Looming struggles over technology for border control

New technologies under development, capable of inflicting pain on masses of people, could be used for border control against asylum seekers. Implementation might be rationalized by the threat of mass migration due to climate change, nuclear disaster or exaggerated fears of refugees created by governments. We focus on taser anti-personnel mines, suggesting both technological countermeasures and ways of making the use of such technology politically counterproductive. We also outline several other types of ‘non-lethal’ technology that could be used for border control and raise human rights concerns: high-powered microwaves, armed robots, wireless tasers, acoustic devices/vortex rings, ionizing and pulsed energy lasers, chemical calmatives, convulsants, bioregulators and malodurants. Whether all these possible border technologies will be implemented is a matter for speculation, but their serious human rights implications warrant advance scrutiny

Comparative clinical and cost effectiveness of non-ST elevation myocardial infarction management strategies in patients living with kidney impairment during the COVID-19 pandemic: protocol for a target trial emulation using English routinely collected health data

Introduction: Recent national and international guidelines recommend an invasive cardiac investigation and treatment strategy for people at high risk of cardiovascular events, regardless of kidney function status. These guidelines are based on observational evidence suggesting that the benefits of invasive cardiac investigation and treatment versus conservative management for non-ST elevated myocardial infarction (NSTEMI) outweigh the risks for people with kidney impairment. Despite this, among people with kidney impairment there is substantial variation in the proportions who have early invasive versus conservative NSTEMI management across hospitals in England. The impact of the COVID-19 pandemic on this variation is unknown. This protocol describes a study to investigate this variation and any changes during the COVID-19 pandemic, and how this variation will be used to evaluate the comparative clinical and cost-effectiveness of alternative NSTEMI treatment strategies among people with reduced kidney function. Methods and analysis: The CVD-COVID-UK/COVID-IMPACT British Heart Foundation (BHF) Data Science Centre Secure Data Environment, which contains nationally representative linked data on over 50 million people living in the United Kingdom, will be used to define a cohort of people hospitalised for NSTEMI. We will use linked secondary care data (Hospital Episode Statistics and National Institute for Cardiovascular Outcomes Research Audit) for cases with recent evidence of kidney impairment in primary care data (General Practice Extraction Service Data for pandemic planning and research) between 2019 and 2024. First, we will describe variation in early invasive versus conservative NSTEMI management at the hospital-level before and during the COVID-19 pandemic. Second, we will emulate a hypothetical trial using the target trial emulation framework to evaluate the comparative and cost-effectiveness of early invasive versus conservative NSTEMI management among people with reduced kidney function. We will use advanced analytical methods (clone-censor-weighting and instrumental variable analyses) to minimise the risk of bias due to immortal time and confounding by indication. Ethics and dissemination: This study was reviewed and approved by the BHF Data Science Centre Scientific and Public Panels. Results will be published in peer-reviewed journals, presented at conferences, and shared at patient and public panels. Analysis code will be shared in line with the BHF Data Science Centre’s code-sharing procedures

The use of SGLT2 inhibitors in people with diabetes‐related foot disease: A Delphi‐based consensus study

Aims To generate expert consensus-based clinical recommendations on the use of SGLT2 inhibitors in those with diabetes and diabetes-related foot disease (DFD). Materials and Methods This study employed a two-round online Delphi technique. Participants were healthcare practitioners from a range of relevant clinical backgrounds, recruited using convenience sampling. The statements for consideration were iteratively developed by study team members with expertise in managing diabetes and prescribing SGLT2 inhibitors, supported by key professional organisations and people with lived experience of DFD. Statements were ranked using a 6-point Likert Scale from Strongly Agree to Strongly Disagree. Consensus status for each statement was based on the Average Percent of Majority Opinions for each statement. Results Twenty-one participants completed round 1 of the survey, with 19 completing round 2. Participants represented a diverse range of healthcare professions, including Diabetologists, General Practitioners, Nurses and Pharmacists. Of the 25 total statements, 16 reached consensus (13 in round 1 and 3 in round 2), including: agreement on prescribing SGLT2 inhibitors to people with type 2 diabetes (regardless of ulceration status) with concurrent heart failure and/or chronic kidney disease; agreement that those with a previous healed ulcer or amputation should be prescribed SGLT2 inhibitors; disagreement that SGLT2 inhibitors per se increase amputation risk; agreement that canagliflozin should be avoided in this group. Conclusions These findings evidence the relative confidence of experienced clinicians in prescribing SGLT2 inhibitors to those with DFD, provided that they do not have a current ulcer and that canagliflozin is not prescribed

The typing of enteroviruses in tissue culture by neutralization with composite antiserum pools

A scheme is described for the identification of enteroviruses in tissue culture by neutralization with composite antiserum pools. The method for making these pools is given. Antisera to twenty-seven enteroviruses were included in the pools which were used to examine 115 viruses consisting of ninety-eight recently isolated viruses and seventeen prototype strains. The results indicate that this scheme provides a useful screening method for identifying enteroviruses. It has proved to be practicable, time saving and very economical in tissue culture.We are grateful to Dr C. M. P. Bradstreet who made available some of the rabbit antisera.</jats:p