United States Army Command and General Staff College

Weather and climate extremes have been varying and changing on many different time scales. In recent decades, heat waves have generally become more frequent across the United States, while cold waves have been decreasing. While this is in keeping with expectations in a warming climate, it turns out that decadal variations in the number of U.S. heat and cold waves do not correlate well with the observed U.S. warming during the last century. Annual peak flow data reveal that river flooding trends on the century scale do not show uniform changes across the country. While flood magnitudes in the Southwest have been decreasing, flood magnitudes in the Northeast and north-central United States have been increasing. Confounding the analysis of trends in river flooding is multiyear and even multidecadal variability likely caused by both large-scale atmospheric circulation changes and basin-scale “memory” in the form of soil moisture. Droughts also have long-term trends as well as multiyear and decadal variability. Instrumental data indicate that the Dust Bowl of the 1930s and the drought in the 1950s were the most significant twentieth-century droughts in the United States, while tree ring data indicate that the megadroughts over the twelfth century exceeded anything in the twentieth century in both spatial extent and duration. The state of knowledge of the factors that cause heat waves, cold waves, floods, and drought to change is fairly good with heat waves being the best understood.

The class imbalance problem is encountered in real-world applications of machine learning and results in a classifier's suboptimal performance. Researchers have rigorously studied the resampling, algorithms, and feature selection approaches to this problem. No systematic studies have been conducted to understand how well these methods combat the class imbalance problem and which of these methods best manage the different challenges posed by imbalanced data sets. In particular, feature selection has rarely been studied outside of text classification problems. Additionally, no studies have looked at the additional problem of learning from small samples. This paper presents a first systematic comparison of the three types of methods developed for imbalanced data classification problems and of seven feature selection metrics evaluated on small sample data sets from different applications. We evaluated the performance of these metrics using area under the receiver operating characteristic (AUC) and area under the precision-recall curve (PRC). We compared each metric on the average performance across all problems and on the likelihood of a metric yielding the best performance on a specific problem. We examined the performance of these metrics inside each problem domain. Finally, we evaluated the efficacy of these metrics to see which perform best across algorithms. Our results showed that signal-to-noise correlation coefficient (S2N) and Feature Assessment by Sliding Thresholds (FAST) are great candidates for feature selection in most applications, especially when selecting very small numbers of features.

This article presents an algorithm for constructing orthogonal Latin hypercubes, given a fixed sample size, in more dimensions than previous approaches. In addition, we detail a method that dramatically improves the space-filling properties of the resultant Latin hypercubes at the expense of inducing small correlations between the columns in the design matrix. Although the designs are applicable to many situations, they were developed to provide Department of Defense analysts flexibility in fitting models when exploring high-dimensional computer simulations where there is considerable a priori uncertainty about the forms of the response surfaces.

CONTEXT: US soldiers are required to undergo screening for depression, posttraumatic stress disorder (PTSD), and other mental health problems on return from service in Iraq or Afghanistan as part of routine postdeployment health assessments. OBJECTIVE: To assess the influence of the anonymity of screening processes on willingness of soldiers to report mental health problems after combat deployment. DESIGN: Anonymous and nonanonymous surveys. SETTING: US military. PATIENTS: US infantry soldiers' reporting of mental health problems on the routine Post-Deployment Health Assessment was compared with their reporting on an anonymous survey administered simultaneously. MAIN OUTCOME MEASURES: The Primary Care PTSD Screen, the Patient Health Questionnaire-2 (modified), the suicidal ideation question from the Patient Health Questionnaire-9, and several other questions related to mental health were used on both surveys. Soldiers were also asked on the anonymous survey about perceptions of stigma and willingness to report honestly. RESULTS: Of 3502 US Army soldiers from one infantry brigade combat team undergoing the routine Post-Deployment Health Assessment in 2008, a total of 2500 were invited to complete the anonymous survey, and 1712 of these participated (response rate, 68.5%). Reporting of depression, PTSD, suicidal ideation, and interest in receiving care were 2-fold to 4-fold higher on the anonymous survey compared with the routine Post-Deployment Health Assessment. Overall, 20.3% of soldiers who screened positive for depression or PTSD reported that they were uncomfortable reporting their answers honestly on the routine postdeployment screening. CONCLUSIONS: Current postdeployment mental health screening tools are dependent on soldiers honestly reporting their symptoms. This study indicates that the Post-Deployment Health Assessment screening process misses most soldiers with significant mental health problems. Further efforts are required to reduce the stigma of reporting and improve willingness to receive care for mental health problems.

