UK Ministry Of Defence Research Articles

Women are not small men: the UK’s new, comprehensive Tri-Service Anthropometry survey

Human Factors Engineers need accurate anthropometric data to design military equipment that is safe, comfortable and enables performance under extreme operational conditions and in the most severe environments. The Ministry of Defence (MOD) acknowledges that its current anthropometry dataset is becoming increasingly unrepresentative of today’s Armed Forces personnel, particularly women and minority ethnic groups. To address this issue, MOD has launched a new, comprehensive anthropometry survey. Whilst this survey has the potential to benefit the design of all new military equipment and clothing, the principal driver for the study is the development of new body armour for the UK’s Armed Forces personnel. This paper describes the requirements underpinning this survey, with a focus on body armour; the planned solution; and the results of Pilot Studies that have tested the robustness, reliability and accuracy of the measurement technologies and procedures. The work reported in this paper has been funded by the MOD’s Defence Innovation Unit. Practitioner statement: The UK Ministry of Defence has launched a new, comprehensive anthropometry survey, in acknowledgement of the fact that its current anthropometry dataset is becoming increasingly unrepresentative of today’s Armed Forces personnel. This paper describes the requirements underpinning the survey, the planned solution and the result of Pilot Studies.

‘Enemy Action’: The UK Ministry of Defence, Academia and the Historical Record

The publication of Uncivil War, Huw Bennett’s history of the early years of the Northern Ireland conflict, has highlighted an increasingly obstructive and uncooperative approach by the UK Ministry of Defence (MoD) towards academic researchers. Geraint Hughes argues that the impediments the MoD is placing by restricting access to archival evidence on recent military conflicts is not only undemocratic, but also distorts public awareness of the complexities of these wars, and hampers the British armed forces’ own efforts to develop as ‘learning institutions’ that can use military history to support their own professional understanding of the challenges posed by contemporary warfare. He calls for a dialogue between the MoD and the academic community that addresses the balance between operational security and accountability, and contributes to a mutually beneficial relationship where scholarship can contribute to the armed forces’ own process of self and institutional education.◼

Joint Bi-Modal Tomographic Reconstruction from Observations with Missing Data

A method for tomographic reconstruction of bi-modal data sets using cross modal regularization was developed. The method constrains the Simultaneous Algebraic Reconstruction Technique by using clustering-based segmented images and quality controlled fused images, to jointly regularize the reconstruction of structures imaged with different methods. The joint regularized reconstruction method was tested using a synthetic X-Ray and neutron data set with a mix of attenuation driven data starvation. Assuming consistent material boundaries in the different imaging modalities, it was shown that improvements in terms of the Feature Similarity Index Measure are made compared to a traditional SART-TV reconstruction. UK Ministry of Defence ©Crown Owned Copyright 2023/AWE

Investigating infrasonic signal amplitudes at the lateral edges of propagation ducts

Azimuthal variation in expected infrasonic signal strength is often modelled using Nx2D finite-frequency acoustic propagation models. Such simulations frequently exhibit rapid changes in transmission loss (>30 dB across 5°) at the lateral edges of stratospheric propagation ducts, due to the sensitivity of acoustic ducting to the along-path windspeed. The inclusion of microbarometers in the USArray Transportable Array, with an inter-station separation of ∼70 km, has provided improved resolution across the lateral extent of tropospheric and stratospheric ducts within which infrasound is propagated over local and near-regional distances (10s to 100s km). We analyse signals from two explosions that generated infrasound across a broad swath of USArray microbarometers. Signals from the October 2012 Camp Minden Ammunition Plant explosion, Louisiana, show smoothly varying amplitudes across the stratospheric duct edge while those from the October 2011 Atchison Grain Elevator explosion, Kansas, exhibit less azimuthal variation. These signals provide a basis for comparison with current numerical modelling methods. Understanding infrasonic amplitudes at the lateral duct edge is important for both accurate signal interpretation from events of interest and for detection capability assessments of infrasound sensor networks. UK Ministry of Defence © Crown Owned Copyright 2022/AWE

Entry Fitness And Subsequent Physical Performance Change In Recruits Across British Army Basic Training Courses.

