WEM Year in Review

In closing out our 35^th year of publication, it is important to take stock of what we have accomplished over the past 12 months. In March, WEM published a specialty issue devoted to the earth's shifting climate and its impact on health and austere medicine. Co-edited by Drs. Wheat and Dresser, the issue sought to examine the relationship between wilderness medicine and a dynamic and changing environment. ¹ Our September issue featured a supplement dedicated to the complex, fascinating, and growing field of space medicine and its interaction with health systems. As Antonsen et al note (cue William Shatner somewhere in the distance), “Space remains the final frontier of exploration. Space beyond low Earth orbit is a distant wilderness characterized by limited resources; confined spaces; exposure to extended periods in microgravity, cosmic radiation, and isolation; and in some cases, the impossibility of rescue or early return to the Earth.” ²

WEM's current issue returns us to some of the challenges facing segments of society here on Earth. Our concentration on women's health in austere settings and extreme sports provides insights into specialty care for a growing population of casual and experienced participants.^3,4 While gender-related research has been much maligned during this past year, it is merely good medicine to pay attention to the specialty care required by a significant portion of the population choosing to participate in adventure and extreme sports.

Our 35^th year also features review articles, clinical practice guidelines regarding care of burns in the wilderness, several concept papers, and primary research, all of which place WEM as a hub for expertise and excellence as we further define and expand the notion of wilderness and austere medicine. Manuscripts from Rolfe et al and Mertens feature WEM's increasing comfort and involvement in providing expertise and guidance in arthropod-borne infectious diseases.^5,6 DeGroot et al review heat illness prevention and treatment in austere environments, and Filiberti et al examine the unfortunate but increasing plight of wildland firefighters as they battle smoke exposure.^7,8 One particularly fascinating article from David et al discusses the ethical dilemma regarding end-of-life care in austere environments. ⁹

Much of the hard work in producing high-quality manuscripts is behind the scenes. A vast network of reviewers is responsible for providing detailed comments and analysis, allowing authors to maximize their manuscript's potential. Peer review is, at times, a brutal and thankless task. During training, most of us never receive formal guidance regarding the peer review of an original manuscript, yet over 2.5 million scientific manuscripts are published annually, and output continues to increase. ¹⁰ One estimate reported that researchers spent about 130 million hours, or 15 000 years, peer reviewing scholarly journals in 2020. ¹¹ In order to assist with peer review at WEM, a reviewer-in-training (RIT) program was presciently conceived by WEM's previous editor and continues under the guidance of Dr Aaron Campbell. The RIT program has graduated 37 reviewers over the past 3 years and offers mentorship and a toolkit for trainees.

Looking ahead, WEM faces a number of challenges. Research funding for climate change, environmental policy, and other topics are under pressure. This could lead to fewer primary research studies, leading to greater competition among journals for significant and seminal studies. In order to ensure WEM's essential role as a central repository for expert reviews, clinical practice guidelines, and original research, the journal will need to be vigilant and supportive of authors from around the globe. An additional challenge, and one that will continue to evolve, is the role of artificial intelligence (AI) in crafting manuscripts, interpreting datasets, generating hypotheses, and the need for stewardship. The journal's publisher offers AI guidelines, but these will need to be continually monitored and updated.

Peer review, as well, is under duress. Insufficient scrutiny, irreproducible results, and economic and time constraints among reviewers continue to plague peer review. ¹² In the misinformation era, there are consequences from legitimizing flawed research. ¹³ As a specialty journal, WEM is fortunate that it has a dedicated and committed stable of reviewers, but future success will require editorial vigilance. I look forward to the next 35 years of WEM and renew our commitment toward maintaining high standards and delivering an academically rigorous journal.