Cohesion and Performance in Military Occupation Specialty Training.

INTRODUCTION: Cohesion within military teams is not only vital to their performance but also modulates the adverse impact of work stressors on mental health, including depression, distress, and morale. This study stems from previous findings concerning cohesion during recruit training in the Australian Army. In that study, ratings of cohesion clustered on three dimensions, namely horizontal bonding among team members, vertical bonding with leaders, and organizational bonding with the wider army. Ratings on all three dimensions increased during recruit training, similar to what has been during U.S. Army basic training. The present study takes the next step, which is to determine the relationship between team cohesion and external measures of group performance during training in three types of military occupational specialty, specifically, infantry, quartermaster, and administrative clerk. MATERIALS AND METHODS: The final sample of respondents consisted of 261 infantry trainees, 22 quartermaster trainees, and 39 administrative clerk trainees. These sample sizes, their gender distribution (9% female), and age distribution are proportional to their representation in the Australian Army. The questionnaires given to trainees and their instructors were adapted from Siebold and Kelly's Platoon Cohesion Index used for measuring the types of bonding within a team. The questionnaire for trainees was administered three times during their respective courses. The cohesion questionnaire for instructors was administered at the completion of training. This study was conducted under defence ethics approval DPR-LREP 069-15. RESULTS: The trainees' ratings of horizontal, vertical, and organizational bonding generally started at a high value and further increased throughout each of the three courses. Vertical bonding tended to be higher than the horizontal bonding, which in turn was consistently higher than organizational bonding. At the end of each course, the trainees' ratings of horizontal bonding had a large significant correlation with their instructors' ratings of the trainees' horizontal bonding (r = 0.70), while the ratings of vertical bonding by the trainees versus their instructors had a smaller correlation (r = 0.21). In relation to the trainees' individual grades on their course, the trainees' grades were not significantly correlated with their section's horizontal bonding (r = 0.29), while their section's mean grade was correlated with their instructors' ratings of horizontal bonding (r = 0.44). CONCLUSIONS: The present results during military occupational specialty training paralleled previous findings that Australian Army recruits quickly developed solid team cohesion early in their training, which generally continued to rise in all three courses. Furthermore, as seen previously with recruits, vertical bonding between section members in all three courses and their instructor leaders tended to be higher than horizontal bonding among team members, which in turn was higher than vertical bonding of the trainees with the wider Army. These findings have useful implications for health professionals. When discussing feelings of depression, distress, and low morale, health professionals might explore a military member's sense of bonding with their team members, their leaders, and their wider organization as possible contributors to their concerns. By the same token, advice aimed at promoting cohesion may help evoke their protective effects.

Development of Cohesion in Mixed-Gender Recruit Training.

INTRODUCTION: With the removal in 2016 of restrictions on recruiting women to the combat arms in the all-volunteer Australian Army, a key question has been whether adding women to small combat teams will reduce the sense of cohesion among their members, which entails their subjective bonds with each other, their leader, and wider organization. Despite recent initiatives in Australia and the USA, there are too few women in combat units in any country to answer this question and how these subjective bonds affect a team's ability to stick together under pressure.Men and women recruits in the Australian Army have undertaken basic soldier training in mixed-gender teams since 1995. Recruit training provides the foundation of teamwork and cohesion in all types of units. The present study capitalized on this well-established practice as an avenue for illuminating the development of cohesion in the form of subjective bonds within mixed-gender teams. MATERIALS AND METHODS: The respondents were 89 females and 434 males, who were members of 46 teams denoted as "sections," each consisting of 9-12 recruits. The gender mix of the sections varied from 0% female (all males) up to 55.6% females. The recruits were surveyed on three occasions during the 81-day recruit training (Days 10, 46, 80). The questionnaire comprised 18 items asking the recruits' ratings of "vertical" bonding with their instructor/leaders, "horizontal" bonding within their sections, and "organizational" bonding with the wider Australian Army. This study was conducted under Defence ethics approval DPR-LREP 069-15. RESULTS: At the start of training, vertical bonding of the recruits with their instructor/leaders was significantly higher than horizontal and organizational bonding, which were similar. During training, all three types of bonding as rated by both female and male recruits increased and largely converged to a high level. Any apparent gender-related differences were not statistically significant.Bonding scores for females did decline slightly as the proportion of women increased, but only significantly for vertical bonding. Even these declines all occurred within a band of high scores. For male recruits, there was no discernible relationship of bonding scores with the percentage of females in a section; the lines of best fit appeared flat. CONCLUSIONS: Within the Australian Army, women and men have been trained in mixed-gender sections since 1995 with sustained success, at least anecdotally. The present findings provide the first independent confirmation that all three dimensions of cohesion increase in strength during recruit training much to the same degree in women and men alike. To the extent that felt cohesion translates into effective teamwork, mixed-gender training establishes a sound foundation for integrating women into combat units as well as support units, where they have traditionally served.

