The bioscience revolution & the biological weapons threat: levers & interventions

In December 2008, the US Commission on the Prevention of Weapons of Mass Destruction Proliferation and Terrorism, released a report, World At Risk. The Report points to the fact that, not only is the use of a weapon of mass destruction in a terrorist attack before the end of 2013, more likely than not, but also to the fact that terrorists are more likely to be able to obtain and use biological weapons than nuclear. This paper examines the recommendations of the report in the context of the historic and geopolitical changes, in particular globalization. The authors highlight the "dual-use" dilemma, as described in the report, as the paradoxical use of technology developed for the benefit of mankind being used for sinister purposes. The mitigation of such a threat lies in broad stakeholder involvement and cooperation, including non-state actors, governments and the bio-tech industry itself. The importance of vigilance measures within the life science community is emphasized and, the authors propose, could include a web-based didactic course in bioterrorism and weapons of mass destruction identification. The site could outline safety protocols, have detailed disaster management tutorials, and could be specifically tailored for different subsets of industry and health professionals. The paper concludes with an endorsement of a multi-pronged approach including strong international guidelines and intelligence cooperation and preparatory measures such as the wide-spread use of detection systems as well as diagnostic decision support systems for bioterrorism detection at the local level

Advances in the simulation of debris flow erosion: The case study of the Rio Gere (Italy) event of the 4th August 2017

Abstract Debris flows are natural hazards causing fatalities and damages to infrastructures every year. One of the current challenges is to improve the predictability of such events using simulation tools. In this direction, the paper aims to model debris-flow generation starting from the water component and then simulating the motion of the bulked solid-fluid mixture mass flow. The debris component is progressively increased through entrainment of the channel bed material. The simulation has been performed exploiting the tool r.avaflow, which implements a physically-based model (Pudasaini and Mergili, 2019) for the flow propagation and an empirical multi-phase model for the entrainment processes. The investigated study case occurred in the Northeastern Alps of Italy, near the town of Cortina d'Ampezzo (Veneto Region), during the summer of 2017. The debris flow was triggered by a heavy rainstorm that caused extreme surface runoff, leading to entrainment of sediment from the channel bed. The debris flow obstructed the bridge of a regional road and consequently flooded the adjacent areas. Different types of debris flow simulations are performed, testing four specific functions to compute the entrainment rate. The simulated results are then compared against field observations. The analysis considers the differences in volume and depth of entrainment and in the output hydrograph. We conclude that entrainment is correlated with the terrain slope, particularly if it is calculated on a smoothed digital elevation model, which dilutes a less significant local steepness. We calibrate a spatially distributed slope-dependent erosion coefficient that successfully reproduced the observed entrainment volumes. The outcomes highlight the great importance of simulating debris flow entrainment processes adopting a multiphase model, which resulted particularly suitable for an accurate reproduction of the investigated event. The results, corroborated by further verifications, can improve the reliability of challenging predictive simulations on debris flow erosion

Global health funding and economic development

The impact of increased national wealth, as measured by Gross Domestic Product (GDP), on public health is widely understood, however an equally important but less well-acclaimed relationship exists between improvements in health and the growth of an economy. Communicable diseases such as HIV, TB, Malaria and the Neglected Tropical Diseases (NTDs) are impacting many of the world's poorest and most vulnerable populations, and depressing economic development. Sickness and disease has decreased the size and capabilities of the workforce through impeding access to education and suppressing foreign direct investment (FDI). There is clear evidence that by investing in health improvements a significant increase in GDP per capita can be attained in four ways: Firstly, healthier populations are more economically productive; secondly, proactive healthcare leads to decrease in many of the additive healthcare costs associated with lack of care (treating opportunistic infections in the case of HIV for example); thirdly, improved health represents a real economic and developmental outcome in-and-of itself and finally, healthcare spending capitalises on the Keynesian 'economic multiplier' effect. Continued under-investment in health and health systems represent an important threat to our future global prosperity. This editorial calls for a recognition of health as a major engine of economic growth and for commensurate investment in public health, particularly in poor countries

Real-time PCR-based methods for detection of Hepatitis E virus in pork products: a critical review

