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The article of record as published may be found at https://doi.org/10.7326/M19-1567

NPS NRP Executive Summary ; Report Type: Final Report ; Project Summary: Sexual assault in the United States Marine Corps remains high in the list of priorities and at the forefront of public concern. To better understand and combat the issue, our work examines how career outcomes for Marines who filed a formal unrestricted report of sexual assault, case Marines, differ from those who never filed a report, control Marines. Additionally, we evaluate whether career outcomes for Marines who filed a formal unrestricted report of sexual assault differ based on key demographics. Enlisted Marines of ranks E-1 through E-4 who filed unrestricted reports from 2011 to 2015 are matched by age, rank, gender, Military Occupational Specialty (MOS), and report date to Marines who have never filed an unrestricted report. Using logistic regression analysis, career outcomes are measured by separation status and narrative within one year from the sexual assault report date. Results reveal that in general, case Marines are more likely to separate, and separate for reasons other than end of contract than their control Marine counterparts. Variables such as rank, occupational field, number of dependents, and average professional and conduct scores (PROCONS), class, and change are contributing variables. ; HQMC Manpower & Reserve Affairs (M&RA) ; HQMC Manpower & Reserve Affairs (M&RA) ; HQMC Manpower & Reserve Affairs (M&RA) ; NPS-17-N157-A ; Approved for public release; distribution is unlimited.

Military members often work in challenging environments. Their sleep is degraded by extended operational commitments and the requirement to work in shifts. Exposure to light at circadian inappropriate times may also have a detrimental impact on service members' sleep, fatigue levels, and mood. This two-week field study assessed whether sleep-related attributes can be improved by limiting exposure to blue light prior to sleep. Participants (N=30) were observed for one week without using blue light blocking glasses followed by a second week when they used blue light blocking glasses for two hours prior to their bedtimes. Sleep was assessed with wristworn actigraphy. Daytime sleepiness decreased (p=0.011), and mood improved (p<0.001) after wearing the glasses. Insomnia symptoms decreased while sleep onset latency and sleep quality improved, although not at statistically significant levels. These findings suggest that controlling exposure to blue light for two hours prior to sleep has a beneficial effect on sleep quality and mood. ; Naval Ophthalmic Support and Training Activity, Yorktown, Virginia ; Document # M5405016WRSLP02

The article of record as published may be found at http://dx.doi.org/10.7326/M15-2785 ; Suicide prevention programs have become ubiquitous among military units; identifying temporal trends and nonclinical factors associated with the chosen suicide methods may help improve suicide prevention strategies.

BACKGROUND: Reducing the transmission of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is a global priority. Contact tracing identifies people who were recently in contact with an infected individual, in order to isolate them and reduce further transmission. Digital technology could be implemented to augment and accelerate manual contact tracing. Digital tools for contact tracing may be grouped into three areas: 1) outbreak response; 2) proximity tracing; and 3) symptom tracking. We conducted a rapid review on the effectiveness of digital solutions to contact tracing during infectious disease outbreaks. OBJECTIVES: To assess the benefits, harms, and acceptability of personal digital contact tracing solutions for identifying contacts of an identified positive case of an infectious disease. SEARCH METHODS: An information specialist searched the literature from 1 January 2000 to 5 May 2020 in CENTRAL, MEDLINE, and Embase. Additionally, we screened the Cochrane COVID‐19 Study Register. SELECTION CRITERIA: We included randomised controlled trials (RCTs), cluster‐RCTs, quasi‐RCTs, cohort studies, cross‐sectional studies and modelling studies, in general populations. We preferentially included studies of contact tracing during infectious disease outbreaks (including COVID‐19, Ebola, tuberculosis, severe acute respiratory syndrome virus, and Middle East respiratory syndrome) as direct evidence, but considered comparative studies of contact tracing outside an outbreak as indirect evidence. The digital solutions varied but typically included software (or firmware) for users to install on their devices or to be uploaded to devices provided by governments or third parties. Control measures included traditional or manual contact tracing, self‐reported diaries and surveys, interviews, other standard methods for determining close contacts, and other technologies compared to digital solutions (e.g. electronic medical records). DATA COLLECTION AND ANALYSIS: Two review authors independently screened records and all ...

Background: Private healthcare providers deliver a significant proportion of healthcare services in low- and middle-income countries (LMIC). Poorer patients get sick and go without care more frequently, and spend more of their incomes on private healthcare than the wealthy. This review is focused on comparing health outcomes in private versus public care settings. It seeks to summarize what is known regarding the relative morbidity or mortality outcomes that result from treatment by public or private providers in LMIC.Methods: We conducted a systematic review of studies evaluating the impact of public and private healthcare provision. We performed meta-analyses on data within identified studies, in order to estimate the effects of type of healthcare provision on identified health outcomes.Results: Twenty-one studies met our inclusion criteria and explicitly compared health outcomes between the public and private sectors. Of those, 17 were cohortstudies, from 9 countries. Eleven studies were conducted in lower-middle-incomecountries ($996–$3,945 GNI per capita) and 10 studies from upper-middle-incomecountries ($3,946–$12,195 GNI per capita). Eighteen studies were conducted inurban settings. Fifteen of the 21 studies provided mortality for a health outcome,and studies examined a wide range of diseases, with tuberculosis (TB) being themost represented. A meta-analysis of all studies exploring the impact of healthcare type and mortality showed that patients in a private healthcare setting are less likely to die than patients in a public healthcare setting (OR 0.60; 95% CI 0.41–0.88). The pooled analysis showed that patients in a private healthcare facility are more likely to have unsuccessfully completed TB treatment than patients in a public healthcare facility (OR 2.04; 95% CI 1.07–3.89). Regardless of outcomes, the quality of evidence is rated, by objective measures, as either low or very low. Conclusions: More evidence is needed to compare health outcomes between the public and private sectors. Governments and researchers can play a critical role in improving the evidence base for decision making about the contributions of the public andprivate sectors in a given country's health system.Governments should encourage data collection in both public and private settings that would permit ongoing comparison of clinical data. When government facilities are absent or insufficient, contracting with private-sector facilities or providerswould appear to be an acceptable option. Governments must consider appropriateprofit margins, regulations and training for private providers.Further research is needed in this area, and should include low-income countriesand rural settings. Diseases of the poor – notably malaria and childhood illnesses – are largely absent from the current literature, with the exception of one study onHIV/AIDS and six on TB.