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A retrospective naturalistic evaluation was undertaken to identify if pre- and post-disaster factors may predict the likelihood of those considered “at risk” of post-traumatic stress disorder (PTSD) entering a post-disaster clinical treatment program.
Methods
The intake data of 881 people referred to the program following the Queensland (Australia) natural disasters of 2010-11 was evaluated. Those referred scored >2 on the Primary Care PTSD scale. Assessment included the disaster exposure experience, demographic and clinical information, and measures of coping and resilience. Descriptive analyses and a Classification Tree Analysis (CTA) were undertaken to ascertain which factors may predict treatment participation.
Results
The treatment group (TG) in comparison to the non-treatment group (NTG) were more likely to perceive their life was threatened (85.1% vs 8.1%), less able to cope (67% vs 25.8%) and less resilient (4.2% vs 87.5%). The CTA using all the assessment variables found the Connor-Davidson (2-item scale) (P < 0.001), degree of property damage (P < 0.001), financial losses (P < 0.001), perception their life was threatened (P < 0.001) and insurance claims (P < 0.003) distinguished the TG from the NTG.
Conclusions
The study identified factors that distinguished the TG from the NTG and predicted the likelihood of participation in a post-disaster mental health treatment.
To improve the visibility and accessibility of secure inpatients’ physical health needs by measuring staff satisfaction levels towards physical health information and monitoring.
Methods
Through purposive sampling we conducted a five-point Likert Scale on members of the multidisciplinary team (MDT) on one medium-secure forensic ward, within Oxleas NHS Foundation Trust, which provides 124 forensic inpatient beds to southeast London. We collated physical health data from across electronic patient records to create a single-point-of-access workspace on Microsoft OneNote, accessible to all members of the MDT contemporaneously, comprising past medical history, psychotropics requiring close monitoring (e.g. lithium, clozapine, valproate), vital signs, weight, bloodwork, electrocardiogram findings, hospital appointments/results and cancer screening.
We re-sampled members of the ward MDT after the workspace had been created and implemented.
Results
Nine members of the multidisciplinary team were sampled before and after the OneNote workspace was implemented.
• Pre-intervention, 56% disagreed that they were confident in quickly viewing recent investigation results. Post-intervention, 99% of users agreed/strongly agreed, with no negative responses.
• Pre-intervention, 67% disagreed or strongly disagreed that they were confident in knowing what physical health appointments were scheduled. Post-intervention, 100% of respondents agreed/strongly agreed.
• Pre-intervention, 78% disagreed or strongly disagreed that they were happy with the availability of past medical history information. Post-intervention, this increased to 99% agreed/strongly agreed.
• Pre-intervention, 89% disagreed/strongly disagreed that they knew where to see patients on psychotropics requiring close monitoring. Post-intervention, this increased to 100% strongly agreed.
• Pre-intervention, 66% disagreed/strongly disagreed being able to see single-point, up-to-date physical health information, at baseline. This increased to 99% agreed/strongly agreed post-intervention.
Overall, 89% agreed/strongly agreed the workspace would allow them to better understand the physical health and monitoring needs of patients, whilst 78% agreed/strongly agreed it allows for more effective work across wards/sites in the Oxleas forensic directorate.
Conclusion
Physical health information is often overlooked in secure inpatient settings. Due to the limitations of the electronic patient record, it can be difficult to find relevant physical health information quickly. This can lead to dissatisfaction and a lack of confidence in the MDT, as shown in the baseline data.
After the Microsoft OneNote dashboard was introduced, there was a marked improvement in staff confidence, happiness, and awareness of physical health requirements for each patient.
Further data needs to be collected to assess for sustainability of these improvements. We intend to expand the scope of this system across the secure inpatient units in the Trust.
