Historical institutionalism and institutional design: divergent pathways to regime complexes in Asia and Europe.

Why and how do pathways to regime complexes diverge? Building on insights from the literatures on institutional design and historical institutionalism, we argue that early institutional design choices produce long-term variation in the pace, density, and composition of institutional layers within a regime complex. In a first step, we argue that if an institution becomes focal, this increases the exit costs for member-states to leave. Additional institutional layers become a more likely outcome. In a second step, we argue that depending on the focal organization's formal or informal design, variegated sovereignty costs inform the additional layering pathways. If a focal organization is formal, sovereignty costs are high for member-states. Consequently, creating additional institutional layers becomes cumbersome, leading to a slow pace of "negotiated layering" and a regime complex characterized by low density and composed of formal and informal institutions. In contrast, low sovereignty costs associated with informal focal organizations enable a rapid process of "breakout layering" resulting in a high density of mostly informal institutions. We develop our argument by examining the evolution of security institutions in Europe and Asia through diplomatic cables, treaty texts, personal memoirs, and policy memos.

A new innovative method to measure the cost of war: future with fewer conflicts via harm reduction approaches.

BACKGROUND: The destruction of World War I (WWI) and World War II (WWII) changed the world forever. In this analysis, the economic costs of WWI and WWII are considered via a harm reduction approach to highlight the cost of war via the mortality of military personnel. The harm reduction philosophy and homeostasis of a biological cell are utilized as a pragmatic approach and analogy to give a greater context to the findings, despite the omission of civilian casualties and military disabilities. METHODS: Tangible (e.g., loss of wages, productivity, and contributions) and intangible (e.g., quality of life) costs are estimated based on the value of each military personnel derived from secondary data and a mathematical model. This is the first study to estimate the cost of war based on soldier's mortality during the first and second World War. RESULTS: Based on the tangible value, the WWI and WWII cost for the military personnel was US$43.204 billion ($13 billion ≤ α ≤ $97 billion) and US$540.112 billion ($44 billion ≤ α ≤ $1 trillion). When the intangible cost is considered, it is estimated that the WWI cost was beyond US$124 trillion ($43 trillion ≤ ß ≤ $160 trillion), and the WWII cost was above US$328 trillion ($115 trillion ≤ ß ≤ $424 trillion). The sensitivity analyses conducted for WWI and WWII demonstrate different ranges based on tangible and intangible values. CONCLUSIONS: In the current climate of increasing hostilities, inequalities, global warming, and an ever-changing world, economic prosperities are directly linked to peace, stability, and security. Therefore, any future decisions for military conflicts need to increasingly consider harm reduction approaches by considering the cost of life and potential disabilities for each nations' soldiers, sailors, and pilots.

Porous organizational boundaries and associated states: introducing memberness in international organizations.

The current binary understanding of membership in international organizations (IOs), especially regional organizations (ROs), creates blind spots and biases in our understanding of who matters in IOs, as well as why and how they matter. Existing scholarship primarily looks at full member-states or non-state actors to capture who influences such organizations. Associated states are often portrayed as passive receivers of IO rules instead of active contributors. We address this blind spot and resulting analytical bias by exploring what types of association relationships exist and how they impact IOs. We propose a novel conceptualization of membership that we call memberness. On the level of IOs, memberness is based on the relative openness of organizational boundaries and stratified access via material and ideational contributions. On the level of states, memberness captures associated states' individual choices to contribute materially and/or ideationally to an IO. Memberness moves away from a purely rights-based understanding of membership (or who you are in an IO) to include a capacity-based understanding (or what you do in an IO). This shift in focus uncovers new channels of influence on IOs. Associated states' material and ideational contributions to IOs constitute three memberness types: payroller, sponsor, and advisor. We argue that these memberness types impact IOs' vitality, design, and performance in previously unrecognized ways. We illustrate these types with empirical examples from ROs across the globe and discuss the implications of memberness for IO research programs.