Standard methods for detection of hepatitis A virus and norovirus in at-risk foodstuffs are available, but currently there is no standard method for detection of hepatitis E virus (HEV) in pork products or other foods that can be contaminated with the virus. Detection assays for HEV are mainly based on nucleic acid amplification, particularly the reverse transcription polymerase chain reaction (RTPCR) in real-time format. RTPCR-based methods can be sensitive and specific, but they require a suite of controls to verify that they have performed correctly. There have been several RTPCR methods developed to detect HEV in pork products, varying in details of sample preparation and RTPCR target sequences. This review critically discusses published HEV detection methods, with emphasis on those that have been successfully used in subsequent studies and surveys. RTPCR assays have been used both qualitatively and quantitatively, although in the latter case the data acquired are only reliable if appropriate assay calibration has been performed. One particular RTPCR assay appears to be ideal for incorporation in a standard method, as it has been demonstrated to be highly specific and sensitive, and an appropriate control and calibration standard is available. The review focuses on the detection of HEV in pork products and similar foodstuffs (e.g., boar). The information may be useful to inform standardisation activities

Unraveling the complexities of the Last Glacial Maximum climate: the role of individual boundary conditions and forcings

In order to quantify the relative importance of individual boundary conditions and forcings, including greenhouse gases, ice sheets, and Earth’s orbital parameters, on determining Last Glacial Maximum (LGM) climate, we have performed a series of LGM experiments using a state-of-the-art climate model AWI-ESM, in which different combinations of boundary conditions and forcings have been applied following the protocol of Paleoclimate Modelling Intercomparison Project phase 4 (PMIP4). In good agreement with observational proxy records, a general colder and drier climate is simulated in our full-forced LGM experiment as compared to the present-day simulation. Our simulated results from non-full-forced sensitivity simulations reveal that both the greenhouse gases and ice sheets play a major role in defining the anomalous LGM surface temperature compared to today. Decreased greenhouse gases in LGM as compared to present day leads to a non-uniform global cooling with polar amplification effect. The presence of LGM ice sheets favors a warming over the Arctic and northern Atlantic oceans in boreal winter, as well as a cooling over regions with the presence of ice sheets. The former is induced by a strengthening in the Atlantic meridional overturning circulation (AMOC) transporting more heat to high latitudes, whilst the latter is due to the increased surface albedo and elevation of ice sheets. We find that the Northern Hemisphere monsoon precipitation is influenced by the opposing effects of LGM greenhouse gases and ice sheets. Specifically, the presence of ice sheets leads to significant drying in the Northern Hemisphere monsoon regions, while a reduction in greenhouse gases results in increased monsoon rainfall. Based on our model results, continental ice sheets exert a major control on atmospheric dynamics and the variability of El Niño–Southern Oscillation (ENSO). Moreover, our analysis also implies a nonlinearity in climate response to LGM boundary conditions and forcings

Optimal Strategies in Infinite-state Stochastic Reachability Games

We consider perfect-information reachability stochastic games for 2 players on infinite graphs. We identify a subclass of such games, and prove two interesting properties of it: first, Player Max always has optimal strategies in games from this subclass, and second, these games are strongly determined. The subclass is defined by the property that the set of all values can only have one accumulation point -- 0. Our results nicely mirror recent results for finitely-branching games, where, on the contrary, Player Min always has optimal strategies. However, our proof methods are substantially different, because the roles of the players are not symmetric. We also do not restrict the branching of the games. Finally, we apply our results in the context of recently studied One-Counter stochastic games