Diffusion of alkali and low-atomic-number elements during the microbeam analysis of some silicates by analytical electron microscopy (AEM) has been known for some time. Our repeated analyses at 300 kV of kaolinite, halloysite, smectite, biotite, muscovite and pyrophyllite, however, showed differential loss (relative to Si) of not only alkali elements (such as K, Na, Mg) and low-atomic-number elements (such as Al) but also higher-atomic-number elements (such as Fe, Ti). For AEM of these phyllosilicates, a Philips EM430/EDAX facility with a tungsten filament was used to provide a current of 0.3 nA in a stationary beam of nominal diameter 90 nm. The loss of Al in kaolin minerals during analysis is particularly severe. Kaolin crystals can be damaged by the electron irradiation over several seconds, making it the most sensitive clay to the electron beam; in general, relative phyllosilicate stabilities are kaolin < smectite < pyrophyllite < mica. A clear dependence of element loss on crystallographic orientation has been observed for layer silicates in our study; a greater element loss occurred when the plane of the specimen foil was perpendicular to the basal planes of the phyllosilicate crystals than when the foil was parallel to the basal planes. Lower beam current, larger beam diameter and thicker specimens all reduce the loss of elements. The initial stage of irradiation produces highest rates of element loss and the rate of loss can be fitted by an exponential decay law. The analyses at low temperature of phyllosilicates showed that element loss remains serious in our analytical conditions. Since the element loss appears to be instrument- and method-dependent, one should use closely related, well-characterized phyllosilicates as compositional standards to calibrate any AEM instrument that is to be used to analyze unknown phyllosilicates, and the standards and unknowns should be analyzed under identical conditions.
Although some animal research suggests possible sex differences in response to THC exposure (e.g., Cooper & Craft, 2018), there are limited human studies. One study found that among individuals rarely using cannabis, when given similar amounts of oral and vaporized THC females report greater subjective intoxication compared to males (Sholler et al., 2020). However, in a study of daily users, females reported indistinguishable levels of intoxication compared to males after smoking similar amounts (Cooper & Haney, 2014), while males and females using 1–4x/week showed similar levels of intoxication, despite females having lower blood THC and metabolite concentrations (Matheson et al., 2020). It is important to elucidate sex differences in biological indicators of cannabis intoxication given potential driving/workplace implications as states increasingly legalize use. The current study examined if when closely matching males and females on cannabis use variables there are predictable sex differences in residual whole blood THC and metabolite concentrations, and THC/metabolites, subjective appraisals of intoxication, and driving performance following acute cannabis consumption.
Participants and Methods:
The current study was part of a randomized clinical trial (Marcotte et al., 2022). Participants smoked ad libitum THC cigarettes and then completed driving simulations, blood draws, and subjective measures of intoxication. The main outcomes were the change in Composite Drive Score (CDS; global measure of driving performance) from baseline, whole blood THC, 11-OH-THC, and THC-COOH levels (ng/mL), and subjective ratings of how “high” participants felt (0 = not at all, 100 = extremely). For this analysis of participants receiving active THC, males were matched to females on 1) estimated THC exposure (g) in the last 6 months (24M, 24F) or 2) whole blood THC concentrations immediately post-smoking (23M, 23F).
Results:
When matched on THC exposure in the past 6 months (overall mean of 46 grams; p = .99), there were no sex differences in any cannabinoid/metabolite concentrations at baseline (all p > .83) or after cannabis administration (all p > .72). Nor were there differences in the change in CDS from pre-to-post-smoking (p = .26) or subjective “highness” ratings (p = .53). When matched on whole blood THC concentrations immediately after smoking (mean of 34 ng/mL for both sexes, p = .99), no differences were found in CDS change from pre-to-post smoking (p = .81), THC metabolite concentrations (all p > .25), or subjective “highness” ratings (p = .56). For both analyses, males and females did not differ in BMI (both p > .7).
