Preparing Canada’s health system for military conflicts

Canadian Medical Association Journal

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To prepare for major armed conflict involving Canada or its North Atlantic Treaty Organization (NATO) allies, the country must create a national framework for civilian–military medical integration, as the public health system would bear the burden of medical care, argue authors in a commentary in CMAJ (Canadian Medical Association Journal) https://www.cmaj.ca/lookup/doi/10.1503/cmaj.252067.

“Canada’s vulnerability in the context of military conflict lies in its lack of a national framework that would coordinate large-scale evacuation of casualties, allocate scarce resources, and integrate provincial and federal surge capacity,” writes Dr. Jeremy Grushka, assistant professor of surgery, McGill University, Trauma Surgery Fellowship Program director, McGill University, co-director MUHC Centre for Global Surgery, Montréal, Quebec, with coauthors. “The country also lacks a standing command structure linking Canadian Forces Health Services, provincial and territorial ministries of health, the Public Health Agency of Canada, and Canadian Blood Services during national emergencies.” 

“Civilian hospitals would carry any additional clinical burden of caring for injured service members, repatriated casualties, and affected civilians.”

The authors describe several scenarios in which Canada’s various health systems may need to respond, from providing clinical health care and rehabilitation services to repatriated casualties, responding to domestic mass casualty attacks, and addressing cyber attacks that would disrupt health information systems and delivery. Military operations to support sovereignty in Canada’s north could put additional strains on health systems and infrastructure. 

“In each scenario, the limiting resources would be trauma surgery, intensive care beds, blood supply, transport coordination, and real-time situational awareness,” writes Dr. Andrew Beckett, medical director, Trauma Program, St. Michael’s Hospital, Unity Health, Toronto and lieutenant-colonel, Canadian Forces Health Services. “All these resources depend on digital infrastructure enabling patient tracking, hospital capacity management, and interfacility communication, which may themselves be disrupted during cyber attacks.”

To help Canada prepare, a viable national framework should include 3 foundational pillars: sustained clinical readiness, dual-use capacity that can be expanded when necessary, and formal coordination between the Canadian Forces Health Services, Health Canada, and the Public Health Agency of Canada, in partnership with the provinces and territories. 

This is not unprecedented, as Canada has had coordinated civilian–military medical governance in past war times.

“During World War II, federal authorities established mechanisms to balance military and civilian physician allocation and procurement at scale,” they write. “The contemporary context is more complex, but the principle endures. National emergencies require coherent medical governance that transcends institutional silos.”

“[W]e do not argue for militarizing health care but for structural coherence. Civilian hospitals will bear the clinical burden of sustained casualty events involving Canada’s people. Institutionalizing civilian–military medical integration now is a prudent investment in national resilience and the stability of Canadian health care,” the authors conclude. 

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Journal

Canadian Medical Association Journal

DOI

10.1503/cmaj.252067 

Method of Research

Commentary/editorial

Subject of Research

Not applicable

Article Title

Preparing Canada’s health system for conflict: a framework for civilian–military medical readiness

Article Publication Date

30-Mar-2026

 

Developing a new predictive model to assess chemical risks in cetaceans

Assessing the impact of chemical contaminants on finless porpoises using in vitro data and mass distribution modeling

Ehime University

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A conceptual diagram of the risk assessment framework evaluating the health risks of harmful chemicals (POPs) by comparing data from finless porpoise biological samples (blood and blubber) with cultured cell data.

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Credit: Environ. Sci. Technol. 2026, 60, 11, 8353-8362

[Background] Cetaceans, as apex predators in the marine ecosystem, accumulate persistent organic pollutants (POPs) at high concentrations. However, due to ethical constraints, toxicity testing using live animals is impossible, leaving a long-standing challenge of how to link the results of in vitro experiments (using cultured cells) to actual "in vivo risk assessments." Conventionally, the "nominal concentrations" in cell experiments were directly compared with the "measured total concentrations" in actual organisms. However, this method carries high uncertainty because it does not account for the binding of chemicals to proteins and lipids within the body.

[Methodology] Using the finless porpoise as a model species, this study introduced a quantitative approach to predict actual in vivo effects from cell experiment results by using the "freely dissolved concentration" (the concentration of free chemicals not bound to proteins or lipids), which is directly responsible for triggering toxicity, as a common metric. We measured the protein and lipid contents of finless porpoise blood and blubber, as well as the culture media used in the cell experiments, and constructed a mass distribution model for 15 types of POPs.

