23 April, 2019 06:41

U.S. Mint Video: American Legion Commemorative Coin
Apr 20, 2019 | U.S. Mint, video
[Video at link above.]
Chief Engraver Joe Menna and Sculptor-Engravers Michael Gaudioso and Phebe Hemphill discuss their work on the 2019 American Legion 100th Anniversary Commemorative Coin Program.
Watch the video on YouTube →.
NYT: The Military Wants Better Tests for PTSD. Speech Analysis Could Be the Answer.

By Dave Philipps

• April 22, 2019

Post-traumatic stress disorder has long been one of the hardest mental health problems to diagnose because some patients try to hide symptoms while others exaggerate them. But a new voice analysis technique may be able to take the guesswork out of identifying the disorder using the same technology now used to dial home hands-free or order pizza on a smart speaker.
A team of researchers at New York University School of Medicine, working with SRI International, the nonprofit research institute that developed the smartphone assistant Siri, has created an algorithm that can analyze patient interviews, sort through tens of thousands of variables in their speech and identify minute auditory markers of PTSD that are otherwise imperceptible to the human ear, then make a diagnosis.
The results, published online on Monday in the journal Depression and Anxiety, show the algorithm was able to narrow down the 40,500 speech characteristics of a group of patients — like the tension in the larynx and the timing in the flick in the tongue — to just 18 relevant indicators that together could be used to diagnose PTSD. Based on those 18 speech clues, the algorithm was able to correctly identify patients with PTSD 89 percent of the time.
“They were not the speech features we thought,” said Dr. Charles Marmar, a psychiatry professor at N.Y.U. and one of the authors of the paper. “We thought the telling features would reflect agitated speech. In point of fact, when we saw the data, the features are flatter, more atonal speech. We were capturing the numbness that is so typical of PTSD patients.” As the process is refined, speech pattern analysis could become a widely used biomarker for objectively identifying the disorder, he said.

For many it can’t come too soon. The Department of Defense, which funded the study, has been on the hunt for a reliable biomarker for the disorder for more than a decade. Fueled by military dollars, research teams across the country have worked to develop brain scans, blood tests and other objective measures that might take some of the uncertainty out of diagnosing PTSD.
The most common method currently used for identifying PTSD relies largely on a subjective process in which patients answer questions about symptoms and clinicians make a judgment. That works well when patients report symptoms accurately, Marmar said, but — consciously or not — patients are notoriously unreliable.
Some active-duty troops, police officers and firefighters downplay symptoms because they fear being sidelined, or don’t want to admit weakness. Others seeking compensation for PTSD caused by the job may exaggerate symptoms to increase their payout. Complicating matters even more, disorders including insomnia and anxiety share many symptoms with PTSD, and the biases of clinicians doing assessments can sometimes shape diagnoses.
At the Department of Veterans Affairs, PTSD claims have tripled in recent years and now make up more than a fifth of all benefits claims, causing some in Congress and the department to question the accuracy of the diagnosis method. It is a common frustration across psychiatry, said Craig Bryan, a former Air Force psychologist and Iraq war veteran who now runs the National Center for Veterans Studies at the University of Utah. “On active duty, I was always worried patients were lying to me because they are afraid of what was going to happen if they admitted they were having issues,” Bryan said. “Speech analysis could potentially solve that problem.”
Bryan, who was not involved in the N.Y.U. research, said his clinic participated in a separate study funded by the Defense Department focused on a voice biomarker that delivered similarly strong results. Those results were published in February. He said speech analysis was just one of a number of objective methods for diagnosing PTSD, including testing blood or saliva for stress hormones, that are on the cusp of being reliable enough to use in a clinical setting. “The advantage of voice analysis is that you don’t need a needle, you don’t need a lab,” he said. “Potentially, all you might need is a smartphone.”
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The N.Y.U. study looked at 129 male military veterans all around 32 years old who had significant exposure to combat, screening out any who also had other disorders that might complicate the study, such as depression or alcohol abuse. Researchers conducted a traditional structured interview, known as a Clinician-Administered PTSD Scale, or CAPS, to identify 52 veterans with PTSD and 77 without.
Researchers recorded each interview, then fed the audio recordings through the speech analysis software at SRI International in Menlo Park, Calif. For five years a team of scientists there has been developing speech software that can understand not only what people say, but also what emotions are expressed in how they say it. The team deconstructed the interviews into 40,526 objective speech-based features that documented tone, variation, pacing and annunciation. This same process is used to help automated customer service programs respond to irate customers.
The data was sent back to New York, where Eugene Laska, a statistician in the psychiatry department at N.Y.U., fed it through an artificial intelligence program that searched repeatedly through the thousands of features until it learned which ones best distinguished the patients with PTSD. In the end it settled on just 18.
Patients with PTSD tended to speak in flatter speech, with less articulation of the tongue and lips and a more monotonous tone, the researchers reported. “We’ve known for a long time that you can tell how someone is doing from their voice. You don’t have to be a doctor to know when someone is feeling down,” Laska said. “But this could take some of the fuzziness out of the process, and help clinicians make better decisions.”
Rather than replace traditional diagnostic interviews, he said, potential biomarkers would most likely become a tool to help psychologists make difficult calls. The results of the study are encouraging, and can be built on to create more sophisticated screening tools, said Rachael Yehuda, director of the Traumatic Stress Studies Division at the Mount Sinai School of Medicine, but she cautioned that in its current form, the algorithm may be of limited practical use.
Many patients with PTSD arrive at the psychologist’s office with a host of other disorders, including depression and substance abuse, and it is unclear how well speech analysis would fare under more complicated real-life circumstances, Yehuda said. Also unclear is whether the signals identified by the algorithm are caused by PTSD or pre-existing conditions that make patients more vulnerable to the disorder, she said.
“We should be enthusiastic but sober,” she added. “This is an important effort. But mental health conditions are complicated and I suspect there is more work to be done.”
Marmar agreed that the technology will need more work before it can be deployed to the field, but said his team hoped to eventually apply for approval by the Food and Drug Administration. “The advantage of this approach is it’s noninvasive and it will become low cost, and easy to perform,” he said. “In theory, we could use this assessment on troops anywhere in the world.”