Conclusions:
When male/female cannabis users are well-matched on use history, we find no significant differences in cannabinoid concentrations following a mean of 5 days of abstinence, suggesting that there are no clear biological differences in carryover residual effects. We also find no significant sex differences following ad libitum smoking in driving performance, subjective ratings of “highness,” nor whole blood THC and metabolite concentrations, indicating that there are no biological differences in acute response to THC. This improves upon previous research by closely matching participants over a wider range of use intensity variables, although the small sample size precludes definitive conclusions.
The Epilogue examines how trends from the 1990s continued to develop in the following decade. These included the growing civil–military gap, even as the American public lauded the troops as heroes; tensions between notions of the soldier as a male warrior and more inclusive visions of soldiers might be; and the question of what roles soldiers might be asked to take on. First, it explores how soldiers began to talk about themselves as ‘Spartans’, referencing their separate status as a warrior caste. It also examines how popular culture and the military itself began to increasingly venerate Special Forces ‘operators’, using these images to sell products as diverse as video games, fitness regimes and coffee blends, but also to reinforce notions of American soldiers as quasi-supermen, capable of incredible feats. Finally, it examines a cultural phenomenon that cut against the grain of ‘Spartan’ and ‘operator’ images: the ‘Fobbit’ – a term that refers to the personnel deployed to Forward Operating Bases but who avoided combat by remaining at the base, a description that then broadened to describe all sorts of personnel who deployed overseas but didn’t face the prospect of combat.
Even as the Army increased its commitment to peacekeeping, its overall strength declined, as defence budgets dropped from their Cold War heights. This drawdown saw the Army turn inwards as it managed the shift from a forward-deployed overseas force to a smaller one primarily based in the continental United States. As the Army’s numbers fell and the overseas missions it deployed on increased, soldiers and their families suffered from the increase in operational tempo and the Army struggled to retain personnel. Later in the decade, the Army faced a severe recruiting shortfall amid a booming economy, as it missed its enlistment targets in 1998 and 1999. This shortfall, which coincided with an increasing reliance on the National Guard and Army Reserve for overseas deployments, as well as internal deliberations over the changing role of the Army, prompted renewed concerns about the health of the All-Volunteer Force. Tensions between the twin ideals of the ‘citizen soldier’ and the ‘profession of arms’ were heightened after the end of the Cold War, as the Army’s leadership struggled to rethink the nature of military service while managing a large-scale drawdown from their 1980s peak.
This chapter traces the Army’s rehabilitation of its reputation in the wake of the Vietnam War. Two features were central to this transformation: the first was the advent of the All-Volunteer Force and the post-Vietnam reforms to Army training, equipment and doctrine. After a shaky start, the All-Volunteer Force’s success normalised the notion of soldiering as an occupation rather than an obligation, and reforms seemed to create a much more professional and competent force than the one that was wracked by unrest and uncertainty. Second, the Army’s performance in Operation Desert Storm affirmed this narrative of professionalism and competence. Nowhere was this more apparent than in the aftermath of the war. The celebrations that took place to welcome home Gulf War veterans stood out as the largest seen in the United States since the end of World War II. Representing a crucial moment in the American public’s deepening veneration for US soldiers and veterans, the Gulf War celebrations marked a turning point when the Vietnam-era image of the soldier as a broken or rebellious draftee was finally and purposefully eclipsed by the notion of the volunteer service member as hero.
As the Army found itself caught up in debates about a ‘kinder, gentler military’, Army leaders reacted by emphasising cultural change. Part of this cultural shift came from the bottom up, as commanders in elite combat units showed a new interest in the psychology of killing and brought in consultants to lecture their instructors on how to more effectively inculcate a willingness to kill. Much of it came from the top, though. General Eric Shinseki controversially mandated that all soldiers would wear black berets as their working headdress to symbolise a new Army culture, and he commissioned a study on the ‘warrior ethos’ and begin to enshrine that ethos into Army doctrine and training. This warrior ethos – the idea that all soldiers are de facto heroic and potential Rangers – had the goal of democratizing notions of soldiering within the Army. However, not only did the warrior ethos require all soldiers to psychologically orientate themselves towards combat, but one of the unintended consequences of the decision may have been to help to put the American soldier a little higher on the pedestal of public opinion and inadvertently widen the gap between soldier and citizen.
