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Abstract: Our study was design to determine the association between depressive symptoms and mortality in adults over 60 years old Navy Peruvian Veterans. We performed a retrospective cohort study based on a previous cohort study. A total of 1681 patients over 60 years old were included between 2010–2015. Demographic information, self-reported information about falls, physical frailty assessment, tobacco consumption, hypertension, Type 2 Diabetes Mellitus, Chronic Obstructive Pulmonary Disease and was collected. Depression was assessed by the short form of the Geriatric Depression Scale. We found that depressive symptoms were present in 24.9% of the participants and 40.5% of them died. Mortality risk in patients with depressive symptoms, physical frailty, and male sex was: RR of 23.1 (95% CI: 11.7–45.7), 3.84 (95% CI: 2.16–6.82), and 1.37 (95% CI: 1.07–1.75) respectively. We concluded that depressive symptoms in Peruvian retired military personnel and their immediate relatives are high and are significatively associated with mortality. Also, being male and frail was associated with an increased risk of death. This reinforces that early detection and assessment of depressive symptoms could be an opportunity to improve the health status of older adults.

The materials of war, defined as what soldiers carry into battle and off the battlefield, have much to offer as a means of identifying and analyzing the culture of those combatants. The Vietnam War is extremely rich in culture when considered against the changing political and social climate of the United States during the 1960s and 70s. Determining the meaning of the materials carried by Vietnam War soldiers can help identify why a soldier is fighting, what the soldier’s fears are, explain certain actions or inactions in a given situation, or describe the values and moral beliefs that governed that soldier’s conduct. “Carry,” as a word, often refers to something physical that can be seen, touched, smelled, or heard, but there is also the mental material, which does not exist in the physical space, that soldiers collect in their experiences prior to, during, and after battle. War changes the individual soldier, and by analyzing what he or she took (both physical and mental), attempts at self-preservation or defense mechanisms to harden the body and mind from the harsh realities of war are revealed. In the same respect, what the soldiers brought home is also a means of preservation; preserving those memories of their experiences adds validity and meaning to their experiences. An approach employing aspects of psychology, sociology, and cultural theory demonstrates that any cookie-cutter answer or characterization of Vietnam veterans is unstable at best, and that a much more complex picture develops from a multidisciplinary analysis of the soldiers who fought the war in Vietnam.

Stigmatization has shown to negatively impact service members with Posttraumatic Stress Disorder (PTSD). Published research has shown stigma to significantly affect service members through increased suicide, homicide, unemployment, homelessness, and criminal justice system interaction rates. Additionally, stigma also affects overall readiness and cohesion of the military organization. However, little research has focused on the perceptions of Reserve Officer Training Corps (ROTC) cadets about service members with a combat-related stress disorder in which they will eventually be charged with leading. The purpose of this quantitative study was to measure a cohort of ROTC cadets and determine their perceptions about service members serving with PTSD. Socialization theory was used as the lens to measure ROTC cadet's acceptance into the military culture. The study population consisted of 14 cadets within 5 ROTC battalions in Louisiana. Fisher's exact test revealed no significant relationships among ROTC cadet's overall perceptions. However, valuable insight was discovered regarding religion and branch of service the cadets intended to commission with as potential significant variables regarding their perceptions about PTSD. Further research, including a larger population size, is still needed to determine how these perceptions impact currently serving service members. Implications for positive social change include improved knowledge about PTSD and the stigma associated with negative perceptions, which will improve education through socialization into the military culture and reduce suicide, homicide, criminal justice system interaction, homelessness, and unemployment rates in addition to improving the overall readiness and cohesion of the Armed Forces.

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Seventy percent of organizational change initiatives fail. Among organizations where change and adaptation are necessary for survival, the U.S. military stands at the top. The disparity between desired health and fitness behaviors and actual behaviors is a glaring reminder that change is difficult to implement and that current change systems struggle. Merit-based systems offer a solution by rewarding and reinforcing good behavior to generate lasting change. This paper evaluates Kotter's Change Model and Nudge Theory and found them insufficient because they do not sufficiently address reinforcement learning or the temporal tie between behaviors and rewards for reinforcement. This paper then examines behavior modification through a theoretical framework called Active Inference. Active Inference suggests agents or organisms will engage in behavioral tradeoffs based on their prior knowledge, present sensing, and future beliefs. This paper suggests that the modeling of behaviors using active inference allows supervisors to predict and target behaviors that will need to be reinforced by a merit-based system to produce long-term change. Finally, this paper examines and recommends the adoption of blockchain play-to-earn models to standardize and automate rewards to produce lasting habits that result in long-term change.

