Advice on assistance and protection from the Scientific Advisory Board of the Organisation for the Prohibition of Chemical Weapons : Part 2. On preventing and treating health effects from acute, prolonged, and repeated nerve agent exposure, and the identification of medical countermeasures able to reduce or eliminate the longer term health effects of nerve agents

The Scientific Advisory Board (SAB) of the Organisation for the Prohibition of Chemical Weapons (OPCW) has provided advice in relation to the Chemical Weapons Convention on assistance and protection. We present the SAB’s response to a request from the OPCW Director-General in 2014 for information on the best practices for preventing and treating the health effects from acute, prolonged, and repeated organophosphorus nerve agent (NA) exposure. The report summarises pre- and post-exposure treatments, and developments in decontaminants and adsorbing materials, that at the time of the advice, were available for NAs. The updated information provided could assist medics and emergency responders unfamiliar with treatment and decontamination options related to exposure to NAs. The SAB recommended that developments in research on medical countermeasures and decontaminants for NAs should be monitored by the OPCW, and used in assistance and protection training courses and workshops organised through its capacity building programmes.Peer reviewe

Advice from the Scientific Advisory Board of the Organisation for the Prohibition of Chemical Weapons on riot control agents in connection to the Chemical Weapons Convention

Compounds that cause powerful sensory irritation to humans were reviewed by the Scientific Advisory Board (SAB) of the Organisation for the Prohibition of Chemical Weapons (OPCW) in response to requests in 2014 and 2017 by the OPCW Director-General to advise which riot control agents (RCAs) might be subject to declaration under the Chemical Weapons Convention (the Convention). The chemical and toxicological properties of 60 chemicals identified from a survey by the OPCW of RCAs that had been researched or were available for purchase, and additional chemicals recognised by the SAB as having potential RCA applications, were considered. Only 17 of the 60 chemicals met the definition of a RCA under the Convention. These findings were provided to the States Parties of the Convention to inform the implementation of obligations pertaining to RCAs under this international chemical disarmament and non-proliferation treaty.Peer reviewe

advice from the scientific advisory board of the organisation for the prohibition of chemical weapons on isotopically labelled chemicals and stereoisomers in relation to the chemical weapons convention

AbstractThe Chemical Weapons Convention (CWC) is an international disarmament treaty that prohibits the development, stockpiling and use of chemical weapons. This treaty has 193 States Parties (nations for which the treaty is binding) and entered into force in 1997. The CWC contains schedules of chemicals that have been associated with chemical warfare programmes. These scheduled chemicals must be declared by the States that possess them and are subject to verification by the Organisation for the Prohibition of Chemical Weapons (OPCW, the implementing body of the CWC). Isotopically labelled and stereoisomeric variants of the scheduled chemicals have presented ambiguities for interpretation of the requirements of treaty implementation, and advice was sought from the OPCW's Scientific Advisory Board (SAB) in 2016. The SAB recommended that isotopically labelled compounds or stereoisomers related to the parent compound specified in a schedule should be interpreted as belonging to the same schedule. This advice should benefit scientists and diplomats from the CWC's State Parties to help ensure a consistent approach to their declarations of scheduled chemicals (which in turn supports both the correctness and completeness of declarations under the CWC). Herein, isotopically labelled and stereoisomeric variants of CWC-scheduled chemicals are reviewed, and the impact of the SAB advice in influencing a change to national licensing in one of the State Parties is discussed. This outcome, an update to national licensing governing compliance to an international treaty, serves as an example of the effectiveness of science diplomacy within an international disarmament treaty

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Advice on chemical weapons sample stability and storage provided by the Scientific Advisory Board of the Organisation for the Prohibition of Chemical Weapons to increase investigative capabilities worldwide

Abstract The Scientific Advisory Board (SAB) of the Organisation for the Prohibition of Chemical Weapons (OPCW) has provided advice on the long-term storage and stability of samples collected in the context of chemical weapons investigations. The information they compiled and reviewed is beneficial to all laboratories that carry out analysis of samples related to chemical warfare agents and is described herein. The preparation of this report was undertaken on request from the OPCW Director-General. The main degradation products for chemicals on the Schedules in the Annex on Chemicals of the Chemical Weapons Convention are tabulated. The expertise of the 25 scientists comprising the SAB, a review of the scientific literature on environmental and biomedical sample analysis, and answers to a questionnaire from chemists of nine OPCW Designated Laboratories, were drawn upon to provide the advice. Ten recommendations to ensure the long-term storage and stability of samples collected in relation to the potential use of chemical weapons were provided and are repeated here for the consideration of all laboratories worldwide.Peer reviewe

Advice on assistance and protection provided by the Scientific Advisory Board of the Organisation for the Prohibition of Chemical Weapons: Part 1. On medical care and treatment of injuries from nerve agents

