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Recent expansions in the roles of women in combat have prompted increased interest in the psychological toll combat exposure may have on female service members as compared to males. This study examined the interactive effects of gender and combat exposure on transitions in posttraumatic stress disorder (PTSD) diagnostic status (presence or absence of PTSD diagnosis). We used administrative data of 20,000 U.S. Army soldiers whose combat exposure was assessed after return from deployment between January 1, 2008 and June 30, 2014; soldiers' PTSD diagnostic status was determined using International Classification of Diseases-9 diagnoses at four time points separated by 12 months. We used a mixed-effects logit transition model to examine the effects of combat and gender on incidence, persistence, and prevalence of PTSD diagnosis. Incidence and prevalence of PTSD diagnosis were higher among women, but persistence of PTSD diagnosis was higher in men. Higher rates of new PTSD diagnosis among women were not dependent on combat exposure, suggesting that other types of trauma may be responsible for increased rates among women. Gender differences in prevalence and persistence of PTSD diagnosis were greater among combat-exposed soldiers than among those not exposed to combat. Men maintained a PTSD diagnosis over longer periods of time than women suggesting greater PTSD persistence, and this pattern was particularly pronounced among soldiers exposed to combat. These results have implications for the recent policy changes and gender-based prevention strategies, and suggest that women in combat roles may be no more vulnerable to PTSD than are their male counterparts. Though the gender differences were small, they are indicative of healthcare utilization patterns that may be important for prevention and that warrant further exploration.

A proof-of-concept practice-based implementation network was developed in the US Departments of Veteran Affairs (VA) and Defense to increase the speed of implementation of mental health practices, derive lessons learned prior to larger-scale implementation, and facilitate organizational learning. One hundred thirty-four clinicians in 18 VA clinics received brief training in the use of the PTSD checklist (PCL) in clinical care. Two implementation strategies, external facilitation and technical assistance, were used to encourage the use of outcomes data to inform treatment decisions and increase discussion of results with patients. There were mixed results for changes in the frequency of PCL administration, but consistent increases in clinician use of data and incorporation into the treatment process via discussion. Programs and clinicians were successfully recruited to participate in a 2-year initiative, suggesting the feasibility of using this organizational structure to facilitate the implementation of new practices in treatment systems.

The Department of Defense (DoD) and veterans affairs (VA) built the practice-based implementation (PBI) Network in 2013 to facilitate more rapid translation of psychological health (PH) res...

The U.S. Defense Department partnered with the International Initiative for Mental Health Leadership on effective leadership and operational practices for delivery of mental health (MH) as well as addiction services throughout the world for Service Members (SM) and beneficiaries. A Military Issues Work Group (MIWG) was established in 2011 to focus on challenges experienced by military SM and beneficiaries among countries. The MIWG found common concerns related to MH care delivery to rural and remote beneficiaries. Gaps in access to care were identified and prioritized to explore. This led to better collaboration and understanding of telemental health (TMH) practices and technology applications (apps) which increase access to care for rural and remote SMs and beneficiaries. An assessment of the number of SMs and dependents distant from MH care services in the USA was conducted, as well as an environmental scan for psychological health-focused mobile apps and TMH services geared toward SM, veterans, and beneficiaries. The MIWG is developing a compendium of existing military TMH programs and apps that address MH concerns and extant literature on use of technology to extend global access to care for military members and their families across the world.

