VA enhances mental health treatment with measurement based care
VAntage PointBy Laura O. Wray, Ph.D., David W. Oslin, M.D., & Mona J. Ritchie, Ph.D., L.C.S.W.
How do we measure mental health?
Mental health treatment can be complicated, and adjustments are often needed to make it as effective as possible. When treatment isn’t meeting the Veteran’s goals or leading to improvement, VA encourages the Veteran and provider to discuss potential reasons and consider modifications or alternative treatments that better meet the patient’s needs.
To help, VA uses standardized questionnaires to measure change along the way. This process, known as measurement-based care (MBC), transforms the way VA delivers mental health care. MBC involves the following steps:
The Veteran routinely completes brief questionnaires about their symptoms and progress toward treatment goals.
The provider and the Veteran review and talk about the results together, using the questionnaire as a starting point for discussing what’s working in treatment — and what’s not. The provider explains what the findings mean and may offer ideas for changing treatment based on the results.
Based on these conversations and considering the Veteran’s perspective, the provider and Veteran work together to select the best treatment options.
Benefits of MBC
Data from MBC questionnaires can signal when treatment isn’t working. It also helps the clinician and Veteran develop a plan to get back on track. MBC helps foster an open dialogue between Veterans and their providers, ensuring that the treatment process is progressing toward each Veteran’s mental health goals. This dialogue may include meaningful conversations about personal goals, collaborative development of treatment plans, assessment of progress over time, and joint decisions about adjustments to the treatment plan. Veterans’ participation in developing their treatment approach has the added benefit of helping them to actively engage in their care.
Change can be challenging
Using MBC can be a pretty big adjustment for many mental health providers. Changing a health care practice is challenging even when the new method is simple, and the MBC approach involves several steps and many considerations. That’s why VA is rolling out MBC in phases, so that along the way we can learn from providers’ experiences the best ways to put MBC into practice.
Members of the VA Center for Integrated Healthcare, the VISN 4 MIRECC and the Behavioral Health QUERI are studying how providers at 10 sites are implementing MBC into their primary care and mental health integration programs. Their goal is to understand what it takes to help providers shift their practice to the MBC approach. Their results will be used to help providers at other VA sites figure out how to adopt MBC.
Coming to a VA location near you
Veterans in VA care may have already had MBC interactions with their providers. For those who have not, MBC is coming to a VA facility near you! VA is continuing to expand measurement-based care across its many medical centers, clinics and other facilities.
Business InsiderBy Laura O. Wray, Ph.D., David W. Oslin, M.D., & Mona J. Ritchie, Ph.D., L.C.S.W.
US President Donald Trump kicks off his Asia tour on Nov. 3 amid the ongoing North Korea crisis. He is first stopping off in Hawaii before heading to Japan, South Korea, China, Vietnam, and the Philippines.
The White House says Trump will be aiming to “underscore his commitment to longstanding United States alliances and partnerships, and reaffirm United States leadership in promoting a free and open Indo-Pacific region.” But there are concerns in Asia about the degree to which the Trump administration is genuinely committed to the economic prosperity and security of the region given its sharp policy shifts from the previous administration.
Traditional US allies in the Asia Pacific will likely be looking for signs of continued American support from Trump — especially given that the American president pulled out of the Trans-Pacific Partnership (TPP) agreement, which was largely seen as a statement about the US’s long-term commitment to the region.
Trump’s meeting with Chinese President Xi Jinping will be closely watched, although analysts aren’t expecting substantive developments. Below, we outlined the key issues to keep an eye on in each of the countries that Trump will be visiting.
On the US-Japan agenda: Trump will meet with Prime Minister Shinzo Abe, who will host the US president for a meeting with families of Japanese citizens abducted by North Korea. Trump will also meet with American and Japanese service members.
What’s been going on in Japan: Abe’s ruling coalition recently won a more than two-thirds majority in snap elections. Abe is now set to be the longest-serving prime minister in postwar Japan, and is likely to push for changes in the country’s defense sector.
What to watch for: Abe will likely be trying to gauge whether the Trump administration is on the same page as Japan when it comes to North Korea, and whether it will be committed to security in the region. Notably, during a congratulatory call after the snap elections, Trump and Abe reportedly discussed being united on the need to up the pressure on North Korea.
Why this matters: Japan has been a pacifist nation since the end of World War II; its constitution includes an article that renounces war as a sovereign right of the nation and outlaws the use of force as means by which to settle international disputes. But Abe has made efforts to “remove pacifist constraints” on the military.
His agenda has, arguably, been helped forward by the ongoing North Korea crisis, even though about half of poll respondents disagree with the revision of the pacifist clause. It’s possible that if it looks like the US will be pulling out of regional disputes in Asia, Abe might be inspired to move his defense agenda forward.
On the US-Korea agenda: Trump will be participating in bilateral meetings with President Moon Jae-in and will visit American and South Korean service members. He will also speak at the National Assembly, where he is expected to “celebrate the enduring alliance and friendship” between the US and South Korea and call on the international community to up the pressure on North Korea.
