Journal articles on the topic 'Civilian Military Task Force (Guam)'

This article uses two puzzles from the Brezhnev period to test competing models of Soviet military policy and of innovation in military “doctrine.” An organizational model of Soviet military policy offers the best explanation of both cases: why the Soviet Union's Brezhnevera military strategy contradicted the Politburo's priorities (to prevent any war from escalating to nuclear use) and why the Soviet Union agreed to the ABM treaty. The ABM case shows that civilian leaders can force change in military “doctrine” when they have a policy handle–a way of redefining the issue to remove it from the military's exclusive area of competence. When civilians lack a policy handle, as in the military strategy case, they are unable to force innovation if the military is unwilling.The Russian government now faces the task of finding effective policy handles that will institutionalize civilian control of military policy. The fate of Russia's reforms may depend on it.

In contrast to other European countries, Italy lacks a Civil Defense Organization. Air Rescue is a task for the Italian Air Force Search and Rescue (S.A.R.) organization. It may also draw, if necessary, on the cooperation of the other Armed Forces and State Corps, the Merchant Navy, civilian organizations, the Italian Red Cross (C.R.I.), and the Mountain Rescue Service of the Italian Alpine Club (C.A.I.). The S.A.R. units intervene at the request of civil, state, public and private, national and international organizations. The tasks currently performed by the S.A.R. in Italy include search and rescue of civilian and military air crews lost at sea or over land and of shipwrecked survivors; emergency transport of doctors and supplies to the seriously sick or injured patients from ships at sea; inaccessible localities, earthquakes, floods, and other disasters.

Abstract Defence organisations are unique in that they comprise integrated military and civilian personnel working in partnership with each other (e.g., in headquarters, on bases, on missions, in academic settings). Many defence civilians are supervised by military supervisors and managers, while others are themselves responsible for managing military personnel. At the same time, despite often high levels of partnership and integration, military and civilian personnel are governed by very different personnel management systems, and have distinct cultures. These factors can affect the nature and quality of the collaboration and influence personnel outcomes and organisational effectiveness. Indeed, defence organisations are increasingly recognizing the importance of optimizing integration between their military and civilian workforces, with many adopting organisational terms implying that the military and civilian workforces form a cohesive whole: the Defence Team (Canada), the Whole Force Concept (United Kingdom), One Defence Team (Sweden), and Total Defence Workforce (New Zealand). This paper presents results from the Military–Civilian Personnel Survey (MCPS), which was administered in 11 nations as part of a NATO Research Task Group on the topic of military-civilian personnel collaboration and integration (NATO STO HFM RTG-226). This survey was the first systematic examination of large samples of military and civilian respondents, and the first to examine military–civilian relations from the perspective of both military and civilian personnel. The results presented here are based on three open-ended questions included in the survey, which asked respondents to identify 1) the most important factors for establishing and maintaining positive military-civilian personnel work culture and relations, 2) the challenges of working in a military-civilian environment, and 3) the main advantages of working in a military-civilian environment. Results of 5 nations, including Canada, Netherlands, New Zealand, Sweden, and the United Kingdom (n =1,513 military respondents and n = 2,099 defence civilians) are presented. Results indicate that mixed military-civilian work environments present both unique challenges and advantages, and identified the factors considered to be important for enhancing integration and collaboration between military and civilian personnel. Given that many cross-national patterns emerged, these findings provide useful insights for enhancing military and civilian personnel integration and collaboration across nations. *Adapted from the material first reported in Goldenberg, I. & Febbraro, A.R. (2018; in publication). Civilian and Military Personnel Integration and Collaboration in Defence Organizations. NATO Science and Technology Organization Technical Report - STO-TR-HFM-226. DOI 10.14339/STO-TR-HFM-226. ISBN: ISBN 978-92-837-2092-8.

Abstract With emergency powers, President Rodrigo Duterte mobilized and deployed military and police to enforce lockdown measures in Metro Manila and Cebu City. For several months in 2020, the deployed forces ran quarantine control points in borders and city wards, and enforced curfew and liquor bans. This article examines how said deployment affected civilian control by the President and local civil-military dynamics. The heightened visibility of uniformed personnel in these urban spaces, and subsequent arrests and detention of quarantine violators came under heavy criticism. Against the backdrop of ex-military dominated national Inter Agency Task Force for Infectious Diseases (IATF), the militarized lockdown failed to stem the virus’ spread and expanded the military’s reach into civilian domain. Its involvement in law enforcement operations alongside the police poses dangers to local civil-military balance and to democracy. President Duterte’s reliance on the state’s coercive apparatus to carry out the pandemic response enabled him to assert control over local governments and to repress dissent.

Within the context of increasingly digital work, it appeared interesting to look at how military leaders and their leadership style will have to adapt to remain “up-to-speed” with current challenges. It is qualitative research based on interviews with military and civilian experts. Four interviews have been conducted, but there would be the potential to interview many more experts and look deeper into the matter. Within the context of digitalised military leadership, the importance of communication and mutual trust has been underscored by the experts. They agreed that leaders nowadays must embrace digital developments and include them in their leadership styles. The civilian world can learn from the military when it comes to leadership approaches, which is happening at the time of publication of this article with practical examples (senior military leaders assigned to lead the pandemic task force in some countries). Overall, the outcome of the research is that a relevant and resilient military leadership style in the 21st century resembles the elements of the situational leadership style developed by Hersey-Blanchard.

The spread of COVID-19 has been declared a non-natural national disaster, and it is recognized as a genuine non-military threat that necessitates collaboration among various institutions, particularly within the context of non-military defense, which falls under the purview of the Indonesian National Armed Forces (TNI). Responding to COVID-19 falls under the government’s responsibility, which includes the establishment of the COVID-19 Response Acceleration Task Force. The collaboration between civilian institutions and the TNI as elements of the unit is expected to demonstrate a streamlined and effective command line, aiming to uphold and safeguard the nation’s security effectively. This paper aims to analyze the role and capacity of TNI in addressing the COVID-19 Pandemic as a non-military threat by measuring the impact of various determinants on the implementation of the role and capabilities of TNI. The research employed a mixed methods approach, incorporating both sequential and concurrent models. Additionally, it involved an in-depth qualitative analysis of each determinant utilized in handling the COVID-19 pandemic. Generally, the primary elements in the COVID-19 Response Acceleration Task Force are civilian institutions based on the category of disaster and its societal impact. Nevertheless, the involvement of TNI through Military Operations Other Than War (OMSP) can expedite COVID-19 management through aid and humanitarian operations. Non-military defense operations strategically establish control command between ministries/agencies and local governments. The optimization of TNI’s capabilities in crisis management involves deploying personnel across Indonesia, with a central command under the TNI Commander and the establishment of command centers in crisis-affected areas. The success of TNI’s performance can be evaluated by examining its strategic leadership and patterns of civil-military cooperation in a systematic and deliberate manner.

ABSTRACT Initial DoD support of Federal Emergency Management Agency (FEMA) operations for New York City (NYC) coronavirus disease 2019 (COVID-19) relief included the deployment of military medics to the Javits New York Medical Station and USNS Comfort. When Air Force (AF) Reservists arrived in NYC, 64th Air Expeditionary Group leaders worked with FEMA, Task Force New York/New Jersey, and NYC chains of command to send Airmen to NYC hospitals, including Lincoln Medical Center (LMC). Within 72 hours of arrival, 60 AF Reservists, including 30 registered nurses and 3 medical technicians, integrated into LMC to provide support during April and May 2020. This assistance began during the peak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections. Air Force nurses provided over 6,000 hours of care to over 800 patients in the emergency department and ad hoc intensive care and medical-surgical units. As infections declined, AF nurses shifted to providing care in established units. In these units, AF nurses provided patient care and worked directly with LMC nurses to provide directed teaching experiences to improve their comfort and competency with caring for acutely ill COVID-19 patients. The deployment of AF Reservists into civilian facilities was a success and bolstered the capability of three facilities struggling to care for SARS-CoV-2 patients. This effort was recognized by military and civilian healthcare leaders and resulted in over 600 military medical personnel being sent to support 11 NYC public hospitals.

executive summary: This article compares the logistical challenges associated with the West's military resupply of Ukraine and those of resupplying Taiwan in a potential future conflict. main argumentDespite facing critical munitions shortages and growing political divisiveness over the substantial financial burden of this policy, the West's resupply of the Ukrainian military during Ukraine's current war with Russia has—so far—been a success, keeping forces battle-worthy and able to continue fighting after nearly two years of high-intensity conventional warfare. Would the resupply of Taiwan against China in wartime be similarly feasible for the U.S. and its regional partners in the Pacific? Major obstacles distinguish the Taiwan scenario. In prioritizing planning for a Taiwan contingency, the U.S. government should consider five major logistical factors: geopolitical ambiguity, the tyranny of distance, the need to resupply by air and sea, the involvement of reliable regional partners, and China's tolerance for the supply of armament to Taiwan in wartime. policy implications• Pre-positioning war materiel forward on allied soil is crucial to enable a rapid response to any military aggression against Taiwan. Besides increasing stocks of arms and ammunition in Taiwan itself, materiel should be pre-positioned with short reach to Taiwan in Japan, South Korea, and the Philippines and closely linked with depots in Guam, Hawaii, Australia, and the continental U.S. in a hub-and-spoke framework. • To assist Taiwan in establishing reserves of arms and munitions, the U.S. should increase technology transfer and joint production of critical war materiel with and in Taiwan. Boosting Taiwan's own defense industry base will help ensure the security of supply and an independent maintenance, repair, and overhaul capability in a conflict. Moreover, to ensure the materiel survives, hardening, decentralization, and the ability to disperse at least parts of the industrial production and maintenance, repair, and overhaul capability should be advanced. • In a war across the Taiwan Strait, Taiwanese ports and airports would come under attack early on, and even if they were not destroyed, the People's Liberation Army would try to block access to them, hindering resupply efforts. Strong emphasis should be placed on the development of robust amphibious and civilian roll-on/roll-off capabilities, buildup of temporary piers, and improvement of Taiwan's transportation infrastructure.

