Battlefield ethics training: integrating ethical scenarios in high-intensity military field exercises

There is growing evidence that modern missions have added stresses and ethical complexities not seen in previous military operations and that there are links between battlefield stressors and ethical lapses. Military ethicists have concluded that the ethical challenges of modern missions are not well addressed by current military ethics educational programs. Integrating the extant research in the area, we propose that scenario-based operational ethics training in high-intensity military field training settings may be an important adjunct to traditional military ethics education and training. We make the case as to why this approach will enhance ethical operational preparation for soldiers, supporting their psychological well-being as well as mission effectiveness.</p

Online_Supplemental_Material - Do Investments in Mental Health Systems Result in Greater Use of Mental Health Services? National Trends in Mental Health Service Use (MHSU) in the Canadian Military and Comparable Canadian Civilians, 2002-2013

Online_Supplemental_Material for Do Investments in Mental Health Systems Result in Greater Use of Mental Health Services? National Trends in Mental Health Service Use (MHSU) in the Canadian Military and Comparable Canadian Civilians, 2002-2013 by Deniz Fikretoglu, Aihua Liu, Mark Allen Zamorski, Corneliu Rusu, and Rakesh Jetly in The Canadian Journal of Psychiatry</p

Restoring large-scale brain networks in PTSD and related disorders: a proposal for neuroscientifically-informed treatment interventions

Three intrinsic connectivity networks in the brain, namely the central executive, salience, and default mode networks, have been identified as crucial to the understanding of higher cognitive functioning, and the functioning of these networks has been suggested to be impaired in psychopathology, including posttraumatic stress disorder (PTSD). 1) To describe three main large-scale networks of the human brain; 2) to discuss the functioning of these neural networks in PTSD and related symptoms; and 3) to offer hypotheses for neuroscientifically-informed interventions based on treating the abnormalities observed in these neural networks in PTSD and related disorders. Literature relevant to this commentary was reviewed. Increasing evidence for altered functioning of the central executive, salience, and default mode networks in PTSD has been demonstrated. We suggest that each network is associated with specific clinical symptoms observed in PTSD, including cognitive dysfunction (central executive network), increased and decreased arousal/interoception (salience network), and an altered sense of self (default mode network). Specific testable neuroscientifically-informed treatments aimed to restore each of these neural networks and related clinical dysfunction are proposed. Neuroscientifically-informed treatment interventions will be essential to future research agendas aimed at targeting specific PTSD and related symptoms.</p

Correlations between the classification confidence (MEG-based measures) and self-reported clinical scores.

(A) severity; and (B) symptoms for mTBI patients. The higher confidence that a given subject is classified as having mTBI, the higher the corresponding clinical scores. The correlations are shown as functions of the number of best features extracted from alpha connectivity and ranked before training. Scatter plots between classification confidence and clinical scores are shown at specific thresholds: k = 11 and k = 33 for (C) severity score; and (D) symptoms scores, respectively.</p

Detecting Mild Traumatic Brain Injury Using Resting State Magnetoencephalographic Connectivity - Table 1

<p>Detecting Mild Traumatic Brain Injury Using Resting State Magnetoencephalographic Connectivity</p> - Table

Spatial distribution of 33 best features (connectivity at alpha frequencies), which were used for prediction (see Fig 3).

<p>The red spheres indicate the location of the 33 best features (connections) for detection of mTBI, while the blue lines represent the inter-regional alpha connections (features). Line thickness denotes the robustness of contribution of specific features across subjects. The same connectiones are plotted in <a href="http://www.ploscompbiol.org/article/info:doi/10.1371/journal.pcbi.1004914#pcbi.1004914.g008" target="_blank">Fig 8B</a> in a matrix form.</p

The 90 x 90 maps of increased phase synchrony at alpha frequencies in mTBI.

