Establishment of a combat damage control surgery training platform for explosive combined thoraco-abdominal injuries

PURPOSE

It is challenging to prepare military surgeons with the skills of combat damage control surgery (CDCS). The current study aimed to establish a damage control surgery (DCS) training platform for explosive combined thoraco-abdominal injuries.

METHODS

The training platform established in this study consisted of 3 main components: (1) A 50 m × 50 m square yard was constructed as the explosion site. Safety was assessed through cameras. (2) Sixteen pigs were injured by an explosion of trinitrotoluene attached with steel balls and were randomly divided into the DCS group (accepted DCS) and the control group (have not accepted DCS). The mortality rate was observed. (3) The literature was reviewed to identify the key factors for assessing CDCS, and testing standards for CDCS were then established. Expert questionnaires were employed to evaluate the scientificity and feasibility of the testing standards. Then, a 5-day training course with incorporated tests was used to test the efficacy of the established platform. In total, 30 teams attended the first training course. The scores that the trainees received before and after the training were compared. SPSS 11.0 was employed to analyze the results.

RESULTS

The high-speed video playback confirmed the safety of the explosion site as no explosion fragments projected beyond the wall. No pig died within 24 h when DCS was performed, while 7 pigs died in the control group. After a literature review, assessment criteria for CDCS were established that had a total score of 100 points and had 4 major parts: leadership and team cooperation, resuscitation, surgical procedure, and final outcome. Expert questionnaire results showed that the scientific score was 8.6 ± 1.25, and the feasibility score was 8.74 ± 1.19. When compared with the basic level, the trainees' score improved significantly after training.

CONCLUSION

The platform established in this study was useful for CDCS training.

The Politicised Child During the Seventeenth-Century British Civil Wars: An Historical Perspective on Representations of Children and Trauma During Conflict

The seventeenth-century British Civil Wars had a scale and impact to rival modern conflicts and its effects extended to children as well as adults. What might be today termed "child soldiers" were found in the armies in combat and supporting roles. Many more were witnesses to the conflict or had their lives changed by its consequences. This article is an historical case study of socio-cultural constructions of children, childhood and warfare. It aims to highlight the diverse nature of both historic and modern child experiences of warfare, and the plethora of ways that these experiences were and are understood and represented by adults. It argues that the evidence from the Civil Wars supports the scholarship of child psychologists such as Derek Summerfield that children in conflict should not always be regarded as victims but could display agency, whilst also acknowledging social, cultural, economic and political pressures. Although children in the Civil Wars may have experienced trauma, the evidence is insufficient to prove this and evidence for a contemporary concept of the psychologically damaged child as a result of conflict is ambiguous. However, what the evidence does uncover is the ways in which adults used representations of children to express their own anxieties about the Civil Wars.

Nature Trauma: Ecology and the Returning Soldier in First World War English and Scottish Fiction, 1918-1932

Nature has been widely represented in literature and culture as healing, redemptive, unspoilt, and restorative. In the aftermath of the First World War, writers grappled with long cultural associations between nature and healing. Having survived a conflict in which relations between people, and the living environment had been catastrophically ruptured, writers asked: could rural and wild places offer meaningful sites of solace and recovery for traumatised soldiers? In Virginia Woolf's Mrs Dalloway (1925), Rebecca West's The Return of the Soldier (1918), Nan Shepherd's The Weatherhouse (1930) and Lewis Grassic Gibbon's Sunset Song (1932), trauma severs emotional, social, and cultural relationships with the natural world. These interwar literatures offer counter-narratives to simplistic depictions of nature as a healing space and highlight the difficulties of returning to rural environments and 'reconnecting' with known and natural places.

Patterns of trauma across Andean South America: New discoveries and advances in interpretation

In his review article John W. Verano covered trauma, warfare, trophy taking, and human sacrifice, but his discussion mostly focused on the results of studies of museum or private collections and the recent discovery of the mass human sacrifice from Huaca de la Luna. Due to the renewed interest in the paleopathology of South America, a trend which Verano observed, these types of investigations have grown exponentially in the past twenty years since his initial publication. Here we synthesize the published data on the study and interpretation of traumatic injuries across time and space and we tease out some of the themes that have emerged in the twenty odd years since the seminal paper written by Verano. We searched and analyzed publications from 1997 to 2017 that pertained specifically to Andean South America through the review of library databases and then narrowed our search to trauma-related topics. In our literature review and meta-analysis of published studies on traumatic injuries, we found that nearly one-third of publications related to the field of paleopathology in Andean South America dealt with subjects we classified under trauma (N = 116/378), such as trephination, violence, sacrifice, warfare, etc. Large sample sizes, population-focused research, advances in methods of analysis, and hypothesis driven investigations have led to sophisticated and nuanced interpretations along a wide range of themes so that we understand a great deal more about violence, sacrifice, trephination, warfare and their sociopolitical and environmental contexts in prehistoric and early colonial Andean South America.