Since 2013, the northern region of Nigeria has witnessed the unprecedented mobilization of militia group Civilian Joint Task Force to aid combating the Islamic fundamentalist Boko Haram. The participation of the militia was reportedly successful in routing the insurgent. Before the CJTF, Boko Haram defied most of the counterinsurgency measures of the government including the military and the political approaches. However, despite the successes of the CJTF, the strategy that influences the successes was not adequately known. This article, therefore, investigated the strategy of the CJTF that influences its successes. The study was conducted using a qualitative method designed in a case study. Data were collected from thirteen informants through in-depth interviews supported by non-participant observation. The finding shows that CJTF is a kind of informal self-defense group that emerged in response to the inadequate protections by the State. The combating successes of the group were influenced by the information-centric approach of its campaign. Careful intelligence gathering and procession along with the sociocultural linkage of the participants and in-depth knowledge over the physical terrain emerged influential to the groups’ combating. The article recommended that the Nigerian government should re-strategize its existing conventional counterinsurgency approach to adapt to the population-centric paradigm. The government should also adopt palliative measures of promoting sustainable counter-insurgency that should focus on inclusive governance, accountability, and addressing socio-economic issues of poverty and unemployment with all levels of seriousness rather than sticking to the security-only campaign.

The Royal Norwegian Air Force (RNoAF) performs a large number of mission types. Many of these missions are undertaken in exceedingly difficult operational environments. Because of the challenges presented by seasonal variations, poor weather conditions and demanding operational task requirements, the importance of an optimal working environment to ensure crew health and safe flight operations should be emphasized. In the Norwegian concept of Health, Environment and Safety (HES), all aspects of the working environment have been taken into consideration, including human factors, ergonomics, physical and chemical factors as well as social and organizational psychology. As civilian legislation excludes military aviation in this area, the RNoAF has developed a new system that allows HES improvements to be implemented in a more efficient way. This system is based on a new military regulation for HES in RNoAF flight operations. Good coordination of HES issues, predictability and standard handling procedures are key elements in this system which is meant to be an effective managerial tool for correct HES decision-making.

BackgroundThe Army Medical Department (AMEDD) Military-Civilian Trauma Team Training (AMCT3) Program was developed to enhance the trauma competency and capability of the medical force by embedding providers at busy civilian trauma centers. Few reports have been published on the outcomes of this program since its implementation.MethodsThe medical and billing records for the two AMCT3 embedded trauma surgeons at the single medical center were retrospectively reviewed for care provided during August 2021 through July 2022. Abstracted data included tasks met under the Army’s Individual Critical Task List (ICTL) for general surgeons. The Knowledge, Skills, and Abilities (KSA) score was estimated based on previously reported point values for procedures. To assess for successful integration of the embedded surgeons, data were also abstracted for two newly hired civilian trauma surgeons.ResultsThe annual clinical activity for the first AMCT3 surgeon included 444 trauma evaluations and 185 operative cases. The operative cases included 80 laparotomies, 15 thoracotomies, and 15 vascular exposures. The operative volume resulted in a KSA score of 21 998 points. The annual clinical activity for the second AMCT3 surgeon included 424 trauma evaluations and 194 operative cases. The operative cases included 92 laparotomies, 8 thoracotomies, and 25 vascular exposures. The operative volume resulted in a KSA score of 22 799 points. The first civilian surgeon’s annual clinical activity included 453 trauma evaluations and 151 operative cases, resulting in a KSA score of 16 738 points. The second civilian surgeon’s annual clinical activity included 206 trauma evaluations and 96 operative cases, resulting in a KSA score of 11 156 points.ConclusionThe AMCT3 partnership at this single center greatly exceeds the minimum deployment readiness metrics established in the ICTLs and KSAs for deploying general surgeons. The AMEDD experience provided a deployment-relevant case mix with an emphasis on complex vascular injury repairs.

Abstract The Ombudsman type institutions are appointed to investigate individuals’ complaints against public authority and represent important actors in human rights protection system and in implementing democratic controls of the security system. These institutions have the task of interrupting human rights and the fundamental freedoms of armed force personnel, as well as ensuring the over-protection and prevention of defamation of armed forces. At the European level, the institutions of the Ombudsman are particularly important for ensuring the accountability of public authorities outside the contradictory environment of the courts. Ombudsman’s general institutions are mandated to receive complaints about all or almost all state organs, and their attributions concern all public services and government branches, including the armed forces. In addition, the ombudsman institutions with exclusive jurisdiction are independent and have exclusive jurisdiction over the armed forces, usually civilian and independent of the military command chain. Also, the Ombudsman institutions operating within the army can be identified and these are not completely independent, most often subordinated to the defense ministry and receive money from the defense budget.

The war waged by the Nigerian military against Boko Haram insurgency in Borno State and the North-East at large had suffered setbacks as the complexity of the contemporary security challenges overwhelms the public security sector and therefore government has subscribed to the need to extend the security sector to include ‘private security providers’ and the citizens as stakeholders. This study assessed volunteer security outfit and the fight against terrorism in Nigeria with focus on Civilian Joint Task Force (CJTF) in Borno State. The study employed a qualitative method and the Partnership Theory of Crime Prevention and Resistance Theory was adopted as the theoretical framework for the study. KIIs were conducted with ten (10) stakeholders from different professions. Data elicited through KII was analyzed thematically. The study findings revealed that volunteer security outfit is an approach in combating terrorism in Nigeria. The findings further revealed that Civilian JTF activities have helped other government security agencies in coordinating and arresting key Boko Haram members in Borno State thereby becoming a fundamental component to assisting and winning the war against Boko Haram insurgency. The study therefore recommends that educating and sensitizing members of the community and CJTF to be alert to their patriotic duty of reporting crime and illegal entry of other nationals should be advocated and intensified by the Borno State government. The study further recommends that with the current insecurity confronting Nigeria, establishment of local vigilante group of youth in communities across Nigeria should be encouraged to assist and support the security agencies. Since terrorism is a global problem, countries should adopt volunteer security outfit model to end organised crime and terrorism. This should be executed with the highest sense of local ownership and in collaboration with key stakeholders in their domain. Above all, for lasting peace, security and stability to prevail in Borno State, committed and sincere leadership should be demonstrated at all levels of governance in the State.

Abstract This study explores two main questions: What are the experiences of soldiers who have fought against Boko Haram? What can these experiences teach us about the seeming incapacity of the Nigerian military to defeat Boko Haram? Six major themes are explored. These are perspectives on the mission, morale of troops, military equipment and weapons, suicide and murder–suicide among troops, intelligence leaks, and relationships of troops with the Civilian Joint Task Force, an extralegal militia. Soldiers’ discourses on the mission against Boko Haram reveal three overlapping dimensions. First, there are suspicions about the sponsors and political godfathers of Boko Haram. This suggests a belief that Boko Haram is a conspiracy involving the government and top brass of the military. Second, the patronage system involved in deployment into key positions on the war front. Third, participants believe that the war is being deliberately prolonged because it is a moneymaking machinery for the political and military elites. The evidence suggests that availability of weapons varies by unit and the agency of commanders—their networks and influence within the military and willingness to disobey orders from superiors if their demands are not met. This situation produces radically variegated wartime experiences among troops. Non-commissioned soldiers believe senior commissioned officers perpetrate intelligence leaks and are responsible for the protracted war. Senior Army Generals interviewed in this study support this perspective. The study has major policy implications for successful operations against Boko Haram in the Lake Chad Basin area and the broader war against terrorism in the Sahel.