Instructor and Trainee Judgments of Cohesion in Mixed-Gender Military Teams.

INTRODUCTION: In integrating women into combat roles, one key question has been whether women will reduce the cohesion of small teams, which is their ability to stick together and perform well under pressure. Among other things, team cohesion protects the mental health of military personnel during initial training as well in operational zones. To provide new converging evidence on the cohesion of all-male versus mixed-gender recruit teams at the end of training, cohesion ratings were obtained from both recruits and their instructors. MATERIALS AND METHODS: The recruits consisted of 83 females, 398 males, and 8 non-specified individuals across 46 small teams. The teams' gender mix varied from 0% female (all males) up to 64% female. The recruit questionnaire comprised 18 items that covered the bonding of the recruits with each other (horizontal), with their instructor leaders (vertical), and with the wider Army (organizational). In addition, two to three instructors rated each team on their horizontal and vertical bonding. This study had Defence ethics approval (DPR-LREP 069-15). RESULTS: (1). The ratings of recruits and instructors were significantly correlated for both horizontal bonding (r = 0.44) and vertical bonding (r = 0.49). These correlations were similar to correlations obtained previously from U.S. Army infantry platoons. (2). The recruits in the present study gave their teams significantly higher ratings for horizontal bonding (M = 4.18, SD =0.33) than did their instructors (M = 3.95, SD =0.31), F(1,45) = 22.12, p < 0.001). Neither the ratings of recruits nor their instructors were significantly correlated with the percentage of females per team, rs = 0.063, 0.249, ps > 0.05. (3). For vertical bonding, the recruits' ratings (M = 4.48, SD =0.37) were high and similar to those of instructors (M = 4.56, SD =0.44), F(1,45) = 1.65, p > 0.20). The vertical bonding scores were also not significantly correlated with the percentage of females per team, rs = -0.168, -0.139, ps > 0.25. CONCLUSIONS: Our findings agree with a previously published analysis of recruit performance over a 5-year period (2011-2015). Composite instructor ratings of recruit performance, including their teamwork, were similar for males and females regardless of the gender composition of platoons, which ranged from all male to 45% female.The next step in this research is to determine the pattern and dynamics of bonding between team members and their leaders as soldiers progress through their advanced training and ultimately operational deployment. Such research should reveal whether any differences in cohesion appear in relation to team gender composition.The present results have useful implications for health professionals. When discussing feelings of stress, depression, and/or with male or female military clients, health professionals may find it worthwhile to explore their clients' sense of bonding with their team members, their leaders, and their wider organization as one possible contributor to the individual's concern. By the same token, advice aimed at promoting the three dimensions of cohesion may help capitalize on their protective effects.

Women and Men Together in Recruit Training.

Introduction: Although men and women recruits to the Australian Army have trained in mixed-gender platoons since 1995, restrictions on women joining the combat arms were only removed in 2016. As part of a longitudinal study starting with recruit training, this article examined recruit records collected before 2016 with the aims of delineating (1) the relative performance of women versus men in mixed-gender platoons and (2) the relative performance of men in mixed-gender platoons versus all-male platoons. Materials and Methods: De-identified instructor ratings for 630 females and 4,505 males who completed training between 2011 and 2015 were obtained. Recruits were distributed across 128 platoons (averaging 41.6 members, SD = 8.3) of which 75% contained females, in proportions from 5% to 45%. These analyses were conducted under defense ethics approval DPR-LREP 069-15. Results: Factor analyses revealed that instructor ratings generally loaded onto a single factor, accounting 77.2% of the variance. Consequently, a composite recruit performance score (range 1-5) was computed for 16 of 19 competencies. Analyses of the scores revealed that the distributions of the scores for females and males overlapped considerably. Observed effects were negligible to small in size. The distributions were all centered between 3.0 and 3.5. In mixed-gender platoons, 51% of the females and 52% of the males fell in this band, and 44% of recruits in all-male platoons had scores in this band. The lower three bands (1.0-3.0) contained a slightly greater proportion of females (18%) than males in either mixed-gender platoons (12%) or all-male platoons (12%). Conversely, the upper three bands (3.5-5.0) contained a slightly smaller percentage of females (31%) than males in either mixed-gender platoons (36%) or all-male platoons (44%). Although scores for females were reliably lower than those of males in mixed-gender platoons, χ2 (4) = 16.01, p < 0.01, the effect size (V = 0.07) did not reach the criterion for even a small effect (0.10). For male recruits, those in mixed-gender platoons had scores that were reliably lower than in all-male platoons, χ2 (4) = 48.38, p < 0.001; its effect size (V = 0.11) just exceeded the criterion for a small effect (0.10). Further analyses revealed that male scores had a near-zero correlation (r = -0.033) with the proportion of females in platoons (0-45%). Conclusion: This large-scale secondary analysis of instructor ratings of female and male recruits provides a platform for monitoring the integration of women into the combat arms. The analyses revealed nearly complete overlap in the performance of female versus male recruits. The detected gender-related differences were negligible to small in size. These small differences must be viewed with considerable caution. They may be artifacts of rater bias or other uncontrolled features of the rating system, which was designed for reporting individual recruit performance rather than aggregate analyses. Even with these limitations, this baseline snapshot of recruit performance suggests that, at recruit training, women and men are already working well together, which bodes well for their subsequent integration into the combat arms.