Soldiers require high levels of fitness to perform physically demanding role-related tasks, such as load carriage and moving equipment. Developing cardiorespiratory endurance and muscular strength through progressive physical training programmes during Basic Training (BT) will support soldiers to perform their duties and reduce musculoskeletal injury risk. PURPOSE: To (1) quantify physical performance changes in recruits undertaking three British Army BT courses; Standard Entry (SE), Junior Entry Short (JE-Short) and Long (JE-Long) and (2) explore differences between courses, men and women, and entry fitness level. METHODS: Performance of 2 km run, medicine ball throw (MBT) and mid-thigh pull (MTP) were assessed at entry and completion of BT (14 [SE]), 23 [JE-Short] or 49 [JE-Long] weeks in duration) for 2350 (272 women) British Army recruits. Performance change was analysed with entry performance as a covariate (ANCOVA), before an additional interaction term allowing different slopes for course and gender. RESULTS: There was high heterogeneity, although BT courses saw average improvements in surrogate tests for cardiovascular endurance (2 km run: SE: -6.8% [-0.62 min], JE-Short: -4.6% [-0.43 min], JE-Long: -7.7% [-0.70 min]; all p < 0.001) and muscular strength and power (MBT: 1.0-8.8% [0.04-0.34 m]; all p < 0.05; MTP: 4.5-26.9% [6.5-28.8 kg]; all p < 0.001). Regression models indicated a form of regression to the mean whereby performance change was negatively associated with entry fitness (those with low baseline fitness exhibit larger improvements), particularly for women. However, when matched for entry fitness, men displayed considerable improvements in all tests, relative to women. CONCLUSIONS: British Army BT courses were effective in developing physical fitness and entry fitness was negatively associated with change over time. Other factors not measured including age and physical maturity could also be contributors to the training response. Individualising physical training may enhance physical fitness development and role-related job-task performance. Funded by the UK Ministry of Defence (Army).

Intimate partner violence and abuse experience and perpetration in UK military personnel compared to a general population cohort: A cross-sectional study.

SummaryBackgroundResearch exploring prevalence of, and factors associated with, increased risk of experiencing or perpetrating Intimate Partner Violence and Abuse (IPVA) in military communities is limited. This study aimed to describe IPVA prevalence in a military sample, explore the role of military-specific risk factors, and draw comparisons with a general population cohort.MethodsWe utilised data from a sample of military personnel participating in a cohort study of the health and wellbeing of UK military personnel who reported having an intimate relationship in the previous 12 months (n = 5557). To allow for comparison with civilian populations, participants from a general population cohort study in England (n = 6075) were matched on age and sex to the military cohort (n = 8093).FindingsThe 12-month prevalences of IPVA experience and perpetration in the military sample were 12.80% (95% CI 11.72–13.96%) and 9.40% (8.45–10.45%), respectively. Factors associated with both increased IPVA experience and perpetration included childhood adversity, relationship dissatisfaction, military trauma, and recent mental health and alcohol misuse problems. Compared to the civilian cohort, adjusted odds (95% CI) of IPVA experience and perpetration were higher in the military: 2.94 (2.15–4.01) and 3.41 (1.79–6.50), respectively.InterpretationThis study found higher prevalences of IPVA experience and perpetration in the military compared to the general population cohort and highlighted both non-military and military factors associated with increased risk of both. Relationship dissatisfaction, military trauma and mental health difficulties mark key areas for IPVA prevention and management efforts to target.FundingFunded by the UK Ministry of Defence and National Institute of Health Research.