The European Defence Fund (EDF) has been interpreted by a number of scholars as a step beyond intergovernmental cooperation and towards the introduction of supranationalism in defence policy. We suggest that past developments in space policy can be a guide for developments in the defence area given the functional dependencies between the two fields and their institutional similarities. Based on this, we believe that the Commission will be unable to convert its new authority over the EDF into actual influence over use of force. On the contrary, the EDF may signal that European defence industrial policy is increasingly motivated by civilian and predominantly commercial considerations, dissociated from the operational objectives of national defence policies. Like the EDF, the European Union’s (EU’s) space programmes involve the supranational financing of militarily relevant capabilities. We argue that Member States have accepted supranationalism in space policy insofar as the Commission was able to civilianize matters of industrial governance and keep them separate from the conduct of military operations. We show that the EU implemented civilian programmes in areas that were otherwise driven by national militaries. In instances where civilianization was impossible, Member States’ security interests are preserved through intergovernmental modes of decision-making, even within purportedly ‘community’-driven processes. Member States have also retained significant control over future developments by exploiting a web of overlapping institutions and hazy task allocation. spillover, neofunctionalism, space policy, European Defence Fund, defence industry, industrial policy

ABSTRACT The Department of Defense (DOD), operating through the Directorate of Military Support in the Department of the Army, supports state, local and other federal agency response operations in a wide range of natural and man-caused emergencies. Examples within the past six years include the Ashland Oil tank collapse in Floreffe, Pennsylvania, Exxon Valdez cleanup, Loma Prieta earthquake, hurricanes Hugo and Andrew, Mexico City earthquake, Armero (Columbia) volcanic eruption, and Puerto Rico floods and mudslides. From March 24 to September 27, 1989, the period of the Exxon Valdez initial cleanup operations, DOD provided military and civilian personnel, U. S. Navy ships for housing response workers, cargo and medical evacuation aircraft (fixed wing and helicopters), skimmers, modified dredges, landing craft, Dracones, Zodiak boats, radios, computers, and other miscellaneous equipment. This was in addition to assets of the Alaska Army and Air National Guard, which were committed by the governor. Support was provided to the U. S. Coast Guard on-scene coordinator and supervised by the Alaska Oil Spill Joint Task Force. The General Accounting Office, in its January 1990 report, Federal Costs Resulting from the Exxon Valdez Oil Spill, estimated that DOD spent $62.8 million through September 30, 1989, the largest expenditure by any federal agency. Use of military resources is a realistic scenario in certain situations. Primary responders at the federal and state level should understand how to request and employ these assets. This paper provides a background on DOD support to disaster relief operations, and discusses the types of support available to agencies responding to natural or man-caused emergencies, request and approval mechanisms, the Department of Defense organization to provide support, and reimbursement of the department.

The crew requirements definition system (CRDS) is a computer-based methodology designed to minimize the time required to accomplishment any set of tasks while using the fewest resources. It enables analysts and researchers to study in a timely and cost effective manner the effects of varying crew size, task start times (and hence task sequencing), and task allocation to crewmembers or equipment items during the performance of designated missions without the need to observe crews actually performing their duties. The CRDS is programmed in C-language and is designed to be used on an “XT” or faster class of personal computer. The basis of the system is several automated PERT, GANTT, and critical path method calculations. In addition, the system produces other automated calculations and summaries to aid the user. The user should have some knowledge of these operations research techniques to use the system effectively. Also needed is an understanding of the tasks to be performed, the personnel and equipment items available to perform the tasks, each task's duration, and any requirements for task sequencing. The U.S. Army Research Institute for the Behavioral and Social Sciences (ARI) developed the CRDS for the Force Design Directorate at the U.S. Army Combined Arms Combat Development Activity. However, the system is useful in any military or civilian situations in which there is a need to design and evaluate alternative small unit organizational structures. The system can be used whenever the user has some knowledge, or is willing to venture some guesstimates, of the tasks that need to be performed and the capabilities of various assets to perform those tasks.

ABSTRACT Introduction The U.S. Space Force was stood up on December 20, 2019 as an independent branch under the Air Force consisting of about 16,000 active duty and civilian personnel focused singularly on space. In addition to the Space Force, the plans by NASA and private industry for exploration-class long-duration missions to the moon, near-earth asteroids, and Mars makes semi-independent medical capability in space a priority. Current practice for space-based medicine is limited and relies on a “life-raft” scenario for emergencies. Discussions by working groups on military space-based medicine include placing a Role III equivalent facility in a lunar surface station. Surgical capability is a key requirement for that facility. Materials and Methods To prepare for the eventuality of surgery in space, it is necessary to develop low-mass, low power, mini-surgical robots, which could serve as a celestial replacement for existing terrestrial robots. The current study focused on developing semi-autonomous capability in surgical robotics, specifically related to task automation. Two categories for end-effector tissue interaction were developed: Visual feedback from the robot to detect tissue contact, and motor current waveform measurements to detect contact force. Results Using a pixel-to-pixel deep neural network to train, we were able to achieve an accuracy of nearly 90% for contact/no-contact detection. Large torques were predicted well by a trained long short-term memory recursive network, but the technique did not predict small torques well. Conclusion Surgical capability on long-duration missions will require human/machine teaming with semi-autonomous surgical robots. Our existing small, lightweight, low-power miniature robots perform multiple essential tasks in one design including hemostasis, fluid management, suturing for traumatic wounds, and are fully insertable for internal surgical procedures. To prepare for the inevitable eventuality of an emergency surgery in space, it is essential that automated surgical robot capabilities be developed.

Abstract Introduction Lung cancer is the leading cause of cancer death among men and women, accounting for more fatalities than colon, breast, and prostate cancers combined. Smoking causes about 85% of all lung cancers in the United States and is the single greatest risk factor. In 2013, the US Preventive Services Task Force (USPSTF) published initial guidelines for low-dose computed tomography lung cancer screening (LCS) among patients 55–80 years old, with a 30-pack-year history, who are current smokers or who quit within the previous 15 years. Smoking prevalence is higher among military personnel compared to the civilian population, demonstrating a need for vigilant screening. Materials and Methods A retrospective review of Naval Medical Center San Diego’s (NMCSD) LCS data was conducted to examine screening numbers, lung cancer rates, and initial analysis of screening results. Patients were referred for screening if they met the USPSTF criteria. Between September 2013 and September 2018, 962 patients underwent LCS. A total of 1758 examinations were performed, including follow-up and annual surveillance examinations. The American College of Radiology’s Lung CT Screening Reporting and Data System (Lung-RADS) was used to classify lung nodules’ risk for malignancy. Results On this initial analysis, 42 enrolled patients received the diagnosis of lung cancer detected by screening. The initial calculated lung cancer rate is 4.4% (42/962) over the 5-year reporting period. The lung cancer rate among those patients with a Lung-RADS score of 3 or 4 was 31% (42/135). Thirty-seven patients were classified as having non-small cell lung cancer (NSCLC), while five were classified as having small cell lung cancer. Of the 37 NSCLC patients, 76% (28/37) were diagnosed at stage I and II, 11% (4/37) were diagnosed at stage III, and 13% (5/37) were diagnosed at stage IV. The total number of years a person smoked was a significant risk factor (P = 0.004), but not pack-years a person smoked (P = 0.052). Conclusions These preliminary results demonstrate the success of a Military Treatment Facility (MTF)-based LCS Program in the detection of early stage lung cancer. Earlier stage detection may result in better health outcomes for affected patients. In the population studied, duration of smoking proved to be more significant than pack-years in predicting lung cancer risk. These results validate the newly dedicated resources and continued efforts to strengthen the LCS program at NMCSD and across MTFs.

Abstract Introduction In partnership with the Veterans Health Administration, in 2010, the Department of Defense/Veterans Health Administration Pain Management Task Force Final Report recommended a comprehensive pain management plan. Consequently, each Army medical center established an Interdisciplinary Pain Management Clinic (IPMC) for pain treatment, and each IPMC implements a multidisciplinary outpatient functional restoration program (FRP) as an alternative to or in addition to pharmacological therapy. This article reports our first-year FRP results at William Beaumont Army Medical Center IPMC. Materials and Methods The FRP is designed to improve the participants’ functionality and quality of life, both personally and professionally. Service members with chronic pain were evaluated for psychological and physical clearance before enrollment in an intense and structured FRP for 8 hours a day over 3 weeks. The program focused on physical and occupational exercises, yoga, acupuncture, and educational classes regarding pain medications, nutrition, and coping skills. The resulting data were analyzed using paired two-tailed t-tests with a predetermined significance level of 0.05 to examine the participants’ mean changes upon completion of the FRP. Results The pre-post comparison indicated significant improvement after completion of the FRP. The fear-avoidance of physical activities and the fear of movement scores were reduced significantly (P < 0.05); the Canadian occupational performance and satisfaction, physical strength and endurance were improved significantly (P < 0.0001) in sit-to-stand, plank balance, lifting and carrying, and 10-minute 7-to-1 Pyramid tests; however, fear-avoidance of work was not significantly reduced (P = 0.2319). Conclusions Because of the lack of randomization and the small number of subjects (N = 32, 7 cohorts), unknown sources of bias may have influenced the results. Despite these limitations, the results from this report support the program’s effectiveness and are consistent with the outcomes from FRP programs in other military facilities and in civilian studies.