[Results] The mass distribution modeling revealed that the freely dissolved concentrations of POPs in the bioassay media, blood, and blubber were 2-3, 4-6, and 6-8 orders of magnitude lower than their nominal and measured total concentrations, respectively. Using this freely dissolved concentration as a baseline, we calculated the "QIVIVE ratio" (risk prediction ratio) to compare actual exposure concentrations in vivo with the effect concentrations in cell experiments. The results indicated that mixed exposure to POPs at current environmental levels poses a low risk of reducing cell viability or inducing apoptosis (cell death).

[Future Outlook] This predictive approach, based on mass distribution modeling and freely dissolved concentrations, enables a realistic and mechanistically grounded risk assessment of chemicals in cetaceans. In the future, by incorporating chronic endpoints such as endocrine disruption and immunotoxicity into this framework, it is expected to be applied to more comprehensive health risk assessments for marine mammals.

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Journal

Environmental Science & Technology

DOI

10.1021/acs.est.5c13935 

 

Choosing embryos based on genetic predictions raises new ethical and legal concerns

A new global review shows countries taking very different approaches to regulating polygenic embryo testing

Hokkaido University

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A human embryo obtained through in vitro fertilization (IVF). 

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Credit: Dr. Yasuyuki Mio, MIO Fertility Clinic

For more than four decades, in vitro fertilization (IVF) has helped families have children. Scientists estimate that more than 10 million people worldwide have been born through IVF and related assisted reproductive technologies, according to the International Committee for Monitoring Assisted Reproductive Technologies.

As part of these procedures, prospective parents may choose to genetically test embryos before implantation in the uterus. This process, known as preimplantation genetic testing (PGT), was originally developed to identify serious inherited diseases caused by single errors in the DNA or gene mutations, such as cystic fibrosis or haemophilia, and prevent them from being passed on to the next generation. However, advances in technology have significantly expanded the potential scope of preimplantation genetic testing.

In a new article published in Frontiers in Reproductive Health, Professor Tetsuya Ishii of Hokkaido University examines the emerging use of genomic testing to predict complex traits in embryos, such as intelligence or the risk of developing conditions like diabetes, heart disease, or Alzheimer’s disease later in life. As embryo testing moves beyond disease prevention toward the prediction of complex human social characteristics, Ishii argues that stronger oversight and clearer regulations are needed.

Many traits, such as intelligence and physical appearance, as well as the likelihood of developing common diseases like schizophrenia and cancer, are shaped by both our genes and our environment. Unlike monogenic diseases, which result from a mutation in a single gene, polygenic diseases and traits arise from the combined effects of many genes, each contributing subtly, alongside lifestyle and environmental factors.

In recent years, scientists have identified numerous genetic variants linked to these complex traits and can combine them into a single polygenic score, a statistical estimate of an individual’s genetic tendency to a particular trait or condition. With this advancement, preimplantation genetic testing has expanded from screening for monogenic diseases (PGT-M) to assessing polygenic conditions (PGT-PS), which often emerge later in life.

“However, predicting complex traits remains highly uncertain. Polygenic scores attempt to predict these complex traits using only an embryo’s genetic variants and data from large genetic studies, without accounting for environmental influences,” explains Ishii.

Countries around the world regulate polygenic embryo testing in very different ways. In the United States, polygenic embryo screening has been commercially available since 2019, and some fertility clinics routinely offer it to prospective parents who wish to select embryos. Surveys suggest that many Americans support using polygenic scores to reduce disease risk, and some are also open to using them for non-medical traits.

In contrast, several European countries have adopted stricter limits. Germany and Italy allow embryo testing only to prevent serious genetic diseases, while the United Kingdom currently does not permit the use of polygenic scores for embryo selection.

In many other countries, however, clear regulations have yet to be established. Without explicit rules, the use of polygenic scores in embryo selection could expand even as scientists continue to debate their clinical value.

The technology has also raised several ethical concerns. Prospective parents could develop unrealistic expectations about their future children based on genetic predictions that remain uncertain. “Because of environmental influences, parental behavior, the child’s autonomy, and many other factors, the use of polygenic scores cannot guarantee that a child will develop the predicted trait,” says Ishii.