Exploring Warfare and Violence from a Cross-Cultural Perspective : Introduction to the Special Issue

This special issue of Human Nature presents selected works from the 2015 and 2017 "Warfare, Environment, Social Inequality, and Pro-Sociability" (WESIPS) conferences held at the Center for Cross-Cultural Study in Seville, Spain. These investigations explore the manifestations of indigenous warfare and violence from a host of theoretical perspectives. Topics range from the origins of warfare to the psychological repercussions of combat, the relationship between warfare and status, as well as the documentation of peace processes among warring groups. This issue also examines the effects of militarization and coercive conservation on indigenous peoples.

The Impacts of Conservation and Militarization on Indigenous Peoples : A Southern African San Perspective

There has been a long-standing debate about the roles of San in the militaries of southern Africa and the prevalence of violence among the Ju/'hoansi and other San people. The evolutionary anthropology and social anthropological debates over the contexts in which violence and warfare occurs among hunters and gatherers are considered, as is the "tribal zone theory" of warfare between states and indigenous people. This paper assesses the issues that arise from these discussions, drawing on data from San in Angola, Namibia, Botswana, and Zimbabwe. Utilizing cases of how San have been affected by military forces and wildlife conservation agencies in what became protected areas in southern Africa, this article shows that indigenous peoples have been treated differentially by state and nongovernmental organizations involved in anti-poaching, shoot-to-kill, and forced resettlement policies. Particular emphasis is placed on the !Xun and Khwe San of southern Angola and northern Namibia and the Tshwa San of western Zimbabwe and northern Botswana, who have been impacted by militarization and coercive conservation efforts since the late nineteenth century. Principal conclusions are that conservation and militarization efforts have led to a reduction in land and resources available to indigenous people, higher levels of poverty, increased socioeconomic stratification, and lower levels of physical well-being. San have responded to these trends by engaging in social activism, forming community-based institutions, and pursuing legal actions aimed at obtaining human rights and equitable treatment.

Civilian science: the potential of participatory environmental monitoring in areas affected by armed conflicts

Legal and policy initiatives to address the environmental dimensions of armed conflicts and their impact on people, ecosystems and sustainable development are highly dependent on the availability of environmental data from conflict-affected areas. Socio-political and security conditions in these areas often impede data collection, while traditional models of post-conflict environmental assessments are limited in scope. In response, an increasing range of actors is utilising remote sensing and open source data collection to identify and estimate health and ecological risks during and after conflicts. This paper considers the role of participatory citizen science methodologies in complementing both remote monitoring and post-conflict assessments. It examines existing models and mechanisms for environmental data collection and utilisation in conflict contexts, and the extent to which the core values and principles of citizen science are transferable. We find that 'civilian science' is feasible and could be well-suited to conflict conditions. In addition to addressing gaps in data collection, it may also empower communities affected by environmental degradation, enhance their environmental human rights, supplement the often limited monitoring capacity of governmental agencies and facilitate cooperation and peacebuilding. The paper concludes by proposing methodological approaches for three common forms of environmental degradation associated with armed conflicts.

Warfare induces post-marital residence change

Post-marital residence is a sex-biased dispersal defined by the place where a newly-wed couple lives after marriage. Common choices for this practice include patrilocal residence, where the couple lives with the man's family, and matrilocal residence, where they live with the woman's family. Deviations from accepted practice typically invoke strong sanctions, but despite this pressure to conform to post-marital residence norms, residence states are unexpectedly dynamic over time. Theories have been proposed to explain the pressures, both internal and external, that drive these changes in post-marital residence state. Two of the most popular emphasize the importance of warfare, but are largely restricted to qualitative statements. Here, we develop an agent-based model that captures key features of these theories, with a particular focus on warfare. We show that warfare can change post-marital residence practices, but such change only propagates through a wider network of communities under a narrow set of conditions. Additional factors, potentially including a strong sex-bias in the division of labor, are required to induce change more widely. While warfare thus serves as an important trigger for residence change, multiple interacting forces appear to be necessary to shift communities between different post-marital residence states under most conditions.