BACKGROUND: Progressive peri-implant bone losses, which are accompanied by inflammatory lesions in the soft tissues, are referred to as peri-implantitis. The aim of this study was to compare the effects of photodynamic therapy (PDT) and conventional technique on microbial reduction in ligature-induced peri-implantitis in dogs. METHODS: Eighteen third premolars from nine Labrador retriever dogs were extracted and the implants were submerged. After osseointegration, peri-implantitis was induced. After 4 months, ligature was removed and natural bacterial plaque was allowed to form for another 4 months. The animals were then randomly divided into two groups. In the conventional group, they were treated using mucoperiosteal flaps for scaling the implant surface and chlorexidine (conventional) irrigation. In the PDT group, only mucoperiosteal scaling was carried out before photodynamic therapy. Inside the peri-implant pocket, a paste-based azulene photosensitizer was placed and then a GaAlAs low-power laser (lambda=660 nm, P=40 mW, E=7.2 J for 3 minutes) was used. Microbiological samples were obtained before and immediately after treatment. Before treatment, one implant was removed and analyzed by scanning electron microscopy to validate the contamination. RESULTS: The results of this study showed that Prevotella sp., Fusobacterium sp., and S. Beta-haemolyticus were significantly reduced for both groups. After treatment, no significant differences were observed between the groups. CONCLUSION: These findings suggest that photodynamic therapy is a non-invasive method that could be used to reduce microorganisms in peri-implantitis.

Swift starting action teams (STATs) are increasingly prevalent in organizations, and the development of trust is often a critical issue for their effectiveness. However, current theory and research do not provide a clear picture regarding how trust toward the team (i.e., the team as the target) is developed in these settings. The primary contribution of this article is to present a theoretical framework describing how individual-level trust toward one’s team is developed in STAT contexts. This article integrates several existing trust theories into one comprehensive context-specific multilevel theory of how trust develops in STATs from cognitive, affective, behavioral, and contextual perspectives. This framework furthers our understanding of the unique antecedents of initial trust in STATs, how trust attitudes are adjusted over the short amount of time the team interacts, and how the team context influences this developmental process.

Describing hand prehension patterns in the context of functional hand evaluations may not provide the therapist or surgeon with an accurate portrayal of a patient's capabilities. Although dexterity involves both static and dynamic components of hand usage, most descriptions of prehension patterns study the static phase alone. Hand use is a function of anatomic integrity, mobility, strength, sensation, coordination, age, sex, mental status, disease or trauma, and the condition of other proximal extremity joints (shoulder, elbow, wrist). In this study, various descriptions of hand prehension patterns were reviewed and 11 functional hand evaluations were analyzed. The purpose was to see if the descriptions and the evaluations have common elements. The conclusions are that there are no common elements, that no hand function evaluation is appropriate for all types of patients, and that such evaluations should consist of tasks representative of everyday functional activities.

BACKGROUND: Changes in Doppler flow patterns of hepatic veins (HV), portal vein (PV) and intra-renal veins (RV) reflect right atrial pressure and venous congestion; the feasibility of obtaining these assessments and the clinical relevance of the findings is unknown in a general ICU population. This study compares the morphology of HV, PV and RV waveform abnormalities in prediction of major adverse kidney events at 30 days (MAKE30) in critically ill patients. STUDY DESIGN AND METHODS: We conducted a prospective observational study enrolling adult patients within 24 h of admission to the ICU. Patients underwent an ultrasound evaluation of the HV, PV and RV. We compared the rate of MAKE-30 events in patients with and without venous flow abnormalities in the hepatic, portal and intra-renal veins. The HV was considered abnormal if S to D wave reversal was present. The PV was considered abnormal if the portal pulsatility index (PPI) was greater than 30%. We also examined PPI as a continuous variable to assess whether small changes in portal vein flow was a clinically important marker of venous congestion. RESULTS: From January 2019 to June 2019, we enrolled 114 patients. HV abnormalities demonstrate an odds ratio of 4.0 (95% CI 1.4-11.2). PV as a dichotomous outcome is associated with an increased odds ratio of MAKE-30 but fails to reach statistical significance (OR 2.3 95% CI 0.87-5.96), but when examined as a continuous variable it demonstrates an odds ratio of 1.03 (95% CI 1.00-1.06). RV Doppler flow abnormalities are not associated with an increase in the rate of MAKE-30 INTERPRETATION: Obtaining hepatic, portal and renal venous Doppler assessments in critically ill ICU patients are feasible. Abnormalities in hepatic and portal venous Doppler are associated with an increase in MAKE-30. Further research is needed to determine if venous Doppler assessments can be useful measures in assessing right-sided venous congestion in critically ill patients.