The development of unmanned aerial vehicles is of great interest to both the largest aircraft companies and design enthusiasts, and among the total volume of developments, the volume of multicopter unmanned aerial vehicles occupies one of the leading positions. In this regard, the analysis of existing developments and the definition of future research in this direction is relevant. Multi-helicopter drones have a wide range of functions in both military and civilian use.The paper collects and analyzes statistical data of micro-unmanned aerial vehicles of the multicopter type to determine the achievements in the field of design of micro-unmanned aerial vehicles (UAVs). The current classification of UAVs is considered; as a result of the analysis of statistical data its expansion is offered. The take-off and mass characteristics of the micro UAV are described. The tables showing the existing UAVs are given. In addition, the flight characteristics, aerodynamic schemes and type of engine that are most rationally suited for micro-unmanned aerial vehicles according to their purpose and class are determined.Based on the obtained data, a prototype model of a micro-UAV with improved characteristics was built. The model successfully completed all tasks. This indicates that the new UAV "Fear-1" is a successful project and it has the ability to remotely control by phone or any other equipment designed for this purpose. In addition, the designed device can additionally hang in the specified coordinates."Fear-1" confidently performs tasks in automatic mode, as well as independently decides to return to the starting point of takeoff, if: there is a loss of communication, the battery level has reached a certain level, the UAV has completed its task or used more miles -amperes than specified by the output parameters. The drone has the ability to fly in "Follow me" mode on the selected GPS transmitter. The quadcopter was tested in difficult weather conditions, when the wind force reached 8 points (about 22 m / s). Noise immunity tests were also performed in the industrial frequency range (from 2.4 GHz to 5.8 GHz).

IntroductionPrior to deployment of the Netherlands Army Task Force Urozgan in Afghanistan, the Dutch Military and civilian healthcare systems had limited experience in treating blast injuries and their long-term consequences. This meant that guidelines for treatment and rehabilitation were lacking. The aim of this cohort study was to quantify kinematic and kinetic abnormalities in service members with foot injuries in relation to functional outcome using gait analysis.MethodIn nine service members with combat-related talus, calcaneus and/or navicular bone (TCN) fractures and nine controls, gait parameters were measured using Gait Real-Time Analysis Interactive Lab system. High-level mobility was evaluated by the Comprehensive High-Level Activity Mobility Predictor (CHAMP), and functional ability was assessed by Lower Extremity Functional Scale (LEFS) questionnaire.ResultsSignificant differences were found for LEFS and CHAMP scores (P<0.01), comfortable walking speed and ankle joint range of motion (ROM) (P<0.05), all lower in the group with TCN fractures. For this group, a trend (0.1>P>0.05) for higher step width and lower stride duration and peak power was found. A strong correlation (0.6>r>0.79) is shown between LEFS and comfortable walking speed and CHAMP and ankle joint ROM. The correlations between LEFS and stride duration, step width, ankle joint ROM and peak power, and between CHAMP and comfortable walking speed and stride duration, were moderate (0.4>r>0.59).ConclusionsThis study demonstrated that service members with TCN fractures, compared with healthy controls, have altered gait characteristics, specifically lower walking speed and ankle joint ROM, both related to lower physical functioning. Patients with bilateral depressed Böhler’s angle had the worse functional performance, and further research is recommended to evaluate the relationship between Böhler’s angle and physical performance.Clinical TrialThe Dutch Ministry of Defence (MOD) and the Institutional Review Board and Medical Ethics Review Committee Brabant, The Netherlands, approved this study (P1550).

This updated issue of the professional publication Bulletin of the Slovenian Armed Forces is dedicated to the question of the Slovenian commitment to finding peaceful solutions to conflicts. As Commander­in­Chief of the Defence Forces of the Republic of Slovenia, I find this subject not only necessary but also entirely essential. There are many reasons for this. The historical experience of the Slovenian people has not always been pleasant regarding the preservation of national identity, manifested in the language as well as in the cultural and national tradition. Despite different repressive and denationalising measures taken by many foreign authorities, our ancestors managed to preserve the Slovenian nation through much wisdom, deep national awareness and political skill. The importance of consistent compliance with the provisions of international law in crisis situations, including wars, was seen in 1991. Slovenia won the war, not only in a military sense but also by complying with all legal norms, thus soon becoming recognised as a young European democratic country founded on high legal and moral principles. The lessons of war in 1991 increased the resolve of the Slovenian people for clear rejection of the use of force in finding solutions to any kind of conflict. For this reason, my pleasure at being invited to write about the topic of Slovenian people in the service of peace is that much greater, in part also due to the fact that I spent a large part of my professional life, from 1992 to 2005, working in the United Nations, first as the ambassador of the Republic of Slovenia, later as UN Assistant Secretary­General. In both functions I dealt with peacekeeping operations to a considerable extent. United Nations peacekeeping operations were in full swing at that time and underwent great development on the one hand, but also bitter disappointment and moments of deep doubt on the other. However, they continued to develop to the current extent. The topic of the Bulletin is presented in truly deep, scientific, theoretical and practical ways, from strategic and tactical levels, considering the evolutionary and transformational characteristics of peacekeeping operations, and deriving from historical experience. The most respected authors in the Slovenian professional field have thrown light upon important conceptual changes in the area of peacekeeping operations, which result from numerous factors, in particular from important geopolitical changes in the world. We must not disregard the increasing cooperation of regional organisations in the implementation of peacekeeping operations, which has indirectly brought about a different understanding of the term “peacekeeping operation” and opened technical discussions in the area of terminology as well as in the technical fulfilment of obligations, all the way to the question of the necessity of a preliminary UN mandate. These deficiencies can also be seen in Slovenia and point to the need for conducting a deep technical discussion as soon as possible and unifying the understanding of both the structure of the Slovenian Armed Forces and the broader defence and security system. The introductory and in particular the more theoretical parts of the Bulletin may be taken as important contributions in this regard. Some of the articles offer interesting historical insight into the cooperation of Slovenian men, and later women, in various endeavours for peace launched by individual great powers and international organisations. Although it is difficult to understand the military intervention of European forces on the island Crete in 1897 as a peacekeeping operation, the objective which is still in the forefront of contemporary efforts of the international community in this area was achieved for at least some time. This intervention ensured an armistice between the parties involved in the conflict and enabled a diplomatic solution on the island without unnecessary victims. The confidence that the highest political and military authorities in the Austro­Hungarian Empire had in the 2nd Battalion of the 87th Infantry Regiment from Celje was truly special. This was particularly the case because the military unit was mainly composed of Slovenes, and at the time of deployment in Crete its commander was a Slovene as well. However, we need to emphasise that such thinking is unconventional. By studying the literature on peacekeeping operations we see that such operations were first mentioned around 1919 in connection with peace conferences after the end of World War I and with managing various border issues in Europe, different plebiscites and other situations which, besides political and other diplomatic action, also required the protection of security and were followed by military operations intended for this particular purpose. History tells us much about peacekeeping operations intended to maintain truces. In these operations, coalition forces were deployed to an area in which a truce already existed and had to be maintained among well organised and disciplined armed forces. Today, the status of armed forces is quite different. We have to look at all of history and every aspect of international military engagement which is not armed combat by nature but a military presence with various aspects of employment of military force and the constant readiness and capability of peace forces to defend themselves effectively and be prepared to use weapons to fulfil their mandate. If today we see peacekeeping operations as valid in this respect, it is clear that we have to be familiar with history and evaluate what we can learn from past experience and how we are obliged to consider the present. Of course, we must consider the present. If we look at the status of peacekeeping operations today, we see how important this military activity is for the modern world. I will only dwell upon the United Nations, which from the standpoint of peacekeeping operations is the most important organisation operating today. Approximately 140,000 soldiers participate in peacekeeping operations under the auspices of the United Nations. No other military force has that number of uniformed personnel operating abroad. These people are assigned to eighteen currently active peacekeeping operations, each costing the organisation about seven billion dollars. This is the largest component of the budget of the United Nations. However, this expenditure is small in comparison to other kinds of military deployment outside the UN, to operations which are not peacekeeping operations by nature. Peacekeeping operations have become very multidimensional. The latest such operations, established in Africa (Darfur, Chad, Central African Republic), have been among the most demanding from the very beginning. We can thus conclude that peacekeeping operations are becoming increasingly more complex, which also results in a higher degree of risk. In 2007, 67 members of UN peacekeeping operations lost their lives. Looking at individual operations we see that six people died in Lebanon alone that year. Ever since peacekeeping operations have been in existence, Lebanon has been one of the most dangerous areas. Today, however, it is somewhat outside the sphere of interest. This may be due to the fact that there is a peacekeeping operation active in the area, on account of which a state of relative peace can be better maintained. Peacekeeping operations are both dangerous and multidimensional, multidimensional because they are no longer focused merely on keeping belligerent parties apart. Modern peacekeeping operations include both standard and supplemental functions. Providing a secure environment for political normalisation, humanitarian activity and development is a comprehensive task, requiring the engagement of peacekeeping forces in operations that are far from being common types of military deployment. This raises different questions about the training and competence of peacekeeping forces. We also have to ask ourselves how we can fully consider the lessons learned from previous peacekeeping operations and organise a system of command, particularly in organisations such as the United Nations, while at the same time making sure that national contingents do not lose their identity. There are thus two lines of communication, one through channels established by international organisations and the other through those established by national systems of armed forces. How to balance this and achieve efficient functioning? How to ensure the operation of different cultures, members and levels of competence in a way that facilitates the success of peacekeeping operations? These are always important questions to consider. In recent years the question of interest has pointed to the complexity of modern peacekeeping operations. Peacekeeping operations are frequently required to facilitate an environment in which elections can be conducted and assist in the establishment of a legal order and institutions to maintain that order. Both tasks are extremely demanding. The establishment of a safe environment for conducting elections in a country with poor communications, with no tradition of elections and with violence linked to every political event, is an extremely difficult task. The establishment of a legal order in areas with no such tradition or adequate infrastructure is even harder. There is often a need to include the civilian police, whose tasks in peacekeeping operations are very demanding. Civilian police have a number of other particularities besides problems connected to the aforementioned multidimensionality. It is necessary to adapt to the local environment in order to facilitate effective police performance. How to facilitate this in an environment such as Haiti, for example, with its difficult past? How to facilitate this in linguistically demanding environments such as East Timor until recently and in other difficult circumstances? These are all extremely demanding tasks. However, there is not much understanding with regard to all the details and problems arising from their implementation. The international political community is often satisfied merely by defining the mandate of a peacekeeping operation. For many people this signifies the solution to the problem, considering that the mandate is defined and that the deployment of forces will occur. However, this is where real problem solving only begins. Only then does it become obvious what little meaning general resolutions of the United Nations Security Council and other acts by which mandates are defined have in the context of actual situations. Therefore, I am of the opinion that we have to take a detailed look at experience from the distant past as well as the present. When speaking of the civilian police we also have to consider the fully human aspects that characterise every peacekeeping operation. Once I spoke to a very experienced leader of civilian police operations about the need to send additional police officers to the mission in Kosovo in the spring, when winter is over and people become more active, which also results in a higher crime rate. He explained that this is not only a problem in the area of this mission but elsewhere in Europe. In spring, the crime rate rises everywhere. Therefore it is difficult to find police officers during this time who are willing to leave their homeland, where they are most needed, and go to a mission area which is just then facing increased needs. I mention this to broaden understanding of the fact that the deployment of peacekeeping forces, both military and civilian police, is not only a matter of mandates and military organisation, but sometimes of the purely elementary questions that accompany social development. I have already mentioned that memory of the past is a very important component of considering present peacekeeping operations. I would like to conclude with another thought. I believe the manner of organising the knowledge of peacekeeping operations is of great importance to all countries, especially those that are new to cooperating in peacekeeping operations. This knowledge cannot be gained from books written at universities, but only from monitoring and carefully analysing the previous experiences of others. It is very important that this knowledge be carefully organised, that these experiences be carefully gathered and analysed, and that a doctrine be developed gradually. This doctrine is required for a country like Slovenia, which is new at conducting peacekeeping operations, to be able to manage well and define its role in international peacekeeping operations properly. To achieve this objective, a new country must cooperate with those countries which have been conducting peacekeeping operations for a long time and therefore have a richer experience. The neighbouring Austria is known to have one of the longest and most interesting systems of experience in peacekeeping operations within the United Nations. Ever since it joined the UN, Austria has been active in numerous activities linked to peacekeeping operations. Its soldiers and the civilian police have participated in a number of peacekeeping operations. Experience gained in this way is of great value, and using this experience is necessary for successful planning of and operating in future peacekeeping operations. The future will be complicated! At one time, when the members of peacekeeping operations numbered approximately 80,000, the United Nations thought that nothing more could be done, and a larger number of members was unthinkable. Today the number of members is significantly larger, development will most likely still continue and conditions will become even more demanding. I do not wish to forecast events which have not yet taken place. However, I would like to strongly emphasise that the history of peacekeeping operations is not over yet and that the future will be full of risks and challenges. I would also again like to stress the importance of this issue of the Bulletin of the Slovenian Armed Forces, which is entering a new decade, and express my pleasure at being able to note down a few thoughts. Let me particularly emphasise that as Commander­in­Chief of the Slovenian Defence Forces I will continue to devote special attention to achievements in the area of cooperation in peacekeeping operations in the future, having a special interest in these experiences. I thank the authors of the articles of this important issue of the Bulletin for their scientific and professional contributions – and I greatly respect those who have already done important work in the name of the Republic of Slovenia with the Slovenian flag on their shoulders, with the hope that they continue to fulfil their obligations in accordance with the rules.

