Royal Marines Research Articles

Sustained attention when squatting with and without an exoskeleton for the lower limbs

Twelve Royal Marines participated in a laboratory study of a passive lower limb exoskeleton. Participants stood for 5 min in a semi-squatting posture in the laboratory while performing the Sustained Attention to Response Test (SART), repeated on separate days while wearing and without the exoskeleton. Performance on the SART was degraded when the semi-squatting posture was adopted and did not recover after 15 min of rest. The SART was rated as less frustrating when the exoskeleton was worn, while less time pressure and task conflict were reported and the need to exert self-control to maintain the posture was rated lower. There was no effect of the exoskeleton on SART performance. However, subjects’ increase in heart rate when squatting, without the exoskeleton, was positively correlated with an increase in their SART error rate. The findings are discussed in relation to the cognitive demands of performing physically demanding tasks and the possibility that new technologies designed to enhance human physical ability may also improve cognitive capacity.

Comparison of Pandolf Equation and Measured Metabolic Cost of Load Carriage in UK Military Personnel

PURPOSE: The metabolic cost of load carriage (LC) is frequently predicted using the Pandolf et al. (1977) equation. Recent laboratory investigations have identified that the Pandolf equation under-predicts the metabolic cost of LC in untrained personnel during treadmill walking (Drain et al., 2017). However, the relationship between the actual and Pandolf predicted metabolic cost of outdoor LC in UK Armed Forces personnel has not been established. METHODS: Twenty-two UK Armed Forces personnel (Royal Marine Commandos and Parachute Regiment, mean ± SD: age 23 ± 3 years; stature 180.9 ± 4.9 cm; body mass 83.1 ± 6.6 kg; predicted V[Combining Dot Above]O2max 54.0 ± 3.1 ml·kg-1·min-1) completed 15, 20 minute stages of outdoor LC, with external load masses ranging from 25 to 70 kg. The stages were completed at a patrol, forced, and insertion marching speed (2.5, 4.8, and 5.5 km·h-1, respectively). During the final 2-4 minutes of each LC stage, oxygen uptake (V[Combining Dot Above]O ) was measured using the Douglas bag technique. Predicted V[Combining Dot Above]O2 for each speed-load mass combination was calculated using the Pandolf equation and compared to the measured V[Combining Dot Above]O2 using paired t-tests and 95 % Limits of Agreement (LoA). RESULTS: The Pandolf equation systematically under-predicted the metabolic cost of LC for all speeds and load masses combined [mean difference 3.2 ± 2.9 ml·kg-1·min-1 2 p<0.001), 95% LoA -2.5-8.9 ml·kg-1·min-1] resulting in a V predictive error of 17.5 %. Mean difference and 95% LoA at the different speeds were: (a) 2.5 km·h-1 [4.8 ± 1.9 ml·kg-1·min-1, (p<0.001), 95% LoA 1.0-8.6 ml·kg-1·min-1], (b) 4.8 km·h-1 [1.5 ± 2.7 ml·kg-1·min-1 (p<0.001), 95% LoA -3.9-6.9 ml·kg-1·min-1], and (c) 5.5 km·h-1 [4.2 ± 3.3 ml·kg-1·min-1 (p<0.001), 95% LoA -2.1-10.7 ml·kg-1·min-1], with prediction errors of 30 %, 6 % and 14 %, respectively. CONCLUSIONS: The current study demonstrates a systematic under-prediction of V[Combining Dot Above]O2 for British Army personnel during outdoor LC when applying the Pandolf equation, supporting the findings of previous laboratory studies. Furthermore, the error appears to be of greater magnitude when LC speeds are lower, i.e. at a representative patrolling pace. This in part could be attributed to the load mass distribution of the modern solider, which differs from the back mounted load carried data used to develop and refine the Pandolf equation.

