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In this thesis, I use a meta narrative analysis approach to identity effective stress management techniques that fit the unique operational environment of the U.S. Navy from prior investigations. From the earlier literature, I identify effective behavioral techniques for stress management to include mindfulness, cognitive behavioral therapy, social resilience, physical activity, program interventions, meditation and mind-body medicine, emotion regulation, mental health awareness, self-care, and coping. I then map them to the domains of the Total Sailor Fitness used by the 21st Century Sailor initiative to provide stress management support to sailors. Furthermore, I analyze the responses to an exploratory questionnaire from two shore commands and find that sailors tend to use humor and engage in hobbies as social resilience techniques, although sailors perceive the most effective coping techniques to be video games and physical activity (aerobic exercise). These initial findings can inform a follow-on study that can augment the data collection within a pilot framework to support the assessment of the stress management programs currently offered by the Navy under the 21st Century Sailor initiative., NPS Naval Research Program, This project was funded in part by the NPS Naval Research Program., Lieutenant, United States Navy, Approved for public release. Distribution is unlimited.

Senior leaders onboard U.S. Navy vessels afloat have constantly evolving schedules that are rarely consistent from day to day. Over the past two decades, studies of work and rest patterns have confirmed anecdotal reports of insufficient sleep of enlisted Sailors. The sleep of senior Officers has not been closely examined. Assessing sleep of surface fleet Officers as they perform their duties in the fleet may provide insight into the bigger picture of health and wellness in the U.S. Navy. As part of a multi-year project, sleep patterns of senior leaders were assessed while in training and in the fleet. An 18-month longitudinal data collection commenced when participants were attending Surface Warfare Schools Command (SWSC) in Newport, RI, and continued as participants assumed their operational positions in the fleet. This thesis takes an initial look into the sleep, mood, and other physiological patterns of senior leaders in these two settings over the first few months of the study. Participants completed validated questionnaires to assess their overall wellbeing and wore physiological monitors (ŌURA rings) to assess the duration and quality of their sleep. In this first opportunity to examine patterns in the data, we found statistically significant differences in sleep duration of senior leaders depending on where they were living and working; that is, when they were attending school, between school and operational command, and after they arrived at their operational command., Lieutenant, United States Navy, Approved for public release. Distribution is unlimited.

Around the world, watchfloors provide information, intelligence, and technical support to operational commands 24 hours a day. Watchstanders often work long shifts surpassing full time 40-hour work weeks, which include night and weekend shifts. Shiftwork has been associated with a decreased amount of sleep in both quantity and quality, which leads to exhaustion and compromised cognitive function. Exposure to high energy visible (HEV) light at appropriate times has the potential to shift the body’s circadian rhythm to align faster to a new shift schedule. Adjusting to shifting work hours quicker could lead to less sleep loss, enhanced sleep quality, and less severe levels of fatigue. This study aims to assess the impact and potential benefits of intentionally introducing HEV light when watchstanders on a shore-based watchfloor are transitioning to a different work shift. The study will consider how the strategic application of HEV light affects circadian entrainment, thereby impacting sleep, performance, mood, and sleepiness. This work will inform recommendations to other shore-based watchfloors at the Pentagon that require non-traditional work schedules to support watchstanding operations., Naval Medical Research Center – Advanced Medical Development Program Silver Spring, MD 20910, Lieutenant Commander, United States Navy, Approved for public release. Distribution is unlimited.

Video games have become a staple in entertainment since the inception of digital gaming and can be used as a healthy way of escaping the stresses of modern society. With the increased usage of technology, military personnel have easier access to computer/internet gaming through various platforms. However, through excessive exposure, video games may become problematic and even addictive. With the potential issues that problematic video gaming may have on the Naval mission, this study assessed the prevalence, severity, and associated factors of video gaming on 87 Sailors from two U.S. Navy warships and compared these results with data from three U.S. Marine Corps commands from a similar study (954 Marines). Results showed that higher–severity gamers experienced statistically higher levels of depression, anxiety, loneliness, stress, and were 35% more likely to experience daytime sleepiness and 48% more likely to have an alcohol problem than lower–severity gamers. The strongest motivations to game for greater severity gamers were to escape from reality, cope with stress, and to compete with other gamers. We did not identify substantive differences between Sailors and Marines who played videogames. Further studies are needed to evaluate whether videogaming is the cause of a drop in the well-being of greater severity gamers and to reliability assess the criteria for both “problematic” and “disordered” video gaming that are more suited for an operational military environment.