The aim of this paper was to describe the development of ‘Traum’cast’, an ambitious project to create a high-quality, open-access, 12-week video podcast programme providing evidence-based continuing medical education for civilian and military healthcare practitioners dedicated to the management of trauma caused by weapons of war. The management of such patients became a particular public health issue in France following the 2015 terrorist attacks in Paris, which highlighted the need for all healthcare professionals to have appropriate knowledge and training in such situations. In 2016, the French Health General Direction asked the French Military Medical Service (FMMS) to create a task force and to use its unique and considerable experience to produce high-quality educational material on key themes including war injuries, combat casualty care, triage, damage control surgery, transfusion strategies, psychological injury and rehabilitation. The material was produced by FMMS and first broadcast in French and for free, on the official FMMS YouTube channel in September 2020. Traum’cast provides evidence-based continuing medical education for civilian and military healthcare practitioners. Traum’cast is an educational innovation that meets a public health requirement.

Abstract Introduction With more than 370,000 military and civilian personnel stationed across Pacific Command (PACOM), medical evacuation in this largest command presents unique challenges. The authors describe medical evacuations analyzed from the U.S. Air Force Transportation Command Regulating and Command & Control Evacuation System (TRAC2ES) in PACOM. Materials and Methods We performed a retrospective review of all TRAC2ES medical records for medical evacuations of adult patients from the PACOM theater of operations conducted between January 1, 2008 and December 31, 2018. We abstracted free text data entry in TRAC2ES to characterize the diagnoses requiring patient movement. Data are presented using descriptive statistics. Results During this 11-year period, 3,328 PACOM TRAC2ES encounters met inclusion criteria. Of these evacuations, 65.8% were male and were comprised mostly of active duty military (1,600, 48.1%) and U.S. civilians (1,706, 51.3%). Most transports originated in Japan (1,210 transports, 36.4%) or Guam (924 transports, 27.8%) with Hawaii (1,278 transports, 38.4%) as the most frequent destination. The majority of evacuations were routine (72.5%) with only 4.9% urgent evacuations. Medical conditions (2,905 transports, 87%) accounted for the largest proportion of transports, surpassing injuries (442 transports, 13%). The most common reasons for medical transports were behavioral health (671 transports, 20.2%) and cardiovascular disease (505 transports, 15.1%). Conclusions The majority of medical evacuations in PACOM were because of medical illness with routine precedence category, mirroring the largely noncombat operations occurring across this large area.

Abstract For all the academic and policy interest in Nigeria’s Boko Haram insurgency, the coping strategies of civilians who survive amid everyday violence have received relatively little attention. Focusing on the Civilian Joint Task Force (CJTF), a pro-government militia fighting Boko Haram in northeastern Nigeria, Agbiboa explores how and why the group emerged, the nature of its relationship with the state and local communities, and how counterinsurgent vigilantism affects the prospects for peace. A focus on vigilantes and civil militias vis-à-vis the state points to the vital role of civil-military cooperation for effective counterinsurgency campaigns and for reducing state violence against civilians. At the same time, it underscores the precariousness of protection both in terms of increasing the targeting of civilians by vengeful insurgents as well as the tendency for civilian defense groups to “turn bad” and become threats to the communities they were expected to protect.

The paper discusses the problem of the withdrawal of multinational forces from the territory of Afghanistan in 2021. An attempt is made to answer the question: What has caused the failure of the international intervention and what could the further consequences of the withdrawal of the NATO coalition forces be? The paper also presents the problem of the decay of Afghanistan and threats to Polish military contingents during the ‘Enduring Freedom’, ISAF and ‘Resolute Support’ operations. The study takes advantage of the results of unique research conducted by the author in the zones of war and stabilization in Afghanistan and previously unpublished source documents. The field research was carried out in the area of responsibility of the Polish Task Force stationed in the Ghazni province in March and April 2009. Moreover, the non-confidential part of the documentation from the activities of individual organizational units of the Polish military contingent was used. The chapter may be of interest to researchers of international and national security, academics (teachers and students) of military and civilian universities as well as activists of governmental and non-governmental organizations providing aid in areas of armed conflicts and after their end.

This article considers the role of the Civilian Joint Task Force (popularly called CJTF), a group of armed local population participating in the joint battle against Boko Haram, has become a platform for recruitment into the Nigerian security institutions in north-eastern Nigeria. CJTF members have played many roles, from mostly discrete surveillance networks in the north-eastern region of Nigeria to military combat auxiliaries or semi-autonomous fighting forces in the country. For the region’s overstretched and under pressure militaries, they have somewhat filled the security gap and provided local knowledge. CJTF can be a powerful counter-insurgency tool, but there is a compelling need to confront the immediate concerns it raises, notably in terms of impunity, and to begin planning for its long-term post-conflict transformation. The article adopts Galula’s theory of counter-insurgency. It reveals several lessons in how a community-based security structure can be applied to a conventional security engagement.