The role of the Royal Air Force Deployed Readiness Preparation Team in the UK.

Royal Air Force (RAF) Waddington and Cranwell are both based in Lincolnshire and have Defence Primary Health Care Dental Centres on Station to provide dental care to service personnel. The facility at RAF Waddington was temporarily closed for refurbishment early 2020 and this saw the amalgamation of the two Dental Centres. This, alongside COVID, significantly impacted on the ability to deliver dental care to a combined patient group. Military dental teams are routinely deployed overseas to provide care for patients; however, the Deployed Readiness Preparation Team (DRPT) had not previously been activated in the UK in support of RAF Dental Centres. This UK-based deployment was to be innovative and able to demonstrate the wider utility of the military dental teams and portable equipment, to expand the facility at RAF Cranwell.The aim of this paper is to highlight the key principles and utility of deployable Defence dentistry by discussing the establishment and use of portable dental equipment to facilitate the increased clinical output of a dental centre. Through energetic and focused leadership, training and assurance, dentistry can be delivered with an occupational focus to provide a responsive and deployable care capability in a UK setting.

COVID-19 at War: The Joint Forces Operation in Ukraine.

The ongoing pandemic disaster of coronavirus erupted with the first confirmed cases in Wuhan, China, in December 2019, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) novel coronavirus, the disease referred to as coronavirus disease 2019, or COVID-19. The World Health Organization (WHO) confirmed the outbreak and determined it a global pandemic. The current pandemic has infected nearly 300 million people and killed over 3 million. The current COVID-19 pandemic is smashing every public health barrier, guardrail, and safety measure in underdeveloped and the most developed countries alike, with peaks and troughs across time. Greatly impacted are those regions experiencing conflict and war. Morbidity and mortality increase logarithmically for those communities at risk and that lack the ability to promote basic preventative measures. States around the globe struggle to unify responses, make gains on preparedness levels, identify and symptomatically treat positive cases, and labs across the globe frantically rollout various vaccines and effective surveillance and therapeutic mechanisms. The incidence and prevalence of COVID-19 may continue to increase globally as no unified disaster response is manifested and disinformation spreads. During this failure in response, virus variants are erupting at a dizzying pace. Ungoverned spaces where nonstate actors predominate and active war zones may become the next epicenter for COVID-19 fatality rates. As the incidence rates continue to rise, hospitals in North America and Europe exceed surge capacity, and immunity post infection struggles to be adequately described. The global threat in previously high-quality, robust infrastructure health-care systems in the most developed economies are failing the challenge posed by COVID-19; how will less-developed economies and those health-care infrastructures that are destroyed by war and conflict fare until adequate vaccine penetrance in these communities or adequate treatment are established? Ukraine and other states in the Black Sea Region are under threat and are exposed to armed Russian aggression against territorial sovereignty daily. Ukraine, where Russia has been waging war since 2014, faces this specific dual threat: disaster response to violence and a deadly infectious disease. To best serve biosurveillance, aid in pandemic disaster response, and bolster health security in Europe, across the North Atlantic Treaty Alliance (NATO) and Black Sea regions, increased NATO integration, across Ukraine's disaster response structures within the Ministries of Health, Defense, and Interior must be reinforced and expanded to mitigate the COVID-19 disaster.

NATO and evidence-based military and disaster medicine: case for Vigorous Warrior Live Exercise Series.

The North Atlantic Treaty Organization (NATO) is the premier and only security alliance uniting 30 countries and growing with many partner states in the provision of collective security and against threats posed by conflict and natural disasters. Security of countries and communities is increasingly threatened by a broad spectrum of unconventional types of war and disease threats - from hybrid and asymmetric to multi-domain and peer-to-peer/near-peer conflict. The NATO Centre of Excellence for Military Medicine (MILMED COE) is the centre of gravity for medical best practices and promotion of medical doctrine across the NATO alliance. Disaster medicine is multidisciplinary and in NATO, multinational, requiring best practices that are driven by data and evidence to prevent death on the battlefield and prepare for future conflicts. "Vigorous Warrior" is a live military and disaster medicine exercise series using both civilian and military actors across all sectors of health focused on health security and identifying lessons learned to ready the alliance for future threats. In this brief report, we make the case that the Vigorous Warrior exercise exposes gaps, highlights challenges and generates an evidence base to make NATO military medicine systems more robust, more efficient and in provision of best medical practices. We specifically argue that clinical data capture must be duplicated and continuous across the alliance to ensure evidence-based medicine stays current in NATO military medical doctrine.