Massive Atenolol, Lisinopril, and Chlorthalidone Overdose Treated with Endoscopic Decontamination, Hemodialysis, Impella Percutaneous Left Ventricular Assist Device, and ECMO.

BACKGROUND: Overdose of cardiovascular medications is increasingly associated with morbidity and mortality. We present a case of substantial atenolol, chlorthalidone, and lisinopril overdose treated by multiple modalities with an excellent outcome. CONCLUSION: Aggressive medical intervention did not provide sufficient hemodynamic stability in this patient with refractory cardiogenic and distributive shock. Impella® percutaneous left ventricular assist device and extracorporeal membrane oxygenation provided support while the effects of the overdose subsided. We present concentrations demonstrating removal of atenolol with continuous venovenous hemodiafiltration. This is the first report of esophagogastroduo denoscopy decontamination of this overdose with a large pill fragment burden.

Hardiness as a predictor of mental health and well-being of Australian army reservists on and after stability operations.

This study tested whether cognitive hardiness moderates the adverse effects of deployment-related stressors on health and well-being of soldiers on short-tour (4-7 months), peacekeeping operations. Australian Army reservists (N = 448) were surveyed at the start, end, and up to 24 months after serving as peacekeepers in Timor-Leste or the Solomon Islands. They retained sound mental health throughout (Kessler 10, Post-Traumatic Checklist-Civilian, Depression Anxiety Stress Scale 42). Ratings of either traumatic or nontraumatic stress were low. Despite range restrictions, scores on the Cognitive Hardiness Scale moderated the relationship between deployment stressors and a composite measure of psychological distress. Scatterplots revealed an asymmetric pattern for hardiness scores and measures of psychological distress. When hardiness scores were low, psychological distress scores were widely dispersed. However, when hardiness scores were higher, psychological distress scores became concentrated at a uniformly low level.

Reservists in a postconflict zone: deployment stressors and the deployment experience.

In postconflict zones, both aid and military personnel face chronic stress, including boredom, isolation, family separation, and difficult living conditions, plus the intra-organizational and interpersonal frictions found in all work settings. Australian Army reservists (N = 350) were surveyed during and after peacekeeping in the Solomon Islands. Most respondents reported having a positive experience (66%) and fewer reported their experience was neutral (16%) or negative (17%). The stressors reported by reservists predominately emanated from work-related sources rather than from separation or the operational environment. The discussion considers leadership factors, especially the role of organizational justice in deployed organizations, that may influence the deployment experience.

Perceptions of deployment of Australian Army reservists by their employers.

The views and concerns of the employers of reservists sent on overseas deployments are largely unknown. A survey was conducted of 126 Australian employers who participated in Exercise Boss Lift sponsored by the Australian Defence Force, which involved a visit to their employees deployed on overseas service in the Solomon Islands and Malaysia during the period 2006-2010. Employers reported a substantial number of positive aspects of reservist deployment for both their enterprise and the individual reservist employee, including an increase in leadership, teamwork, skills, maturity, and confidence. There were 40% fewer reported negatives, which primarily concerned the costs associated with the absence of an important employee. The employers expressed needs for greater information regarding dates of absence of their reservist employee and assistance from the ADF to enable them to enhance the overall deployment. Importantly, employers sought confirmation of ways to effectively manage the transition of their reservist from military service back to their civilian roles. Some employers offered to act as advocates.

Psychological adjustment and retention of Australian Army reservists following a stability operation.

Australian Army reservists (n=92) and a comparable group of regulars (n=90) were surveyed at the end of a 7-month deployment on a stability operation in Timor Leste and again approximately 6 months after returning to Australia. Both reservists and regulars displayed sound mental health, as measured by the K10 and PCL-C at both time points. Conversely, both groups reported only low levels of traumatic stress (Traumatic Stress Exposure Scale-Revised) and nontraumatic stress (Major Stressors Inventory). The nontraumatic stress reported by the reservists emanated predominately from work-related frustrations, more so than the regulars. Notwithstanding their reports of work-related stress and only average morale, 65% of the reservists reported that deployment was a positive experience, and 70% continued to render ongoing military service continuously over a 6-year follow-up, significantly more than either the sample of regulars (48%) or projections for reservists (32%). Future directions for research are identified that may promote mental health and retention of reservists.