Air-purifying full-face masks, such as military chemical–biological–radiological–nuclear masks, might offer superior protection against severe acute respiratory syndrome coronavirus 2 compared to disposable polypropylene P2 or N95 masks. In addition, disposable masks are in short supply, while military chemical–biological–radiological–nuclear masks can be disinfected then reused. It is unknown whether such masks might be appropriate for civilians with minimal training in their use. Accordingly, we compared the Australian Defence Force in-service chemical–biological–radiological–nuclear Low Burden Mask (AirBoss Defense, Newmarket, Canada) with polypropylene N95 masks and non-occlusive glasses worn during simulated tasks performed by civilian clinicians in an Australian tertiary referral hospital intensive care unit. After brief training in the use of the Low Burden Mask, participants undertook a simulated cardiac arrest scenario. Previous training with polypropylene N95 masks had been provided. Evaluation of 10 characteristics of each mask type were recorded, and time to mask application was assessed. Thirty-three participants tested the Low Burden Mask, and 28 evaluated polypropylene N95 masks and glasses. The Low Burden Mask was donned more quickly: mean time 7.0 (standard deviation 2.1) versus 18.3 (standard deviation 6.7) seconds; P = 0.0076. The Low Burden Mask was rated significantly higher in eight of the 10 assessed criteria, including ease of donning, comfort (initially and over a prolonged period), fogging, seal, safety while removing, confidence in protection, and overall. Visibility and communication ability were rated equally highly for both systems. We conclude that this air-purifying full-face mask is acceptable to clinicians in a civilian intensive care unit. It enhances staff confidence, reduces waste, and is likely to be a lower logistical burden during a prolonged pandemic. Formal testing of effectiveness is warranted.

Abstract Introduction Colorectal cancer is the second leading cause of cancer deaths in the USA, and screening tests are underutilized. The aim of this study was to determine the proportion of individuals at average risk who utilized a recommended initial screening test in a universal healthcare coverage system. Materials and Methods This is a retrospective cohort study of active duty and retired military members as well as civilian beneficiaries of the Military Health System. Individuals born from 1960 to 1962 and eligible for full benefits on their 50th birthday were evaluated. Military rank or rank of benefits sponsor was used to determine socioeconomic status. Adherence to the U.S. Preventive Services Task Force guidelines for initial colorectal cancer screening was determined using “Current Procedural Terminology” and “Healthcare Common Procedure Coding System” codes for colonoscopy, sigmoidoscopy, fecal occult blood test, and fecal immunohistochemistry test. Average risk individuals who obtained early screening ages 47 to 49 were also identified. Results This study identified 275,665 individuals at average risk. Of these, 105,957 (38.4%) adhered to screening guidelines. An additional 19,806 (7.2%) individuals were screened early. Colonoscopy (82.7%) was the most common screening procedure. Highest odds of screening were associated with being active duty military (odds ratio [OR] 3.63, 95% confidence interval [CI] 3.43 to 3.85), having highest socioeconomic status (OR 2.37, 95% CI 2.31 to 2.44), and having managed care insurance (OR 4.36, 95% CI 4.28 to 4.44). Conclusions Universal healthcare coverage does not ensure initial colorectal cancer screening utilization consistent with guidelines no does it eliminate disparities.

ABSTRACT The rationing of medical resources became a common practice during the SARS-CoV-2 (COVID-19) pandemic. To cope with overwhelming patient numbers, hospitals were forced to adopt “crisis standards of care” (CSC) guidelines, which allow physicians to navigate the task of rationing health care resources in both an effective and ethically sound manner. The Military Health System currently has clinical guidelines for mass casualty incident (MCI) triage but lacks deployed Role 3 intensive care unit (ICU) CSC guidelines. In future peer and near-peer conflicts, this gap may prove detrimental when thousands of casualties following a single battle create a continuous and prolonged mass casualty event. The challenges of providing critical care in a battlefield hospital during a large conflict are unique and numerous, but lessons from COVID-19 ICUs such as transitioning to a utilitarian ethic, clear definitions, decision points, and decision authorities, as well as the establishment of clinical practice guidelines formulated from evidence-based protocols, can better prepare the U.S. expeditionary medical force for future conflicts. A battlefield CSC will allow military critical care physicians and nurses to manage overwhelmed ICUs and make better triage decisions, allowing them to provide a higher quality of care to the collective. In this commentary, we explore the need for Wartime CSC in the battlefield Role 3 ICU and the tools and methods used by civilian and military institutions to create and enact CSCs throughout the COVID-19 pandemic.

Abstract Introduction The U.S. Preventive Services Task Force recommends regular cervical cancer screening for women aged 21-65 years. Such screening is key to reducing mortality and morbidity. Despite improvement in the screening rate, cervical cancer still disproportionately affects women of minority groups because of access to quality health care. The Military Health System (MHS) mitigates this barrier through universal healthcare coverage for all active duty service members and their families. However, such racial/ethnic disparities, seen in civilian population, have not been studied in the MHS. Materials and Methods This is a retrospective cross-sectional study utilizing fiscal years 2011-2016 claims data obtained from the MHS Data Repository for 112,572 active duty service women aged 21-64 years. Study analyses included descriptive statistics on patient demographics, calculations of the proportion of patients who received cervical cancer screenings as well as the proportion of patients in compliance with USPSTF guidelines, and unadjusted odds ratios for the likelihood of compliance by race and military service. Results Of the study population, 50.0% of active duty women were screened for cervical cancer. When compared to White women, Black (1.05 OR, 1.03-1.08 CI), Native American/Alaskan Native (1.26 OR, 1.15-1.39 CI), and Other (1.12 OR, 1.06-1.18 CI) women were significantly more likely to receive cervical cancer screenings. The proportions of 3-year compliance were relatively equal within each race category (ranging from 43% to 45%), with no significant findings for the odds of compliance in any race when compared to White active duty women; however, proportions of 3-year compliance by service ranged from 11.7% in the Marines to 84.4% in the Navy, and active duty women in the Navy were six times more likely to be in compliance with guidelines than women in the Army. When looking at 5-year compliance in active duty women aged 30-64 years, women in the Navy were more likely than women in the Army to meet compliance guidelines (1.24 OR, 1.14-1.36 CI), while women in the Air Force were slightly less likely (0.90 OR, 0.82-0.98 CI). Conclusions The women in our population demonstrated similar or lower compliance than other studies conducted in the U.S. general population, and racial disparities for cervical cancer screening were partially mitigated in active duty service women. While our research demonstrates that universal insurance can help provide equal access and care, investigation into the factors that encourage greater usage among members of different military branches may help to understand and develop policies to improve health care systems.

ObjectiveUsing a large nationally representative dataset, we estimated the prevalence of self-reported hepatitis C testing among individuals who were recommended to be tested (i.e., baby boomer cohort born between 1945 and 1965) by the CDC and United States Preventive Services Task Force.IntroductionHepatitis C virus (HCV) infection is the most common blood-borne disease in the US and the leading cause of liver-related morbidity and mortality. Approximately 3.5 million individuals in the US were estimated to have been living with hepatitis C in 2010 and approximately half of them were unaware that they were infected. Among HCV infected individuals, those born between 1945 and 1965 (usually referred to as the baby boomer cohort) represents approximately 75% of current cases. Because of the substantial burden of disease among this age group, CDC expanded its existing hepatitis C risk-based testing recommendations to include a one-time HCV antibody test for all persons born between 1945 and 1965. The United States Preventive Services Task Force (USPSTF) subsequently made the same recommendation in June 2013.DescriptionMethodsThe following question "Have you ever had a blood test for hepatitis C?" has been administered annually from 2013 through 2017 on the National Health Interview Survey (NHIS). The NHIS is a nationally representative cross-sectional face-to-face household interview of civilian noninstitutionalized individuals in the U.S. The NHIS survey uses a complex multistage probability design that includes stratification, clustering, and oversampling. We estimated the prevalence of hepatitis C testing for adults in the US during the study period from 2013 to 2017. In addition, we carried out stratified analyses comparing those with private insurance to those who did not have private insurance. We reported weighted estimates taking into account the NHIS survey design. The R statistical software (R Core Team, 2018) was used to estimate weighted prevalence estimates for hepatitis C testing.ResultsDuring the study period from 2013-2017, there were 148,674 adults who responded to the ever tested for hepatitis C question. In addition, 33.56% of these individuals were born between 1945 and 1965; among all adults, the weighted percentage of individuals that responded yes they had received a hepatitis C screening test was 12.82% (95% CI: 12.54-13.10%) while for baby boomers the estimate was 13.93% (95% CI: 13.51-14.35%).Figure 1 presents the annual trend in the hepatitis C test prevalence over the study period by birth cohorts. For both cohorts, there were significant increases over time in hepatitis C testing prevalence. The two trend lines began to diverge in 2015 with the baby boomer cohort reporting higher rates of hepatitis C testing. For the baby boomer cohort, there was also a substantial increase in reported hepatitis C testing in 2017 relative to 2016. Similar trends were found for the samples when we restricted the sample to only those with private insurance. Compared to the people with private insurance, the baby boomers with 'Non-private’ insurance, including Medicaid, Medicare, or military- government sponsored insurances, reported higher rates of testing.ConclusionAcross the five-year period from 2013 through 2017, we found increasing rates of self-reported hepatitis C testing among non-institutionalized U.S. adults. For the baby boomer cohort, we saw a substantial increase in testing in 2017, which was likely due in part, to increased awareness among both physicians and patients of the CDC and USPSTF recommendation to have all baby boomers tested. Efforts to increase the awareness of these recommendations should continue. Additional targeted promotions among hard to reach populations should also be considered.How the Moderator Intends to Engage the Audience in Discussions on the TopicThis panel will discuss strengths and weaknesses for monitoring hepatitis C testing using alternative data sources including self-reported data, insurance claims data, and laboratory testing data.