This pilot study examines the impact of combined immersion and embodiment on learning and emotional outcomes. The results are intended to better enable U.S. Army senior leaders to decide if dismounted infantry Soldiers would benefit from a more immersive simulation-based training capability. The experiment's between-subject design included a sample of 15 participants randomly assigned to one of three system configurations representing different levels of combined immersion and embodiment. The control group was a typical desktop, and the two experimental groups were a typical configuration of a Virtual Reality headset (VR) and a novel configuration using VR supported by an omnidirectional treadmill (ODT) for full body exploration and interaction. Unique from similar studies, this pilot study allows for an analysis of the Infinadeck ODT's impact on learning outcomes and the value of pairing tasks by type with various levels of immersion. Each condition accessed the same realistically modeled geospatial virtual environment (VE), the UCF Virtual Arboretum, and completed the same pre and post VE-interaction measurement instruments. These tests included complicated and complex information. Declarative information involved listing plants/communities native to central Florida (complicated tasks) while the situational awareness measurement required participants to draw a sketch map (complex task). The Kruskal-Wallis non-parametric statistical test showed no difference between conditions on learning outcomes. The non-parametric Spearman correlation statistical test showed many significant relationships between the system configuration and emotional outcomes. Graphical representations of the data combined with quantitative, qualitative, and correlational data suggest a larger sample size is required to increase power to answer this research question. This study found a strong trend which indicates learning outcomes are affected by task type and significant correlations between emotions important for learning outcomes increased with combined immersion and embodiment.

Indiana University-Purdue University Indianapolis (IUPUI) / Traumatic brain injury (TBI) has emerged as a major cause of morbidity among U.S. soldiers who have served in Iraq and Afghanistan. Even mild TBI (mTBI) can result in cognitive impairments that can impact how veterans experience such things as physical symptoms, emotions and behaviors, instrumental activities of daily living, interpersonal interactions, and community reintegration. The purpose of this study was to develop a comprehensive self-management intervention for veterans with mTBI to facilitate their community reintegration upon returning from deployment to combat zones. This study was conducted in two Phases. Phase I entailed collecting qualitative data regarding needs, concerns, strategies used, and advice given by eight veterans with mTBI, guided by a conceptual model derived from Ferrans’ and colleagues’ health-related quality of life model and the TBI literature. Six key categories and predominant themes emerged providing further support for the model (cognitive impairments, physical symptoms, emotions and behaviors, instrumental activities of daily living, interpersonal interactions, and community reintegration). Guided by the conceptual model, a mTBI Veteran Needs and Concerns Checklist and 14 algorithms making up the VETeranS Compensate, Adapt, REintegrate (VETSCARE) intervention were developed. Phase II entailed obtaining review of the mTBI Veteran Needs and Concerns Checklist and the 14 VETSCARE algorithms from six TBI experts. On a scale of 1 to 5, with 5 being strongly agree, expert ratings provided moderate evidence of content validity for the checklist (3.33), and for the 14 algorithms (problem relevance 3.92, accuracy 3.73, feasibility 3.80, acceptability 3.84). The average overall expert rating for the VETSCARE intervention was 3.82. The checklist and the 14 algorithms are being revised based on specific comments provided by the experts. Once revised, the mTBI Veteran Needs and Concerns Checklist and the VETSCARE intervention will be tested for feasibility in a future pilot study with veterans with mTBI who have recently returned from combat zones in Iraq and Afghanistan.

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New positions have recently become available in the military and will eventually lead to increases in the number of female veterans in America. These women are influenced by adverse childhood events (ACE), post-traumatic stress disorder, and other life-altering incidents. Some female veterans show positive mental health status, resiliency, and lead healthy lives, while others female veterans battle high rates of alcohol abuse, substance abuse, homelessness, and suicide. Uncovering factors that lead to a positive mental health status is a critical component towards implementing gender-specific strategies to help female veterans build resiliency and coping mechanisms. An analysis of the ACE module included from the 2011 and 2012 Behavioral Risk Factor Surveillance System (BRFSS) was used to build multiple linear regression models, Page 118 2016 Appalachian Student Research Forum and evaluate prevalence of three ACE events. These negative sexual events included being touched sexually by another, being forced to touch another sexually, or being forced to have sex as a child. Female veterans show higher prevalence of negative sexual ACE events when compared to civilian women. The biggest difference was being touched sexually prior to the age of 18 with 19% of veterans reporting this experience, compared to 14% of civilian women. The multiple linear regression model analyzed self-reported mentally healthy days of women within the last 30 days. Female veterans had 0.59 (p = 0.044) fewer mentally unhealthy days than civilian women during a 30-day period. The three sexual ACE variables significantly predicted unhealthy days for female veterans and civilians. Women forced to have sex had 2.5 (p = 0.000) more mentally unhealthy days and 1.9 (p = 0.000) more mentally unhealthy days when forced to touch another sexually. Older age, additional education, and increased income were significant and lowered the number of mentally unhealthy days, while marriage led to an increase of 0.18 (p = 0.005) unhealthy days. Results indicated that female veterans had1.35 (p = 0.002) fewer physically unhealthy days. It is noteworthy that female veterans are reporting a significant increase in mentally healthy days compared to their civilian counterparts, despite the higher prevalence of negative sexual ACEs. Further investigation is needed to discover the mental, behavioral, and demographic features that help some female veterans overcome the typical dose-response relationship between negative ACEs and unhealthy days. Evidence -based resiliency programs can then better assist female veterans who are struggling to survive.