The Afghanistan National Development Strategy identified billions of dollars of needs for transportation, water, energy, telecommunications, and other necessary infrastructure development for the rebuilding of Afghanistan. With economic sustainability as a primary aim, the coordination and prioritization of investments has been a challenge in part because of Afghanistan's volatile security situation along with the intricacies of the negotiating and coordinating efforts of numerous stakeholders. An understanding of the contributions of infrastructure systems and associated projects to the national development strategy is needed. This paper formulates a scenario-informed multicriteria approach to prioritize major project investments for infrastructure development subject to deep, nonprobabilistic uncertainties. The methods are inclusive of stakeholder values and accounts for deep uncertainties in governance, security, economy, environment, workforce, and other topics. The methods are applied in Afghanistan's Nangarhar province to assist in the selection among twenty-seven candidate infrastructure projects that are vulnerable to potential refugee immigration among other emergent conditions. The paper describes the relationships of selected projects to strategic goals while facilitating collaboration among government and nongovernment investors, donors, technologists, and other stakeholders.

A prospective study of orthopaedic injuries to children (ages 6 to 17) was conducted for a calendar year in the controlled environment of a military post. Data were collected on the number of participants, the hours of participation, and the number of injuries for six supervised sports (football, soccer, basketball, baseball, swimming, and gymnastics). An injury index factor was derived by a formula: (number of injuries x 10(4)) divided by [(number of participants) x (average number of hours of participation) x (number of weeks in the season of the sport)]. When the injury index factors were compared, the risk a participant has for sustaining an injury in football was twice as high (1.72) as its nearest competitors, basketball (0.88) and gymnastics (0.85). Soccer had an index factor of 0.29; baseball, 0.14; and swimming had a factor of zero. Eighty percent of all sports-related orthopaedic injuries involved the upper extremities. Lower extremity orthopaedic injuries occurred only in football and gymnastics. The evidence suggests that those persons concerned with reducing the number of injuries to the growing athlete in supervised sports should focus their attention on reducing the risk of injury to the upper extremities.

Hamstring stretching is an important part of treatment programs aimed at decreasing the likelihood of hamstring injury. Few studies have examined the use of superficial thermal modalities in conjunction with hamstring stretching. The purpose of this study was to determine if the application of a superficial heating or cooling modality, followed by static stretch, increased the efficacy of static stretching of the hamstring muscles. This study examined 12 male and 12 female subjects, ages 18-38. All subjects received each of the following treatments: heat followed by static stretch, cold followed by static stretch, and static stretch alone. Each treatment was separated by at least 1 week. Pre- and post-treatment measurements of hamstring length were obtained using the Active-Knee-Extension (AKE) test. The data were analyzed via a 2 x 3 analysis of variance experimental design. Results indicated that there was an increase in hamstring length regardless of stretch treatment used, with F(1,23) = 35.49, p < .001. However, no significant differences were detected among stretch treatments, F < 1.0, nor among interaction effects, F < 1.0. The results of this study suggest that adequate hamstring stretching can occur without the use of a superficial thermal modality.

Performance improvement is reliant on information and data, as you cannot improve what you do not measure. The US military went to war in 2001 without an integrated trauma care system to collect and analyze combat casualty care data. By 2006, the conflict in Afghanistan began appreciating the capture and consolidation of hospital care documentation into the Department of Defense Trauma Registry. In contrast, a paucity of documentation has existed for prehospital or tactical combat casualty care (TCCC). Using the 75th Ranger casualty documentation model established in 2005, the Joint Trauma System developed a casualty data collection system for prehospital care using the TCCC Card, the TCCC After Action Report (AAR), and the Prehospital Trauma Registry. In 2013, this system was mandated for use by US forces in Afghanistan. The Joint Trauma System also created and deployed a prehospital team to be an integral part of the Joint Theater Trauma System in Afghanistan. This prehospital team provided prehospital training and facilitated prehospital data capture. Described and analyzed in this report are prehospital data captured in Afghanistan from 2013 to 2014 using the TCCC Card and the TCCC AAR.

Agriculture is one of the easiest sectors of the U.S. economy to disrupt, and its disruption could have catastrophic consequences for the U.S. and world economies. Agriculture in the U.S. accounts for 13% of the current Gross Domestic Product (GDP) and provides employment for 15% of the population. It produces high-quality, cheap, plentiful food for domestic consumption and accounts for more than $50 billion in exports. The likelihood of terrorist acts interrupting the production, processing, and distribution of agricultural products is high: A number of different possible plant or animal pathogens could cause harm or loss of production, and even an act of agroterrorism that did not result in the destruction of foodstuffs or interruptions in the food supply could have a psychological impact. A number of recent unintentional events and epidemics have prompted the U.S. and other countries to provide resources to counteract contagious diseases and contain their impact, including increased funding to federal agencies that are responsible for protecting domestic agriculture. This article presents recommendations to protect agriculture, including changing the way agriculture is viewed on the federal level and increasing the resources to protect agriculture from terrorist attack.

