Royal British Legion

Carbon dioxide removals (CDR) have become central to climate policy. Current policy approaches, however, are insufficient to create the basis for CDR technologies to scale because they are not yet aligned with the complexity shaping the emerging sector. In this article, we provide an approach to understanding the characteristics of CDR which we argue is composed of both market-creation and market-led complexity. Our engagement with market actors since 2020 suggests that we have entered this new paradigm of complexity earlier than was the case for renewables and in a different way due to the nature of demand. We illustrate how these complexity characteristics are not well captured by existing tools that support policymaking. And we provide an alternative approach to the support of decision-making which is both exploratory and participatory in nature. We call for governments to embrace new tools to facilitate engagement between the public and private sector actors in ways that can more directly capture the sector's complexity. Public-private collaborations for the next phase of CDR investment will be needed to allow governments to both guide the sector whilst also providing a backstop to risk for private sector partners. Participatory and dialectic stakeholder deliberation processes should be integrated throughout analysis, policy design and cross-sector approaches rather than being thought of as separate in order to facilitate timely, targeted interventions that are robust to different possible futures.

Abstract We explore some of the risks related to Artificial Intelligence (AI) from an actuarial perspective based on research from a transregional industry focus group. We aim to define the key gaps and challenges faced when implementing and utilising modern modelling techniques within traditional actuarial tasks from a risk perspective and in the context of professional standards and regulations. We explore best practice guidelines to attempt to define an ideal approach and propose potential next steps to help reach the ideal approach. We aim to focus on the considerations, initially from a traditional actuarial perspective and then, if relevant, consider some implications for non-traditional actuarial work, by way of examples. The examples are not intended to be exhaustive. The group considered potential issues and challenges of using AI, related to the following key themes: Ethical ○ Bias, fairness, and discrimination ○ Individualisation of risk assessment ○ Public interest Professional ○ Interpretability and explainability ○ Transparency, reproducibility, and replicability ○ Validation and governance Lack of relevant skills available Wider themes This paper aims to provide observations that could help inform industry and professional guidelines or discussion or to support industry practitioners. It is not intended to replace current regulation, actuarial standards, or guidelines. The paper is aimed at an actuarial and insurance technical audience, specifically those who are utilising or developing AI, and actuarial industry bodies.

IntroductionTraumatic brain injury (TBI) affects both young and elderly populations and results in a significant global healthcare burden. TBI patients often suffer from costly long-term neurological and cognitive problems that reduce quality of life and ability to work, including motor deficits, gait abnormalities, memory impairments and anxiety. Current clinical practice for TBI is largely supportive, centred on non-specific endpoints such as management of tissue oxygenation, cerebral perfusion pressure and intracranial pressure. At present there are no clinically validated drug treatments aimed specifically at preventing neuronal loss following TBI. Xenon is a noble gas used medically as a general anaesthetic and in MRI imaging. We previously showed xenon-treatment improves short and long-term outcomes, prevents late-onset cognitive impairments and improves survival after moderate TBI in mice. The aim of this study is to evaluate the efficacy of xenon in a second species, rats, and in a severe injury model.MethodAdult male Sprague Dawley rats (N=22) underwent controlled cortical impact (CCI) brain trauma or sham surgery. Animals were randomised to receive either 50%Xe:25%O2:25%N2 or 75%N2:25%O2. Locomotor function (CatwalkXT) and histological outcomes [lesion volume, neuronal cell count (NeuN), microglia (Iba1) and astrocytes (GFAP)] were assessed by blinded observers.ResultsThe xenon-treated group exhibited a reduction in locomotor deficits. Lesion volume was reduced in the xenon-treated group. Xenon-treatment resulted in preservation of neurons in cortical and subcortical regions that was associated with increases in numbers of resting microglia and reactive astrocytes.ConclusionWe show xenon is neuroprotective after severe TBI in rats. Functional improvement and neuronal preservation was associated with a xenon-induced enhancement of resting microglial cell numbers and astrocyte activation. These findings are consistent with a role for early beneficial neuroinflammation in xenon’s neuroprotective effect. Xenon may be of benefit in the treatment of clinical brain trauma.

IntroductionDisaster management is the process of preparing, responding and recovering to an emergency whether that be natural or man-made. It is a time-consuming, resource-heavy process with the aim of reducing the risk of certain events and, where not possible, reducing the impact of said disaster, ensuring that the risks have been identified and appropriate rescue and recovery plan is in place.MethodsWe carried out a thorough literature search on the complications of hot, cold and altitude environments in disaster management and distilled the learnings into this article.ResultsThe incidence of disasters of natural, man-made and complex origin is likely to continue increasing as global temperatures continue to rise.ConclusionDisaster management in the extreme environments of hot, cold and high altitude is fraught with unique challenges, especially around the physiological response of rescuers, resource constraints and logistics. Recognising these challenges is an important aspect of planning and preparation for disaster management in these environments.