Ubiquitous in airports, border checkpoints, and other securitised spaces throughout the world, full-body imaging scanners claim to read bodies in order to identify if they pose security threats. Millimetre-wave body imaging machines—the most common type of body scanner—display to the operating security agent a screen with a generic body outline. If an anomaly is found or if an individual does not align with the machine’s understanding of an “average” body, a small box is highlighted and placed around the “problem” area, prompting further inspection in the form of pat-downs or questioning. In this complex security regime governed by such biometric, body-based technologies, it could be argued that nonalignment with bodily normativity as well as an attendant failure to reveal oneself—to become “transparent” (Hall 295)—marks a body as dangerous. As these algorithmic technologies become more pervasive, so too does the imperative to critically examine their purported neutrality and operative logic of revelation and readability.Biometric technologies are marketed as excavators of truth, with their optic potency claiming to demask masquerading bodies. Failure and bias are, however, an inescapable aspect of such technologies that work with narrow parameters of human morphology. Indeed, surveillance technologies have been taken to task for their inherent racial and gender biases (Browne; Pugliese). Facial recognition has, for example, been critiqued for its inability to read darker skin tones (Buolamwini and Gebru), while body scanners have been shown to target transgender bodies (Keyes; Magnet and Rodgers; Quinan). Critical security studies scholar Shoshana Magnet argues that error is endemic to the technological functioning of biometrics, particularly since they operate according to the faulty notion that bodies are “stable” and unchanging repositories of information that can be reified into code (Magnet 2).Although body scanners are presented as being able to reliably expose concealed weapons, they are riddled with incompetencies that misidentify and over-select certain demographics as suspect. Full-body scanners have, for example, caused considerable difficulties for transgender travellers, breast cancer patients, and people who use prosthetics, such as artificial limbs, colonoscopy bags, binders, or prosthetic genitalia (Clarkson; Quinan; Spalding). While it is not in the scope of this article to detail the workings of body imaging technologies and their inconsistencies, a growing body of scholarship has substantiated the claim that these machines unfairly impact those identifying as transgender and non-binary (see, e.g., Beauchamp; Currah and Mulqueen; Magnet and Rogers; Sjoberg). Moreover, they are constructed according to a logic of binary gender: before each person enters the scanner, transportation security officers must make a quick assessment of their gender/sex by pressing either a blue (corresponding to “male”) or pink (corresponding to “female”) button. In this sense, biometric, computerised security systems control and monitor the boundaries between male and female.The ability to “reveal” oneself is henceforth predicated on having a body free of “abnormalities” and fitting neatly into one of the two sex categorisations that the machine demands. Transgender and gender-nonconforming individuals, particularly those who do not have a binary gender presentation or whose presentation does not correspond to the sex marker in their documentation, also face difficulties if the machine flags anomalies (Quinan and Bresser). Drawing on a Foucauldian analysis of power as productive, Toby Beauchamp similarly illustrates how surveillance technologies not only identify but also create and reshape the figure of the dangerous subject in relation to normative configurations of gender, race, and able-bodiedness. By mobilizing narratives of concealment and disguise, heightened security measures frame gender nonconformity as dangerous (Beauchamp, Going Stealth). Although national and supranational authorities market biometric scanning technologies as scientifically neutral and exact methods of identification and verification and as an infallible solution to security risks, such tools of surveillance are clearly shaped by preconceptions and prejudgements about race, gender, and bodily normativity. Not only are they encoded with “prototypical whiteness” (Browne) but they are also built on “grossly stereotypical” configurations of gender (Clarkson).Amongst this increasingly securitised landscape, creative forms of artistic resistance can offer up a means of subverting discriminatory policing and surveillance practices by posing alternate visualisations that reveal and challenge their supposed objectivity. In his 2018 audio-video artwork installation entitled SANCTUM, UK-based American artist Zach Blas delves into how biometric technologies, like those described above, both reveal and (re)shape ontology by utilising the affectual resonance of sexual submission. Evoking the contradictory notions of oppression and pleasure, Blas describes SANCTUM as “a mystical environment that perverts sex dungeons with the apparatuses and procedures of airport body scans, biometric analysis, and predictive policing” (see full description at https://zachblas.info/works/sanctum/).Depicting generic mannequins that stand in for the digitalised rendering of the human forms that pass through body scanners, the installation transports the scanners out of the airport and into a queer environment that collapses sex, security, and weaponry; an environment that is “at once a prison-house of algorithmic capture, a sex dungeon with no genitals, a weapons factory, and a temple to security.” This artistic reframing gestures towards full-body scanning technology’s germination in the military, prisons, and other disciplinary systems, highlighting how its development and use has originated from punitive—rather than protective—contexts.In what follows, we adopt a methodological approach that applies visual analysis and close reading to scrutinise a selection of scenes from SANCTUM that underscore the sadomasochistic power inherent in surveillance technologies. Analysing visual and aural elements of the artistic intervention allows us to complicate the relationship between transparency and recognition and to problematise the dynamic of mandatory complicity and revelation that body scanners warrant. In contrast to a discourse of visibility that characterises algorithmically driven surveillance technology, Blas suggests opacity as a resistance strategy to biometrics' standardisation of identity. Taking an approach informed by critical security studies and queer theory, we also argue that SANCTUM highlights the violence inherent to the practice of reducing the body to a flat, inert surface that purports to align with some sort of “core” identity, a notion that contradicts feminist and queer approaches to identity and corporeality as fluid and changing. In close reading this artistic installation alongside emerging scholarship on the discriminatory effects of biometric technology, this article aims to highlight the potential of art to queer the supposed objectivity and neutrality of biometric surveillance and to critically challenge normative logics of revelation and readability.Corporeal Fetishism and Body HorrorThroughout both his artistic practice and scholarly work, Blas has been critical of the above narrative of biometrics as objective extractors of information. Rather than looking to dominant forms of representation as a means for recognition and social change, Blas’s work asks that we strive for creative techniques that precisely queer biometric and legal systems in order to make oneself unaccounted for. For him, “transparency, visibility, and representation to the state should be used tactically, they are never the end goal for a transformative politics but are, ultimately, a trap” (Blas and Gaboury 158). While we would simultaneously argue that invisibility is itself a privilege that is unevenly distributed, his creative work attempts to refuse a politics of visibility and to embrace an “informatic opacity” that is attuned to differences in bodies and identities (Blas).In particular, Blas’s artistic interventions titled Facial Weaponization Suite (2011-14) and Face Cages (2013-16) protest against biometric recognition and the inequalities that these technologies propagate by making masks and wearable metal objects that cannot be detected as human faces. This artistic-activist project contests biometric facial recognition and their attendant inequalities by, as detailed on the artist’s website,making ‘collective masks’ in workshops that are modelled from the aggregated facial data of participants, resulting in amorphous masks that cannot be detected as human faces by biometric facial recognition technologies. The masks are used for public interventions and performances.One mask explores blackness and the racist implications that undergird biometric technologies’ inability to detect dark skin. Meanwhile another mask, which he calls the “Fag Face Mask”, points to the heteronormative underpinnings of facial recognition. Created from the aggregated facial data of queer men, this amorphous pink mask implicitly references—and contests—scientific studies that have attempted to link the identification of sexual orientation through rapid facial recognition techniques.Building on this body of creative work that has advocated for opacity as a tool of social and political transformation, SANCTUM resists the revelatory impulses of biometric technology by turning to the use and abuse of full-body imaging. The installation opens with a shot of a large, dark industrial space. At the far end of a red, spotlighted corridor, a black mask flickers on a screen. A shimmering, oscillating sound reverberates—the opening bars of a techno track—that breaks down in rhythm while the mask evaporates into a cloud of smoke. The camera swivels, and a white figure—the generic mannequin of the body scanner screen—is pummelled by invisible forces as if in a wind tunnel. These ghostly silhouettes appear and reappear in different positions, with some being whipped and others stretched and penetrated by a steel anal hook. Rather than conjuring a traditional horror trope of the body’s terrifying, bloody interior, SANCTUM evokes a new kind of feared and fetishized trope that is endemic to the current era of surveillance capitalism: the abstracted body, standardised and datafied, created through the supposedly objective and efficient gaze of AI-driven machinery.Resting on the floor in front of the ominous animated mask are neon fragments arranged in an occultist formation—hands or half a face. By breaking the body down into component parts— “from retina to fingerprints”—biometric technologies “purport to make individual bodies endlessly replicable, segmentable and transmissible in the transnational spaces of global capital” (Magnet 8). The notion that bodies can be seamlessly turned into blueprints extracted from biological and cultural contexts has been described by Donna Haraway as “corporeal fetishism” (Haraway, Modest). In the context of SANCTUM, Blas illustrates the dangers of mistaking a model for a “concrete entity” (Haraway, “Situated” 147). Indeed, the digital cartography of the