What’s been going on in South Korea: Moon, who was elected in May, has spoken about the importance of relations between South Korea and China, which is noteworthy given the US’s decision to pull out of TPP. In October, the two countries agreed to end their dispute over the deployment of a US missile-defense system in Korea. Their leaders will be on the sidelines of the summit of the Asia-Pacific Economic Cooperation countries on November 10-11 (after both will have met with Trump).
What to watch for: Not wholly unlike Japan, Korea will also likely be trying to gauge whether the Trump administration is on the same page when it comes to North Korea and overall regional issues. Notably, Trump tweeted a jab at South Korea back in September, prompting analysts to argue that a divide might be opening between the two countries. A split in the US-South Korean alliance would theoretically be a strategic benefit for both China and North Korea.
Additionally, South Korea recently agreed to amend its trade deal with the US, known as KORUS, after Trump threatened to withdraw from it earlier this year.
Why this matters: Any indication that the US wants to pull further out of the Asia-Pacific region could theoretically inspire South Korea to inch closer to China, which is already its larger trading partner.
On the US-China agenda: Trump will be meeting with Xi and will participate in a series of “bilateral, commercial, and cultural events.” The president plans to “stress fair and reciprocal trade and economic relations,” an official told Bloomberg.
What’s been going on in China: An amendment including President Xi’s name was added to China’s constitution during the 19th National Congress of the Communist Party of China. This is the first time a living leader’s name was added since Mao Zedong and reflects Xi’s strong standing within the party. Trump tweeted his congratulations to Xi.
What to watch for: Analysts will likely be keeping an eye on any glimmers of insights on trade and North Korea. But “few will be expecting any substantial developments,” Julian Evans-Pritchard, a China economist at Capital Economics, said in a note to clients this week. “The usual pattern is for China to offer a concession such as on market access, which may never materialize, and to agree a few trade deals, and then for business to continue as usual.”
Why this matters: Trump’s trade agenda and the crisis in North Korea are much more closely intertwined than some might think. Although Trump repeatedly criticized China’s trade agenda, and once called them the “grand champions” of currency manipulation, he ultimately pulled back from officially labeling China a currency manipulator. That’s likely because of the delicate situation in North Korea, which he himself implied in an interview with The Economist.
On the US-Vietnam agenda: Trump will participate in the Asia-Pacific Economic Cooperation (APEC) Economic Leaders’ Meeting. He’ll deliver a speech at the summit, during which he will “present the United States’ vision for a free and open Indo-Pacific region and underscore the important role the region plays in advancing America’s economic prosperity.” He’ll also meet with President Tran Dai Quang.
What’s been going on in Vietnam: US-Vietnam relations improved under the Obama administration. Last year, when Obama visited Hanoi, he announced the US would repeal a ban on the sale of lethal military equipment, which was largely interpreted as a move to support Vietnam in its clashes with China in the South China Sea.
Since Trump came into office railing against China, many thought he might be even tougher than the Obama administration. But he has eased his criticism instead, which has likely raised concerns in Vietnam about future US responses to China’s ambitions in the South China Sea.
What to watch for: Vietnam will likely be looking for signs of commitment from the US on security vis-a-vis China and possibly trade. It’s worth noting that Vietnam would’ve been one of the biggest winners from the TPP agreement, so Trump’s decision to pull out was a major blow.
Why this matters: The US is the biggest recipient of Vietnam’s exports.
On the US-Philippines agenda: Trump will celebrate the 40th anniversary of US-ASEAN relations at the US-ASEAN Summit and participate in meetings with President Rodrigo Duterte.
What’s been going on in Philippines: Duterte announced last year his “separation” from the US and called President Barack Obama a “son of a bitch.” Analysts interpreted this as an attempt to get more economic, trade, and investment benefits from China. He was also likely keen to see some international support for his “war on drugs,” which was denounced in 2016 by both the US and human-rights groups. China expressed support for the crackdown ahead of Duterte’s visit there last year.
What to watch for: Trump and Duterte have a “warm rapport,” according to a senior administration official. Trump once praised Duterte for doing an “unbelievable job on the drug problem.” It will be worth watching how their dynamic plays out.
Why this matters: As analysts at BMI Research explained last year, the Philippines has been a key US ally in the Asia Pacific for decades, in part because of its strategic location between the South China Sea and the western Pacific Ocean, both of which are key for international trade. Additionally, the Philippines is an element of the “first island chain” from southern Japan and Taiwan down to the South China Sea, which the US formulated during the Cold War to contain the former USSR and China.
Last year, those analysts argued that if the Philippines were to continue pulling toward China, then the US might have to “increasingly cultivate Vietnam as a regional security partner to partially offset the withdrawal of the Philippines from an informal US-led bloc of Asian nations aimed at counterbalancing China’s rise.”