Occurrence and spatial distribution of chemical contaminants in edible fish species collected from UK and proximate marine waters

The occurrence of a range of regulated and emerging organic environmental contaminants was investigated in 182 samples of edible marine fish sampled mainly from UK marine regions, but extending northerly to the coast of Norway and south to the Algarve. These species (sprats, mackerel, turbot, halibut, herring, grey mullet, sea bass, grey mullet, sardines, etc.) are among those considered to be at the highest risk of contamination with regulated contaminants such as polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs, dioxins), and polychlorinated biphenyls (PCBs), but the occurrence of polybrominated diphenylethers (PBDEs) and polybrominated biphenyls (PBBs) was also investigated. Sub-sets of samples (50–75) were also analysed for emerging contaminants: polychlorinated naphthalenes (PCNs), polybrominated and mixed halogenated dibenzo-p-dioxins, dibenzofurans and biphenyls (PBDD/Fs, PXDD/Fs and PXBs) and perfluoroalkyl substances (PFAS). Contaminant occurrence varied with species and location, but all measured contaminants were detected, with sprats, sea bass, sardines, mackerel, and herring showing higher tissue concentrations. The concentrations of the different contaminants in the various samples were mapped utilising the GPS coordinate data of the capture locations to visualise spatial distribution levels. In terms of catch location, fish sampled from the coasts of southern Britain, north-western France and the Irish Sea appeared to contain proportionately higher levels of some contaminants - e.g. samples from the Irish Sea tended to show higher PCN concentrations, whereas higher levels of PCBs were observed in some fish sampled off the coasts of northern France. Similarly, samples of mullet from the southeast coast of UK showed much higher concentrations of BDE-99 than the other regions. In terms of occurrence trends, PCDD/F and PCB concentrations show a modest decline over the last decade but where limited background data is available for emerging contaminants, there is no evidence of downward trends.

Richard Jolly: naval medical officer who was decorated by both sides in the Falklands

At one point during his Royal Marine commando training in Lympstone in Devon in 1972 Rick Jolly felt totally defeated by the notoriously challenging assault course. After being encouraged by...

Back-pack palsy in Royal Marine recruits at the Commando Training Centre Royal Marines

Abstract Introduction Peripheral nerve injury secondary to load carrying is a rare condition most often described in military personnel secondary to heavy load carrying for prolonged periods. A series of patients is described presenting with compression neuropathy secondary to load carrying, and their disease characteristics are compared to those described in the literature. Methods Our rehabilitation database was searched for all cases of shoulder neuropraxia reported between 2008-2016 during initial military training of 8790 Royal Marine (RM) recruits. Incidence, median rehabilitation period required to return to mainstream training, affected nerve distribution, and investigations performed were identified. Also described was the long-term outcome in terms of recovery from neuropathy and onward fitness for RM service. Results The incidence of shoulder neuropraxia in RM recruits during training was 330 per 100,000. Of the 29 patients identified, 66% made a full recovery over a median period of 20 weeks. Median follow-up time was 2.3 years. The most common nerve affected was the axillary nerve. Conclusion Shoulder neuropraxia is more common in the RM recruit population than in other previously studied groups. This could be explained by the arduous nature of the loaded marches during RM recruit training, the load including heavy packs, irregular terrain and long distances. Emphasis should be placed on prevention, by providing good recruit education on appropriate kit adjustment during load carries and early identification of symptoms.

Spatial analysis of polybrominated diphenylethers (PBDEs) and polybrominated biphenyls (PBBs) in fish collected from UK and proximate marine waters

