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Army units worldwide depend on a complex network of distribution centers, managed primarily by the Defense Logistics Agency, to support equipment readiness and sustainability. Rapid and reliable logistics distribution support is especially important for U.S. Army forces deployed into theaters of operations. There are many factors that can cause performance changes affecting the distribution timeliness to the Army. Currently, distribution problems are detected manually and reactively by Army units once these problems start to affect equipment readiness. This report describes (1) algorithms developed by the authors that monitor the logistics distribution system and automatically detect distribution problems (or potential distribution problems) that might affect equipment readiness, and (2) data visualizations developed by the authors that assist Army managers and analysts to determine the root causes and potential corrective actions related to the detections. The report also provides several case studies illustrating the algorithms' effectiveness.

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The U.S. Army Medical Department has a dual mission: to care for the war wounded during times of conflict and to operate medical treatment facilities (MTFs) that provide care to service members, their beneficiaries, and military retirees. Because the injuries that require treatment during wartime can be very different from the case mix seen in MTFs, the Army asked RAND Arroyo Center to identify ways to help providers prepare for wartime missions while they are stationed at home. Using a variety of data sources, RAND Arroyo Center quantified how providers were assigned during wartime relative to their home duties, how the types of procedures seen in theater compared with those performed at home-station MTFs, and the rate at which providers attended mandatory predeployment trauma training (PDTT). In addition, the research team interviewed previously deployed providers to gather their perspectives on how they prepared — clinically and for trauma specifically — for the deployment mission, what their roles were in theater and how their patient mix in theater differed from the types of cases they treated in MTFs, and what additional training or other preparation would have helped them for the deployment mission.

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Deaths involving synthetic opioids in the United States increased from roughly 3,000 in 2013 to more than 30,000 in 2018. In fact, synthetic opioids like fentanyl are now involved in twice as many deaths as heroin. This book offers a systematic assessment of the past, present, and possible futures of synthetic opioids in the United States. It is rooted in secondary data analysis, literature reviews, international case studies, and key informant interviews. The goal is to provide decisionmakers, researchers, media outlets, and the public with insights intended to improve their understanding of the synthetic opioid problem and how to respond to it. The authors conclude that (1) fentanyl and other synthetic opioids are becoming dominant in some parts of the United States and Canada, but remain less common in other parts of these countries; (2) a confluence of factors, including the dissemination of simplified and novel synthesis methods and increasing e-commerce, helps explain the surge in synthetic opioids; (3) much can be learned from other countries' experiences with synthetic opioids; (4) supplier decisions, not user demand, drive the transition to fentanyl; (5) fentanyl's spread is episodically fast and has ratchet-like persistence; (6) synthetic opioids drive up deaths rather than the number of users; (7) problems with synthetic opioids are likely to worsen before they improve, and states west of the Mississippi River must remain vigilant; (8) improving surveillance and monitoring is crucial; and (9) limiting policy responses to existing approaches seems unlikely to reverse this tide.

Weapons systems --- Inventory control --- Evaluation. --- Maintenance and repair --- Weapons Systems Support Program (U.S.) --- United States --- Armed Forces --- Operational readiness --- Procurement.