Mental health outcomes of male UK military personnel deployed to Afghanistan and the role of combat injury: analysis of baseline data from the ADVANCE cohort study

The long-term psychosocial outcomes of UK armed forces personnel who sustained serious combat injuries during deployment to Afghanistan are largely unknown. We aimed to assess rates of probable post-traumatic stress disorder (PTSD), depression, anxiety, and mental health-associated multimorbidity in a representative sample of serving and ex-serving UK military personnel with combat injuries, compared with rates in a matched sample of uninjured personnel. This analysis used baseline data from the ADVANCE cohort study, in which injured individuals were recruited from a sample of UK armed forces personnel who were deployed to Afghanistan and had physical combat injuries, according to records provided by the UK Ministry of Defence. Participants from the uninjured group were frequency-matched by age, rank, regiment, deployment, and role on deployment. Participants were recruited through postal, email, and telephone invitations. Participants completed a comprehensive health assessment, including physical health assessment and self-reported mental health measures (PTSD Checklist, Patient Health Questionnaire-9, and Generalised Anxiety Disorder-7). The mental health outcomes were rates of PTSD, depression, anxiety, and mental health-associated multimorbidity in the injured and uninjured groups. The ADVANCE study is ongoing and is registered with the ISRCTN registry, ISRCTN57285353. 579 combat-injured participants (161 with amputation injuries and 418 with non-amputation injuries) and 565 uninjured participants were included in the analysis. Participants had a median age of 33 years (IQR 30-37 years) at the time of assessment. 90·3% identified as White and 9·7% were from all other ethnic groups. The rates of PTSD (16·9% [n=89] vs 10·5% [n=53]; adjusted odds ratio [AOR] 1·67 [95% CI 1·16-2·41], depression (23·6% [n=129] vs 16·8% [n=87]; AOR 1·46 [1·08-2·03]), anxiety (20·8% [n=111] vs 13·5% [n=71]; AOR 1·56 [1·13-2·24]) and mental health-associated multimorbidity (15·3% [n=81] vs 9·8% [n=49]; AOR 1·62 [1·12-2·49]) were greater in the injured group than the uninjured group. Minimal differences in odds of reporting any poor mental health outcome were noted between the amputation injury subgroup and the uninjured group (AOR range 0·77-0·97), whereas up to double the odds were noted for the non-amputation injury subgroup compared with the uninjured group (AOR range 1·74-2·02). Serious physical combat injuries were associated with poor mental health outcomes. However, the type of injury sustained influenced this relationship. Regardless of injury, this cohort represents a group who present with greater rates of PTSD than the general population, as well as increased psychological burden from multimorbidity. The ADVANCE Charity.

HULLFORM &amp; HYDRODYNAMIC CONSIDERATIONS IN THE DESIGN OF THE UK FUTURE AIRCRAFT CARRIER (CVF)

An overview is provided of the manner in which hydrodynamic and hullform-related design considerations were addressed in the development of the BAE SYSTEMS team’s design proposal for the UK Future Aircraft Carrier (CVF). It also outlines how broader design considerations such as aviation, survivability and supportability requirements influenced these aspects of the design. A summary is also provided of some of the more detailed requirements development, option assessment and performance evaluation work that has been undertaken. The aircraft carrier designs discussed in this paper correspond to the BAE SYSTEMS team’s final design submission as it stood in January 2003, at the time it was discontinued by the UK Ministry of Defence, in favour of the rival Thales / BMT team design that has since been developed into the UK Royal Navy’s new ‘Queen Elizabeth’ class aircraft carrier. This final BAE SYSTEMS design submission consisted of two distinct design variants - one configured to operate a CTOL-based air group, the other configured to accommodate a STOVL air group. Both variants were based on a common ‘core’ ship design. The discussion presented in this paper is applicable to both variants.