Analytic Hierarchy Process (AHP)-Based Aggregation Mechanism for Resilience Measurement: NATO Aggregated Resilience Decision Support Model.

Resilience is a complex system that represents dynamic behaviours through its complicated structure with various nodes, interrelations, and information flows. Like other international organizations NATO has also been dealing with the measurement of this complex phenomenon in order to have a comprehensive understanding of the civil environment and its impact on military operations. With this ultimate purpose, NATO had developed and executed a prototype model with the system dynamics modelling and simulation paradigm. NATO has created an aggregated resilience model as an upgrade of the prototype one, as discussed within this study. The structure of the model, aggregation mechanism and shock parametrization methodologies used in the development of the model comprise the scope of this study. Analytic Hierarchy Process (AHP), which is a multi-criteria decision-making technique is the methodology that is used for the development of the aggregation mechanism. The main idea of selecting the AHP methodology is its power and usefulness in mitigating bias in the decision-making process, its capability to increase the number of what-if scenarios to be created, and its contribution to the quality of causal explanations with the granularity it provides. The parametrized strategic shock input page, AHP-based weighted resilience and risk parameters input pages, one more country insertion to the model, and the decision support system page enhance the capacity of the prototype model. As part of the model, the decision support system page stands out as the strategic level cockpit where the colour codes give a clear idea at first about the overall situational picture and country-wise resilience and risk status. At the validation workshop, users not only validated the model but also discussed further development opportunities, such as adding more strategic shocks into the model and introduction of new parameters that will be determined by a big data analysis on relevant open source databases. The developed model has the potential to inspire high-level decision-makers dealing with resilience management in other international organizations, such as the United Nations.

A Decade of mTBI Experience: What Have We Learned? A Summary of Proceedings From a NATO Lecture Series on Military mTBI.

Mild traumatic brain injury (mTBI, also known as a concussion) as a consequence of battlefield blast exposure or blunt force trauma has been of increasing concern to militaries during recent conflicts. This concern is due to the frequency of exposure to improvised explosive devices for forces engaged in operations both in Iraq and Afghanistan coupled with the recognition that mTBI may go unreported or undetected. Blasts can lead to mTBI through a variety of mechanisms. Debate continues as to whether exposure to a primary blast wave alone is sufficient to create brain injury in humans, and if so, exactly how this occurs with an intact skull. Resources dedicated to research in this area have also varied substantially among contributing NATO countries. Most of the research has been conducted in the US, focused on addressing uncertainties in management practices. Development of objective diagnostic tests should be a top priority to facilitate both diagnosis and prognosis, thereby improving management. It is expected that blast exposure and blunt force trauma to the head will continue to be a potential source of injury during future conflicts. An improved understanding of the effects of blast exposure will better enable military medical providers to manage mTBI cases and develop optimal protective measures. Without the immediate pressures that come with a high operational tempo, the time is right to look back at lessons learned, make full use of available data, and modify mitigation strategies with both available evidence and new evidence as it comes to light. Toward that end, leveraging our cooperation with the civilian medical community is critical because the military experience over the past 10 years has led to a renewed interest in many similar issues pertaining to mTBI in the civilian world. Such cross-fertilization of knowledge will undoubtedly benefit all. This paper highlights similarities and differences in approach to mTBI patient care in NATO and partner countries and provides a summary of and lessons learned from a NATO lecture series on the topic of mTBI, demonstrating utility of having patients present their experiences to a medical audience, linking practical clinical care to policy approaches.

