Commentary-A Military Health Care Ethics Framework.

Ethical practice within military health care is a significant topic of professional and academic debate. The term "military health care ethics" enfranchises the entire health care team. Military health care professionals are subject to tension between their duties as military personnel, and their ethical duties as health care professionals, so-called "Dual Loyalty." Some military health care practitioners have suffered moral injury because of the psychological stress associated with ethical challenges on military operations. It is important to define military health care ethics and also to consider how it should be taught. The essence of ethical practice is ethical decision-making. It has become self-evident from our experience of teaching military health care ethics that a simple and agreed framework for analyzing an ethical problem is required. This paper describes the development of the King's Military Healthcare Ethics Framework in support of a military health care ethics policy on behalf of the NATO Military Healthcare Working Group. There is logic to using a stepped approach to analyze an ethical problem in military health care. These steps are: "Identify" the problem, "Analyze" the problem including consideration of perspectives, "Fuse" the analysis, and "Decide". Step 1-Identify-is intended to orientate the decision-making group, and to articulate the problem specifically and clearly in order to determine the exact ethical issue and the secondary issues that arise. Step 2-Analyse-considers the problem from 4 perspectives: patient, clinical, legal, and societal/military. These reflect the breadth of perspectives that impact on health care practice within a military context. Step 3-Fuse-is the culminating step. The conclusions from the analysis of perspectives should be summarized and key references cited. This will determine the exact decision(s) to be made. Step 4-Decide-clearly articulates the decision made and provides the record of the key reasons for making that decision. This may include areas of enduring uncertainly and any planned review of the decision. The King's Military Healthcare Ethics Analytical Framework has been evaluated for content validity through iterative discussion at 4 meetings of the NATO MHCWG and a specific workshop on military health care ethics over 2022/2023. It is included within the draft NATO Standardization Agreement on Military Healthcare Ethics.

Influence of hydrology on the fish body condition in a large subtropical floodplain

With the objective of finding fluctuations on fish body condition in the Middle Paraná River floodplain in different hydrological scenarios, this attribute was analyzed in several trophic groups of a secondary floodplain channel and its associated lakes between 2010 and 2012. Standardized residuals generated by length-weight regressions were calculated for each species and the relative weight (Wr) of the most abundant species per group was examined. A two-way factorial ANOVA was carried out (factors: hydrology and habitats) to evaluate the existence of significant spatial-temporal differences by groups and species. Results showed that body condition in detritivorous, herbivorous and omnivorous species fluctuated significantly depending on hydrology and the environment. Optimal body condition was recorded after the largest flood pulse in most species. Body condition decreased during the low-water period and after two disconnection periods, whereas during the second flood pulse it increased in detritivores, herbivores and omnivores. No floods occurred thereafter, but two flow pulses were registered, and body condition increased under these hydrologic scenarios, with similar or higher values to those recorded after the largest pulse. These results indicate that flow pulses, which are supplementary to flood pulses, may have a positive effect on fish body condition.(AU)

Con el objetivo de conocer la fluctuación de la condición corporal de peces en la planicie de inundación del tramo medio del río Paraná ante diferentes escenarios hidrológicos, se analizó este atributo de diferentes grupos tróficos en un cauce secundario de la planicie y sus lagunas asociadas durante 2010 a 2012. Se calcularon los residuos estandarizados generados por las regresiones longitud-peso para cada especie y se examinó el peso relativo (Wr, por sus siglas en ingles) de las especies más abundantes de cada grupo. Se llevó a cabo un ANOVA factorial de dos vías (factores: hidrología y ambientes) para evaluar la existencia de diferencias significativas espacio-temporales por grupos y por especies. Los resultados mostraron que la condición corporal de las especies detritívoras, herbívoras y omnívoras fluctuó significativamente en función de la hidrología y los ambientes. Óptimas condiciones corporales se registraron en la mayoría de las especies después del mayor pulso de inundación. La condición corporal disminuyó durante el período de aguas bajas y luego de dos períodos de desconexión, mientras que, durante el segundo pulso, aumentó en detritívoros, herbívoros y omnívoros. No hubieron inundaciones luego, pero ocurrieron dos pulsos de flujo y las condiciones corporales se incrementaron bajo estos escenarios hidrológicos, presentando valores similares o incluso mayores a los registrados luego del gran pulso. Esto destaca que los pulsos de flujo complementarios a los pulsos de inundación pueden tener un efecto positivo sobre la condición corporal de peces.(AU)