A1 Introduction to the 8th Annual Conference on the Science of Dissemination and Implementation: Optimizing Personal and Population Health David Chambers1, Lisa Simpson2 1Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Rockville, MD, 20850, USA; 2AcademyHealth, Washington, DC, 20036, USA For the second year in a row, we are pleased to be able to share the proceedings of the Annual Conference on the Science of Dissemination and Implementation in Health, a large meeting reflecting the expanding and evolving research field that seeks to optimize the use of evidence, interventions, and tools from health research within the myriad of settings where people receive health care, make health-related decisions, and increase knowledge of influences on the health of the population. We once again benefitted from a strong partnership, co-led by AcademyHealth and the National Institutes of Health (NIH), with co-sponsorship from the Agency for Healthcare Research and Quality (AHRQ), the Patient Centered Outcomes Research Institute (PCORI), the Robert Wood Johnson Foundation (RWJF), the US Department of Veterans Affairs (VA), and the WT Grant Foundation. In addition, we benefitted from the collaboration of staff from the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO). NIH and AcademyHealth again co-led the program planning committee, which focused on the development of the plenary sessions, and convened a scientific advisory panel to suggest speakers and advise on the overall conference development. The planning committee identified four key areas around which to focus the plenary panels and keynote address. Dr. America Bracho, M.D., M.P.H., Executive Director of Latino Health Access in Orange County, California, spoke about the opportunities for implementation science to inform efforts to improve community health and engage underserved populations. The three plenary panels each focused on a significant future direction for dissemination and implementation (D & I) research: the interface between D&I science and population health, emerging opportunities for global implementation science, and the challenges around implementation of precision medicine. The plenary sessions were complemented by facilitated lunchtime discussions on the same three topics, which offered participants an opportunity to identify key research questions for each and brainstorm next steps. Synopses of the lunchtime discussions are included in this supplement. Given the overwhelming success of the 2014 conference and the large number of abstracts received in 2014 (660), the program planning committee identified eight program tracks for abstract submitters to respond to, and through which the concurrent sessions of the conference would be organized. These tracks—Behavioral Health, Big Data and Technology for Dissemination and Implementation Research, Clinical Care Settings, Global Dissemination and Implementation, Promoting Health Equity and Eliminating Disparities, Health Policy Dissemination and Implementation, Prevention and Public Health, and Models, Measures and Methods— were designed to enable conference participants to follow a consistent theme across the multiple sessions of the conference and form the structure of this supplement. The call for abstracts, including individual paper presentations, individual posters and panel presentations, resulted in 515 submissions, spread across the eight thematic tracks. Over one hundred reviewers devoted their time to ensuring a comprehensive and expert review, and reviews were conducted within each track and coordinated by the track leads. For the final program, 64 oral presentations, 12 panels, and 263 posters were presented over the two-day meeting. Slides for the oral presentations and panels (with the agreement of the authors) were posted on the conference website (http://diconference.academyhealth.org/archives/2015archives) and all abstracts were included on the conference webapp (https://academyhealth.confex.com/academyhealth/2015di/meetingapp.cgi). This supplement has compiled the abstracts for presented papers, panel sessions, and lunchtime discussions from the 8th Annual Meeting on the Science of Dissemination and Implementation in Health: Optimizing Personal and Population Health. We are pleased to have the abstracts from the conference together in one volume once again, and look forward to the 9th Annual meeting, scheduled for December in Washington, D.C.

Purpose: The aim of this systematic review is to report on the current knowledge regarding patient satisfaction as a primary outcome for maxillary complete denture therapy. We asked, "For the maxillary edentulous patient treated using maxillary dentures, what are the patient-based outcomes regarding quality of life and treatment satisfaction." Materials and Methods: An electronic search of publications up to March 2014 was established using four databases: PubMed, Web of Science, Scopus, and Embase. To meet the ultimate goal of establishing clinical guidelines based on available information, prospective comparative studies, cohort prospective studies, and retrospective studies on more than 10 subjects were included. The electronic search identified 4,530 articles that were evaluated at the title, abstract, and article level to include 31 articles of interest. The patient-based outcomes and satisfaction data included were examined and reported. Results: The studies included 5,485 participants. Of these, 2,685 were identified as wearing maxillary complete dentures. Reported mean ages ranged from 59.7 to 73.6 years. A systematic review indicated that the provision of new maxillary complete dentures for edentulous patients results in improved self-reported satisfaction and oral health-related quality of life. The included reports, while providing evidence that complete denture satisfaction of participants and new dentures improve self-reported outcomes, did not include variables that influence these positive outcomes. Conclusion: A broad range of evidence supports the use of complete dentures for rehabilitation of the edentulous maxilla. When considering treatment of the edentulous maxilla, the expectations of patients for esthetic and phonetic (social) rehabilitation are high and can be met using maxillary complete dentures as the mode of prosthetic rehabilitation. Patients dissatisfied with new complete dentures may be referred for dental implant therapies involving fixed or removable prostheses.