A COMPREHENSIVE APPROACH TO SURVIVABILITY ASSESSMENT IN NAVAL SHIP CONCEPT DESIGN

Alongside deploying weapons and sensors what makes a warship distinct is its survivability, being the measure that enables a warship to survive in a militarily hostile environment. The rising cost of warship procurement, coupled with declining defence budgets, has led to cost cutting, often aimed at aspects, such as survivability, which may be difficult to quantify in a manner that facilitates cost capability trade-offs. Therefore, to meet ever-reducing budgets, in real terms, innovation in both the design process and the design of individual ships is necessary, especially at the crucial early design stages. Computer technology can be utilised to exploit architecturally orientated preliminary design approaches, which have been conceived to explore innovation early in the ship design process and the impact of such issues as survivability. A number of survivability assessment tools currently exist; however, most fail to integrate all the constituent elements of survivability (i.e. susceptibility, vulnerability and recoverability), in that they are unable to balance between the component aspects of survivability. Some of these tools are qualitative and therefore less than ideal in specifying survivability requirements, others are aimed towards the more detailed design stages where implementing changes is heavily constrained or even impractical. This paper presents a survivability assessment approach combining various tools used by UCL and the UK Ministry of Defence, as well as a new approach for recoverability assessment. The proposed method attempts to better integrate and quantify survivability in early stage ship design, which is facilitated by the UCL derived, architecturally focused, design building block approach. The integrated survivability method is demonstrated for a set of naval combatant concept designs and for two replenishment ship studies to test the robustness of the proposed approach.

Insider lobbying and government contracts: The moderating role of firm size

AbstractThis study examines insider lobbying as a form of relational Corporate Political Activity (CPA) that can be used by firms to gain an advantage in the competition for government contracts, and how firm size moderates the effectiveness of different insider lobbying strategies. Drawing on a unique dataset that captures meetings between private companies and British government ministers, we find that both the breadth and depth of insider lobbying are positively related to the value of the contracts awarded by the UK Ministry of Defence. Further analysis reveals that the benefits from a strategy of lobbying depth are stronger for small firms, than those from a strategy of lobbying breadth. The findings suggest that the bridging and bonding social capital cultivated through meetings with politicians can be deployed in alternative ways by different‐sized firms.

Inverse photoemission of the light actinide metals and dioxides

Inverse photoemission spectroscopy (IPES) operating in the isochomat mode (≈10 eV) has been used to probe the unoccupied states in the actinide dioxides of thorium, uranium and plutonium, and the actinide metals of thorium, uranium, α-plutonium and a plutonium-gallium alloy, δ-Pu(Ga). The IPE spectra of the dioxides show a signal predominantly occurring from the 5f unoccupied states and where possible have been curve fit to obtain the 5f5/2 – 5f7/2 spin orbit coupling and intensity values. Combined with the HeI Ultraviolet Photoelectron Spectroscopy of the actinide dioxides the band gap values have been determined. The IPE spectra of the metals show a weak signal on a large background contribution with little difference between the α- and δ-Pu(Ga) phases. The IPE spectra of the metals have been used to aid interpretation of the possible screening mechanisms in the 4f core level photoelectron spectra. Photoelectric work functions for these materials are also reported. UK Ministry of Defence © Crown Owned Copyright 2021/AWE

Association Between DXA And HR-pQCT Measurements Of BMD In Active, Recruit-aged Men And Women

Dual-energy X-ray absorptiometry (DXA) areal bone mineral density (aBMD) measurements are routinely employed to assess fracture risk despite the limitations of a two-dimensional, estimated projection of bone volume. Conversely, high-resolution peripheral quantitative computed tomography (HR-pQCT) provides three-dimensional volumetric BMD (vBMD) measurements of total, trabecular, and cortical bone, offering better characterization of fracture risk. It remains unclear whether regional aBMD accurately reflects vBMD of specific bone compartments in the distal tibia, a common injury site for military personnel. PURPOSE: To determine if lower limb aBMD correlates with distal total (Tt), trabecular (Tb) and cortical (Ct) vBMD in healthy, recruit-aged men and women. METHODS: Seventy-six recreationally active men (n = 43;26.4 ± 0.8 yrs.), and women (n = 33;26.2 ± 4.7 yrs.), free of any musculoskeletal conditions that could influence BMD, completed two HR-pQCT (XtremeCT; Scanco Medical) and one total body DXA (Lunar iDXA; GE Healthcare) scans. Total body DXA and non-dominant tibial HR-pQCT scans at the metaphysis (4% site) and diaphysis (30% site) were obtained. Lower leg aBMD was assessed in DXA scans with custom region of interest (ROI) analysis between the ultradistal tibia and the tibial plateau. Associations between variables were analyzed with Pearson’s correlation coefficient (r2); alpha was set at p < 0.05. RESULTS: aBMD positively correlated with Tt vBMD at the 4% site for men (r2 = 0.42; p < 0.001) and women (r2 = 0.17; p = 0.016) but only in men at the 30% site (r2 = 0.16; p = 0.008). aBMD positively correlated with Tb vBMD at the 4% site for men (r2 = 0.35; p < 0.001) and women (r2 = 0.20; p = 0.010), but not at the 30% site for either sex. aBMD was not correlated with Ct vBMD at the 4% site for either sex but was positively correlated with Ct vBMD at the 30% site in men (r2 = 0.12; p = 0.032). CONCLUSIONS: There is poor to moderate association between lower limb aBMD and tibial vBMD at both sites, with greater association in men than in women. aBMD is unlikely to provide a suitable assessment of distal tibial bone health. aBMD and tibial vBMD should, therefore, not be used interchangeably to examine the bone response to interventions or for the prediction of fracture risk. Supported by UK Ministry of Defence (WGCC 5.5.6-Task 0107).

