Israeli necropolitics and the pursuit of health justice in Palestine.

We abhor the continuation and acceleration of the Israeli state's systemic violence against the Palestinian people. We reassert that resolution of the settler colonial root causes of violence in Palestine is central to the pursuit of justice and peace. The moral foundations of global health and medical practice require us to prioritise and foreground oppressed realities, and to practise epistemic resistance. Framing Palestinian violence on October 7 as provocation and Israeli violence as response is ahistoric and indicates indifference to the everyday violence experienced by Palestinians. The Israeli state practises both fast violence against Palestinians, while simultaneously creating the conditions for their ‘slow death’. The systematic targeting and destruction of the health system and healthcare workers in Gaza has been central to Israel's military strategy, while many Israeli officials have expressed clear genocidal intent. The occupation of Palestine demonstrates the horrors of Israeli necropolitics, which leads to the creation of 'death-worlds' in which people survive and resist in perpetual proximity to death

The natural history of flail chest injuries

Purpose: Flail chest (FC) injuries represent a significant burden on trauma services because of its high morbidity and mortality. Current gold standard conservative management strategies for FC, are now being challenged by renewed interest in surgical rib fixation. This retrospective epidemiological study sets out to evaluate FC patients, and quantify the natural history of this injury by studying the injury patterns, epidemiology and mortality of patients sustaining FC injuries admitted to a major trauma centre (MTC). Methods: A retrospective cohort analysis has been conducted at an MTC with full trauma service. All patients (age > 16 years) sustaining FC were included. Patient demographics, injury characteristics and inpatient stay information were extracted. Results: Two hundred and ninety-three patients were identified, with a mean injury severity score (ISS) of 28.9 (range 9â75), average age of 56.1 years (range of 16â100), and a male predominance (78%). Road traffic accidents accounted for 45% (n = 132) of injuries, whilst 44% were fall or jump from height (n = 129).Associated lung contusion was present in 133 patients (45%) while 76% of patients were found to have 5 or more ribs involved in the flail segment (n = 223) with 96% (n = 281) having a unilateral FC. Inpatient treatment was required 19.9 days (range 0â150 days) with 59% of patients (n = 173) requiring intensive care unit (ICU) level care for 8.4 days (range 1â63) with 61.8% requiring mechanical ventilation (n = 107) for 10.5 days (range 1â54), and 7.8% underwent rib fixation with rib plates (n = 23).The mortality rate was found to be 14% (n = 42). A non-significant trend towards improved outcomes in the conservative group was found when compared with the fixation group; ventilation days (6.94 vs 10.06, p = 0.18) intensive treatment unit (ITU) length of stay (LOS) (12.56 vs 15.53, p = 0.28) and hospital LOS (32.62 vs 35.24, p = 0.69). Conclusion: This study has successfully described the natural history of flail chest injuries, and has found a nonsignificant trend towards better outcomes with conservative management. With the cohort and management challenges now defined, work on outcome improvement can be targeted. In addition the comparability of results to other studies makes collaboration with other MTCs a realistic proposal. Keywords: Flail chest, Natural history, Epidemiology, Rib plate

Independent monitoring and the new pandemic agreement

Negotiations are underway at the WHO for a legally binding instrument for pandemic prevention, preparedness and response. As seen in the International Health Regulations, however, countries signing up to an agreement is no guarantee of its effective implementation. We, therefore, investigated the potential design features of an accountability framework for the proposed pandemic agreement that could promote countries’ compliance with it. We reviewed the governance of a number of international institutions and conducted over 40 interviews with stakeholders and experts to investigate how the pandemic agreement could be governed.We found that enforcement mechanisms are a key feature for promoting the compliance of countries with the obligations they sign up for under international agreements but that they are inconsistently applied. It is difficult to design enforcement mechanisms that successfully avoid inflicting unintended harm and, so, we found that enforcement mechanisms generally rely on soft political levers rather than hard legal ones to promote compliance. Identifying reliable information on states’ behaviour with regard to their legal obligations requires using a diverse range of information, including civil society and intergovernmental organisations, and maintaining legal, financial, and political independence.We, therefore, propose that there should be an independent mechanism to monitor states’ compliance with and reporting on the pandemic agreement. It would mainly triangulate a diverse range of pre-existing information and have the authority to receive confidential reports and seek further information from states. It would report to a high-level political body to promote compliance with the pandemic agreement