Although women have served in the U.S. military officially since 1901, the medical needs of women in combat have historically been poorly understood. Recent expansion of the opportunities females may now play in combat roles has created an urgent need for a review of how Department of Defense supports females as they transition into these new roles, as well as current science related to key aspects of the health of female warriors. There is currently no systematic institutional structure in place to regularly and methodically examine gaps in policy, research, and treatment for issues related to women in combat.This article serves as a brief overview and introduction to some of the critical topics related to the health of women in combat roles, to include women's health issues research and treatment efforts, physiological differences between sexes, and leadership and unit factors.The Department of Defense should continue to explore and address policy, research, and practice related to the complex ongoing needs of military females in combat roles, and ensures sufficient staffing, resources and support from senior military leaders.

The literature on gender differences related to psychological health among in-theater service members who are deployed in a combatant role is limited. Much focuses on retrospective reports of service members who have returned from deployment. Potential key factors that contribute to gender differences in psychological health among combatants are found in literature across several topic areas, but integration of findings across disciplines is lacking. A growing body of literature on gender differences related to psychological health of postdeployment military populations suggests males and females respond differently to perceived levels of social support pre-and postdeployment. One study on service members who were deployed suggested no significant gender differences related to reported psychological health symptoms, but did appear to find significant gender differences related to reported perception of unit morale. In another related area, research explores how ostracism impacts physical and psychological health of individuals and organizations, and can result in perceptions of physical pain, although research on gender differences related to the impact of ostracism is scarce. Research has also begun to focus on sex differences in pain responses, and has identified multiple biopsychosocial, genetic, and hormonal factors that may contribute as potential underlying mechanisms. In this brief review, we focus on and begin to integrate relevant findings related to the psychological health of females in combat roles, gender differences in the impact of perception of social support on psychological health, the psychological and physical impact of ostracism on individuals and organizations, and the current literature on sex differences in pain perception. We conclude with a synthesis and discussion of research gaps identified through this review, implications for clinical practice, and potential future research directions. In conclusion, there appear to be gender differences related to the presence or absence of social support, the impact of ostracism, and the perception of pain. These differences may play a critical role in the psychological health of female combatants. More research on this topic is needed.

Numerous descriptive as well as prospective studies have indicated that mortuary workers, body handlers, and those tasked to work with human remains are at risk for symptoms related to post-traumatic stress disorder and other psychological sequelae. There have been no controlled studies outlining psychological interventions to prevent or minimize the impact of being assigned to perform such duties. In this article, we describe a method of psychological intervention with mortuary workers mobilized as a result of the September 11 attack on the Pentagon. The intervention included the use of Critical Incident Stress Teams and was based on a behavioral health consultant model that has been demonstrated to be effective for behavioral interventions in primary care settings. The model incorporated knowledge from previous studies on mortuary workers and individuals tasked to work with human remains. Qualitative analysis indicated that the behavioral health consultants were well received, recommendations were implemented, and few personnel were removed from duty as a result of psychological factors leading to impaired performance. Implications related to popular models of critical incident intervention and directions for future controlled research are discussed. Language: en