The puzzle of altruism: Why do 'selfish genes' behave so unselfishly?

There are sound evolutionary and philosophical reasons for believing that human beings have a powerful innate disposition towards pure altruism-an altruism that is not a form of disguised selfishness, a survival strategy, or limited to those with whom we are closely genetically related. An overview of archaeological and anthropologic evidence suggests that the so-called 'environment of evolutionary adaptedness' was very different to the brutal, competitive struggle typically depicted by evolutionary psychologists. It is false to assume that competitiveness and selfishness are inevitable and fundamental human traits. An alternative view that altruism and co-operation are fundamental traits could more justifiably be drawn from archaeological and anthropological evidence. The philosophy of 'panspiritism' suggests that pure altruism is the result of the human capacity for empathy, which itself is the result of our fundamental interconnectedness.

Serious psychological distress and disability among older persons living in conflict affected areas in eastern Ukraine: a cluster-randomized cross-sectional household survey

Background

Older persons are often unable to leave conflict areas; however, little is known about the mental and physical health among this population. Our objective was to determine the prevalence of and whether there was an association between psychological distress and disability among older persons affected by conflict in eastern Ukraine.

Methods

We conducted a cluster-randomized cross-sectional household survey of persons aged ≥60 years in government and non-government controlled areas (GCA and NGCA) of Donetsk and Luhansk regions in January–March 2016. Psychological distress and dependency (degree of disability) were measured using the Kessler K6 Psychological Distress Scale and Katz Index of Independence in Activities of Daily Living, respectively. Association between psychological distress and dependency was assessed using logistic regression adjusting for demographic and socioeconomic characteristics.

Results

Final sample included 758 and 418 persons in GCA and NGCA, respectively. Prevalence of serious psychological distress was 33.6% (95% Confidence Interval (CI), 28.0–39.7%) in GCA and 42.5% (95%CI, 36.1–49.2%) in NGCA. Overall, 32.2% (95%CI, 27.9–36.7%) of independent persons and 74.0% (95%CI, 65.2–81.2%) of moderately/severely dependent persons reported serious psychological distress (P < .0001). Being dependent, a woman, and having a chronic disease were all significantly associated with psychological distress in a logistic regression model.

Conclusions

Prevalence of serious psychological distress was very high compared with rates reported from developed countries and was highly associated with disability. Health services for the disabled, including psychological as well as physical support, could help in reducing the proportion of people needing mental health services not normally identified.

Electronic supplementary material

The online version of this article (10.1186/s13031-019-0194-0) contains supplementary material, which is available to authorized users.

Moffett's muted mules: the science of laryngology in the art of war

BACKGROUND

Mules and other equine species have been used in warfare for thousands of years to transport goods and supplies. Mules are known for 'braying', which is disadvantageous in warfare operations. This article explores the fascinating development of surgical techniques to stop military mules from braying, with particular emphasis on the key role played by the otolaryngologist Arthur James Moffett in devoicing the mules of the second Chindit expedition of World War II.

METHOD

The PubMed database (1900-2017) and Google search engine were used to identify articles related to devoicing mules in the medical and veterinary literature, along with information and images on the Chindit expedition.

RESULTS

This paper reviews the surgical techniques aimed at treating braying in mules, ranging from ventriculectomy and arytenoidectomy to Moffett's approach of vocal cordectomy.

CONCLUSION

Moffett's technique of vocal cordectomy provided a quick, reproducible and safe solution for devoicing mules. It proved to be advantageous on the battlefield and demonstrated his achievements outside the field of medicine.

Hearing loss in the trenches - a hidden morbidity of World War I

BACKGROUND

One hundred years ago, millions of British and Allied troops were fighting in the trenches of the Great War. With a tenth of soldiers losing their lives, hearing loss seemed a low priority; however, vast numbers of troops sustained significant hearing loss.

METHOD

A review was conducted of literature published between 1914 and 1925.