Some commonly consumed marine fish species are considered to display a higher risk of bio-accumulating organic environmental contaminants such as PBDEs. As part of a study to investigate the spatial distribution of these contaminants, data on polybrominated diphenlyethers (PBDEs) and polybrominated biphenyls (PBBs) were collected and analysed by introducing a web-based resource which enables efficient spatial, species and concentration level representations. Furthermore, hierarchical cluster analyses permits correlations within the data to be predicted. The data provide current information on levels of PBDE and PBB occurrence, allowing identification of locations that show higher contaminant levels.135 fish samples of various species were analysed from UK marine waters, but encompassing the waters around Norway in the North and to the Algarve in the South. PBDEs were observed in all samples with the majority of measured congeners being detected. The concentrations ranged from 0.087 μg/kg to 8.907 μg/kg whole weight (ww) for the sum of all measured PBDE congeners. PBBs occurred less frequently showing a corresponding range of <0.02 μg/kg to 0.97 μg/kg ww for the sum of seven PBB congeners. Concentrations vary depending on species and locations where landed, e.g. PBBs occurred more frequently and at higher levels in grey mullet from French waters. The high frequency of PBDE occurrence makes it prudent to continue the monitoring of these commonly consumed marine fish species. The web-based resource provides a flexible and efficient tool for assessors and policy-makers to monitor and evaluate levels within caught fish species improving evidenced-based decision processes.

Qualification of oil-spill treatment products – Adopting the Baffled Flask Test for testing of dispersant efficacy in the UK

The UK Marine Management Organisation (MMO) tasked the Centre for Environment, Fisheries & Aquaculture Science (Cefas) with reviewing the current UK dispersant efficacy testing procedures. The aim was to identify possibilities to increase standardisation, improve health and safety performance and explore harmonisation possibilities with international dispersant efficacy testing procedures. The US EPA ‘Baffled Flask Test’ (BFT) was adopted, implemented and validated as a new standard method in the UK. The outputs from this study suggest that dispersant efficacy results from the adopted BFT test and the currently used protocol are in a similar range and results presented by the US EPA.As a result, the transition to the adopted BFT test will require minimal changes in the assessment of the results or reporting and increase harmonisation between tests used in the UK and North America.

Physical demands of a boarding operations training exercise conducted by the Royal Marines

Purpose: Conducting boarding operations (boarding a vessel from either a small craft or from a helicopter) was identified as an important, physically demanding and unique role related task undertaken by Royal Marines (RM). Data are required to quantify the physical demands of boarding operations to inform the development of a Physical Employment Standard (PES) for Ground Close Combat (GCC) roles in the UK Armed Forces.

The Amended European Environmental Impact Assessment Directive: UK marine experience and recommendations

Environmental Impact Assessments (EIAs) are a key legislative requirement used to ensure sustainable development. A notable example of the enabling legislation is the European Union Environmental Impact Assessment Directive (2011/92/EU). In the 25 years since its implementation it has been revised, most recently in 2014, with amendments to accommodate policy, legal and technical changes. The 2014 amendment to the EIA Directive is reviewed here in the marine context with areas identified where the Directive and its implementation may still be deficient. This arises from the experience of the authors of reviewing EIAs, and our recommendations are mainly that standardised guidance and approaches should be applied for comparability. These recommendations have general relevance to all EIA practitioners, not just marine, and to environmental assessments within and beyond the EU.

Estimated third metatarsal bending stresses are highly susceptible to variations in bone geometry

Background: Third metatarsal stress fractures are relatively common during Royal Marines recruit training; however, their aetiology is poorly understood. Mathematical modelling of the third metatarsal may aid in understanding risk factors for stress fracture, particularly if the influence of footwear on peak bending stresses can be determined. This study built on previous models of metatarsal bending stress by integrating individual metatarsal geometry and gait data.Methods: Data from five males with size 11 (UK) feet were acquired. MRI images were digitised to determine cross-sectional bone parameters. Gait variables included vertical ground reaction forces, plantar pressure and foot orientation. The magnitude and location of peak bending stresses were calculated for barefoot running, before standard issue combat boots and trainers were compared.Findings: Estimated peak compressive, tensile and torsional stresses were greater in combat assault boots than in trainers (p < 0.05) with medium effect sizes but wide confidence intervals. However, differences in bone geometry between individuals had a much greater influence on estimated peak stresses.Interpretation: Results suggest that bone geometry has a greater influence on third metatarsal stress fracture risk than footwear. Future bone stress simulations should account for bone geometry. Further development of the model in a variety of participants should proceed to verify these suggestions.