Washington Examiner: US military rules under review after soldiers surrendered pistol to Mexican troops on American soil
by Anna Giaritelli
| April 22, 2019 09:42 PM
A senior defense official says the Pentagon is reviewing how U.S. soldiers responded during an incident this month in which a Mexican troops detained and disarmed Americans on Texas soil.
The standoff between two U.S. soldiers and as many as six Mexican military officials on April 13 is believed to be the first of its kind, according to the senior defense official from Northern Command, or NORTHCOM. "This is the first incident that we’re aware of that the two militaries came together," the official told the Washington Examiner.
Two Army soldiers from Washington state were sitting in an unmarked Customs and Border Protection vehicle south of the U.S. barrier but north of the international boundary near Clint, Texas, when Mexican troops moved in on them.
The Mexican soldiers, each carrying FX-05 Xiuhcoatl rifles, detained, disarmed, and questioned the U.S. troops. One soldier’s Beretta M9 service pistol was taken from him and temporarily confiscated.
The Pentagon is now investigating the incident, which the official said "will help us modify any instructions that we’re giving the troops" about how to deal with such a situation.
Troops deployed to the U.S.-Mexico boundary go through joint readiness staging, or training on how to handle dangerous situations in the area. The official said he could not recall anything similar to last Saturday’s encounter having taken place during a previous active-duty troop deployment.
No official protocol exists for how to navigate a run-in with a foreign military, but the senior official said the soldiers were trained to "de-escalate" the situation. By surrendering at least one gun, they followed existing protocol, though it left them unarmed.
The NORTHCOM official also defended the U.S. soldiers being in the location. The pair had been assigned by Customs and Border Protection to be at those coordinates on the U.S. side of the border. The two soldiers were one of 150 teams serving on mobile surveillance missions who had been assigned that specific location to stake out and monitor surveillance feeds.
Mexican soldiers spotted the pair and did not recognize their unmarked vehicle. The U.S. troops did not recognize the unmarked truck. There was mutual confusion about why either party was at that location.
"That area of the border is kind of confusing," a second NORTHCOM official told the Examiner. "It may have been difficult for them [Mexican forces] to know if they didn’t know the area as well or were new or something. I don’t think — it definitely wasn’t trying to overtake the U.S."
Much of the physical barrier along the U.S.-Mexico border does not sit on the international boundary and is located a few dozen to a few hundred feet north of it.
In areas such as southwestern Arizona and eastern Texas, rivers serve as the official border, but in other regions, it can be more difficult to determine the official line in the sand.
The language barrier further complicated the situation. "There was a U.S. Army soldier that was one of the two that spoke Spanish. That was about when they came to realize they were Mexican military," the official said.
Military Times: Victims of military medical mistakes to tell their stories at congressional hearing seeking legal fixes
By: Leo Shane III  16 hours ago
House lawmakers will hear directly from the victims of military medical mistakes next week in a hearing looking at whether Congress should consider changing the rules regarding malpractice casesagainst the Department of Defense.
Among those scheduled to testify at the hearing on April 30 are Sgt. 1st Class Richard Stayskal, a Green Beret fighting stage four lung cancer because of Army doctors errors, and the widow of Air Force Staff Sgt. Dean Patrick Witt, who was left in a vegetative state after a botched appendectomy surgery.
Natalie Khawam, an attorney for Stayskal, said the 37-year-old father of two is in considerable pain daily but will appear before the House Armed Services Committee to “show that there needs to be accountability for these doctors.”
At issue is a 1950 Supreme Court decision called the Feres doctrine which lower courts have cited repeatedly to block troops from claiming medical malpractice damages for actions related to their military service.
Defense advocates have argued that changing the precedent would prompt a flood of frivolous lawsuits against the military. But critics of the doctrine say the ruling has been applied far beyond issues of troops facing war-related injuries or on-duty accidents, and deprived military families of compensation for negligence and carelessness.
In Stayskal’s case, Army doctors overlooked a tumor in lungs in early 2017, allowing it to grow rapidly in ensuing months. By the time his cancer was properly diagnosed, doctors told him they could not treat the illness, and gave him only a few months to live.
Khawam, who runs the Whistleblower Law Firm, said his family has been unable to sue for damages and to censure the military doctors involved because of the Feres doctrine. The same mistakes in a civilian hospital would face no such legal obstacles.
“ISIS couldn’t kill this guy, but our medical system is,” Khawam said.
In Witt’s case, a nurse inserted a breathing tube into his esophagus instead of his airway, depriving his brain of oxygen. The nurse surrendered her medical license, but the family was blocked from receiving any damages because of the Feres doctrine.
Military officials did not return requests for comment on the malpractice accusations.
Lawmakers in both the House and Senate have said they want a fix to that complete shutdown of legal cases against problematic military physicians. Rep. Jackie Speier, D-Calif., and chairwoman of the House Armed Services personnel subcommittee, has said the issue is one of her top legislative priorities for this year.
Also scheduled to testify at the hearing are former Air Force Judge Advocate Rebecca Lipe and Dwight Stirling, chief executive officer of the Center for Law and Military Policy.
The hearing will begin at 2 p.m. on April 30 and will be streamed online at the committee’s web site.
Stripes: Merit over seniority: Army revamping 50-year-old centralized promotion board