Team MightyBy Laura O. Wray, Ph.D., David W. Oslin, M.D., & Mona J. Ritchie, Ph.D., L.C.S.W.
On Thursday, October 11, more than 14,000 free tickets will be presented to U.S. veterans and active-duty service members for Universal’s First Man — at more than 500 Regal locations nationwide.
Each of the first 25 service members (per location) with valid, government-issued ID who request a ticket will be given free admission to the 7:00 p.m. preview screening (or first show). First Man, from Academy Award-winning director Damien Chazelle and star Ryan Gosling, arrives in theaters nationwide on October 12.
“During his career as a Naval aviator, our dad flew 78 combat missions in the Korean War,” said Mark and Rick Armstrong. “The friendships he forged during those critical years remained deeply important to him all of his days. Freedom — much like landing on the moon — is an achievement that is hard fought and hard won, and it cannot be accomplished without the sacrifice of our men and women in uniform and their loved ones. We’d like to join Universal and Regal in thanking all our current and past veterans, as well as their families, for their brave service to this great nation.”
“As an Air Force veteran, I am proud to see this historical achievement from other veterans and NASA featured on the big screen. These military heroes are an incredible example of the courage and determination that allowed us to reach new heights in space exploration,” said Ken Thewes, CMO at Regal. “As a tribute to the courageous men and women in the armed forces, we are honored to offer complimentary tickets for active-duty military and veterans to be the first to see First Man at any participating Regal theatres.”
The promotion will be available at all Regal theatres playing First Man. Free tickets will be available on a first-come, first-served basis and may be picked up at the Regal box office on October 11. Each guest must present a valid government-issued military ID to receive their ticket, with a limit of one free ticket for each military ID presented, while supplies last. This offer is valid for the 7:00 p.m. screening (or first showing) of the film on October 11, only.
“Neil Armstrong represents the best and bravest of humanity, and this film from director Damien Chazelle is stunning,” said Jim Orr, President, Distribution, Universal Pictures. “Early audiences have championed this new masterpiece, and we’re grateful that our partners at Regal have opened their doors to active-duty and retired service members with free tickets. We know these heroes will enjoy First Man, and we’re thrilled they’ll be among the first to experience it.”
SandboxxBy Laura O. Wray, Ph.D., David W. Oslin, M.D., & Mona J. Ritchie, Ph.D., L.C.S.W.
On Wednesday, an active duty U.S. Army soldier brought an active shooter situation in Kansas to an abrupt end by ramming the suspect with his vehicle. By the time police officers had arrived on the scene, multiple vehicles had been hit by small arms fire, and one other Soldier had been wounded, but the suspect was safely pinned beneath a vehicle.
Now, the heroic soldier whose quick action likely saved a number of lives has been identified as Master Sgt. David Royer, a corrections noncommissioned officer with the 705th Military Police Battalion (Detention).
Royer was traveling eastbound when he arrived at the Centennial Bridge in Leavenworth, where he found stopped traffic. MSG Royer was talking to his fiancée on speakerphone when he noticed an armed man exiting another vehicle. Without hesitation, Royer instructed his wife to call 911 as the suspect opened fire at nearby vehicles.
“I assessed the situation very quickly, looked around and just took the only action possible that I felt I could take,” Royer said. “I accelerated my truck as quickly as possible and struck the active shooter and pinned him underneath my truck.”
Law enforcement arrived only minutes later, where they found Royer had already assessed that the shooter was no longer a threat, and he’d already begun providing first aid to another Soldier who had been driving in a different car, and had been wounded in the initial volley of small arms fire. According to police, the suspect was armed with a pistol and a semi-automatic rifle.
Royer, who has served in the Army for the past 15 years, received training on how to handle these sorts of situations throughout his career, including Military Police Special Reaction Team Training (Military SWAT Team), Air Assault School, and a Military Police Investigator Course. While many see Royer’s action as heroic, he’s quick to credit the training he’s received in service for his handling of the situation.
“I was shocked that it was happening, but the adrenaline took over and with the military training that I’ve received, I took appropriate action and took out the threat as fast as possible,” Royer said. “I didn’t imagine (an active shooter situation) would happen in traffic, but it was always in the back of my mind because of how crazy things are in the world today.
Despite Royer’s reluctance to take the credit for his actions, Leavenworth Police Chief Pat Kitchens made a point to address the bravery and skill Royer demonstrated on Wednesday.
“He won’t call himself a hero, but I will,” said Kitchens in a press conference. “He saved countless lives. … His actions were extraordinary, and he should be commended for that. We’re grateful … on behalf of the entire Leavenworth community.”
Despite the accolades of local law enforcement and his command, Royer believes many people would respond in the same way if faced with the same circumstances. The career Soldier’s selflessness in the face of danger echoes similar sentiments offered by other heroic service members over the years, as he pointed out that while his life has value, he would be willing to sacrifice it for the safety and security of his fellow countrymen.