Nuclear reprocessing-related radiocarbon (14C) uptake into UK marine mammals

To evaluate the transfer of Sellafield-derived radiocarbon (14C) to top predators in the UK marine environment, 14C activities were examined in stranded marine mammals. All samples of harbour porpoise (Phocoena phocoena) obtained from the Irish Sea showed 14C enrichment above background. Mammal samples obtained from the West of Scotland, including harbour porpoise, grey seals (Halichoerus grypus) and harbour seals (Phoca vitulina) showed 14C enrichment but to a lesser extent. This study demonstrates, for the first time, enriched 14C is transferred through the marine food web to apex predators as a consequence of ongoing nuclear reprocessing activities at Sellafield. Total Sellafield 14C discharge activity 24months prior to stranding and, in particular, distance of animal stranding site from Sellafield are significant variables affecting individual 14C activity. 14C activities of West of Scotland harbour porpoises suggest they did not forage in the Irish Sea prior to stranding, indicating a high foraging fidelity.

Development of a Prediction Model for Stress Fracture During an Intensive Physical Training Program: The Royal Marines Commandos.

Background:Stress fractures (SFs) are one of the more severe overuse injuries in military training, and therefore, knowledge of potential risk factors is needed to assist in developing mitigating strategies.Purpose:To develop a prediction model for risk of SF in Royal Marines (RM) recruits during an arduous military training program.Study Design:Case-control study; Level of evidence, 3.Methods:RM recruits (N = 1082; age range, 16-33 years) who enrolled between September 2009 and July 2010 were prospectively followed through the 32-week RM training program. SF diagnosis was confirmed from a positive radiograph or magnetic resonance imaging scan. Potential risk factors assessed at week 1 included recruit characteristics, anthropometric assessment, dietary supplement use, lifestyle habits, fitness assessment, blood samples, 25(OH)D, bone strength as measured by heel broadband ultrasound attention, history of physical activity, and previous and current food intake. A logistic least absolute shrinkage and selection operator (LASSO) regression with 10-fold cross-validation was used to select potential predictors among 47 candidate variables. Model performance was assessed using measures of discrimination (c-index) and calibration. Bootstrapping was used for internal validation of the developed model and to quantify optimism.Results:A total of 86 (8%) volunteer recruits presented at least 1 SF during training. Twelve variables were identified as the most important risk factors of SF. Variables strongly associated with SF were age, body weight, pretraining weightbearing exercise, pretraining cycling, and childhood intake of milk and milk products. The c-index for the prediction model, which represents the model performance in future volunteers, was 0.73 (optimism-corrected c-index, 0.68). Although 25(OH)D and VO2max had only a borderline statistically significant association with SF, the inclusion of these factors improved the performance of the model.Conclusion:These findings will assist in identifying recruits at greater risk of SF during training and will support interventions to mitigate this injury risk. However, external validation of the model is still required.

Framing the transit: expeditionary culture and identities in Lieutenant E.J.W. Noble's caricatures of the 1874 transit of Venus expedition to Honolulu

SummaryMaking use of a source previously unknown to historians, this article sheds new light on the British expedition to the Sandwich Islands to observe the 1874 transit of Venus. This source, a series of caricature drawings that follow the expedition from departure to return, gives insight into expeditionary culture and the experience of a previously unremarked member of this astronomical expedition, Evelyn J.W. Noble, a career officer of the Royal Marine Artillery. It also reveals overlapping military, scientific and masculine identities, developed in dialogue with, and often deliberately subverting, more public accounts. The article explores this unique source as a product of naval, imperial and expeditionary cultures; as a contribution to the wide textual and visual culture that surrounded the transit expeditions; and as a series of drawings that united the expedition members through the use of humour and irony, by differentiating the group from others they encountered, and by reflecting or rejecting ideas about the nature of scientific work and personae. The artist represented himself not as a serving officer but as part of a (mostly) united group, dedicated to but humorously self-deprecating about their contribution to the scientific effort.

