Innovation strategies for defence: the successful case of Defence Medical Services

Over the past 20 years, the Defence Medical Services (DMS, the umbrella organisation for medical provision within the British armed forces) has been innovating consistently and at pace within the Ministry of Defence. The result of this sustained effort has led to progressive improvement in the outcomes of the critically injured. Separately, it has also led to global transformational innovation in support of the response to the Ebola epidemic in Sierra Leone. Through planned and orchestrated interventions across the entire organisation, from leadership to technology, medical practices to training and organisational design, the DMS can legitimately claim to have achieved a ‘Revolution in Military Medical Affairs’. Matthew Ford, Timothy Hodgetts and David Williams examine the innovation lifecycle within the DMS as it defines its response to the challenges of the changing character of conflict and consider the way defence medicine is an example to the wider military

Effects of publication bias on conservation planning

Conservation planning needs reliable information on spatial patterns of biodiversity. However, existing data sets are skewed: some habitats, taxa, and locations are under-represented. Here, we map geographic publication density at the sub-national scale of individual 'provinces'. We query the Web of Science catalogues SCI and SSCI for biodiversity-related publications including country and province names (for the period 1993-2016). We combine these data with other provincial-scale factors hypothesised to affect research (i.e. economic development, human presence, infrastructure and remoteness). We show that sites that appear to be understudied, compared with the biodiversity expected from their bioclimatic conditions, are likely to have been inaccessible to researchers for a diversity of reasons amongst which current or recent armed conflicts are notable. Finally, we create a priority list of provinces where geographic publication bias is of most concern, and discuss how our provincial-scale model can assist in adjusting for publication biases in conservation planning.Comment: 10 pages; 3 figures; 1 table;R code on https://github.com/raffael-hickisch; data at https://zenodo.org/record/998889; interactive at http://bit.ly/publication_density_ma

Discovery of an unknown diversity of Leucinodes species damaging Solanaceae fruits in sub-Saharan Africa and moving in trade (Insecta, Lepidoptera, Pyraloidea)

The larvae of the Old World genera Leucinodes Guenée, 1854 and Sceliodes Guenée, 1854 are internal feeders in the fruits of Solanaceae, causing economic damage to cultivated plants like Solanum melongena and S. aethiopicum . In sub-Saharan Africa five nominal species of Leucinodes and one of Sceliodes occur. One of these species, the eggplant fruit and shoot borer L. orbonalis Guenée, 1854, is regarded as regularly intercepted from Africa and Asia in Europe, North and South America and is therefore a quarantine pest on these continents. We investigate the taxonomy of African Leucinodes and Sceliodes based on morpho - logical characters in wing pattern, genitalia and larvae, as well as mitochondrial DNA, providing these data for identification of all life stages. The results suggest that both genera are congeneric, with Sceliodes syn. n. established as junior subjective synonym of Leucinodes . L. orbonalis is described from Asia and none of the samples investigated from Africa belong to this species. Instead, sub-Saharan Africa harbours a complex of eight endemic Leucinodes species. Among the former nominal species of Leucinodes (and Sceliodes ) from Africa, only L. laisalis (Walker, 1859), comb. n. ( Sceliodes ) is confirmed, with Leucinodes translucidalis Gaede, 1917, syn. n. as a junior subjective synonym. The other African Leucinodes species were unknown to science and are described as new: L. africensis sp. n. , L. ethiopica sp. n. , L. kenyensis sp. n. , L. malawiensis sp. n. , L. pseudorbonalis sp. n. , L. rimavallis sp. n. and L. ugandensis sp. n. An identification key based on male genitalia is provided for the African Leucinodes species. Most imports of Leucinodes specimens from Africa into Europe refer to Leucinodes africensis , which has been frequently imported with fruits during the last 50 years. In contrast, L. laisalis has been much less frequently re - corded, and L. pseudorbonalis as well as L. rimavallis only very recently in fruit imports from Uganda. Accordingly, interceptions of Leucinodes from Africa into other continents will need to be re-investigated for their species identity and will likely require, at least in parts, revisions of the quarantine regulations. The following African taxa are excluded from Leucinodes : Hyperanalyta Strand, 1918, syn. rev. as revised synonym of Analyta Lederer, 1863; Analyta apicalis (Hampson, 1896), comb. n. ( Leucinodes ); Lygropia aureomarginalis (Gaede, 1916), comb. n. ( Leucinodes ); Syllepte hemichionalis Mabille, 1900, comb. rev. , S. hemichionalis idalis Viette, 1958, comb. rev. and S. vagans (Tutt, 1890), comb. n. ( Aphytoceros ). Deanolis iriocapna (Meyrick, 1938), comb. n. from Indonesia is originally described and misplaced in Sceliodes , and L. cordalis (Doubleday, 1843), comb. n. ( Margaritia ) from New Zealand, L. raondry (Viette, 1981) comb. n. ( Daraba ) from Madagascar as well as L. grisealis (Kenrick, 1912), comb. n. ( Sceliodes ) from New Guinea are transferred from Sceliodes to Leucinodes . While Leucinodes is now revised from Africa, it still needs further revision in Asia.publishedVersio

Outcrop conservation : Promoting accessibility, inclusivity, and reproducibility through digital preservation

We thank Georgina Heldreich for providing useful comments on an early draft of the manuscript. We gratefully acknowledge the detailed and constructive reviews by Kim Senger and two anonymous reviewers, all of which greatly improved the manuscript.Peer reviewedPublisher PD

Quantitative fibronectin to help decision-making in women with symptoms of preterm labour (QUIDS) part 1: Individual participant data meta-analysis and health economic analysis.