Interoperability Among Unmanned Maritime Vehicles: Review and First In-field Experimentation.

Complex maritime missions, both above and below the surface, have traditionally been carried out by manned surface ships and submarines equipped with advanced sensor systems. Unmanned Maritime Vehicles (UMVs) are increasingly demonstrating their potential for improving existing naval capabilities due to their rapid deployability, easy scalability, and high reconfigurability, offering a reduction in both operational time and cost. In addition, they mitigate the risk to personnel by leaving the man far-from-the-risk but in-the-loop of decision making. In the long-term, a clear interoperability framework between unmanned systems, human operators, and legacy platforms will be crucial for effective joint operations planning and execution. However, the present multi-vendor multi-protocol solutions in multi-domain UMVs activities are hard to interoperate without common mission control interfaces and communication protocol schemes. Furthermore, the underwater domain presents significant challenges that cannot be satisfied with the solutions developed for terrestrial networks. In this paper, the interoperability topic is discussed blending a review of the technological growth from 2000 onwards with recent authors' in-field experience; finally, important research directions for the future are given. Within the broad framework of interoperability in general, the paper focuses on the aspect of interoperability among UMVs not neglecting the role of the human operator in the loop. The picture emerging from the review demonstrates that interoperability is currently receiving a high level of attention with a great and diverse deal of effort. Besides, the manuscript describes the experience from a sea trial exercise, where interoperability has been demonstrated by integrating heterogeneous autonomous UMVs into the NATO Centre for Maritime Research and Experimentation (CMRE) network, using different robotic middlewares and acoustic modem technologies to implement a multistatic active sonar system. A perspective for the interoperability in marine robotics missions emerges in the paper, through a discussion of current capabilities, in-field experience and future advanced technologies unique to UMVs. Nonetheless, their application spread is slowed down by the lack of human confidence. In fact, an interoperable system-of-systems of autonomous UMVs will require operators involved only at a supervisory level. As trust develops, endorsed by stable and mature interoperability, human monitoring will be diminished to exploit the tremendous potential of fully autonomous UMVs.

The Basic Helix-Loop-Helix Gene Nato3 Drives Expression of Dopaminergic Neuron Transcription Factors in Neural Progenitors.

The floor plate of the developing midbrain gives rise to dopaminergic (DA) neurons, an important class of cells involved in Parkinson's disease (PD). Neural progenitors of the midbrain floor plate utilize key genes in transcriptional networks to drive dopamine neurogenesis. Identifying factors that promote dopaminergic neuron transcriptional networks can provide insight into strategies for therapies in PD. Using the chick embryo, we developed a quantitative PCR (qPCR) based method to assess the potential of a candidate factor to drive DA neuron gene expression, including the basic helix-loop-helix transcription factor Nato3 (Ferd3l). We then showed that overexpression of Nato3 in the developing chick mesencephalon produces a regionally dependent increase in genes associated with the DA neurogenesis, (such as Foxa2, Lmx1b and Shh) as well as DA neuron genes Nurr1 (an immature DA neuron marker) and mRNA expression of tyrosine hydroxylase (TH, a mature DA neuron marker). Interestingly, our data also showed that Nato3 is a potent regulator of Lmx1b by its broad induction of Lmx1b expression in neural progenitors of multiple regions of the CNS, including the midbrain and spinal cord. These data introduce a new, in vivo approach to identifying a gene that can drive DA transcriptional networks and provide the new insight that Nato3 can drive expression of key DA neuron genes, including Lmx1b, in neural progenitors.

Acute neurosurgical management of traumatic brain injury and spinal cord injury in French armed forces during deployment.