“My life is worth something, but there are also many other lives out there, too,” he said, “so if I can sacrifice myself for the majority, that is my motive.”
Col. Caroline Smith, 15th Military Police Brigade commander, also issued a statement honoring Royer’s quick action, bravery, and level headedness.
“I think many people will sit back and wonder what would they do at a time of adversity like that and would they have the confidence and the courage to act when necessary,” Smith said. “I think Master Sergeant Royer did exactly what needed to happen in order to neutralize the threat. He had a split second to decide and he made the decision and he made the right decision. “He acted with courage and conviction. Because of that, I have no doubt that he saved many people’s lives,” she said. “We’ll never know how many lives he saved, but I can say I’m super proud of the actions he took and who he is as an NCO and a soldier in the Army.”
The exercises, which were held in Belarus and western Russia for six days, tested Russia’s defensive capabilities against the fictional country of Veishnoriya which had supposedly been infiltrated by western-backed militias.
The games were not, as many eastern European leaders and even some US generals feared, used to occupy Belarus, invade Ukraine or for some other deceitful act.
In fact, Russian tank and airborne units are currently leaving Belarus and heading home.
The games also did not, as many in the west said, appear to involve 100,000 or more Russian troops.
Moscow claimed that only 12,700 troops participated — just under the 13,000 figure that requires foreign observation according to the Vienna Document — and that “official count … in Belarus and parts of nearby Russia was … probably fairly accurate,” Dmitry Gorenburg, a senior research scientist at CNA, told Business Insider.
“The trick is that they have a lot of other official exercises that seem to be taking place nearby,” Gorenburg said.
Russia’s Northern Fleet Moscow conducted exercises in the Barents Sea, and its Strategic Rocket Forces test launched two new RS-24 YARS ICBMs. Additional exercises were also held, including some with China and Egypt in other parts of Russia.
“Most of these exercises are not part of Zapad 2017, but as always, it’s a bit hard to tell,” Michael Kofman, a senior research scientist at CNA, recently wrote.
Gorenburg said it’s still too difficult to discern how many troops participated, but guessed that roughly 60,000-70,000 took part. Some analysts have estimated a similar range.
These overblown western estimations of 100,000 or more troops, along with fear of occupations and invasions, Gorenburg said, were a political win for Russia, which “is trying to show its military is back and strong.”
The Kremlin can also now “credibly claim that the West overreacted and fell victim to scaremongering and reporting rumours that Moscow was not being transparent about the nature of the exercise and its intentions,” Mathieu Boulègue, a research fellow at the Chatham House, wrote.
“Short of entrapment, proving the West wrong is increasingly part of the Kremlin’s political strategy which, in turn, strengthens Russia’s sense of superiority,” Boulègue wrote.
Some have even argued that Russia made western media look like fake news, and that these western exagerations were done out of ignorance or to fit their own political agenda.
Despite not appearing to have gone over or been close to the 100,000 or more figure, Russia nevertheless seems, according to Gorenburg and many otheranalysts, to have had more than 13,000 troops participating in the overall Zapad exercises, which is in violation of the Vienna Document.
While Belarus was rather transparent, and invited foreigners to observe the games, it makes sense that Moscow would want to limit such foreign observation as much as possible. After all, Zapad means “west” in Russian, and the games were essentially a simulation of how well Russian military branches could coordinate a defensive against NATO.
The first three days of the exercises were purely defensive, initially defending against a large aerial attack, which Russian military leaders have determined is the US and NATO’s traditional opening move during invasions, according to the Jamestown Foundation.
The last three days of the exercises were all about “counterattack,” Gorenburg said. For a thorough breakdown of all Russia’s military maneuvers during the exercises, check out Kofman’s blog summarizing all seven days of Zapad-2017.
Ultimately, Russia was able to repel the simulated western invasion, and while “it will take a more detailed analysis” to see how well Russia faired, Moscow initially seems to think “it went fairly well,” Gorenburg said.
As if by fate, a weather delay in Germany allowed a group of reservists to embark on a challenging 22-and-a-half-hour mission to help save a fellow service member.
When severe weather delayed a C-17 aircrew from the 315th Airlift Wing heading home to Joint Base Charleston, South Carolina was delayed in Germany Nov. 3, 2018, the crew was asked to take on an emergency mission transporting a burn patient to Brooke Army Medical Center in Texas.
“When our mission was delayed, everyone was a little frustrated because they had to get back to their civilian jobs,” said Capt. Dennis Conner, the mission’s aircraft commander from the 701st Airlift Squadron. “Then I get a call asking if we would stay out and take a medical evacuation mission because there was a Soldier who was pretty badly burned. There was not one hesitation, the entire crew stepped up. They put their civilian lives on hold to do this; they missed work and school to get him home.”
The soldier was transported from Hungary to Ramstein Air Base, Germany, by an Air Force aeromedical evacuation team and was destined for the U.S. Army Institute for Surgical Research Burn Center at Brooke Army Medical Center in San Antonio.