INTRODUCTION: The aim of the QUIDS study is to develop a decision support tool for the management of women with symptoms and signs of preterm labour, based on a validated prognostic model using quantitative fetal fibronectin (qfFN) concentration, in combination with clinical risk factors. METHODS AND ANALYSIS: The study will evaluate the Rapid fFN 10Q System (Hologic, Marlborough, Massachusetts) which quantifies fFN in a vaginal swab. In part 1 of the study, we will develop and internally validate a prognostic model using an individual participant data (IPD) meta-analysis of existing studies containing women with symptoms of preterm labour alongside fFN measurements and pregnancy outcome. An economic analysis will be undertaken to assess potential cost-effectiveness of the qfFN prognostic model. The primary endpoint will be the ability of the prognostic model to rule out spontaneous preterm birth within 7 days. Six eligible studies were identified by systematic review of the literature and five agreed to provide their IPD (n=5 studies, 1783 women and 139 events of preterm delivery within 7 days of testing). ETHICS AND DISSEMINATION: The study is funded by the National Institute of Healthcare Research Health Technology Assessment (HTA 14/32/01). It has been approved by the West of Scotland Research Ethics Committee (16/WS/0068). PROSPERO REGISTRATION NUMBER: CRD42015027590. VERSION: Protocol version 2, date 1 November 2016

Study protocol: quantitative fibronectin to help decision-making in women with symptoms of preterm labour (QUIDS) part 2, UK Prospective Cohort Study.

INTRODUCTION: The aim of the QUIDS study is to develop a decision support tool for the management of women with symptoms and signs of preterm labour, based on a validated prognostic model using quantitative fetal fibronectin (fFN) concentration, in combination with clinical risk factors. METHODS AND ANALYSIS: The study will evaluate the Rapid fFN 10Q System (Hologic, Marlborough, Massachusetts, USA) which quantifies fFN in a vaginal swab. In QUIDS part 2, we will perform a prospective cohort study in at least eight UK consultant-led maternity units, in women with symptoms of preterm labour at 22+0 to 34+6 weeks gestation to externally validate a prognostic model developed in QUIDS part 1. The effects of quantitative fFN on anxiety will be assessed, and acceptability of the test and prognostic model will be evaluated in a subgroup of women and clinicians (n=30). The sample size is 1600 women (with estimated 96-192 events of preterm delivery within 7 days of testing). Clinicians will be informed of the qualitative fFN result (positive/negative) but be blinded to quantitative fFN result. Research midwives will collect outcome data from the maternal and neonatal clinical records. The final validated prognostic model will be presented as a mobile or web-based application. ETHICS AND DISSEMINATION: The study is funded by the National Institute of Healthcare Research Health Technology Assessment (HTA 14/32/01). It has been approved by the West of Scotland Research Ethics Committee (16/WS/0068). VERSION: Protocol V.2, Date 1 November 2016. TRIAL REGISTRATION NUMBER: ISRCTN 41598423andCPMS: 31277

Does It Matter Who Writes Medical News Stories?

David Henry and colleagues review Australian news stories over a five-year period to assess whether quality is associated with who wrote the story: a specialist health journalist or a non-specialist

QUANTIFYING THE EFFECTIVENESS OF ACTIVE MITIGATION ON TRANSPORTATION CORRIDORS

ABSTRACT: Numerous efforts have been made to quantify avalanche risk in transportation corridors (Schaerer 198

The effects of an enhanced simulation programme on medical students' confidence responding to clinical deterioration

BACKGROUND: Clinical deterioration in adult hospital patients is an identified issue in healthcare practice globally. Teaching medical students to recognise and respond to the deteriorating patient is crucial if we are to address the issue in an effective way. The aim of this study was to evaluate the effects of an enhanced simulation exercise known as RADAR (Recognising Acute Deterioration: Active Response), on medical students’ confidence. METHODS: A questionnaire survey was conducted; the instrument contained three sections. Section 1 focused on students’ perceptions of the learning experience; section 2 investigated confidence. Both sections employed Likert-type scales. A third section invited open responses. Questionnaires were distributed to a cohort of third-year medical students (n = 158) in the North East of Scotland 130 (82 %) were returned for analysis, employing IBM SPSS v18 and ANOVA techniques. RESULTS: Students’ responses pointed to many benefits of the sessions. In the first section, students responded positively to the educational underpinning of the sessions, with all scores above 4.00 on a 5-point scale. There were clear learning outcomes; the sessions were active and engaging for students with an appropriate level of challenge and stress; they helped to integrate theory and practice; and effective feedback on their performance allowed students to reflect and learn from the experience. In section 2, the key finding was that scores for students’ confidence to recognise deterioration increased significantly (p. < .001) as a result of the sessions. Effect sizes (Eta(2)) were high, (0.68–0.75). In the open-ended questions, students pointed to many benefits of the RADAR course, including the opportunity to employ learned procedures in realistic scenarios. CONCLUSIONS: The use of this enhanced form of simulation with simulated patients and the judicious use of moulage is an effective method of increasing realism for medical students. Importantly, it gives them greater confidence in recognising and responding to clinical deterioration in adult patients. We recommend the use of RADAR as a safe and cost-effective approach in the area of clinical deterioration and suggest that there is a need to investigate its use with different patient groups