A Critique of Control and Black Boxes

This article analyzes Ian Hatcher’s online and kinetic poem “⌰ (Total Runout)” (2015) from a point of view of a critique of corporate and governmental black boxing, at the level of its code, text, visual output, sound, and live performance. The multimodal poem is part of the Drone Pilot suite, and it is presented in different versions: as a web-based work, sound piece, and performance. It remixes appropriated text from a WikiLeaked manual by the UK Ministry of Defence, essays on artificial intelligence, and Hatcher’s own text. The overall versions of the work, understood as variable events, boldly problematize communication and cognitive processes in networks—whether they are implemented in computer systems by secret agencies or corporations. Hatcher’s critique of black boxes entails re-creating issues of security, control and surveillance, as digital systems are increasingly paving the way for less privacy and less knowledge about their inner workings. As a result, the poem questions the essence of privacy, redaction, and systemic violence, when access is a privileged asset of agents with security clearances or those with a deep knowledge of programming. This article presents “⌰ (Total Runout)” in the scope of the poet’s aesthetic program. Then, it analyzes its Web version’s interface and source code. The kinetic poem’s spatial and temporal dimensions are discussed via experiments that modify the source code. The methods here presented deform the poem’s temporal display, by means of modifications, or what are called in the article lit mods. Thus, the article proposes an approach for a more informed reading and understanding of digital kinetic poems, since they are ever-changing events. Finally, it locates the work’s aural and performative versions in a cultural and political context.

Inertial confinement fusion: a defence context.

Almost 30 years since the last UK nuclear test, it remains necessary regularly to underwrite the safety and effectiveness of the National Nuclear Deterrent. To do so has been possible to date because of the development of continually improving science and engineering tools running on ever more powerful high-performance computing platforms, underpinned by cutting-edge experimental facilities. While some of these facilities, such as the Orion laser, are based in the UK, others are accessed by international collaboration. This is most notably with the USA via capabilities such as the National Ignition Facility, but also with France where a joint hydrodynamics facility is nearing completion following establishment of a Treaty in 2010. Despite the remarkable capability of the science and engineering tools, there is an increasing requirement for experiments as materials age and systems inevitably evolve further from what was specifically trialled at underground nuclear tests (UGTs). The data from UGTs will remain the best possible representation of the extreme conditions generated in a nuclear explosion, but it is essential to supplement these data by realizing new capabilities that will bring us closer to achieving laboratory simulations of these conditions. For high-energy-density physics, the most promising technique for generating temperatures and densities of interest is inertial confinement fusion (ICF). Continued research in ICF by the UK will support the certification of the deterrent for decades to come; hence the UK works closely with the international community to develop ICF science. UK Ministry of Defence © Crown Owned Copyright 2020/AWE. This article is part of a discussion meeting issue 'Prospects for high gain inertial fusion energy (part 1)'.