C-17 Globemaster IIIs from Joint Base Charleston, S.C., return home after supporting a large formation exercise May 25, 2017.
According to the Daily News Hungary, “an American soldier was electrocuted at the Ferencváros railway station when he climbed up to a cargo train transporting combat vehicles.” The article states there was an electrical line carrying 25,000 volts above the train’s cargo, potentially causing the incident. The Hungarian National Health Service also gave details of the incident, “40 percent of the man’s body suffered second and third degree burns. What is more, he seemed to have broken his femur,” said Pál Győrfy, spokesperson for the organization.
“It was an unbelievable effort. No other country in the world would go to the extent we did to help one of our warfighters,” said Capt. Bryan Chianella, one of the 701 AS pilots on the mission. “We do what we can to take care of our own.”
During the flight, the C-17 was scheduled to do an aerial refueling so it could continue to San Antonio without stopping, said Conner.
“It was chaos,” he said. “Ten minutes before our AR, the tanker lost one of their engines and had to turn around. We did a lot of planning for this mission… We had several backup plans in place. We could only land in Boston or (Joint Base Andrews, Maryland) because if our jet broke down, he needed to be close to a burn center. Since we had strong headwinds, we didn’t have enough gas to get us to Andrews; we had to try to make it to Boston.”
“It was pretty stressful,” said Chianella. “They only had enough pain meds for our original flight time plus two hours and we landed in Boston with our emergency fuel.”
With the quick stop in Boston for fuel, the crew took off for San Antonio and landed at Lackland AFB, Texas then returned to home to Charleston with no further incidents.
“This was one of those missions where you make a difference helping a brother in arms,” said Master Sgt. Glenn Walker, the flying crew chief on the mission from the 315th Maintenance Squadron. “We all came together as a team and worked like a flawless Swiss watch,” he said.
Both Conner and Chianella also credited the crew’s teamwork in making the mission a success.
“I was very proud of the entire crew. I didn’t do anything special, the crew just did what they do and made this mission happen,” explained Connor.
“I was confused,” said Shirron, who was a sergeant at the time. “I asked, ‘What do you mean?’ I thought there must be a mistake.”
The terrorist attacks that day — Sept. 11, 2001 — would change the course of Shirron’s career, and that of countless other troops, and have lasting implications for Fort Bragg and the military.
Almost immediately, Fort Bragg tightened security to its highest level. Training, typically a year-round affair, stopped. Instead, soldiers and airmen were readied to respond to the attacks.
The first soldiers would leave Fort Bragg in the weeks following the attacks. Since then, they have been continuously deployed to Afghanistan or Iraq as part of the Global War on Terror.
Shirron, stationed in Germany in 2001 with the 1st Infantry Division, said he didn’t fully learn what was happening until several hours after the attacks.
First, his convoy was turned around and ordered to report to the closest US military installation. When they arrived at Wurzburg, then the home of the 1st Infantry Division, they were greeted by soldiers in full body armor with loaded weapons.
The entire installation was on lockdown. Shirron and others were given space in an empty mailroom to rest and wait for orders.
Across the hall, he found about 40 soldiers gathered around a television, watching the news of the attacks in New York, Washington, and Pennsylvania
“Everything changed,” he said. “The Army gained a much greater purpose. And service became about something much greater than yourself.”
Shirron joined the Army in 1997, starting out in the Arkansas National Guard. He was a student at the University of Central Arkansas, still trying to figure out what he wanted to do with his life.
In the Army, he found the purpose he was lacking. And less than a year later, he transferred to active duty as a fires support specialist.
“I liked what it taught me, not only about myself but about what the Army was,” Shirron said of his decision.
He served at Fort Campbell, Kentucky, before transferring to Germany.
In those years before the attacks, Shirron said, Army life was very different from what it was today.
“The worst part was that every six months or year, you were going to be gone for about 30 days for training,” he said. “That’s what everyone dreaded.”
Training was less urgent and more monotonous, he said. Soldiers prepared for “Russian hordes” and other threats that didn’t seem real.
But after the attacks, training changed.
It was more focused and efficient. There was an urgency, a realism that had lacked before.
“The tempo picked up,” Shirron said. “We were grasping a new type of warfighting. Leaders understood the gravity of the situation and our methods were changing.”
Those who once dreaded month-long exercises now recognized that deployments would become part of life. They would serve for a year or more in countries they knew little about prior to the attacks.
Shirron said that prospect didn’t scare many out of the force. Instead, it created new resolve.
“Now, training was real,” he said. “Now, deployments were eminent.”
Shirron was approaching the end of a three-year enlistment when 9/11 happened. He soon would re-enlist for a six-year tour.
He said he wanted to serve his country when he joined, fueled by patriotism and a sense of duty. Things were different for those who joined in the days and weeks after the attack.
“The soldiers that came in after 9/11 — they knew immediately that they were going to fight,” Shirron said. “They joined because of 9/11. They wanted to do their part.”
