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Summary: Background: Genomic characterisation has led to an improved understanding of adult melanoma. However, the aetiology of melanoma in children is still unclear and identifying the correct diagnosis and therapeutic strategies remains challenging. Methods: Exome sequencing of matched tumour-normal pairs from 26 paediatric patients was performed to study the mutational spectrum of melanomas. The cohort was grouped into different categories: spitzoid melanoma (SM), conventional melanoma (CM), and other melanomas (OT). Findings: In all patients with CM (n = 10) germline variants associated with melanoma were found in low to moderate melanoma risk genes: in 8 patients MC1R variants, in 2 patients variants in MITF, PTEN and BRCA2. Somatic BRAF mutations were detected in 60% of CMs, homozygous deletions of CDKN2A in 20%, TERTp mutations in 30%. In the SM group (n = 12), 5 patients carried at least one MC1R variant; somatic BRAF mutations were detected in 8.3%, fusions in 25% of the cases. No SM showed a homozygous CDKN2A deletion nor a TERTp mutation. In 81.8% of the CM/SM cases the UV damage signatures SBS7 and/or DBS1 were detected. The patient with melanoma arising in giant congenital nevus (CNM) demonstrated the characteristic NRAS Q61K mutation. Interpretation: UV-radiation and MC1R germline variants are risk factors in the development of conventional and spitzoid paediatric melanomas. Paediatric CMs share genomic similarities with adult CMs while the SMs differ genetically from the CM group. Consistent genetic characterization of all paediatric melanomas will potentially lead to better subtype differentiation, treatment, and prevention in the future. Funding: Found in Acknowledgement.

The 2022 war in Ukraine has highlighted the unacceptable consequences wrought on civilians and health infrastructure by conflict. Children are among the most vulnerable of those affected and constitute an increasing percentage of non-combatants injured in conflicts globally. A disproportionate number of these injuries are caused by blast mechanisms from munitions including ‘conventional’ landmines and indiscriminate explosive weapons such as barrel bombs and improvised explosive devices. In 21st century conflict, children are no longer only accidental casualties of war, but are increasingly targeted by parties through acts such as bombing of school buses and playgrounds, conscription as child soldiers, and use as human shields. In the present viewpoint article, we review the state of pediatric blast injury studies, synthesizing current understandings of injury epidemiology and identifying gaps in research to advance the field towards a concrete agenda to improve care for this vulnerable population.

Abstract Background Decades of war left the Republic of South Sudan with a fragile health system that has remained deprived of resources since the country’s independence. We describe the coverage of interventions for women’s and children’s health in Upper Nile and Unity states, and explore factors that affected service provision during a protracted conflict. Methods We conducted a case study using a desk review of publicly available literature since 2013 and a secondary analysis of intervention coverage and conflict-related events from 2010 to 2017. During June through September 2018, we conducted 26 qualitative interviews with technical leads and 9 focus groups among health workers working in women and children’s health in Juba, Malakal, and Bentiu. Results Coverage for antenatal care, institutional delivery, and childhood vaccines were low prior to the escalation of conflict in 2013, and the limited data indicate that coverage remained low through 2017. Key factors that determined the delivery of services for women and children in our study sites were government leadership, coordination of development and humanitarian efforts, and human resource capacity. Participants felt that national and local health officials had a limited role in the delivery of services, and financial tracking data showed that funding stagnated or declined for humanitarian health and development programming during 2013–2014. Although health services were concentrated in camp settings, the availability of healthcare providers was negatively impacted by the protracted nature of the conflict and insecurity in the region. Conclusions Health care for women and children should be prioritized during acute and protracted periods of conflict by strengthening surveillance systems, coordinating short and long term activities among humanitarian and development organizations, and building the capacity of national and local government officials to ensure sustainability.

The global trend of rapid urbanization raises concerning issues related to the living standards of the urban poor, many of whom live in dense informal settlements. Residents of informal urban settlements can face significant insecurity, with men and women experiencing different threats. While space and socioeconomic status have specific consequences on the hazard of violence that urban residents face, gender modifies the impact of that violence. In an attempt to understand the drivers of insecurity within a social ecological framework, this study investigated underdeveloped neighborhoods in Addis Ababa, Ethiopia; Dhaka, Bangladesh; and Port-au-Prince, Haiti. The qualitative approach employed focus group discussions using various probing techniques and key informant interviews followed by a thematic analysis of the data. The direct quotes and experiences of young and older women compared to those of young and older men highlight how the combination of factors - gender and poverty - drive differential risk for women compared to men among the urban poor in these cities.

Abstract Cattle raiding, a longstanding practice among pastoralists in South Sudan, was historically governed by cultural authorities and ritual prohibitions. However, after decades of on-and-off integration into armed forces, raiders are now heavily armed, and military-style attacks claim dozens if not hundreds of lives at a time. Beginning with the emergence of the infamous Lou Nuer “White Army” in the Bor Massacre of the early 1990s, in which Riek Machar mobilized local herders to mount a devastating attack against the heartland of Sudan People’s Liberation Army Leader John Garang, political leaders have strategically manipulated these local conflicts in order to mobilize armed herders for their political movements. Political leaders’ systematic exploitation of customary raiding practices gravely inflames the current conflict, but the role of intercommunity violence has not been part of the mainstream dialogue around political solutions. Moreover, as allegiances between pastoralist militias and political factions decay, the proliferation of informal armed groups whose motivations are often distinct from the agenda of the state or opposition forces on whose behalf they once fought poses increasing challenges to peacebuilding efforts. Neglecting local realities poses serious implications for the prospects of peace. In this article, we synthesize perspectives from anthropology, regional history, and conflict studies to offer an analysis of the interplay between local conflict and state violence in South Sudan. We highlight opportunities for conflict de-escalation, concluding with policy recommendations focused on justice and enforcement in the rural areas of South Sudan.