Identification and Verification of Critical Physically Demanding Tasks Undertaken by Royal Marines

Identification and Verification of Critical Physically Demanding Tasks Undertaken by Royal Marines

The causes of serious injuries to crew on UK commercial fishing vessels: An investigation combining free-text and coded data

ABSTRACTObjectiveCommercial fishing is one of the riskiest occupations in the UK. While there is a strong evidence base concerning fatalities on commercial fishing vessels and their causes, there is less understanding of the causes of serious non-fatal injuries to crew working on board such vessels. ApproachThis research aimed to extract knowledge from safety incident reports, using traditional statistical in combination with more novel text mining techniques, to generate data-driven insights as to the principal causes of serious injuries to crew working on board UK commercial fishing vessels and how they might be better mitigated. Safety incident data held by the UK Marine Accident Investigation Branch (MAIB), contained in their incident reporting database, provided the primary source of data for this study. Data relating to 1,660 incidents in total, where a member of crew was seriously injured, were analysed. ResultsStudy findings demonstrated that the risks of serious injuries faced by crew working on board commercial fishing vessels are diverse, ranging from injuries received whilst operating fishing gear and other deck machinery, those received whilst processing bait and the catch and injuries received whilst carrying out general shipboard duties. Furthermore, findings suggest that underlying causes and contributory factors are multi-faceted and vary significantly across different types of fishing vessels and whilst different deck duties are being carried out by crew. ConclusionThe application of text mining techniques in this study to extract knowledge from free-text data contained in the incident reports analysed, proved useful in elucidating on the specific circumstances under which vessel crew were injured.

Asymptomatic group A Streptococcal throat carriage in Royal Marines recruits and Young Officers

A prospective observational study was conducted in Royal Marines (RM) recruits to investigate throat carriage of group A Streptococcus (GAS) and incidence of soft tissue infections. 1012 RM recruits were followed through a 32-week training programme, with throat swabs being obtained in weeks 1, 6, 15, and 32. Alongside a separate cohort of 46 RM Young Officers (YO) undergoing training were sampled in parallel. Carriage of group A Streptococcus was detected in only 5/1012 (0.49%) recruits at the beginning of training and remained low throughout training. There was no association between GAS carriage and development of soft tissue infection. There was no carriage of GAS in the smaller YO cohort at the start of training, (0/46). At week 6, a surge in GAS carriage was detected in 8/46 (17%) YO, that could be ascribed to a cluster of GAS genotype emm83. Asymptomatic GAS carriage is very infrequent among young adults in England and this should be borne in mind when considering the relevance of a positive throat swab result in symptomatic patients or outbreaks. Despite low prevalence, there is however potential for GAS to rapidly and transiently disseminate among adults during outbreaks.

Post-deployment screening for mental disorders and tailored advice about help-seeking in the UK military: a cluster randomised controlled trial