UV fluorescence as a method of high throughput surface cleanliness assessment: A comparison with XPS

UV visible fluorescence (UV–vis) was trialled as a method for the rapid screening of surface cleanliness of metals. By comparing the relative intensity of the fluorescence to the film thickness of the carbonaceous contamination, an evaluation of the effectiveness of UV–vis was made. Surface composition and the thickness of carbon contamination on stainless steel/mineral oil and copper/tallow wax samples was measured with X-ray photoelectron spectroscopy (XPS). After vapour degreasing with trichloroethylene it was found that residual tallow wax was not effectively detected by UV–vis; whereas a commercial mineral oil was readily detected by UV–vis. The reason for the lack of fluorescence is that the tallow wax is largely an unconjugated system, in that it mostly comprises saturated or monounsaturated carbon – carbon bonds, which do not fluoresce. Using imaging XPS an increase in carbon film thickness close to the edge of the sample is observed, a result of solvent residue caused by the interfacial tension that exists between the solvent and the substrate. UK Ministry of Defence © Crown Owned Copyright 2020/AWE.

Foot Acceleration Attenuation Reduces During Military Load Carriage

Military personnel are at risk of stress fracture injuries, especially those in load carriage-based military occupational specialty, such as infantry. Recently, wearable inertial measurement unit (IMU)-based accelerometry has become a useful tool for identifying markers of lower extremity musculoskeletal injury risk in soldiers in field settings. PURPOSE: To compare differences in accelerometry between non-dominant and dominant foot using foot-worn IMU sensors during a 2km best effort run with heavy (20kg) load carriage. METHODS: Acceleration data from six healthy participants (3 male: 30.33±6.7 y, 1.82±0.01 m, 77.80±11.0 kg and 3 female: 21.0±2.6 y, 1.66±0.1 m, 64.62±13.5 kg) were recorded using tri-axial IMU affixed to the dorsum of each foot. Participant performed a 2km best effort march (run and walk) across grass carrying 20 kg on their back. Data were divided into 200m +/- blocks from the beginning, middle and end of the exercise for analysis. The acceleration amplitudes from each trial were expressed as the root mean square (GRMS), calculated as the average of the square of the acceleration over time, and were used to quantify the accelerations attenuation. The magnitude of the resultant acceleration signal Accr, referred to as the “composite acceleration signal”, was computed as: sqrt ( accx+accy+accz), where accx, accy and accz are obtained from each individual axis of the tri-axial accelerometer. RESULTS: The mean GRMS values at the three phases obtained for the dominant and non-dominant feet of the men were 4.72, 5.15, and 5.23, and 4.93, 4.75, and 4.41 m/s2, respectively whereas those obtained for the dominant and non-dominant feet of the women were 3.91, 4.32, and 4.78, and 3.87, 4.42, and 4.71 m/s2, respectively. These findings revealed that the GRMS values of the feet obtained for both sexes gradually increased during the load carriage task, except for the non-dominant foot of the men, which decreased. CONCLUSION: Increases in GRMS during loaded marching suggest non-linear increases in culminative mechanical stress exposure as distance increases. Foot worn IMU-based measurement systems may provide means to accurately assess injury risk in real time. Supported by UK Ministry of Defence (WGCC 5.5.6-Task 0107) and US Dept. of Defense (W81XWH-17-2-0070).

Microcirculatory, Endothelial and Inflammatory Responses in Critically Ill Patients with COVID-19 Are Distinct from Those Seen in Septic Shock: A Case Control Study