Then there are broader societal concerns, including the potential stigmatization of certain traits, the risk of viewing children as products designed to meet parental expectations, and fears that the technology could revive ideas associated with eugenics.

The underlying challenge is the growing gap between expert opinion and public attitude. While many physicians and geneticists remain cautious about using polygenic scores for embryo selection, surveys suggest that some prospective parents are more receptive to the technology.

Because polygenic embryo testing remains a rapidly developing field, Ishii argues that policymakers should adopt precautionary regulations while improving public understanding of what genetic predictions can and cannot reliably reveal. Clear guidelines, he suggests, will be essential as reproductive technologies continue to advance.

 

A schematic illustration of how preimplantation genetic testing after IVF allows parents to select embryos with desired traits. 

Credit

Tetsuya Ishii

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Journal

Frontiers in Reproductive Health

DOI

10.3389/frph.2026.1771127 

Method of Research

Systematic review

Subject of Research

People

Article Title

Precautions for polygenic embryo selection: prohibition or cautious use

 

University of Tartu researchers discovered a new gene causing fetal developmental anomalies

Estonian Research Council

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Laura Kasak, Lecturer of Human Genetics at the University of Tartu, investigated a rare family case that led to the discovery of a gene linked to fetal developmental anomalies.

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Credit: Image author: Lilian Mõttus

The Human Genetics Research Group of the University of Tartu Faculty of Medicine has identified a gene whose defect may cause congenital heart malformations in the fetus. The MGRN1 gene has not previously been associated with early human development or with any disease. The discovery will help doctors better recognise similar cases in the future and improve the counselling and treatment offered to affected families. 

The finding emerged during the genetic investigation of one Estonian family. The family had experienced two pregnancies that were terminated after ultrasound scans revealed severe structural anomalies in the fetuses. Pathological examination in both cases demonstrated congenital heart malformations, and in one fetus, abnormal positioning of internal organs.  

At the same time, the family already had two healthy children. Therefore, the family’s genetic material reached the laboratory of Laura Kasak, Lecturer of Human Genetics at the University of Tartu.  

“In clinical practice, the fetuses and the parents had undergone genetic testing, but nothing unusual had been detected. This is not surprising, as the tests focused on known associations,” Kasak explained. “So we began searching for the cause of the anomalies elsewhere.” 

Because both parents were healthy yet the fetuses had similar developmental anomalies, Kasak suspected an autosomal recessive genetic condition. This means that the disorder manifests only when the child inherits a pathogenic variant from both parents. 

The analysis confirmed that both parents carry a rare recessive variant in the MGRN1 gene, which has not been studied in depth because it has never been linked to any specific human disorder. “It is even rarer for two carriers of the same variant to meet,” Kasak noted.  

The researchers’ hypothesis was further supported by genetic testing of the healthy children in the family: none of them carried two defective copies of the gene. Additional confirmation came from mouse-model studies, which showed that a defective MGRN1 gene leads to similar malformations and pregnancy loss in rodents. 

The discovery elicited mixed feelings among the researchers. “On one hand, it is very difficult emotionally, because you feel for the family and think how unfair such a chance event is. On the other hand, you are grateful for the scientific discovery, which may contribute to the early identification of similar situations in the future,” Kasak reflected.  

According to Kasak, further investigation of the gene and additional experiments are needed. The first priority, however, is to share the discovery with the scientific community so that others can recognise the association and expand on the opportunities it offers. 

The article describing the new finding, “MGRN1 is linked to recessive heart and laterality defects: the first genotype–phenotype report in humans”,  was published in the international journal Journal of Medical Genetics. 

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Journal

Journal of Medical Genetics

DOI

10.1136/jmg-2025-111380 

Method of Research

Case study

Subject of Research

Human tissue samples

Article Title

MGRN1 is linked to recessive heart and laterality defects: the first genotype-phenotype report in humans

 

The Earth formed from local building blocks

ETH Zurich

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This is roughly what the formation of the Earth in our solar system might have looked like. The birth of two planets (light brown dots) in a protoplanetary disc around the young star WISPIT 2

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Credit: ESO / Lawlor C et al.

Planetary scientists have long debated where the material that formed our Earth comes from. Despite its location in the inner Solar System, they consider it likely that 6–40 per cent of this material must have come from the outer Solar System, i.e., beyond Jupiter. 