The development of circadian rhythms in a human infant Study Objectives-This study examines the ontogeny and interaction of circadian rhythms of sleep, wake, temperature, melatonin, and feeding in the human newbom, and the influence of photic and non-photic factors on the initiation of entrainment. Design-An infant's sleep-wake state, temperature, and salivary melatonin were monitored from birth to 6 months. Temperature was obtained every hour, and the infant's sleep/eating onset/termination were observed continuously and recorded until day 182. Salivary melatonin was obtained weekly for a 24-hour period, starting at week 3. Setting-The infant slept in his parents' bedroom. All household members awakened, retired, and ate meals according to a fixed schedule during the study, while the infant ate, slept, and woke on demand. Participants-A healthy male infant was the subject. Biological parents gathered data continuously for six months. Interventions-The infant's schedule was on-demand; the household's was fixed. Illumination was restricted to sunlight. Measurements and Results-The circadian rhythm of temperature appeared first, soon after birth, and became statistically significant within one week. The wake circadian rhythm appeared second, attaining significance at day 45; approximately the same time that increased melatonin concentration began to occur at sunset. The sleep circadian rhythm appeared last, attaining significance after day 56. Ninety to 120 minute zones of sustained wakefulness first appeared in the second month of life subsequent to awakening and prior to sleep onset. The infant's noctumal sleep-onset was coupled to sunset before day 60 and subsequently to family bedtime, giving evidence of initial photic entrainment followed by social entrainment. Conclusions-Circadian rhythms appeared much more rapidly in this infant than previously reported; their rapid appearance was probably facilitated by maximal exposure to sunlight, and regular social cues. These lighting conditions replicate universal infant experience prior to the invention of artificial light.

The objective of this study was to test a social interactional model of physical aggression. Specifically, this model hypothesizes that the performance of physical aggression has its roots in socialization settings that are characterized by high densities of aversive stimuli and that provide frequent reinforcement for escalation to high intensity aversive behavior during social conflict. Social conflicts were observed during 10 hr of interaction of each of 20 mothers and their 5-year-old sons; half of the sons were selected based on evidence of frequent aggression in home and school settings. Simple descriptive and sequential analyses indicated that aggressive relative to nonaggressive dyad members were more likely to engage in conflict, engaged in longer conflicts, were more likely to escalate to higher levels of aversiveness, and were less likely to de-escalate the intensity of conflict. In aggressive and nonaggressive dyads, the cessation of conflict contingent on the escalation of one dyad member was reliably associated with an increased likelihood of escalation and with escalation to higher levels of aversiveness by that member in the subsequent conflict. However, escalation occurred more frequently and was more likely to result in cessation of conflicts in aggressive than nonaggressive dyads.

Numerous descriptive as well as prospective studies have indicated that mortuary workers, body handlers, and those tasked to work with human remains are at risk for symptoms related to post-traumatic stress disorder and other psychological sequelae. There have been no controlled studies outlining psychological interventions to prevent or minimize the impact of being assigned to perform such duties. In this article, we describe a method of psychological intervention with mortuary workers mobilized as a result of the September 11 attack on the Pentagon. The intervention included the use of Critical Incident Stress Teams and was based on a behavioral health consultant model that has been demonstrated to be effective for behavioral interventions in primary care settings. The model incorporated knowledge from previous studies on mortuary workers and individuals tasked to work with human remains. Qualitative analysis indicated that the behavioral health consultants were well received, recommendations were implemented, and few personnel were removed from duty as a result of psychological factors leading to impaired performance. Implications related to popular models of critical incident intervention and directions for future controlled research are discussed.

To further define the role of the neuromaturational examination in determining the presence of learning problems, we examined 104 boys, ages 9.5 to 14.1 years, representing three populations of school children: normal (32 boys), gifted (37), and learning disabled (35). Information concerning each child's behavior and development was obtained through a parent questionnaire; cognitive ability and academic achievement were measured by the Wechsler Intelligence Scales for Children (revised) and Woodcock -Johnson Psychoeducational Battery, respectively. Significant relationships emerged between the number of neuromaturational signs and data group membership (LD greater than N greater than G,P less than 0.05). The number of neuromaturational signs decreased with age for normal (P less than 0.05) and gifted (P less than 0.05) children, but not for the learning-disabled group. Tasks that differentiated the normal and learning disabled were entered into a stepwise discriminant analysis, with a resulting classification accuracy of 93.1% and 100% for the normal and learning-disabled boys, respectively. Analysis of covariance indicated that differences in performance of the three groups may reflect IQ differences among the populations. Learning disabled boys were more likely to exhibit synkinesis than normal boys, but gifted boys did not differ from the learning disabled in the frequency of synkinesis. Our data indicate that, although a composite set of neuromaturational tasks can discriminate normal and learning-disabled boys with a high level of accuracy, caution is urged because the findings may be more related to overall intelligence than to a specific learning disability.