Exploring the Global Health and Defence Engagement Interface

Militaries have an important and inevitable role in global health and will interface with existing health systems on deployments. Whilst the primary concern of militaries is not global health, there are clear, and increasingly frequent, circumstances when global health activities align with the interests of defence. Recognising this link between global health and security warrants thoughtful consideration and action where concerns affecting both intersect. In addition to providing medical support to military personnel on operations, advantageous effects can be achieved directly from military medical activities as part of Defence Engagement. Whilst there are limitations and ethical boundaries to the role of militaries in global health, further training, research and conceptual development are warranted to optimise military medical activity at the intersection of security and global health to deliver advantageous effects. This paper forms part of a special issue of BMJ Military Health dedicated to Defence Engagement

External injuries, trauma and avoidable deaths in Agincourt, South Africa : a retrospective observational and qualitative study

Acknowledgments We thank Chodziwadziwa Kabudula (MRC/Wits Rural Public Health and Health Transitions Research Unit—School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg/Acornhoek, South Africa) for his assistance with assembling the Agincourt HDSS data set for our use. The research presented in this paper was in part funded by the Health Systems Research Initiative from the Department for International Development (DFID)/ Medical Research Council (MRC)/Wellcome Trust/Economic and Social Research Council (ESRC) (MR/P014844/1).Peer reviewedPublisher PD

Open Data, Collaborative Working Platforms, and Interdisciplinary Collaboration: Building an Early Career Scientist Community of Practice to Leverage Ocean Observatories Initiative Data to Address Critical Questions in Marine Science

Ocean observing systems are well-recognized as platforms for long-term monitoring of near-shore and remote locations in the global ocean. High-quality observatory data is freely available and accessible to all members of the global oceanographic community—a democratization of data that is particularly useful for early career scientists (ECS), enabling ECS to conduct research independent of traditional funding models or access to laboratory and field equipment. The concurrent collection of distinct data types with relevance for oceanographic disciplines including physics, chemistry, biology, and geology yields a unique incubator for cutting-edge, timely, interdisciplinary research. These data are both an opportunity and an incentive for ECS to develop the computational skills and collaborative relationships necessary to interpret large data sets. Here, we use observatory data to demonstrate the potential for these interdisciplinary approaches by presenting a case study on the water-column response to anomalous atmospheric events (i.e., major storms) on the shelf of the Mid-Atlantic Bight southwest of Cape Cod, United States. Using data from the Ocean Observatories Initiative (OOI) Pioneer Array, we applied a simple data mining method to identify anomalous atmospheric events over a four-year period. Two closely occurring storm events in late 2018 were then selected to explore the dynamics of water-column response using mooring data from across the array. The comprehensive ECS knowledge base and computational skill sets allowed identification of data issues in the OOI data streams and technologically sound characterization of data from multiple sensor packages to broadly characterize ocean-atmosphere interactions. An ECS-driven approach that emphasizes collaborative and interdisciplinary working practices adds significant value to existing datasets and programs such as OOI and has the potential to produce meaningful scientific advances. Future success in utilizing ocean observatory data requires continued investment in ECS education, collaboration, and research; in turn, the ECS community provides feedback, develops knowledge, and builds new tools to enhance the value of ocean observing systems. These findings present an argument for building a community of practice to augment ECS ocean scientist skills and foster collaborations to extend the context, reach, and societal utility of ocean science

Finishing the euchromatic sequence of the human genome

The sequence of the human genome encodes the genetic instructions for human physiology, as well as rich information about human evolution. In 2001, the International Human Genome Sequencing Consortium reported a draft sequence of the euchromatic portion of the human genome. Since then, the international collaboration has worked to convert this draft into a genome sequence with high accuracy and nearly complete coverage. Here, we report the result of this finishing process. The current genome sequence (Build 35) contains 2.85 billion nucleotides interrupted by only 341 gaps. It covers ∼99% of the euchromatic genome and is accurate to an error rate of ∼1 event per 100,000 bases. Many of the remaining euchromatic gaps are associated with segmental duplications and will require focused work with new methods. The near-complete sequence, the first for a vertebrate, greatly improves the precision of biological analyses of the human genome including studies of gene number, birth and death. Notably, the human enome seems to encode only 20,000-25,000 protein-coding genes. The genome sequence reported here should serve as a firm foundation for biomedical research in the decades ahead