For a long time, material from the outer Solar System was considered necessary to bring volatile components such as water to Earth. Accordingly, there must also have been an exchange of material between the outer and inner Solar Systems during the formation of the Earth. But is that really true? 

“We were truly astonished” 

Planetary scientists Paolo Sossi and Dan Bower, from ETH Zurich, compared existing data on the isotopic ratios of a wide range of meteorites, including those from Mars and the asteroid Vesta, with those of Earth. Isotopes are sibling atoms of the same element (same number of protons) that have a different mass (different number of neutrons).

The researchers analysed this data in a new way and arrived at a surprising conclusion: the material that makes up Earth originates entirely from the inner region of the Solar System. 

Material from the outer Solar System, by contrast, is likely to account for less than two per cent of Earth’s mass, or even nothing at all. The corresponding study has just been published in the journal Nature Astronomy. 

“Our calculations make it clear: the building material of the Earth originates from a single material reservoir,” says Sossi. His colleague Bower adds: “We were truly astonished to find that the Earth is composed entirely of material from the inner Solar System distinct from any combination of existing meteorites.” 

For their study, the ETH researchers used existing data on ten different isotopic systems from meteorites, and analysed them using a specialised statistical method. Previous studies have mostly considered only two isotopic systems. 

“Our studies are actually data science experiments,” says Sossi. ‘We carried out statistical calculations that are rarely used in geochemistry, even though they are a powerful tool.’ 

Isotope signature reveals origin 

Isotopes in meteorites have long been used by researchers to determine the origin of celestial bodies, i.e. which part of the Solar System they come from. Historically, however, only the various isotopes of the element oxygen could be used to determine their provenance. 

It was not until the early 2010s that an American researcher discovered that other isotopes, such as of chromium and titanium, could also be used for this purpose. This has enabled researchers to classify meteorites into two categories: non-carbonaceous ones, which form exclusively in the inner Solar System, and carbonaceous ones, which contain more water and carbon and originate in the outer Solar System. 

The new analysis reveals that the Earth is composed entirely of non-carbonaceous material. No evidence for the previously suspected exchange between the outer- and inner solar system reservoirs was found. 

Therefore, the Earth grew within a relatively static system, incorporating its smaller neighbouring planets as it grew. This also implies that most volatile elements, such as water, must have already been present in the inner Solar System. 

Jupiter acts as a material barrier 

But why are there two distinct material reservoirs in our Solar System? Researchers assume that our Solar System split into two reservoirs during its formation due to Jupiter’s rapid growth and size. The gravity of the gas giant tore a gap in the protoplanetary disc orbiting the young Sun. These discs are ring-shaped and consist of gas and dust; they are the birthplace of planets. Jupiter prevented material from the outer solar system from entering the inner region. However, the extent to which this barrier was permeable remained unclear until now. 

In their new analysis, the two ETH researchers demonstrate that almost no material from beyond Jupiter flowed towards Earth. “Our calculations are very robust and rely solely on the data itself, not on physical assumptions, as these are not yet fully understood,” Bower emphasises. The analysis also shows that Earth's material composition is similar to that of Vesta and Mars.  

The researchers also suspect that Venus and Mercury lie on the same line. “Based on our analysis, we can theoretically predict the composition of these two planets,” says Paolo Sossi. However, he cannot verify this analytically, as no rock samples from Mercury and Venus, which are the two innermost planets in the Solar System, are currently available to the researchers. 

New light on the formation history 

“Our results shed new light on the formation history of our Earth and the other rocky planets,” says Sossi. 

Sossi and his team intend to follow up by investigating why there was sufficient water in the hot, inner Solar System to form the Earth’s oceans. Furthermore, they will examine whether these processes can be applied to exoplanetary systems.

“Until then, however, Dan and I will have to engage in many heated debates about the material composition of Earth and its neighbouring planets, because the scientific discourse over the building blocks of Earth is far from over, despite the new findings,” says Sossi.

Reference

Sossi PA, Bower DJ. Homogeneous accretion of the Earth in the inner Solar System, Nature Astronomy, 27 March 2026, DOI: 10.1038/s41550-026-02824-7

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Journal

Nature Astronomy

DOI

10.1038/s41550-026-02824-7 

Article Title

Homogeneous accretion of the Earth in the inner Solar System

Article Publication Date

27-Mar-2026