This chapter examines post–Cold War debates in the United States over the US Army’s participation in peacekeeping operations. Peacekeeping missions may have been a central concern of the US Army in the 1990s, but they also exposed deeper fissures within the Army and broader American society about the organisation’s proper role and the sort of attributes that American soldiers would need in the twenty-first century. Army leaders and personnel deployed on peacekeeping operations struggled to articulate which martial values best applied to peacekeeping. Political commentators tended to be much less ambivalent about peacekeeping, with some neoconservative observers enthusiastic about using such operations to practice ‘soft’ skills that would be useful in later wars, while most conservatives displayed a deep antipathy for such interventions, arguing that they corroded valuable warfighting skills and were symptomatic of an Army that had lost its way. For the few liberal commentators engaged in debates over Army policy, peacekeeping operations represented an opportunity to showcase American values and even to promote a deeper connection between the US military and broader American society.
As the Army reflected on the lessons of the Gulf War, it worried about the challenges it had faced in that war. First, the full build-up of forces had taken months, and time was a luxury the Army might not have again. Second, the triumph of precision airpower seemed to herald the arrival of the Revolution in Military Affairs that threatened to relegate ground troops to supporting roles. To help meet these challenges, Army leaders embraced the concept of ‘transformation’. With it, they pushed the Army towards a lighter, more deployable force, emphasising an ‘expeditionary culture’, and began the process of restructuring the Army around modular brigades rather than the larger, less deployable division. These brigades would be heavily reliant on lighter, faster, wheeled Stryker armed fighting vehicles, advanced communications equipment and precision weapons, and would be rapidly deployable to crisis points. Ironically, these new ‘expeditionary’ units would be heavily reliant on the support of civilian contractors, who took on increasing amounts of logistical and maintenance work within the transformed Army.
This chapter begins with the Army’s position in the 1993 debate over allowing gay personnel to serve openly in the US military. The chapter argues that the generals’ arguments for maintaining the ban on gay people in the military centred on the notion that the military was an exceptional institution within US society, with claims about the need for combat cohesion and the maintenance of a ‘band of brothers’ paramount in their approach to the issue. When it came to the question of women’s service in the military, the debate played out on very similar lines. As with gay soldiers, critics argued that the presence of women would negatively affect the cohesion of these close-knit outfits. Not only that, but a series of sexual assault scandals prompted right-wing critics of the military to contend that the Army should discontinue gender-integrated recruit training and further restrict the role of women in the Army. This went in tandem with complaints that recruit training was now too soft, and that the Army should look to the Marine Corps for an example for how to recruit and train warriors.
The Introduction sketches out the key themes of the book, offers a justification for focusing on the identity of the American soldier as a key issue in the Army’s post–Cold War transformation and introduces the reader to literature on ‘warrior culture’. Just as Army leaders and ordinary soldiers often meant very different things when they spoke about warriors, so contemporary historians, anthropologists and classicists have used the term in various ways. Thus, the latter part of the Introduction spends some time examining how the term has evolved and been deployed in different contexts.
In an era where 'history' had supposedly ended, what was an Army for? This question confronted the US Army at the end of the Cold War. Although public support for the military remained high, fewer were sending their children to enlist and questions were raised about the uncertainty of future operations: How would Army leaders prepare soldiers for difficult peacekeeping operations that called for a more human-oriented approach in light of the promises of high-tech warfare? How best to navigate the broader debates about changing gender and sexual norms in American society? Pulled in different directions, the Army struggled to put forward a compelling vision of who and what the American solder should be. In Uncertain Warriors, David Fitzgerald reveals how, in response to this uncertainty, they eventually fell back on an older vision of martial masculinity, embracing a 'warrior ethos' that was meant to define the contemporary American soldier.