Background: Critically ill patients with COVID-19 infection frequently exhibit a hyperinflammatory response and develop organ failures, however the underlying mechanisms are unclear. We investigated the microcirculatory, endothelial and inflammatory responses in critically ill COVID-19 patients and compared them to a group of patients with septic shock. Methods: Prospective observational case control study. 30 patients with COVID-19 admitted to the ICUs of a tertiary hospital were compared to 33 patients with septic shock. Measurements of sublingual microcirculatory flow were performed using Incident Dark Field (IDF) video-microscopy and serial measurements of IL-6 and Syndecan-1 levels were made. Findings: COVID-19 patients had significantly less vasoactive drug requirement and lower plasma lactate than those with septic shock. Microcirculatory flow was significantly worse in septic patients than those with COVID-19 (MFI 2.6 v 2.9 p 0.02, PPV 88 v 97% p <0.001). IL-6 was higher in patients with septic shock than COVID-19 (1653 v 253 pg/ml, p 0.03) IL-6 levels in COVID 19 patients were not elevated compared to healthy controls except on the day of ICU admission. Syndecan-1 levels were not different between the 2 pathological groups. Interpretation: Compared to patients with bacterial sepsis an overt shock state with tissue hypoperfusion does not appear typical of COVID-19 infection. There was no evidence of significant sublingual microcirculatory impairment, widespread endothelial injury or marked inflammatory cytokine release in this group of critically ill COVID-19 patients. COVID-19 may have a different pathogenesis to bacterial induced septic shock. Funding Statement: Royal Centre for Defence Medicine (UK Ministry of Defence), 2019; European Society of Intensive Care Medicine Point of Care Ultrasound award, 2019. Declaration of Interests: All authors declare that they have no conflicts of interest. Ethics Approval Statement: Yorkshire and Humber (Leeds East) and North West Research Ethics committees (18/YH/0371and 19/NW/0750).

Critically Ill COVID-19 Patients with Acute Kidney Injury Have Reduced Renal Blood Flow and Perfusion Despite&amp;nbsp;Preserved Cardiac Function; A Case-Control Study Using Contrast Enhanced Ultrasound

Background: Acute Kidney Injury (AKI) is a common complication of COVID-19 critical illness but the pathophysiology is uncertain. Some evidence has indicated that a vascular aetiology may be implicated. We used contrast enhanced ultrasound (CEUS) and echocardiography to study renal perfusion and global blood flow and compared our findings with measurements taken in a group of septic shock patients and healthy volunteers. Method: Prospective case-control study. Renal perfusion variables were assessed with contrast enhanced ultrasound (CEUS); macrovascular blood flow was assessed using Doppler analysis of large renal vessels; echocardiography was used to assess right and left heart function and cardiac output. Findings: CEUS derived parameters were reduced in in COVID-19 associated AKI compared to healthy controls (perfusion index 3415 v 548 a.u., p=0·001; renal blood volume 7794 v 3338 a.u., p=0·04). Renal arterial flow quantified using time averaged peak velocity (TAPV) was also reduced compared to healthy controls (36·6 v 20·9 cm/s, p=0.004) despite cardiac index being similar between groups (2.8 v 3.7 L/min/m2, p=0.07). There were no differences in CEUS derived or cardiac parameters between COVID-19 and septic shock patients but patients with septic shock had more heterogeneous perfusion variables. Interpretation:Both large and small vessel blood flow is reduced in patients with COVID-19 associated AKI compared to healthy controls, which does not appear to be a consequence of right or left heart dysfunction. A reno-vascular pathogenesis of COVID-19 AKI seems likely. Funding: Royal Centre for Defence Medicine (UK Ministry of Defence), 2019; European Society of Intensive Care Medicine Point of Care Ultrasound award, 2019 Declaration of Interests: All authors declare that they have no conflicts of interest. Ethics Approval Statement: Yorkshire and Humber (Leeds East) Research Ethics committee (18/YH/0371).

Approaches to the establishment and management of the defence procurement (acquisition) system. the example of the USA depatrment of defense and the UK ministry of defence

The article provides a comparative analysis of the establishment and operation of the systems of defence procurement (acquisition) for the United States` Department of Defense (DoD of the USA) and the United Kingdom's Ministry of Defenсe (MoD of the UK) by analysis of regulatory frameworks and approaches managing of the defence procurement (acquisition) systems. With the help of the structural-functional method, a hierarchy of key participants of the defence procurement system (acquisition), their functional interconnections, roles and functions are identified. By using a systematic approach, it was determined that the establishment and operation of a public procurement (acquisition) system for the defence needs of the USA and the UK is a complex process that is significantly affected by financial and time constraints, strategic vision and priorities for the development of the industry. The main principles for the most efficient organization and operation of the procurement (acquisition) systems of the DoD of the USA and the MoD of the UK are: the application of a procedural framework, the definition of rules and models for the interaction of participants, transparency, the presence of competition, professional development, periodic assessment and verification.