This article aims to describe the French concept regarding combat casualty neurosurgical care from the theater of operations to a homeland hospital. French military neurosurgeons are not routinely deployed to all combat zones. As a consequence, general surgeons initially treat neurosurgical wounds. The principle of this medical support is based on damage control. It is aimed at controlling intracranial hypertension spikes when neuromonitoring is lacking in resource-limited settings. Neurosurgical damage control permits a medevac that is as safe as can be expected from a conflict zone to a homeland medical treatment facility. French military neurosurgeons can occasionally be deployed within an airborne team to treat a military casualty or to complete a neurosurgical procedure performed by a general surgeon in theaters of operation. All surgeons regardless of their specialty must know neurosurgical damage control. General surgeons must undergo the required training in order for them to perform this neurosurgical technique.

Spine surgery in the International Security Assistance Force Role 3 combat support hospital in Mazar-e-Sharif, northern Afghanistan, 2007-2014.

OBJECTIVESince 2007, a continuous neurosurgery emergency service has been available in the International Security Assistance Force (ISAF) field hospital in Mazar-e-Sharif (MeS), Afghanistan. The object of this study was to assess the number and range of surgical procedures performed on the spine in the period from 2007 to 2014.METHODSThis is a retrospective analysis of the annual neurosurgical caseload statistics from July 2007 to October 2014 (92 months). The distribution of surgical urgency (emergency, delayed urgency, or elective), patient origin (ISAF, Afghan National Army, or civilian population), and underlying causes of diseases and injuries (penetrating injury, blunt injury/fracture, or degenerative disease) was analyzed. The range and pattern of diagnoses in the neurosurgical outpatient department from 2012 and 2013 were also evaluated.RESULTSA total of 341 patients underwent neurosurgical operations in the period from July 2007 to October 2014. One hundred eighty-eight (55.1%) of the 341 procedures were performed on the spine, and the majority of these surgeries were performed for degenerative diseases (127/188; 67.6%). The proportion of spinal fractures and penetrating injuries (61/188; 32.4%) increased over the study period. These spinal trauma diagnoses accounted for 80% of the cases in which patients had to undergo operations within 12 hours of presentation (n = 70 cases). Spinal surgeries were performed as an emergency in 19.8% of cases, whereas 17.3% of surgeries had delayed urgency and 62.9% were elective procedures. Of the 1026 outpatient consultations documented, 82% were related to spinal issues.CONCLUSIONSCompared to the published numbers of cases from neurosurgery units in the rest of the ISAF area, the field hospital in MeS had a considerably lower number of operations. In addition, MeS had the highest rates of both elective neurosurgical operations and Afghan civilian patients. In comparison with the field hospital in MeS, none of the other ISAF field hospitals showed such a strong concentration of degenerative spinal conditions in their surgical spectrum. Nevertheless, the changing pattern of spine-related diagnoses and surgical therapies in the current conflict represents a challenge for future training and material planning in comparable missions.

Collection and sharing of medical information and medical intelligence (M2I) in NATO: a transversal survey.

INTRODUCTION: There is a requirement for adequate medical expertise to be available throughout the range of potential future operations involving members of the North Atlantic Treaty Organization (NATO). The aim of this study was to assess the collection and sharing of medical intelligence and medical information (M2I) by NATO Nations, Partner Nations and NATO Command Structure and NATO Force Structure Headquarters (NCS/NFS HQs). MATERIALS AND METHODS: A transversal survey was conducted between December 2014 and March 2015 using a survey form on M2I sent to NATO Nations and Partnership for Peace (PfP) Nations as well as NCS/NFS HQs. RESULTS: Correctly completed responses were received from 15/40 (37.5%) of the possible NATO and PfP Nations (37.5%) and 7/8 (87.5%) of the NCS/NFS HQs (100.0%). Deficiencies in the collection of M2I data were found due to lack of specific doctrines, networks, tools, structures and organisation. CONCLUSIONS: The survey provided an indication even though the participation rate was low for Nations. Part of the problem is thought to be that medical information and medical intelligence often lie in different chains of command. Future directions for this research could include studying the possibilities of a new specific information technology (IT) system to collect and to share M2I. Collection and sharing of M2I within the NATO/PfP community requires facilitation in order to strengthen the basis for decision-making and force health protection. The development of a dedicated NATO IT system may be a precondition for the implementation of an efficient M2I network.