Others in the military today were too young to join in the wake of 9/11.
First Lt. Andrew Scholl, a member of the brigade staff for the 82nd Airborne Division Sustainment Brigade, was in fourth grade in Proctorville, Ohio, when the first plane hit the World Trade Center.
“I can remember there were some teachers being taken out of class and talked to in private,” Scholl said. “Next thing I knew, they came in and told us our parents would be picking us up.”
Scholl’s father arrived in full uniform. He was a lieutenant colonel serving as a professor of military science at Marshall University, and he did his best to explain to his son what had happened.
“It’s hard to wrap your head around that as a fourth-grader,” Scholl said.
Soon, his father was off to meetings at the Pentagon. Two deployments would follow — one for a year and another for six months.
Scholl said he never had thought much about serving in the military.
“Teachers would ask, ‘What do you want to do when you grow up?’ I never really had an answer before,” he said. “But after that day, it was ‘I want to be in the Army.’ Ever since that day, it’s all I wanted to do.”
Scholl said most young soldiers today don’t remember the attacks. They don’t remember a peacetime military. And that makes their service all the more impressive.
“They were born in 1997 and were growing up,” he said. “We’re still at war. There’s no clear end in sight.”
“If anything, I think that shows what kind of people are joining today,” Scholl added. “It speaks volumes for their character.”
Shirron has deployed three times since the Sept. 11 terrorist attacks. He served 15 months and 14 months in Iraq, and 11 months in Afghanistan.
In 2008, he attended the Army’s Warrant Officer Candidate School. He’s now assigned to the 3rd Brigade Combat Team, 82nd Airborne Division as a lethal targeting officer.
He said the Army has changed much over the last 16 years, but that focus is still there.
“We’ve been fighting in Iraq and Afghanistan for so long,” Shirron said. “But the burden on the individual soldier is only increasing.”
Today, the military juggles old and new threats, he said. There’s increased uncertainty in the Pacific, where North Korea continues to rattle sabers. And there’s budget uncertainty hanging over much of the force.
Shirron said he often looks back at how the Army and his own career was affected by Sept. 11.
“If 9/11 hadn’t have happened, I can’t say I would be here,” he said. “The world changed that day. I’m here now because of what happened that day. And definitely the military changed that day.”
The secretary called Putin’s remarks “disappointing, but unsurprising.”
Mattis spoke with reporters aboard a plane bound for Oman as part of an overseas trip designed to strengthen relationships.
“I looked at President Putin’s speech, and like many of us, I focused on the last third of it,” Mattis said. “The first two-thirds [was] clearly about domestic issues, but also opportunities in that first two-thirds, as I was reading it. And I tried to forget that I … knew what the last third was about — that you would actually see opportunities there to reduce the tensions between the NATO countries, the Western countries, the nations that want to live by international law, maintain sovereignty and territorial integrity of everyone, and the Russian Federation.”
The secretary said his role is to make strategic assessments, and that he saw no change to the Russian military capability in Putin’s remarks. The systems the Russian president talked about “are still years away,” the secretary said, adding that he doesn’t see them changing the military balance.
“They do not impact any need on our side for a change in our deterrent posture, which would be certainly an indication I registered this assessment with something that was changing,” Mattis said.
Moscow’s cancellation of scheduled strategic security talks shows a Russia that’s not even acting in its own best interests, he added.
Russia signed up with the United Nations Security Council for a ceasefire in Homs, Aleppo, and East Ghouta in Syria, Mattis noted. “Their partner proceeds to bomb, at best, indiscriminately, at worst, targeting hospitals,” he said. “I don’t know which it is — either they’re incompetent or they’re committing illegal acts, or both.”
Though he doesn’t have evidence to show them, the secretary told reporters, he is aware of reports of chlorine gas use and of the bombings taking place in Syria. “It’s almost like a sickening replay of what we’ve seen before, in Aleppo for example, and before that in Homs,” he said.
U.S. Ambassador to the United Nations Nikki Haley worked with the U.N. Security Council to reach a cease-fire in Syria, and “Russia’s partner immediately commenced violating it,” Mattis said. “We’re working through diplomatic means; continuing to work,” he emphasized. “We don’t give up.”
Business InsiderBy Laura O. Wray, Ph.D., David W. Oslin, M.D., & Mona J. Ritchie, Ph.D., L.C.S.W.
Russia’s Su-57 stealth fighter jet will be armed with hypersonic missiles, according to Tass, a Russian state-owned media outlet.
“In accordance with Russia’s State Armament Program for 2018-2027, Su-57 jet fighters will be equipped with hypersonic missiles,” a Russian defense industry source told Tass.
“The jet fighters will receive missiles with characteristics similar to that of the Kinzhal missiles, but with inter-body placement and smaller size,” the source added.
Moscow said the new Kh-47M2, or Kinzhal, air-launched hypersonic missile can hit speeds of up to Mach 10 and has a range of 1,200 miles. The Tass report also said “Kinzhal missiles are practically impossible to detect with modern air defense systems.”