The effectiveness of post-deployment screening for mental disorders has not been assessed in a randomised controlled trial. We aimed to assess whether post-deployment screening for post-traumatic stress disorder (PTSD), depression, anxiety, or alcohol misuse was effective. We defined screening as the presumptive identification of a previously unrecognised disorder using tests to distinguish those who probably had the disorder from those who probably did not so that those people with a probable disorder could be referred appropriately, and assessed effectiveness and consequences for help-seeking by the odds ratio at follow-up between those receiving tailored help-seeking advice and those who received general mental health advice. We did a cluster randomised controlled trial among Royal Marines and Army personnel in the UK military after deployment to Afghanistan. Platoons were randomly assigned (1:1 initially, then 2:1) by stratified block randomisation with randomly varying block sizes of two and four to the screening group, which received tailored help-seeking advice, or the control group, which received general mental health advice. Initial assessment took place 6-12 weeks after deployment; follow-up assessments were done 10-24 months later. Follow-up measures were the PTSD Checklist-Civilian Version, Patient Health Questionnaire-9, Generalised Anxiety Disorder-7 scale, Alcohol Use Disorder Identification Test (AUDIT), and self-reported help-seeking from clinical and welfare providers comparing those receiving tailored advice and those receiving only general advice. All participants and all investigators other than the person who analysed the data were masked to allocation. The primary outcomes were PTSD, depression or generalised anxiety disorder, and alcohol misuse at follow-up. A key secondary outcome was assessment of whether post-deployment screening followed by tailored advice would modify help-seeking behaviour. Comparisons were made between screening and control groups, with primary analyses by intention to treat. This trial is registered with the ISRCTN Registry, number ISRCTN19965528. Between Oct 24, 2011, and Oct 31, 2014, 434 platoons comprising 10 190 personnel were included: 274 (6350 personnel) in the screening group and 160 (3840 personnel) in the control group. 5577 (88%) of 6350 personnel received screening and 3996 (63%) completed follow-up, whereas 3149 (82%) of 3840 received the control questionnaire and 2369 (62%) completed follow-up. 1958 (35%) of 5577 personnel in the screening group declined to see the tailored advice, but those with PTSD (83%) or anxiety or depression (84%) were more likely than non-cases (64%) to view the advice (both p<0·0001). At follow-up, there were no significant differences in prevalence between groups for PTSD (adjusted odds ratio 0·92, 95% CI 0·75-1·14), depression or anxiety (0·91, 0·71-1·16), alcohol misuse (0·88, 0·73-1·06), or seeking support for mental disorders (0·92, 0·78-1·08). Post-deployment screening for mental disorders based on tailored advice was not effective at reducing prevalence of mental health disorders nor did it increase help-seeking. Countries that have implemented post-deployment screening programmes for mental disorders should consider monitoring the outcomes of their programmes. The US Army Medical Research and Materiel Command-Military Operational Medicine Research Program (USAMRMC-MOMRP).

Role 2 Afloat in a Type 45 destroyer: return to contingency

AbstractRole 2 Afloat (R2A) is an established part of maritime capability whose teams have provided medical support to a number of deployed operations in the recent past. This article describes the capability and constraints of a limited R2A facility embarked on HMS DIAMOND in order to support Royal Marine and Royal Navy boarding teams during Operation LITTEN. The combination of having experienced medical staff, adjusting the medical equipment carried and planning for a limited scenario enabled a bespoke R2A capability to be established on a previously untested platform at short notice. It provides a model for similar future deployments.

Frostbite: an ancient affliction – have we made progress? A case series and review of best practice.

AbstractFrostbite represents a spectrum of injuries that can have long term, permanent sequelae, resulting in lifelong disability of otherwise young, fit, economically active individuals. Furthermore, it is generally preventable. Military personnel are put at risk of this condition by the nature of their occupation. With preventative measures, early recognition, appropriate evacuation and repatriation to a medical facility, the impact of this condition can be minimised.This article describes a case series of Royal Marines who were medically evacuated due to frostbite during an exercise, and a review of current evidence supporting the management of frostbite in the field environment through to definitive care.

The matrix revisited: A bird's-eye view of marine ecosystem service provision

The marine environment provides a range of ecosystem services and benefits for society. A previous study in Marine Policy (Potts et al., 2014) [1] advocated a matrix approach to demonstrate the relative degree of ecosystem service provision from habitats and species within UK Marine Protected Areas (MPAs), but excluded seabird species in its assessment. Despite the number of existing UK MPAs designated specifically for individual seabird species and/or seabird assemblages, and the fact that seabird species have long been used as policy-relevant indicators for the monitoring and management of the marine environment, as yet little research has focussed on the direct role of seabird species in the provision of ecosystem services and how these are captured for marine spatial planning purposes in the context of MPAs. Building on the matrix approach, this paper develops and populates a matrix to illustrate the relationship between key UK breeding seabird species and their relative contribution to the delivery of intermediate ecosystem services and goods/benefits. The original matrix approach has been strengthened to include the development and testing of a set of rules for combining multiple matrices. Confidence scores relating to the underlying evidence base are built into the matrix to provide an illustration of the current understanding and to identify current gaps in evidence. Following a sense check by external seabird experts the matrix is applied in the context of four existing UK MPA case study sites. Further developments and applications of the seabird matrix are discussed within the context of wider marine management.