This study assessed the effectiveness of light exposure in transitioning aviation schedules from days to nights. We hypothesized that a single night of light treatment will delay melatonin onset and improve performance in a simulated flight task. Study participants were military pilots who flew four simulated flights: one baseline daytime flight and three consecutive night flights. Pilots were exposed to four hours of high energy visible (HEV) light (1,000 lux) on the second night but remained in dim light on the first and third nights. Saliva samples for determining melatonin levels were collected every half hour during the three nighttime data collections. Participants also completed questionnaires to include the Bedford Workload Scale and the Karolinska Sleepiness Scale. We tracked each participant’s circadian rhythm using their melatonin onset profiles over the three nights of the study. Pilot performance in a flight simulator was assessed for each of the three data collection sessions using three flight profiles of progressing difficulty. Results showed an average delay in melatonin onset mean of 1.33 hr (SD = .36 hr). Flight performance over the testing period did not show any significant changes. This study showed that light can be used to effectively delay the onset of melatonin, potentially providing a substantive advantage to personnel who must rapidly transition to new work schedules. Further study is recommended before implementing in operational conditions.

This study will investigate the destructive behavior surge during the maintenance phase of the Optimized Fleet Response Plan (OFRP). The Culture of Excellence Campaign's Perform to Plan effort will empower warfighting capability by fostering psychological, physical and emotional toughness. To meet this goal, the Navy needs to understand what encourages signature behaviors and reduces destructive behaviors and how these behaviors impact readiness. This study will provide critical insight to encourage signature behaviors and counter destructive behaviors. Researchers will use a mixed-methods, explanatory sequential design to answer the questions: What are the rates of signature and destructive behaviors during phases of OFRP? Do rates differ by command type? How do signature and destructive behaviors impact readiness?

The goals of this thesis were to assess the prevalence of problematic video gaming within the United States Marine Corps (USMC), identify the motivational factors that lead Marines to engage in video gaming, assess the effects of video gaming on Marines’ lives, and investigate whether Marines use video gaming as a maladaptive coping mechanism. Survey data (n = 1,098 Marines) were collected from three USMC commands. In total, 847 Marines (91%) reported playing video games. Recreation and coping with stress were the most frequently reported motivational factors for playing video games. Most gamers (91%) reported playing video games while at home/off duty. In contrast, 20% of gamers reported playing video games while on duty/in port and 36% reported playing video games while underway/deployed. In our sample, five Marines (2%) were classified as disordered gamers. Disordered gamers reported using dysfunctional coping styles more frequently than the rest of gamers. Disordered gamers reported more severe symptoms of depression and anxiety, higher levels of loneliness, elevated daytime sleepiness, and more symptoms suggestive of heavy drinking. These findings led to three recommendations: a) educate Marines on the risks of problematic video gaming and the factors associated with gaming addiction, b) educate Marines on sleep hygiene practices, and c) implement strategies to mitigate the effects of problematic video gaming., Naval Postgraduate School, Monterey, CA 93940, Lieutenant Junior Grade, United States Navy, Approved for public release. Distribution is unlimited.

Background International standardized criteria for eligibility, evaluable disease sites, and disease response assessment in patients with refractory, progressive, or relapsed high-risk neuroblastoma enrolled in early-phase clinical trials are lacking. Methods A National Cancer Institute-sponsored Clinical Trials Planning Meeting was convened to develop an international consensus to refine the tumor site eligibility criteria and evaluation of disease response for early-phase clinical trials in children with high-risk neuroblastoma. Results Standardized data collection of patient and disease characteristics (including specified genomic data), eligibility criteria, a definition of evaluable disease, and response evaluations for primary and metastatic sites of disease were developed. Eligibility included two distinct patient groups: progressive disease and refractory disease. The refractory disease group was subdivided into responding persistent disease and stable persistent disease to better capture the clinical heterogeneity of refractory neuroblastoma. Requirements for defining disease evaluable for a response assessment were provided; they included requirements for biopsy to confirm viable neuroblastoma and/or ganglioneuroblastoma in those patients with soft tissue or bone disease not avid for iodine-123 meta-iodobenzylguanidine. Standardized evaluations for response components and time intervals for response evaluations were established. Conclusions The use of international consensus eligibility, evaluability, and response criteria for early-phase clinical studies will facilitate the collection of comparable data across international trials and promote more rapid identification of effective treatment regimens for high-risk neuroblastoma.

