseline and weekly throughout treatment. Bivariate latent difference score modeling was used to examine temporal sequential dependencies between the constructs. Results indicated that changes in self-blame and PTSD symptoms were dynamically linked: When examining cross-construct predictors, changes in PTSD symptoms were predicted by prior changes in self-blame, but changes in self-blame were also predicted by both prior levels of and prior changes in PTSD. Changes in other-blame were predicted by prior levels of PTSD, but changes in other-blame did not predict changes in PTSD symptoms. Findings highlight the dynamic relationship between self-blame and PTSD symptoms during treatment in this active military sample.

Purpose: To examine the results of isolated arthroscopic posterior labral repair of the shoulder in an active military population, looking specifically at the reoperation rate and rate of return to previous military activity with a minimum follow-up period of 2 years. Methods: A retrospective case series was performed in active-duty military service members who underwent isolated, primary arthroscopic posterior labral repair at a single academic military treatment facility between 2009 and 2015 and had at least 2 years of follow-up. Patients were excluded if they were of non–active-duty status, had insufficient follow-up (

Desertion from active military service has always been a contentious action, especially in times of war. Deserters in the eighteenth century were routinely castigated as poor patriots or traitorous subjects. Recently, scholars have begun to analyse in greater depth how and why desertions occurred, and have demonstrated that political considerations were less important than issues of identity and interest. However, in the context of the American Revolutionary War, historians have focused on the relationship between deserters and the military, arguing that soldiers who left their posts were less integrated into the camp community. This article suggests that the act of desertion was often more than a protest against conditions or discipline, but instead was shaped by a deserter's connections with civil society rather than the military community.

Military space technology is both stabilizing and destabilizing in international relations in respect to the distinction between passive and active applications. Space has been militarized from the dawn of humanity’s entry to space, but it is presently not weaponized. Although the benefits of passive military space technology are vast and promising, access to these benefits is exclusive and dominated by certain actors, leading other states to possible destabilizing influences of insecurity. Also, the failures of space law and treaties in regulating active military space technology stand to undermine the stabilizing effects of passive military space technology if not addressed.

This paper describes the late imperial militarized mode of adjudication (yi junfa congshi) and its relationship to eighteenth-century cases of summarized execution under the imperial standard (gongqing wangming). It shows that during the Ming and Qing, militarized adjudications, which were essentially summary in nature, occurred along a spatial-temporal gradient of military operations which was a function of proximity to and intensity of active military operations. The paper also demonstrates that prior to the eighteenth century, militarized adjudication was a different mode of adjudication from the routine adjudicative system (zhuanshen, heshen, qingzhi) associated with the Qing Code (DaQing luli). When norm-violating behavior occurred closest to the battlefield at the time of battle, it was more likely that the offender would be summarily adjudicated under modal junfa. This relationship changed over time. Imperial standard executions (gongqing wangming jixing zhengfa), primarily an eighteenth-century phenomenon, developed out of the practice of militarized adjudications. The paper relies on writings of Wang Yangming, and criminal cases to delineate the two different paradigms of modal junfa and the routine adjudicative process. It demonstrates the change in time in the relationship between militarized adjudication, routine adjudication, and the military operations gradient.39-58

This essay explores the connections between Paine’s international thought and the theory of liberal internationalism in the field of Political Science. Paine was first to provide a coherent theory of how democracy, free trade, and limited military spending would promote both peace and prosperity. One troubling inconsistency in Paine’s liberal internationalism rests in his advocacy for both small military budgets and active military intervention to spread democracy. By comparing Paine’s divergent views regarding democracy promotion and intervention in Louisiana and in England, we emerge with a far more nuanced understanding of Paine’s promotion of democracy. I argue that Paine’s vision for active military interventionism is not inconsistent with a small military.