BackgroundThe noble gases argon and xenon are potential novel neuroprotective treatments for acquired brain injuries. Xenon has already undergone early-stage clinical trials in the treatment of ischaemic brain injuries, with mixed results. Argon has yet to progress to clinical trials as a treatment for brain injury. Here, we aim to synthesise the results of preclinical studies evaluating argon and xenon as neuroprotective therapies for brain injuries. MethodsAfter a systematic review of the MEDLINE and Embase databases, we carried out a pairwise and stratified meta-analysis. Heterogeneity was examined by subgroup analysis, funnel plot asymmetry, and Egger's regression. ResultsA total of 32 studies were identified, 14 for argon and 18 for xenon, involving measurements from 1384 animals, including murine, rat, and porcine models. Brain injury models included ischaemic brain injury after cardiac arrest (CA), neurological injury after cardiopulmonary bypass (CPB), traumatic brain injury (TBI), and ischaemic stroke. Both argon and xenon had significant (P<0.001), positive neuroprotective effect sizes. The overall effect size for argon (CA, TBI, stroke) was 18.1% (95% confidence interval [CI], 8.1–28.1%), and for xenon (CA, TBI, stroke) was 34.1% (95% CI, 24.7–43.6%). Including the CPB model, only present for xenon, the xenon effect size (CPB, CA, TBI, stroke) was 27.4% (95% CI, 11.5–43.3%). Xenon, both with and without the CPB model, was significantly (P<0.001) more protective than argon. ConclusionsThese findings provide evidence to support the use of xenon and argon as neuroprotective treatments for acquired brain injuries. Current evidence suggests that xenon is more efficacious than argon overall.

Background: The veteran community are at increased risk of poor mental health and developing dementia as a result of their miliary service, with the potential to lead to delayed onset post-traumatic stress disorder (DOPTSD). The manifestation of DOPTSD may be misinterpreted as behavioural and psychological symptoms of dementia (BPSD), which create difficulties in caring for the person experiencing these distressing symptoms. Aims: This paper details the development of a screening tool for people with dementia, which aims to reframe and contextualise some of the behaviours under the lens of historic traumatic events. Methods: The utility of the screening tool is demonstrated through the presentation and an analysis of an anonymised case study to support nurse practice development. Conclusions: A trauma history tool offers a more comprehensive and interpretive view of the possible historic, trauma-related causes of current behaviours and can aid informal carers' understanding of the stress and distress reactions of their family members.

Admiral Nurses, hosted within the Royal British Legion, sought to reframe behavioural and psychological symptoms of dementia in veterans with a diagnosis of dementia by focusing on the symptoms of possible delayed-onset post-traumatic stress disorder. Through an innovative approach to assessment, the authors propose that a greater understanding of underlying causes for behaviours in this population may afford caregivers a greater understanding of presenting behaviours and provide a more person-centred response to their management.

IntroductionEx SAIF SAREEA 3 was a joint British-Omani military exercise involving approximately 5500 British personnel deployed to Oman over a 6-month period. Role 1 medical care was provided by medical treatment facilities (MTFs) deployed with medical equipment as per the UK 300 medical module.MethodRetrospective analysis was undertaken of prospectively collected equipment usage data from two Role 1 MTFs in Duqm (MTF 1) and Muaskar Al Murtafa (MTF 2) camps over a period of 6–8 weeks. Data were analysed alongside routinely collected epidemiological data (EPINATO) during the deployment. Equipment used in addition to the module was also recorded.ResultsMTF 1 used 50 out of the 179 different items from the module over the 8-week period. MTF 2 used 45 out of the 179 different items from their module over the 6-week period. The most commonly used items across the sites were non-sterile examination gloves, plastic aprons, tympanic thermometer probe covers, disinfectant wipes and self-adhesive plasters. Extramodular items (blunt fill needle, water pump sprayer, Jelonet gauze and stool specimen pot) accounted for 5% of all equipment used in MTF 1.ConclusionThe study showed that the 300 module accommodates 95% of Role 1 patients’ needs but highlights the requirement for dedicated equipment for the treatment of heat casualties if deemed likely and blunt fill/filter needles for the administration of parenteral medication. Commanders must perform a thorough medical estimate and risk assessment prior to deployment to ensure that the 300 medical module is likely to provide the necessary equipment and supplement the module if required.