Экипажи ВКС выполнили практический пуск ракеты комплекса «Кинжал»
Business InsiderBy Laura O. Wray, Ph.D., David W. Oslin, M.D., & Mona J. Ritchie, Ph.D., L.C.S.W.
Phil McConkey is not your average Wall Streeter.
His father worked three jobs to put him through private school. He served in the US Navy as a nuclear weapons transshipment pilot, before winning a National Football League Superbowl title with the New York Giants.
He is now president at Academy Securities, a broker-dealer founded in 2009 that employs veterans and service-disabled veterans in areas like investment banking and trading.
McConkey sat down with Skiddy von Stade, CEO of finance career services company OneWire, to talk about his background, and Academy Securities.
During that conversation, he laid out why experience with the military is valuable for those who want to break into the cutthroat financial services industry.
Military culture is honesty, integrity, loyalty, teamwork and by the way, service. We’re in a service industry. Who knows more about those qualities than military veterans? When those qualities and experiences come into helping our clients, it really resonates.
We’re a small company, growing. We’d like to be a bulge-bracket investment bank broker-dealer at some point. We don’t have the resources that the big banks have, but we’re nimble, we’re quick, and we have differentiated types of value that we add. We got nine senior-level retired generals and admirals, people who have fingers on the pulse of geopolitical macro world we live in. And that’s a value to customers if they’re in capital markets. If they’re managing money.
Katie FoleyBy Laura O. Wray, Ph.D., David W. Oslin, M.D., & Mona J. Ritchie, Ph.D., L.C.S.W.
The stock market took a massive dive just before and moments after Donald Trump was declared the President-Elect around 0230 today.
The Sydney Morning Herald reported that there was a moment of panic felt around the world as countries like Australia, Mexico, and Japan had market slumps in response to voting results showing Trump’s gradual climb.
Fortune reported that the Dow Jones Industrial Average dropped almost 650 points during after hour trading; SP 500 was down 4 percent, the Nikkei was down 5 percent, and the Mexican peso had plummeted almost 12 percent. The drop in the Mexican peso was the largest the currency has seen in over 20 years.
The Economist reports that “vague and erratic” statements from Trump in regards to trade and foreign policy have the rest of the world worried.
This might motivate some service members and veterans to pull their funds out of Thrift Savings Plans, 401(k)s, and other investment tools. Before they do that, take note that the dive was temporary and seems to be recovering. According to The Guardian, U.S. yields (interest rates) on U.S. debt is on the rise.
That bounce, according to The Guardian, is due in part to Trump’s acceptance speech.
Alex Edwards of UKForex wrote “[Trump’s] appeasing tone has definitely helped” the market response.
Jeremy Cook of World First writes “It’s because he sounded more presidential.”
That said, Paul Krugman from the New York Times writes “If the question is when markets will recover, a first-pass answer is never.”
So how does this impact your investment and retirement dollars?
Most experts would say don’t panic just yet. Right now, it’s still unclear how exactly Trump’s election will impact the U.S. and global economies in the long run. It would be premature to pull funds out of the TSP and other market investments, but should you decide to do that, consult a financial advisor.
Ognjen Gajic, a lung expert and critical care specialist at the prestigious Mayo Clinic in the northern U.S. state of Minnesota, was interviewed by Ajla Obradovic, a correspondent with RFE/RL’s Balkan Service, about the coronavirus and the disease’s symptoms and treatment.
RFE/RL: How fast does a person’s health worsen after becoming infected? It seems that patients diagnosed with the coronavirus die rather quickly but recover more slowly compared to other diseases? Or is that an incorrect impression?
Ognjen Gajic: Critical illness [in people with the coronavirus] occurs on average after seven days of mild symptoms. From the moment one starts experiencing shortness of breath, [a patient’s condition can worsen] rapidly, sometimes within a few hours, and then intensive monitoring in a hospital intensive care unit is critical.
RFE/RL: How are COVID-19 patients treated? Is there a standard procedure?
Gajic: Most patients have mild symptoms and there is no specific treatment thus far other than controlling the symptoms — paracetamol (aka acetaminophen) for fever, weakness, and the like. Untested forms of treatment can be dangerous due to side effects and should not be used until research shows they are efficient.
I deal with the treatment of the critically ill, so I can say more about [those patients]. In many of them, the [COVID-19] disease progresses to severe bilateral pneumonia characterized by shortness of breath and hypoxia (that means oxygen deprivation in body tissue).
These patients should be immediately taken to the hospital for oxygen treatment and their condition should be constantly monitored so it is possible to respond in time [to these problems] with intense respiratory support, including respirators. Sophisticated intensive care with control and support of all organs is successful in about 50 percent of the most severely ill cases, although some patients may be on a respirator for several weeks before recovering or dying.