The Scientific Advisory Board (SAB) of the Organisation for the Prohibition of Chemical Weapons (OPCW) has provided advice on assistance and protection in relation to the Chemical Weapons Convention. In this, the first of several papers describing the SAB's work on this topic, we describe advice given in response to questions from the OPCW Director-General in 2013 and 2014 on the status of available medical countermeasures and treatments to organophosphorus nerve agents. This paper provides the evidence base for this advice which recommended to the OPCW pretreatments, emergency care, and long-term treatments that were available at the time of the request for this class of chemical warfare agent (CWA). It includes a bibliography of over 140 scientific references, which can be used as a platform for watching future medical countermeasure developments. The information provided in this paper should serve as a valuable reference for medical professionals and emergency responders who may have no knowledge of the symptoms and treatment options of exposure to nerve agents.Fil: Timperley, Christopher M.. Defence Science and Technology Laboratory; Reino UnidoFil: Forman, Jonathan E.. OPCW Scientific Advisory Board Secretary and Science Policy Adviser; Países BajosFil: Abdollahi, Mohammad. Tehran University Of Medical Sciences; IránFil: Al-Amri, Abdullah Saeed. Saudi Basic Industries Corporation; Arabia SauditaFil: Baulig, Augustin. Secrétariat Général de la Défense et de la Sécurité Nationale; FranciaFil: Benachour, Djafer. Ferhat Abbas University, Setif-1; ArgeliaFil: Borrett, Veronica. Bai Scientific; Australia. University of Melbourne; AustraliaFil: Cariño, Flerida A.. University of the Philippines; FilipinasFil: Geist, Michael. Basf Se; AlemaniaFil: Gonzalez, David. Universidad de la República Facultad de Química; Uruguay. Universidad de la República; UruguayFil: Kane, William. Monsanto Company; Estados UnidosFil: Kovarik, Zrinka. Institute for Medical Research and Occupational Health; CroaciaFil: Martínez Álvarez, Roberto. Universidad Complutense de Madrid; EspañaFil: Mourão, Nicia Maria Fusaro. ABIQUIM; BrasilFil: Neffe, Slawomir. Military University of Technology; PoloniaFil: Raza, Syed K.. Institute Of Pesticide Formulation Technology (ipft); IndiaFil: Rubaylo, Valentin. State Scientific Research Institute of Organic Chemistry and Technology; RusiaFil: Suarez, Alejandra Graciela. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario. Instituto de Química Rosario. Universidad Nacional de Rosario. Facultad de Ciencias Bioquímicas y Farmacéuticas. Instituto de Química Rosario; ArgentinaFil: Takeuchi, Koji. National Institute of Advanced Industrial Science and Technology; JapónFil: Tang, Cheng. National Defence University; ChinaFil: Trifirò, Ferruccio. Universidad de Bologna; ItaliaFil: van Straten, Francois Mauritz. South African Nuclear Energy Corporation SOC Ltd; SudáfricaFil: Vanninen, Paula S.. Helsingin Yliopisto; FinlandiaFil: Vucinic, Slavica. Vojnomedicinska Akademija; SerbiaFil: Zaitsev, Volodymyr. Pontifícia Universidade Católica do Rio de Janeiro; Brasil. Taras Shevchenko National University of Kyiv, Kyiv; UcraniaFil: Zafar Uz Zaman, Muhammad. National Engineering And Scientific Commission (nescom); PakistánFil: Zina, Mongia Saïd. Université de Tunis El Manar, Faculté Des Sciences de Tunis; TúnezFil: Holen, Stian. Opcw Scientific Advisory Board Secretary; Países Bajo

Advice on assistance and protection provided by the Scientific Advisory Board of the Organisation for the Prohibition of Chemical Weapons: Part 3. On medical care and treatment of injuries from sulfur mustard