This thesis assessed the manning structure of HMAS Warramunga in at-sea conditions against Navy Standard Work Week (NSWW) criteria such that a Scheme of Complement (SoC) is “sufficient” to meet the workload and sustainment requirements. IMPRINT Pro Forces Module was used to model planned activities and unplanned events of sailors to include the Marine Engineering Department to assess workload, daily sleep duration (DSD), training, service diversion activities, and task completion rates. Results showed that the crew slept less and worked more than the NSWW criteria. Also, completion rates for all but the highest priority events were low. These findings indicate crew had little surge capacity available without sacrificing administrative and maintenance tasks. With clearer understanding of the limitations on the ship imposed by crew size, decision-makers will be able to assign operational tasking based on knowledge of expected endurance of a ship to maintain such an operational tempo. Findings indicate that the NSWW in its current state should not be used solely to define ships’ SoC. However, using modeling and simulation (M&S) combined with SMEs’ knowledge will provide insight on crew workload, lead to improved SoC, and fulfill the ship’s Statement of Operating Intent (SOI). Another potential application of IMPRINT could be to assess the ship’s pre-sailing risk state based off the ship’s current manning levels and maintenance requirements., Lieutenant Commander, Royal Australian Navy, Approved for public release. distribution is unlimited

Navy and Marine Corps personnel, engaged in support and training operations, face challenges to obtaining consistent sleep due to shiftwork and rotating schedules. Shiftwork has been shown to decrease sleep quality and quantity, which contributes to fatigue and degraded cognitive functions including decision making, alertness, reaction time, problem solving, and ability to learn. When shift changes are more recurrent, the human body must adapt to artificial time changes more often, thereby increasing the likelihood of circadian misalignment and desynchrony. Circadian desynchrony reduces quality and quantity of sleep, which has a cascading negative effect on personnel performance. To ameliorate the negative effects of shift work, rapidly rotating schedules, and associated sleep deprivation, the timing of external cues may be intentionally modified to support circadian alignment to the required wake/work hours. Aligning more quickly to shifting work hours could result in decreased sleep deprivation, improved sleep quality, decreased fatigue, and reductions in the negative impact on cognitive function. This work assessed the current state of sleep, fatigue, mood, and performance of a shore-based watchfloor, establishing a baseline for further study and comparative analysis when a schedule change or intervention is introduced. This study will inform recommendations to shore-based watchfloors that utilize non-traditional work schedules to cover 24-hour operations.

After nearly two decades of war in the Middle East and centuries of conflict, today’s service member is more vulnerable than ever. Our nation’s warriors can deploy to and redeploy from combat in a matter of hours, not the days, weeks, or months of the past. The growing, enduring, and repeating stressors of military service have placed a premium on creating resilient Soldiers, Sailors, Airmen, and Marines. Yet, currently, there is still a void of knowledge surrounding how best to tangibly assess or train the resilience of service members and how to proactively identify those who are at risk or headed toward risk of compromising their resilience. The aim of the current study is to associate physiological metrics with self-reported assessments to enable such a proactive approach to occur. The study occurred outside the sterile confines of the laboratory, choosing instead to follow 44 service members in their normal patterns of life. In collaboration with the University of Arizona, participants in the present study were asked to wear a commercially available health tracker, an ŌURA ring, while self-administering proven subjective assessments and “awareness training,” on an online platform. The results found statistically relevant associations between heart rate variability metrics and the subjective assessments of anxiety, depression, and compassion fatigue. Further studies are needed to confirm and explore these associations, as well as further analysis of the plethora of data., http://archive.org/details/measuringresilie1094566593, Major, United States Army, Approved for public release. distribution is unlimited