Ballistics ordnance gelatine - How different concentrations, temperatures and curing times affect calibration results.

A study was undertaken to determine whether different concentrations of ordnance gelatine, water types, temperatures and curing times would have an effect on projectile penetration of a gelatine tissue surrogate. Both Federal Bureau of Investigation (FBI) and North Atlantic Treaty Organization (NATO) specified gelatines were compared against the FBI calibration standard. 10% w/w and 20% w/w concentrations of gelatine with Bloom numbers of 250 and 285 were prepared and cured at variable temperatures (3-20°C) for 21 hours-3 weeks. Each block was shot on four occasions on the same range using steel calibre 4.5 mm BBs fired from a Daisy(®) air rifle at the required standard velocity of 180 ± 4.5 m/s, to ascertain the mean penetration depth. The results showed no significant difference in mean penetration depth using the three different water types (p > 0.05). Temperature changes and curing times did affect penetration depth. At 10°C, mean penetration depth with 20% gelatine 285 Bloom for the two water types tested was 49.7 ± 1.5 mm after 21 h curing time, whereas the same formulation at 20°C using two different water types was 79.1 ± 2.1 mm after 100 h curing time (p < 0.001). Neither of the NATO 20% concentrations of gelatine at 10°C or a 20% concentration of 285 Bloom gelatine at 10°C met the same calibration standard as the FBI recommended 10% formulation at 4°C. A 20% concentration of 285 Bloom at 20°C met the same calibration/penetration criteria as a 10% concentration of 250 Bloom at 4 °C after 100 h of curing, therefore matching the FBI calibration standard for a soft tissue simulant for wound ballistics research. These results demonstrate significant variability in simulant properties. Failure to standardise ballistic simulants may invalidate experimental results.

Investigating information-processing performance of different command team structures in the NATO Problem Space.

The structure of command teams is a significant factor on their communications and ability to process, and act upon, information. The NATO Problem Space was used in this study to represent three of the main dimensions in the battle-space environment: familiarity, rate of change, and strength of information position. Results show that the five common team structures (chain, Y, circle, wheel and all-connected) did not generally perform as predicted in team literature. Findings suggest that under dynamic and highly variable conditions, high levels of synchronisation and trust should be present. On the other hand, synchronisation and trust are less important in hierarchical, highly centralised structures, because team members are more willing to accept the authority of a single leader and this tight control ensures that these teams can perform well as long as the Problem Space is familiar, information is explicit and the environment does not change. Practitioner Summary: Some types of team structures are better suited to particular constraints of the battle-space than others. This research has shown that the much touted all-connected structure is often the worst performing structure and that the traditional hierarchy of command and control has much merit in the digital information age.

Deployment-related mental health support: comparative analysis of NATO and allied ISAF partners.