Survey of ultrasound practice amongst podiatrists in the UK

Background: Ultrasound in podiatry practice encompasses musculoskeletal ultrasound imaging, vascular hand-held Doppler ultrasound and therapeutic ultrasound. Sonography practice is not regulated by the Health and Care Professions Council (HCPC), with no requirement to hold a formal qualification. The College of Podiatry does not currently define ultrasound training and competencies. This study aimed to determine the current use of ultrasound, training received and mentorship received and/or provided by podiatrists using ultrasound. Methods: A quantitative study utilising a cross-sectional, on-line, single-event survey was undertaken within the UK. Results: Completed surveys were received from 284 podiatrists; 173 (70%) use ultrasound as part of their general practice, 139 (49%) for musculoskeletal problems, 131 (46%) for vascular assessment and 39 (14%) to support their surgical practice. Almost a quarter (n=62) worked for more than one organisation; 202 (71%) were employed by the NHS and/or private sector (n=118, 41%). Nearly all (93%) respondents report using a hand-held vascular Doppler in their daily practice; 216 (82%) to support decisions regarding treatment options, 102 (39%) to provide diagnostic reports for other health professionals, and 34 (13%) to guide nerve blocks. Ultrasound imaging was used by 104 (37%) respondents primarily to aid clinical decision making (n=81) and guide interventions (steroid injections n=67; nerve blocks n=39). Ninety-three percent stated they use ultrasound imaging to treat their own patients, while others scan at the request of other podiatrists (n=28) or health professionals (n=18). Few use ultrasound imaging for research (n=7) or education (n=2). Only 32 (11%) respondents (n=20 private sector) use therapeutic ultrasound to treat patients presenting with musculoskeletal complaints, namely tendon pathologies. Few respondents (18%) had completed formal post-graduate CASE (Consortium for the Accreditation of Sonographic Education) accredited ultrasound courses. Forty (14%) respondents receive ultrasound mentorship; the majority from fellow podiatrists (n=17) or medical colleagues (n=15). Over half (n=127) who do not have ultrasound mentorship indicated they would like a mentor predominantly for ultrasound imaging. Fifty-five (19%) report they currently provide ultrasound mentorship for others. Conclusions: Understanding the scope of ultrasound practice, the training undertaken and the requirements for mentorship will underpin the development of competencies and recommendations defined by the College of Podiatry to support professional development and ensure safe practice.</p

Physical distancing interventions and incidence of coronavirus disease 2019: natural experiment in 149 countries.

OBJECTIVE: To evaluate the association between physical distancing interventions and incidence of coronavirus disease 2019 (covid-19) globally. DESIGN: Natural experiment using interrupted time series analysis, with results synthesised using meta-analysis. SETTING: 149 countries or regions, with data on daily reported cases of covid-19 from the European Centre for Disease Prevention and Control and data on the physical distancing policies from the Oxford covid-19 Government Response Tracker. PARTICIPANTS: Individual countries or regions that implemented one of the five physical distancing interventions (closures of schools, workplaces, and public transport, restrictions on mass gatherings and public events, and restrictions on movement (lockdowns)) between 1 January and 30 May 2020. MAIN OUTCOME MEASURE: Incidence rate ratios (IRRs) of covid-19 before and after implementation of physical distancing interventions, estimated using data to 30 May 2020 or 30 days post-intervention, whichever occurred first. IRRs were synthesised across countries using random effects meta-analysis. RESULTS: On average, implementation of any physical distancing intervention was associated with an overall reduction in covid-19 incidence of 13% (IRR 0.87, 95% confidence interval 0.85 to 0.89; n=149 countries). Closure of public transport was not associated with any additional reduction in covid-19 incidence when the other four physical distancing interventions were in place (pooled IRR with and without public transport closure was 0.85, 0.82 to 0.88; n=72, and 0.87, 0.84 to 0.91; n=32, respectively). Data from 11 countries also suggested similar overall effectiveness (pooled IRR 0.85, 0.81 to 0.89) when school closures, workplace closures, and restrictions on mass gatherings were in place. In terms of sequence of interventions, earlier implementation of lockdown was associated with a larger reduction in covid-19 incidence (pooled IRR 0.86, 0.84 to 0.89; n=105) compared with a delayed implementation of lockdown after other physical distancing interventions were in place (pooled IRR 0.90, 0.87 to 0.94; n=41). CONCLUSIONS: Physical distancing interventions were associated with reductions in the incidence of covid-19 globally. No evidence was found of an additional effect of public transport closure when the other four physical distancing measures were in place. Earlier implementation of lockdown was associated with a larger reduction in the incidence of covid-19. These findings might support policy decisions as countries prepare to impose or lift physical distancing measures in current or future epidemic waves