The aim of this commentary is to discuss potential clinical implications of introducing resilience-building interventions into care for veterans who are living with a war wound. Some war veterans are expected to live with a wound upon discharge from an active military role and also to fit into civilian life. These lifestyle adjustments can tax the person's coping abilities and in that context may hinder successful adaptation. The experience of living with a wound or wounds, either acute or chronic, is connected to losses, including loss of mobility, loss of financial capacity (unable to work at times) and losses attached to changed social roles. Psychological stress is also a common experience for veterans returning to civilian life. Psychological stress is associated with impaired wound healing. Modern health practice is centred on symptom reduction and working with pathology, however, working with people's adaptive behaviours such as resilience has not been considered. Using the resilience model as a conceptual framework health-care professionals can engage with veterans towards resilience within the context of their personal experience of ill health. Using this contemporary framework for considering these aspects of care has the potential to facilitate resistance to stressors associated with being injured, possibly preventing quality-of-life impairments. Declaration of interest: There are no declarations of interest.

This study identifies and describes currently available programs and services for families who have a veteran family member living with Operational Stress Injuries (OSIs). An environmental scan was completed of web-based program information for familial OSI supports. Resources were reviewed and informed a SWOT (strength, weakness, opportunity, and threat) analysis. The study accessed 278 sources. Sixty-six resources met inclusion criteria, including 19 from Canada, 24 from the United States, 15 from the United Kingdom, and eight from Australia. Most resources are for active military members or veterans. Resource descriptions indicate a range of formats and intended family members. Existing resources are often embedded in supporting daily military life rather than issues related to life with OSIs, which may decrease efficacy of OSI-specific interventions. Information on evaluation and evidence for resources is also limited. Due to geographical challenges, there is a call for increasing use of techn...

The majority of research concerning student veterans has been conducted at the university level, with minimum analysis performed at the level where the vast majority of returning veterans attend school: the community college. While some research has discussed what services colleges and universities should offer returning veterans, little research has been conducted on understanding the actual experiences of veterans making the transition from service member to college student. A group of varied gender and racial backgrounds took part in an effort to describe the lived experiences of combat veterans making the transition into community college after active military service. Findings include the inadequacy of current models for use in understanding student-veteran transition experiences, particularly at the community college, and the discovery that the majority of student veterans involved in this study do not take part in on-campus programs specifically designed for them. The experiences of militar...

When confronting the issue of Alcohol and Drug Use Disorders (AUD/DUD) in Active Military and Veteran Personnel of the United States Military several questions arise: Are there reliable information...

The dynamic changes in the social environment marked by positive and negative effects of the priority factors at the macro – and micro level and at the level of interpersonal relationships in the process of social adaptation of servicemen discharged from military service, determine the current importance of the need to search for suitable approaches to the formation of key competencies in them, based on which they can find their realization in the new living conditions .

With increasing threats of terrorism, police and military detection dogs are of growing importance for protecting servicemen/women and society. However, a relatively high proportion of potential working dogs fail to make full operational status, or are later withdrawn from service. To date, research has focused primarily on factors which are associated with a dog’s short term success, such as passing/failing certification after training. Rather than the more important outcome of working life expectancy. In this study, we used two validated instruments of temperament (Positive and Negative Affect Scale (PANAS) and Dog Impulsivity Assessment Scale (DIAS)) to identify factors associated with long-term working dog success. Active working UK police dogs (n = 63) scored significantly higher on the trait “energy and interest” within PANAS and “responsiveness” within DIAS in comparison to a general population of those withdrawn from service (n = 16), and those included for a matched pairs analysis (n = 11pairs), and the wider pet dog population (PANAS n = 343; DIAS n = 571). This suggests that the combination of these traits may be important for a long-term working life. There was no significant difference between active UK police dogs and active military dogs (n = 20) on these factors, suggesting this trait may also be important across different service fields. Comparison with a non-UK police dog sample (active Dutch police dogs n = 28) revealed no significant differences in energy and interest, but higher responsiveness scores in active UK police dogs, further highlighting the importance of these traits in working dog populations. Future research should assess the cause-effect relationship between these traits and success / withdrawal from work in the field.