Blister agents damage the skin, eyes, mucous membranes and subcutaneous tissues. Other toxic effects may occur after absorption. The response of the Scientific Advisory Board (SAB) of the Organisation for the Prohibition of Chemical Weapons (OPCW) to a request from the OPCW Director-General in 2013 on the status of medical countermeasures and treatments to blister agents is updated through the incorporation of the latest information. The physical and toxicological properties of sulfur mustard and clinical effects and treatments are summarised. The information should assist medics and emergency responders who may be unfamiliar with the toxidrome of sulfur mustard and its treatment.Fil: Timperley, Christopher M.. Defence Science And Technology Laboratory; Reino UnidoFil: Forman, Jonathan E.. Organisation For The Prohibition Of Chemical Weapons; Países BajosFil: Abdollahi, Mohammad. Tehran University of Medical Sciences; IránFil: Al-Amri, Abdullah Saeed. Saudi Basic Industries Corporation; Arabia SauditaFil: Baulig, Augustin. Secrétariat Général de la Défense Et de la Sécurité Nationale; FranciaFil: Benachour, Djafer. Ferhat Abbas University; ArgeliaFil: Borrett, Veronica. La Trobe University; AustraliaFil: Cariño, Flerida A.. University Of The Philippines Diliman; FilipinasFil: Curty, Christophe. Spiez Laboratory; SuizaFil: Geist, Michael. Basf Se; AlemaniaFil: Gonzalez, David. Universidad de la República; UruguayFil: Kane, William. Monsanto Company; Estados UnidosFil: Kovarik, Zrinka. Institut Za Medicinska Istrazivanja I Medicinu Rada; CroaciaFil: Martínez Álvarez, Roberto. Universidad Complutense de Madrid; EspañaFil: Mourão, Nicia Maria Fusaro. Brazilian Chemical Industry; BrasilFil: Neffe, Slawomir. Wojskowa Akademia Techniczna; PoloniaFil: Raza, Syed K.. National Accreditation Board For Testing And Calibration Laboratories; IndiaFil: Rubaylo, Valentin. State Research Institute Of Organic Chemistry And Technology; RusiaFil: Suarez, Alejandra Graciela. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario. Instituto de Química Rosario. Universidad Nacional de Rosario. Facultad de Ciencias Bioquímicas y Farmacéuticas. Instituto de Química Rosario; ArgentinaFil: Takeuchi, Koji. National Institute Of Advanced Industrial Science And Technology; JapónFil: Tang, Cheng. Ministry of National Defence. Office for the Disposal of Japanese Abandoned Chemical Weapons; ChinaFil: Trifirò, Ferruccio. Universidad de Bologna; ItaliaFil: Straten, Francois Mauritz van. Independent Former Opcw Sab Member; SudáfricaFil: Vanninen, Paula S.. University of Helsinki; FinlandiaFil: Vucinic, Slavica. Vojnomedicinska Akademija; SerbiaFil: Zaitsev, Volodymyr. Pontifícia Universidade Católica do Rio de Janeiro; BrasilFil: Zafar-Uz-Zaman, Muhammad. National Engineering And Scientific Commission; PakistánFil: Zina, Mongia Saïd. Université de Tunis El Manar, Faculté Des Sciences de Tunis; TúnezFil: Holen, Stian. OPCW; Países BajosFil: Alwan, Wesam S.. Monash University; AustraliaFil: Suri, Vivek. OPCW Office of Strategy and Policy; Países BajosFil: Hotchkiss, Peter J.. Organisation For The Prohibition Of Chemical Weapons; Países BajosFil: Ghanei, Mostafa. Baqiyatallah University Of Medical Sciences; Irá

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population

Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries

© 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 licenseBackground: 80% of individuals with cancer will require a surgical procedure, yet little comparative data exist on early outcomes in low-income and middle-income countries (LMICs). We compared postoperative outcomes in breast, colorectal, and gastric cancer surgery in hospitals worldwide, focusing on the effect of disease stage and complications on postoperative mortality. Methods: This was a multicentre, international prospective cohort study of consecutive adult patients undergoing surgery for primary breast, colorectal, or gastric cancer requiring a skin incision done under general or neuraxial anaesthesia. The primary outcome was death or major complication within 30 days of surgery. Multilevel logistic regression determined relationships within three-level nested models of patients within hospitals and countries. Hospital-level infrastructure effects were explored with three-way mediation analyses. This study was registered with ClinicalTrials.gov, NCT03471494. Findings: Between April 1, 2018, and Jan 31, 2019, we enrolled 15 958 patients from 428 hospitals in 82 countries (high income 9106 patients, 31 countries; upper-middle income 2721 patients, 23 countries; or lower-middle income 4131 patients, 28 countries). Patients in LMICs presented with more advanced disease compared with patients in high-income countries. 30-day mortality was higher for gastric cancer in low-income or lower-middle-income countries (adjusted odds ratio 3·72, 95% CI 1·70–8·16) and for colorectal cancer in low-income or lower-middle-income countries (4·59, 2·39–8·80) and upper-middle-income countries (2·06, 1·11–3·83). No difference in 30-day mortality was seen in breast cancer. The proportion of patients who died after a major complication was greatest in low-income or lower-middle-income countries (6·15, 3·26–11·59) and upper-middle-income countries (3·89, 2·08–7·29). Postoperative death after complications was partly explained by patient factors (60%) and partly by hospital or country (40%). The absence of consistently available postoperative care facilities was associated with seven to 10 more deaths per 100 major complications in LMICs. Cancer stage alone explained little of the early variation in mortality or postoperative complications. Interpretation: Higher levels of mortality after cancer surgery in LMICs was not fully explained by later presentation of disease. The capacity to rescue patients from surgical complications is a tangible opportunity for meaningful intervention. Early death after cancer surgery might be reduced by policies focusing on strengthening perioperative care systems to detect and intervene in common complications. Funding: National Institute for Health Research Global Health Research Unit