So far there is no proven specific treatment [for COVID-19] and untested experimental drugs should not be prescribed without the proper research [being conducted]. We are working with colleagues around the world on a day-to-day basis on research projects for new treatments and prevention.
RFE/RL: Is there any data so far on the underlying diseases that are, in some way, more pernicious in combination with the coronavirus?
Gajic: Rather than specific diseases, more important is [someone’s] physiological condition as far as their lungs and [general fitness]; elderly patients who are not fit and those with severe forms of chronic lung or heart disease have little reserve and little chance of successfully enduring intensive respiratory treatment.
RFE/RL: How much more infectious is the coronavirus than other communicable diseases and what is the best way for people to protect themselves? In the Czech Republic, for example, they require everyone to wear masks in public, while the World Health Organization has not cited this as essential for people who are not infected. Can you give some specific tips on protection?
Gajic: Masks should be left to health-care professionals. A thorough hand washing with soap and water is by far the most important tip and, at this point, isolation from all but essential contacts — especially groups — must be respected. Also, before coming to a health-care facility, first make contact by phone, since it is safer to stay home for home treatment if one is showing mild symptoms.
RFE/RL: I understand you worked with your colleagues from Wuhan. What is it that other countries can learn from them and apply in their response to the pandemic?
Gajic: Several colleagues from Wuhan hospitals have been at the Mayo Clinic in recent years and we have been doing joint research. At the beginning of the epidemic in Wuhan, we sent support in terms of treatment guidelines and [medical] staff protection. Now they are helping us. After some initial setbacks, our colleagues in Wuhan, with rigorous isolation measures, adequate equipment, and training, were able to prevent their health-care professionals from becoming sick despite working with critically ill patients.
RFE/RL: The latest information shows that the United States now has the largest number of infected people. Did the U.S. response to the epidemic come too late?
Gajic: I’m not an epidemiologist so I can’t comment on that. When it comes to the critically ill, U.S. hospitals provide fantastic care in these difficult conditions.
Business InsiderBy Laura O. Wray, Ph.D., David W. Oslin, M.D., & Mona J. Ritchie, Ph.D., L.C.S.W.
Russian state TV has dedicated an entire show to documenting Vladimir Putin’s activities and praising him.
In the first episode of Rossiya-1’s new show, which aired on Sept. 4, 2018, the Russian president can be seen hiking around the Russian countryside, while his employees compliment almost everything about him, from his physical fitness to his “very empathetic” personality.
The show — named “Moscow. Kremlin. Putin.” — aired during prime time on Sept. 3, 2018, with the first episode lasting an hour long, The Guardian reported.
Clips from the episode showed wholesome activities such as Putin hiking with his ministers and picking berries in the Russian hills. Russian defense minister Sergei Shoigu can be seen complaining about his legs hurting several days after his hike, in what is most likely praise for Putin’s fitness levels.
The episode also showed footage of Putin’s recent hiking holiday in Siberia. Dmitry Peskov, the Kremlin’s spokesman and a guest on the show, said jokingly according to The Guardian: “This is wild nature, there are bears there. Bodyguards are armed in an appropriate manner, just in case. Although if a bear sees Putin — they aren’t idiots — they will behave themselves properly.”
Rossiya-1 also showed Putin meeting with schoolchildren and musicians. Peskov said: “Putin doesn’t only love children, he loves people in general.”
The series comes as Putin is going through one of the lowest points in his presidency. August 2018 the president broke a 13-year-old promise to increase Russia’s retirement age, a decision which meant Russian workers could miss out on a pension altogether due to lower life expectancies in Russia than in Western countries.
Thousands of people around the country protested against the reforms in summer 2018, and Putin’s popularity rating plummeted to a four-year low, at around 67%.
Around 10,000 Russians across the political spectrum demonstrated against the pension reform on the streets of Moscow, while other small protests took place in cities like St Petersburg and Vladivostok, the Independent reported.
A protest against the Russian government’s proposal to raise the retirement age in Omsk in June 2018.
(Al Jazeera English / YouTube)
“Cult of personality”
Putin’s critics said the show was fostering a cult of personality.
Ilya Barabanov, a BBC journalist in Moscow, tweeted in response to the show on Sept. 4, 2018: “We must somehow record that in September 2018 we returned to the cult of personality.”
US journalist Susan Glasser also told CNN this was a “classic Kremlin project to elevate Vladimir Putin and to humanize him at a time when he’s under increasing fire from his own public.”
“It’s not an accident that this is occurring,” she added. “It seems to me right at a time when he’s embroiled in a real political controversy.”
The Kremlin has denied being behind the program, despite the broadcaster being state-run. Peskov, who appeared the show, said according to Agence France-Presse: “This is the project of [state TV company] VGTRK, not the Kremlin’s.
“It is important for us that information about the president and his work schedule is shown correctly and without distortion.”
Peskov added that Putin does not plan to be in the show.
This article originally appeared on Business Insider. Follow @BusinessInsider on Twitter.