Understanding the health system utilisation and reasons for avoidable mortality after fatal injury within a Three-Delays framework in Karonga, Northern Malawi:a retrospective analysis of verbal autopsy data

Objectives: To use verbal autopsy (VA) data to understand health system utilisation and the potential avoidability associated with fatal injury. Then to categorise any evident barriers driving avoidable delays to care within a Three Delays framework that considers delays to seeking (Delay 1), reaching (Delay 2) or receiving (Delay 3) quality injury care.Design: Retrospective analysis of existing VA data routinely collected by a demographic surveillance site.Setting: Karonga Health and Demographic Surveillance Site (HDSS) population, Northern Malawi.Participants: Fatally injured members of the HDSS.Primary and secondary outcome measures: The primary outcome was the proportion of fatal injury deaths that were potentially avoidable. Secondary outcomes were the delay stage and corresponding barriers associated with avoidable deaths and the health system utilisation for fatal injuries within the health system.Results: Of the 252 deaths due to external causes, 185 injury-related deaths were analysed. Deaths were predominantly among young males (median age 30, IQR 11–48), 71.9% (133/185). 35.1% (65/185) were assessed as potentially avoidable. Delay 1 was implicated in 30.8% (20/65) of potentially avoidable deaths, Delay 2 in 61.5% (40/65) and Delay 3 in 75.4% (49/65). Within Delay 1, ‘healthcare literacy’ was most commonly implicated barrier in 75% (15/20). Within Delay 2, ‘communication’ and ‘prehospital care’ were the most commonly implicated in 92.5% (37/40). Within Delay 3, ‘physical resources’ were most commonly implicated, 85.7% (42/49).Conclusions: VA is feasible for studying pathways to care and health system responsiveness in avoidable deaths following injury and ascertaining the delays that contribute to deaths. A large proportion of injury deaths were avoidable, and we have identified several barriers as potential targets for intervention. Refining and integrating VA with other health system assessment methods is likely necessary to holistically understand an injury care health system

Quantifying microplastics in fjords along the Western Antarctic Peninsula

Microplastics are ubiquitous around the world. Microplastics have been documented around the Southern Ocean, in coastal sediments and in Antarctic marine organisms, however microplastics data for Antarctic waters remain scarce. Microplastics concentrations were characterized from fjord habitats on the Western Antarctic Peninsula where most glaciers are rapidly retreating. Water samples were collected from 2017 to 2020 from surface and benthos, vacuum-filtered, quantified to determine the classification of microplastic, color, and size. Micro-FTIR spectrophotometry was utilized to confirm chemical composition. Comparisons over time and location were made for average microplastic per liter. Despite the new emergent youth and remoteness of these habitats, it was determined that all fjord habitats had microplastics present each year sampled and increased from 2017 to 2020 in each fjord. Despite physical ‘barriers’ such as the Antarctic Circumpolar Current (and particularly its strongest jet, the Polar Front), microplastics are clearly present and increasing in even recent habitats

Clinical audit of a lymphoedema bandaging system: a foam roll and cohesive short stretch bandages

Objective: Late-stage lymphoedema is characterised by chronic swelling, shape distortion, inflammatory processes and tissue fibrosis. Our aim was to perform a clinical audit of a lymphoedema compression bandaging system (Rosidal Soft foam roll layer and figure-of-eight application of Actico cohesive inelastic bandages) specifically designed for patients with late stage lower limb lymphoedema. Method: The audit explored suitability of the bandaging system, benchmarking limb volume changes with research evidence, and reporting patient and practitioner evaluations. Results: A mean reduction (33%) in excess limb volume was reported for the 11 patients with unilateral lymphoedema who completed a course of bandaging over 12 days. Mean percentage reduction of absolute limb volume after treatment was 8%. Patient and practitioner evaluations indicated the suitability of this bandage system for patients with late stage lymphoedema in terms of comfort and effectiveness. Conclusion: The bandaging system is suitable for patients with late stage chronic swelling. Two parameters for calculating change in limb volume are not interchangeable. Future evaluation of the bandaging system, using validated outcome measures within a comprehensive research study is require