generic mannequin becomes no longer a mode of representation but instead a technoscientific truth.Several scenes in SANCTUM also illustrate a process whereby substances are extracted from the mannequins and used as tools to enact violence. In one such instance, a silver webbing is generated over a kneeling figure. Upon closer inspection, this geometric structure, which is reminiscent of Blas’s earlier Face Cages project, is a replication of the triangulated patterns produced by facial recognition software in its mapping of distance between eyes, nose, and mouth. In the next scene, this “map” breaks apart into singular shapes that float and transform into a metallic whip, before eventually reconstituting themselves as a penetrative douche hose that causes the mannequin to spasm and vomit a pixelated liquid. Its secretions levitate and become the webbing, and then the sequence begins anew.In another scene, a mannequin is held upside-down and force-fed a bubbling liquid that is being pumped through tubes from its arms, legs, and stomach. These depictions visualise Magnet’s argument that biometric renderings of bodies are understood not to be “tropic” or “historically specific” but are instead presented as “plumbing individual depths in order to extract core identity” (5). In this sense, this visual representation calls to mind biometrics’ reification of body and identity, obfuscating what Haraway would describe as the “situatedness of knowledge”. Blas’s work, however, forces a critique of these very systems, as the materials extracted from the bodies of the mannequins in SANCTUM allude to how biometric cartographies drawn from travellers are utilised to justify detainment. These security technologies employ what Magnet has referred to as “surveillant scopophilia,” that is, new ways and forms of looking at the human body “disassembled into component parts while simultaneously working to assuage individual anxieties about safety and security through the promise of surveillance” (17). The transparent body—the body that can submit and reveal itself—is ironically represented by the distinctly genderless translucent mannequins. Although the generic mannequins are seemingly blank slates, the installation simultaneously forces a conversation about the ways in which biometrics draw upon and perpetuate assumptions about gender, race, and sexuality.Biometric SubjugationOn her 2016 critically acclaimed album HOPELESSNESS, openly transgender singer, composer, and visual artist Anohni performs a deviant subjectivity that highlights the above dynamics that mark the contemporary surveillance discourse. To an imagined “daddy” technocrat, she sings:Watch me… I know you love me'Cause you're always watching me'Case I'm involved in evil'Case I'm involved in terrorism'Case I'm involved in child molestersEvoking a queer sexual frisson, Anohni describes how, as a trans woman, she is hyper-visible to state institutions. She narrates a voyeuristic relation where trans bodies are policed as threats to public safety rather than protected from systemic discrimination. Through the seemingly benevolent “daddy” character and the play on ‘cause (i.e., because) and ‘case (i.e., in case), she highlights how gender-nonconforming individuals are predictively surveilled and assumed to already be guilty. Reflecting on daddy-boy sexual paradigms, Jack Halberstam reads the “sideways” relations of queer practices as an enactment of “rupture as substitution” to create a new project that “holds on to vestiges of the old but distorts” (226). Upending power and control, queer art has the capacity to both reveal and undermine hegemonic structures while simultaneously allowing for the distortion of the old to create something new.Employing the sublimatory relations of bondage, discipline, sadism, and masochism (BDSM), Blas’s queer installation similarly creates a sideways representation that re-orientates the logic of the biometric scanners, thereby unveiling the always already sexualised relations of scrutiny and interrogation as well as the submissive complicity they demand. Replacing the airport environment with a dark and foreboding mise-en-scène allows Blas to focus on capture rather than mobility, highlighting the ways in which border checkpoints (including those instantiated by the airport) encourage free travel for some while foreclosing movement for others. Building on Sara Ahmed’s “phenomenology of being stopped”, Magnet considers what happens when we turn our gaze to those “who fail to pass the checkpoint” (107). In SANCTUM, the same actions are played out again and again on spectral beings who are trapped in various states: they shudder in cages, are chained to the floor, or are projected against the parameters of mounted screens. One ghostly figure, for instance, lies pinned down by metallic grappling hooks, arms raised above the head in a recognisable stance of surrender, conjuring up the now-familiar image of a traveller standing in the cylindrical scanner machine, waiting to be screened. In portraying this extended moment of immobility, Blas lays bare the deep contradictions in the rhetoric of “freedom of movement” that underlies such spaces.On a global level, media reporting, scientific studies, and policy documents proclaim that biometrics are essential to ensuring personal safety and national security. Within the public imagination, these technologies become seductive because of their marked ability to identify terrorist attackers—to reveal threatening bodies—thereby appealing to the anxious citizen’s fear of the disguised suicide bomber. Yet for marginalised identities prefigured as criminal or deceptive—including transgender and black and brown bodies—the inability to perform such acts of revelation via submission to screening can result in humiliation and further discrimination, public shaming, and even tortuous inquiry – acts that are played out in SANCTUM.Masked GenitalsFeminist surveillance studies scholar Rachel Hall has referred to the impetus for revelation in the post-9/11 era as a desire for a universal “aesthetics of transparency” in which the world and the body is turned inside-out so that there are no longer “secrets or interiors … in which terrorists or terrorist threats might find refuge” (127). Hall takes up the case study of Umar Farouk Abdulmutallab (infamously known as “the Underwear Bomber”) who attempted to detonate plastic explosives hidden in his underwear while onboard a flight from Amsterdam to Detroit on 25 December 2009. Hall argues that this event signified a coalescence of fears surrounding bodies of colour, genitalia, and terrorism. News reports following the incident stated that Abdulmutallab tucked his penis to make room for the explosive, thereby “queer[ing] the aspiring terrorist by indirectly referencing his willingness … to make room for a substitute phallus” (Hall 289). Overtly manifested in the Underwear Bomber incident is also a desire to voyeuristically expose a hidden, threatening interiority, which is inherently implicated with anxieties surrounding gender deviance. Beauchamp elaborates on how gender deviance and transgression have coalesced with terrorism, which was exemplified in the wake of the 9/11 attacks when the United States Department of Homeland Security issued a memo that male terrorists “may dress as females in order to discourage scrutiny” (“Artful” 359). Although this advisory did not explicitly reference transgender populations, it linked “deviant” gender presentation—to which we could also add Abdulmutallab’s tucking of his penis—with threats to national security (Beauchamp, Going Stealth). This also calls to mind a broader discussion of the ways in which genitalia feature in the screening process. Prior to the introduction of millimetre-wave body scanning technology, the most common form of scanner used was the backscatter imaging machine, which displayed “naked” body images of each passenger to the security agent. Due to privacy concerns, these machines were replaced by the scanners currently in place which use a generic outline of a passenger (exemplified in SANCTUM) to detect possible threats.It is here worth returning to Blas’s installation, as it also implicitly critiques the security protocols that attempt to reveal genitalia as both threatening and as evidence of an inner truth about a body. At one moment in the installation a bayonet-like object pierces the blank crotch of the mannequin, shattering it into holographic fragments. The apparent genderlessness of the mannequins is contrasted with these graphic sexual acts. The penetrating metallic instrument that breaks into the loin of the mannequin, combined with the camera shot that slowly zooms in on this action, draws attention to a surveillant fascination with genitalia and revelation. As Nicholas L. Clarkson documents in his analysis of airport security protocols governing prostheses, including limbs and packies (silicone penis prostheses), genitals are a central component of the screening process. While it is stipulated that physical searches should not require travellers to remove items of clothing, such as underwear, or to expose their genitals to staff for inspection, prosthetics are routinely screened and examined. This practice can create tensions for trans or disabled passengers with prosthetics in so-called “sensitive” areas, particularly as guidelines for security measures are often implemented by airport staff who are not properly trained in transgender-sensitive protocols.ConclusionAccording to media technologies scholar Jeremy Packer, “rather than being treated as one to be protected from an exterior force and one’s self, the citizen is now treated as an always potential threat, a becoming bomb” (382). Although this technological policing impacts all who are subjected to security regimes (which is to say, everyone), this amalgamation of body and bomb has exacerbated the ways in which bodies socially coded as threatening or deceptive are targeted by security and surveillance regimes. Nonetheless, others have argued that the use of invasive forms of surveillance can be justified by the state as an exchange: that citizens should willingly give up their right to privacy in exchange for safety (Monahan 1). Rather than subscribing to this paradigm, Blas’ SANCTUM critiques the violence of mandatory complicity in this “trade-off” narrative. Because their operationalisation rests on normative notions of embodiment that are governed by preconceptions around gender, race, sexuality and ability, surveillance systems demand that bodies become transparent. This disproportionally affects those whose bodies do not match norms, with trans and queer bodies often becoming unreadable (Kafer and Grinberg). The shadowy realm of SANCTUM illustrates this tension between biometric revelation and resistance, but also suggests that opacity may be a tool of transformation in the face of such discriminatory violations that are built into surveillance.ReferencesAhmed, Sara. “A Phenomenology of Whiteness.” Feminist Theory 8.2 (2007): 149–68.Beauchamp, Toby. “Artful Concealment and Strategic Visibility: Transgender Bodies and U.S. State Surveillance after 9/11.” Surveillance & Society 6.4 (2009): 356–66.———. Going Stealth: Transgender Politics and U.S. Surveillance Practices. 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