BACKGROUND: For years there has been a tremendous gap in our understanding of the mental health effects of deployment and the efforts by military forces at trying to minimize or mitigate these. Many military forces have recently systematized the mental support that is provided to support operational deployments. However, the rationale for doing so and the consequential allocation of resources are felt to vary considerably across North Atlantic Treaty Organisation (NATO) International Security Assistance (ISAF) partners. This review aims to compare the organization and practice of mental support by five partnering countries in the recent deployment in Afghanistan in order to identify and compare the key methods and structures for delivering mental health support, describe bottlenecks and illustrate new developments. METHOD: Information was collected through document analysis and semi-structured interviews with key military mental healthcare stakeholders. The review resulted from close collaboration between key military mental healthcare professionals within the Australian Defense Forces (ADF), Canadian Armed Forces (CAF), United Kingdom Armed Forces (UK), Netherlands Armed Forces (NLD), and the United States Army (US). Key stakeholders were interviewed about the mental health support provided during a serviceperson's military career. The main items discussed were training, prevention, early identification, intervention, and aftercare in the field of mental health. RESULTS: All forces reported that much attention was paid to mental health during the individual's military career, including deployment. In doing so there was much overlap between the rationale and applied methods. The main method of providing support was through training and education. The educative focus was to strengthen the mental resilience of individual soldiers while providing a range of mental healthcare services. All forces had abandoned standard psychological debriefing after critical incidents. Instead, by default, mental healthcare professionals acted to support the leader and peer led "after action" reviews. All countries provided professional mental support close to the front line, aimed at early detection and early return to normal activities within the unit. All countries deployed a mental health support team that consisted of a range of mental health staff including psychiatrists, psychologists, social workers, mental health nurses, and chaplains. There was no overall consensus in the allocation of mental health disciplines in theatre. All countries (except the US) provided troops with a third location decompression (TLD) stop after deployment, which aimed to recognize what the deployed units had been through and to prepare them for transition home. The US conducted in-garrison 'decompression', or 'reintegration training' in the US, with a similiar focus to TLD. All had a reasonably comparable infrastructure in the field of mental healthcare. Shared bottlenecks across countries included perceived stigma and barriers to care around mental health problems as well as the need for improving the awareness and recognition of mental health problems among service members. CONCLUSION: This analysis demonstrated that in all five partners state-of-the-art preventative mental healthcare was included in the last deployment in Afghanistan, including a positive approach towards strengthening the mental resilience, a focus on self-regulatory skills and self-empowerment, and several initiatives that were well-integrated in a military context. These initiatives were partly/completely implemented by the military/colleagues/supervisors and applicable during several phases of the deployment cycle. Important new developments in operational mental health support are recognition of the role of social leadership and enhancement of operational peer support. This requires awareness of mental problems that will contribute to reduction of the barriers to care in case of problems. Finally, comparing mental health support services across countries can contribute to optimal preparation for the challenges of military deployment.

Cancer incidence in Dutch Balkan veterans.

Suspicion has been raised about an increased cancer risk among Balkan veterans because of alleged exposure to depleted uranium. The authors conducted a historical cohort study to examine cancer incidence among Dutch Balkan veterans. Male military personnel (n=18,175, median follow-up 11 years) of the Army and Military Police who had been deployed to the Balkan region (1993-2001) was compared with their peers not deployed to the Balkans (n=135,355, median follow-up 15 years) and with the general Dutch population of comparable age and sex. The incidence of all cancers and 4 main cancer subgroups was studied in the period 1993-2008. The cancer incidence rate among Balkan deployed military men was 17% lower than among non-Balkan deployed military men (hazard ratio 0.83 (95% confidence interval 0.69, 1.00)). For the 4 main cancer subgroups, hazard ratios were statistically non-significantly below 1. Also compared to the general population cancer rates were lower in Balkan deployed personnel (standardised incidence rate ratio (SIR) 0.85 (0.73, 0.99). The SIR for leukaemia was 0.63 (0.20, 1.46). The authors conclude that earlier suggestions of increased cancer risks among veterans are not supported by empirical data. The lower risk of cancer might be explained by the 'healthy warrior effect'.

Sword, Shield and Buoys: A History of the NATO Sub-Committee on Oceanographic Research, 1959-1973.

In the late 1950s the North-Atlantic Treaty Organization (NATO) made a major effort to fund collaborative research between its member states. One of the first initiatives following the establishment of the alliance's Science Committee was the creation of a sub-group devoted to marine science: the Sub-committee on Oceanographic Research.This paper explores the history of this organization, charts its trajectory over the 13 years of its existence, and considers its activities in light of NATO's naval defence strategies. In particular it shows how the alliance's naval commands played a key role in the sub-committee's creation due to the importance of oceanographic research in the tracking of enemy submarines. The essay also scrutinizes the reasons behind the committee's dissolution, with a special focus on the changing landscape of scientific collaboration at NATO. The committee's fall maps onto a more profound shift in the alliance's research agenda, including the re-organization of defence research and the rise of environmentalism.