In 2017, two Arleigh Burke–class destroyers, USS John S. McCain and USS Fitzgerald, were each involved in collisions in the Pacific resulting in the deaths of 17 Sailors and injuries to several others. During the Comprehensive Review (CR) of these incidents, it was determined that fatigue, poor watchstanding habits, and the lack of professional knowledge were contributing factors. Since the occurrence of these shattering events, the U.S. Navy has implemented policies which mandate the use of circadian-based watchbills and has equipped leaders with tools and best practices to effectively manage crew fatigue. Though these efforts are trending in the right direction, the Navy currently lacks the ability to determine the level of operational readiness of each Sailor onboard. This study aims to further develop the Scheduling Management Aid for Risk Tracking (SMART) tool by developing new heuristics to address the issues identified by the CR and exploring alternative methods of importing data into the tool. Following the redevelopment of the tool, the functionality of SMART will be evaluated. The overarching goal of this thesis is to provide Commanding Officers with a tool which allows them to visualize the readiness of their crew members to allow them to reduce unnecessary risk and exercise deliberate risk, particularly during special evolutions., Lieutenant, United States Navy, Approved for public release. Distribution is unlimited.

U.S. Navy Sailors assigned to surface ship engineering departments operate, maintain, and repair many systems that provide critical services such as propulsion, damage control, air conditioning, potable water, electricity, and sewage. These engineering Sailors are expected to stand watch vigilantly and train constantly amid demanding work conditions and marginal manning levels. These issues potentially drive higher individual workload, restrict sleep opportunities, and erode crew morale. These challenges may be especially prevalent while ships are in the Basic Phase and may have been further exacerbated during the COVID-19 pandemic. Therefore, the objectives of this thesis are a) to assess the well-being, sleep attributes, and workload of engineering Sailors onboard USS Gonzalez (DDG 66), and b) to explore how the spread of COVID-19 affected the readiness of the department during the Basic Phase. Sailors were assessed using questionnaires, actigraphy, and self-report activity logs. Underway 1—dominated by 5/10 watch rotation and higher OPTEMPO—reflected worse mood compared to Underway 2, which was characterized by more 3/9 watch rotations and lower OPTEMPO (Underway 1 TMD: 68 ± 36.5; Underway 2 TMD: 53.1 ± 30.8; Wilcoxon signed rank test, n = 26, S = -103, p = 0.006). Mood, sleep quality, daytime sleepiness, insomnia symptoms, and proclivity to nap during Underway 1 and Underway 2 were worse compared to data collected from engineering departments across 14 other ships., Naval Medical Research Center - Adv Med Dept, Lieutenant, United States Navy, Approved for public release. Distribution is unlimited.

A significant percentage of active duty service members (ADSMs) spends free time playing video games. This recreational activity is not unexpected given the relatively young age of many ADSMs and the prevalence of video gaming in the US population. The military operational environment, however, is characterized by high levels of occupational stress and poor sleep conditions which can result in increased risk of depression, anxiety, and sleep disorders. In such conditions, video games may be a strategy for coping with stress. In contrast, excessive video gaming can become problematic because it has the potential to affect well-being and behavior. For example, excessive video gaming is associated with high stress levels (Milani et al., 2018), lower psychosocial well-being and psychological functioning (von der Heiden et al., 2019), loneliness and depression (Lemmens et al., 2011), and delinquency and aggressive behavior (Milani et al., 2018; Engelhardt et al., 2011; Ewoldsen et al., 2012). Video gaming may also interfere with sleep when gamers stay up late playing video games instead of sleeping (Matsangas, Shattuck, & Saitzyk, 2020). In extreme cases, video gaming can become an addiction. In the scientific literature, Internet Gaming Disorder (IGD) is associated with poor emotion regulation, impaired prefrontal cortex functioning and cognitive control, poor working memory and decision-making capabilities, and a neuronal deficiency similar to substance-related addictions (Kuss et al., 2018). Given its potential negative impact on individual and team performance, we propose to assess problematic video gaming in two samples: US Marine Corps personnel and US Navy sailors. Based on surveys and focus groups, the research approach will be tailored for the needs of each service. Data will be collected from personnel in up to three USMC commands, whereas data from USN sailors will be collected on two ships, one in port and one underway. The study will focus on assessing the p