RESULTS

Soldiers were exposed to up to 185 dB of sustained noise from new, high-energy weapons, which caused 'labyrinthine concussion'. Traumatic injuries, non-organic hearing loss and malingering were also common. One source estimated that 2.4 per cent of the army was disabled by hearing loss. However, many British doctors viewed this 'soldier's deafness' as a temporary affliction, resulting in soldiers being labelled as malingerers or 'hysterical'.

CONCLUSION

Today, one can recognise that a scant evidence base and misconceptions influenced the mismanagement of hearing loss by otolaryngologists in World War I. However, noise-induced hearing loss is still very much a feature of armed conflict.

Coalitional Play Fighting and the Evolution of Coalitional Intergroup Aggression

Dyadic play fighting occurs in many species, but only humans are known to engage in coalitional play fighting. Dyadic play fighting is hypothesized to build motor skills involved in actual dyadic fighting; thus, coalitional play fighting may build skills involved in actual coalitional fighting, operationalized as forager lethal raiding. If human psychology includes a motivational component that encourages engagement in this type of play, evidence of this play in forager societies is necessary to determine that it is not an artifact of agricultural or industrial conditions. We examine whether coalitional play fighting appears in the hunter-gatherer record and includes motor skills used in lethal raiding. Using the ethnographic record, we generated a list of motor patterns regularly used in forager warfare. Then, using Murdock's Ethnographic Atlas, we identified 100 culture clusters containing forager societies and searched the ethnographic records of these societies for descriptions of coalitional play fighting, operationalized as contact games played in teams. Resulting games were coded for the presence of eight motor patterns regularly used in forager lethal raiding. Although play does not tend to be systematically documented in the hunter-gatherer literature, sufficiently detailed descriptions of coalitional play were found for 46 of the 100 culture clusters: all 46 exhibited coalitional play using at least one of the predicted motor patterns; 39 exhibited coalitional play using four or more of the eight predicted motor patterns. These results provide evidence that coalitional play fighting (a) occurs across a diverse range of hunter-gatherer cultures and habitats, (b) regularly recruits motor patterns used in lethal raiding, and (c) is not an artifact of agricultural or industrial life. This is a first step in a new line of research on whether human male psychology includes motivations to engage in play that develops the deployment of coordinated coalitional action involving key motor patterns used in lethal raiding.

Zoon politikon: The evolutionary origins of human socio-political systems

We deploy the most up-to-date evidence available in various behavioral fields in support of the following hypothesis: The emergence of bipedalism and cooperative breeding in the hominin line, together with environmental developments that made a diet of meat from large animals adaptive, as well as cultural innovations in the form of fire, cooking, and lethal weapons, created a niche for hominins in which there was a significant advantage to individuals with the ability to communicate and persuade in a moral context. These forces added a unique political dimension to human social life which, through gene-culture coevolution, became Homo ludens-Man, the game player-with the power to conserve and transform the social order. Homo sapiens became, in the words of Aristotle's Nicomachean Ethics, a zoon politikon.

Heterogeneity in the long term health effects of warfare

This paper estimates the long-term heterogeneous legacies of exposures to war in utero and during early childhood on height in adulthood. Using a novel dataset on the regional WWII destruction in Germany, combined with the German Socio-Economic Panel (SOEP), we find that individuals who experienced warfare in utero and during childhood are an average of 2cm shorter as adults, suggesting that the negative scarring effect of WWII dominated the positive effect coming from a selection. Among war survivors, children from less privileged families who resided in highly destroyed regions, particularly girls, suffered the greatest health consequences of warfare. Our analyses also show that wartime children who lost their parents during the war years are an average of 1.3cm shorter as adults. However, the father's conscription during WWII had no long-term effect on adult height.

War during childhood: The long run effects of warfare on health

This paper estimates the causal long-term consequences of an exposure to war in utero and during childhood on the risk of obesity and the probability of having a chronic health condition in adulthood. Using the plausibly exogenous city-by-cohort variation in the intensity of WWII destruction as a unique quasi-experiment, I find that individuals who were exposed to WWII destruction during the prenatal and early postnatal periods have higher BMIs and are more likely to be obese as adults. I also find an elevated incidence of chronic health conditions such as stroke, hypertension, diabetes, and cardiovascular disorder in adulthood among these wartime children.