The current study sought to report the base rates of Symptom Validity Test (SVT) failure in an active duty military sample as well as to compare the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Effort Index (EI) to stand-alone measures of symptom validity. SVT failure varied from previous studies and even among different subgroups in the current sample, ranging from 8% to 30%. The RBANS EI demonstrated modest sensitivity in the detection of suboptimal effort when compared with stand-alone SVTs. Although the index appears to add some utility to the detection of suboptimal effort, sole use of the EI as a measure of symptom validity could conceivably result in an unnecessarily high rate of false negatives.

The study examined Symptom Validity Test (SVT) performance in a sample of military service members on active orders as a function of evaluation context. Service members were assessed in the context of either a pending disability evaluation (Medical Evaluation Board; MEB) or a non-MEB/clinical evaluation. Overall, 41.8% of the sample failed the Word Memory Test; however, significantly more individuals in the MEB group (54%) failed the measure relative to the non-MEB/clinical group (35%). Regardless of group membership, SVT performance had a notable impact on neurocognitive test scores as measured by effect sizes. SVT performance was less strongly associated with self-reported psychological symptoms as gauged by the Personality Assessment Inventory. The current results are discussed in light of previous research on SVT performance in veteran and active duty samples.

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Domestic terrorism accounts for a vast majority of all attacks, yet it is far less studied than its transnational counterpart. As a result, the literature on domestic terrorism remains theoretically and empirically underdeveloped. One of the reasons for this is the dearth of comprehensive crossnational domestic terrorism datasets. This article seeks to address the problem by proposing a method for refining original Global Terrorism Database (GTD) data into a constructively valid, crossnational domestic terrorism dataset. The analysis begins with the definition of terrorism and further develops it by conceptually distinguishing its domestic and transnational forms. Because the GTD includes nonterrorist events and conflates transnational and domestic incidents, its raw form is unsuited for domestic research. Therefore, the article examines common definitional attributes from terrorism and domestic terrorism literature. It concludes by specifying steps for assembling a dataset and examining descriptive statistics of the resulting population.

Combat exposure is a consistent predictor of posttraumatic stress (PTS). Understanding factors that might buffer the effects of combat exposure is crucial for helping service members weather the stress of war. In a study of U.S. Marines returning from Iraq, hierarchical multiple regression analyses revealed that unit cohesion and combat exposure predicted PTS, depression, and anger. Furthermore, results indicated that unit cohesion may be an important buffer, possibly limiting the development of PTS and depression following combat exposure.

Biomarkers of polycyclic aromatic hydrocarbon (PAH) exposure and genetic biomarkers of potential cancer susceptibility were determined in a group of United States Army soldiers who were deployed to Kuwait and Saudi Arabia in 1991 in the aftermath of the Persian Gulf War. Because hundreds of oil well fires were still burning, there was concern that ground troops stationed in Kuwait might be exposed to high levels of PAHs and other toxicants. The United States Army Environmental Hygiene Agency monitored air and soil for ambient PAHs. In addition, a group of 61 soldiers was involved in the biomonitoring study reported here. These soldiers kept diaries of daily activities and provided blood and urine samples in Germany (June) before deployment to Kuwait, after 8 weeks in Kuwait (August), and 1 month after the return to Germany (October). Here we present data for PAH-DNA adducts measured by immunoassay in blood cell DNA samples obtained at all three sampling times from 22 soldiers and bulky aromatic adducts measured by 32P-postlabeling in blood cell DNA samples from 20 of the same soldiers. Urinary 1-hydroxypyrene-glucuronide levels were determined by synchronous fluorescence spectrometry in a matched set of samples from 33 soldiers. Contrary to expectations, environmental monitoring showed low ambient PAH levels in the areas where these soldiers were working in Kuwait. For both DNA adduct assays, levels were the lowest in Kuwait in August and increased significantly after the soldiers returned to Germany (October). Urinary 1-hydroxypyrene-glucuronide levels were also lowest in Kuwait and highest in Germany, but the differences were not statistically significant. The PAH-exposure biomarker levels were not significantly influenced by polymorphic variations of CYP1A1 (MspI) and glutathione S-transferases M1 and T1. Overall, the data suggest that this group of soldiers was not exposed to elevated levels of PAHs while deployed in Kuwait.