Rotational thromboelastometry alongside conventional coagulation testing in patients with Crimean–Congo haemorrhagic fever: an observational cohort study

SummaryBackgroundData describing the coagulopathy of Crimean–Congo haemorrhagic fever are scarce. We did rotational thromboelastometry (ROTEM) and conventional coagulation testing in patients with Crimean–Congo haemorrhagic fever to increase our understanding of the coagulopathy of this infectious disease.MethodsWe did a prospective observational cohort study of adults aged 18 years and older and admitted to hospitals with PCR-confirmed Crimean–Congo haemorrhagic fever in Samsun and Tokat, Turkey. Demographic, clinical, and laboratory data were collected and blood samples for ROTEM analysis and coagulation testing were drawn at admission and during hospital admission and convalescence (up to 30 days after onset of illness). For the ROTEM analysis we recorded the following extrinsically activated ROTEM (EXTEM S) variables, with normal ranges indicated: clotting time (38–79 s), clot formation time (34–159 s), amplitude at 10 min after clotting time (43–65 mm), maximum clot firmness (50–72 mm), and maximum lysis (>15% at 1 h). The following fibrin-specific ROTEM (FIBTEM S) variables were also recorded: amplitude at 10 min after clotting time (normal range 7–23 mm) and maximum clot firmness (9–25 mm). Disease severity was assessed by Swanepoel criteria, severity grading score (SGS), and the severity scoring index (SSI), with mild disease defined as meeting no Swanepoel criteria, graded mild by SSI, and graded low risk by SGS.FindingsBetween May 27, 2015, and Aug 2, 2015, 65 patients with confirmed Crimean–Congo haemorrhagic fever were recruited and had blood taken at 110 time points. Most were male (40 [62%] of 65) with mild disease (49 [75%] of 65). Haemorrhage occurred in 13 (20%; 95% CI 11·1–31·8) of 65 patients and 23 (35%) of 65 received blood products (15 received fresh frozen plasma and eight received red blood cell concentrates), and 21 patients received platelet transfusions. At admission, the following EXTEM S variables differed significantly between mild cases and moderate to severe cases: median clotting time 56 s (range 42–81; IQR 48–64) versus 69 s (range 48–164; IQR 54–75; p=0·01); mean amplitude at 10 min after clotting time 45·1 mm (SD 7·0) versus 33·9 mm (SD 8·6; p<0·0001); median clot formation time 147 s (range 72–255; IQR 101–171) versus 197 s (range 98–418; IQR 156–296; p=0·006); and maximum clot firmness 54·4 mm (SD 7·2) versus 45·1 mm (SD 12·5; p=0·003). The EXTEM S variables were compared at different time points; maximum clot firmness (p=0·024) and amplitude at 10 min after clotting time (p=0·090) were lowest on days 4–6 of illness. We found no significant differences in FIBTEM variables between mild and moderate to severe cases (median amplitude at 10 min, 13 mm [range 8–20; IQR 11–15] vs 12 mm [range 6–25; IQR 10–15; p=0·68]; and median maximum clot firmness, 15 mm [range 9–60; IQR 13–21] vs 17 mm [range 7–39; IQR 13–23; p=0·21]); and no hyperfibrinolysis (maximum lysis >15%).InterpretationCoagulopathy of Crimean–Congo haemorrhagic fever is related to defects in clot development and stabilisation that are more marked in severe disease than in mild disease. The combination of normal and slightly deranged coagulation screens and FIBTEM results with the absence of hyperfibrinolysis suggests that the coagulopathy of Crimean–Congo haemorrhagic fever relates to platelet dysfunction.FundingWellcome Trust, UK Ministry of Defence, and National Institute for Health Research Health Protection Research Unit.