(A) z-scores associated with the increases in connectivity in mTBI; and (B) connections cotributing to classification, robustrly across frequencies and subjects. Similar to Fig 7, panel A shows only the connections associated with the bootstrap ratio values less than -1. To compare the hyper-connectivity in mTBI at alpha frequencies with classification results, Panel B represents a matrix version of the 3D spatial pattern (Fig 5), which corresponds to the situation wherein 33 best features are used for prediction (see Fig 3).</p

Deployment-related mental health support: comparative analysis of NATO and allied ISAF partners

For years there has been a tremendous gap in our understanding of the mental health effects of deployment and the efforts by military forces at trying to minimize or mitigate these. Many military forces have recently systematized the mental support that is provided to support operational deployments. However, the rationale for doing so and the consequential allocation of resources are felt to vary considerably across North Atlantic Treaty Organisation (NATO) International Security Assistance (ISAF) partners. This review aims to compare the organization and practice of mental support by five partnering countries in the recent deployment in Afghanistan in order to identify and compare the key methods and structures for delivering mental health support, describe bottlenecks and illustrate new developments. Information was collected through document analysis and semi-structured interviews with key military mental healthcare stakeholders. The review resulted from close collaboration between key military mental healthcare professionals within the Australian Defense Forces (ADF), Canadian Armed Forces (CAF), United Kingdom Armed Forces (UK), Netherlands Armed Forces (NLD), and the United States Army (US). Key stakeholders were interviewed about the mental health support provided during a serviceperson's military career. The main items discussed were training, prevention, early identification, intervention, and aftercare in the field of mental health. All forces reported that much attention was paid to mental health during the individual's military career, including deployment. In doing so there was much overlap between the rationale and applied methods. The main method of providing support was through training and education. The educative focus was to strengthen the mental resilience of individual soldiers while providing a range of mental healthcare services. All forces had abandoned standard psychological debriefing after critical incidents. Instead, by default, mental healthcare professionals acted to support the leader and peer led “after action” reviews. All countries provided professional mental support close to the front line, aimed at early detection and early return to normal activities within the unit. All countries deployed a mental health support team that consisted of a range of mental health staff including psychiatrists, psychologists, social workers, mental health nurses, and chaplains. There was no overall consensus in the allocation of mental health disciplines in theatre. All countries (except the US) provided troops with a third location decompression (TLD) stop after deployment, which aimed to recognize what the deployed units had been through and to prepare them for transition home. The US conducted in-garrison ‘decompression’, or ‘reintegration training’ in the US, with a similiar focus to TLD. All had a reasonably comparable infrastructure in the field of mental healthcare. Shared bottlenecks across countries included perceived stigma and barriers to care around mental health problems as well as the need for improving the awareness and recognition of mental health problems among service members. among service personnel as well as the need for improving the awareness and recognition of symptoms as being indicative of a mental health problems among service members. This analysis demonstrated that in all five partners state-of-the-art preventative mental healthcare was included in the last deployment in Afghanistan, including a positive approach towards strengthening the mental resilience, a focus on self-regulatory skills and self-empowerment, and several initiatives that were well-integrated in a military context. These initiatives were partly/completely implemented by the military/colleagues/supervisors and applicable during several phases of the deployment cycle. Important new developments in operational mental health support are recognition of the role of social leadership and enhancement of operational peer support. This requires awareness of mental problems that will contribute to reduction of the barriers to care in case of problems. Finally, comparing mental health support services across countries can contribute to optimal preparation for the challenges of military deployment.</p

A diagram illustrating one round of leave-one-out cross-validation to estimate classification accuracies.

<p>A diagram illustrating one round of leave-one-out cross-validation to estimate classification accuracies.</p

Phase-locking values for three specific connections at three characteristic frequencies.

<p>i) between the left middle occipital gyrus (Occipital Mid L) and the left median cingulate and paracingulate gyri (Cingulum Mid L) at 2 Hz; ii) between the temporal pole of the left middle temporal gyrus (Temporal Pole Mid L) and the left gyrus rectus (Rectus L) at 8 Hz; and iii) between the left inferior temporal gyrus (Temporal Inf R) and the right calcarine fissure and surrounding cortex (Calcarine R) at 75 Hz. Shown are the means across subjects and corresponding standard errors.</p