By CHAD GARLAND | STARS AND STRIPES Published: April 22, 2019
The Army will revamp its centralized promotion board processes over the next few years to focus on advancing senior noncommissioned officers on merit, not time served.

Gone will be annual sequenced promotion lists and the “P” status for promotable NCOs, to be replaced by quarterly forecasts and monthly selection processes for sergeant and above.

Officials also plan to expand the use of merit-based rankings for other uses beyond the promotion process, such as for identifying subpar soldiers for separation, the Army said in a directive published earlier this month.

The changes are aimed at “promoting the right people at the right time,” the service’s top enlisted soldier said in a statement last week. The first changes will take effect this year with the master sergeant promotion board but are slated to be implemented across the NCO corps in the next three to four years.

“This is the first major overhaul to our enlisted centralized promotion board in the 50 years we’ve conducted them,” said Sgt. Major of the Army Dan Dailey, as quoted in the statement. “We will see a number of benefits with these changes, but the most important one will be the impact to readiness.”

The new system is expected to ensure retention of the “most talented” NCOs, said Dailey, who began efforts to revise the process two years ago.

“This change now truly rewards the most qualified soldiers who are seeking advancement instead of simply promoting people based on seniority,” he said.

The current system, which dates back to 1969, relies on long-range projections of soldiers leaving the force, sometimes created 24 months in advance, which has at times resulted in surpluses of promotable soldiers, said Gerald Purcell, an Army personnel official and retired sergeant major responsible for integrating NCO professional development policies. The new system is meant to fix such inefficiencies, he said.

“We are creating a process that reacts to emerging requirements and it stops us from creating skill and grade imbalances,” he said, adding that it is expected to prevent promotion stagnation or the need to separate soldiers because there are too many at a particular rank.

The new system will identify soldiers who are “fully qualified” for promotion in each grade and occupational specialty, and then sequence them for promotion using a system that takes skills, knowledge and behavior into account. The current system sequences promotions using time-based measures, which Purcell said can fail to reward or recognize deserving candidates with less seniority.

Merit-based sequence numbers are expected for all ranks sometime this year.

In the next few months, soldiers should be able to privately check their standing on the list, known as an order of merit list, or OML, on the Army Career Tracker website. This year, OML standings will be used for command sergeant major and sergeant major eligibility but will eventually be used for promotion in all other NCO ranks.

The OML standings will also be used for things like scheduling professional military education, assignment to developmental positions and retention decisions, said the new directive, signed by Army Secretary Mark T. Esper on April 4.

Beginning next year, the standings are expected to assist with assignment and training decisions, the Army said in a statement last week. The service will also begin notifying soldiers if they fail to qualify for promotion by not completing the mandatory Structured Self-Development or Distributed Leaders Course.

After a soldier is identified as not qualified for a second time — in 2021 at the earliest — a mandatory separation date will be set for six months in the future. The soldier will be allowed to retire, if eligible, or will be involuntarily separated.

Quarterly promotion forecasts and monthly promotions for all NCO ranks are also slated to be in place by the end of 2021 — soldiers would be notified of their selection for promotion on the 15th of the month, with an effective promotion date on the first of the following month.

The first separations for soldiers who fail to meet qualifications twice are also expected to begin that same year, which will allow the Army to eliminate time-in-service limits for each rank.
“We are calling this a talent management effort,” Purcell said. “There is a place for everybody in the Army as long as you are performing.”

garland.chad
Twitter: @chadgarland