An Examination of the Potential Threat of a State-Sponsored Biological Attack Against the United States: A Study of Policy Implications

In 2002, US Navy Seals found a list of pathogens in an Afghanistan cave that Al Qaeda had planned to use in a series of biological attacks. Unique about the discovery was that the pathogens were not limited to human ones. Six pathogens targeted livestock and four targeted crops. Despite this discovery, limited attention has been given to the possibility of a state-sponsored terrorist attack utilizing biological agents against the US population, food source, or water supply. Throughout history, biological agents have been developed for use as an offensive weapon for both states and terrorist groups. The United States may soon see a successful biological attack by a state or nonstate actor against its troops in the Middle East, the Asia Pacific, or its homeland population and agricultural industry. While it is unlikely that such attacks will occur from traditional terrorist groups, it is possible that a state with a biological weapons program will sponsor a biological terrorist attack as a way of progressing its interests against the United States. This thesis provides a background for understanding biological attacks and examines the threat of a state-sponsored biological terrorist attack against the United States and its assets abroad, what the impact would be, possible scenarios for an attack, and policy recommendations to preventing and containing a futuristic attack

Quality of life after sleeve gastrectomy and adjustable gastric banding

Abstract Background: With the addition of laparoscopic vertical sleeve gastrectomy (SG) to the bariatric surgery procedural toolkit, patients desiring a restrictive bariatric procedure often choose between adjustable gastric banding (LAGB) and SG. One study compared quality of life after these 2 procedures and found no difference. The purpose of our study was to re-evaluate the postoperative quality of life in LAGB and SG patients at a military teaching hospital in the United States. Methods: A retrospective review of 108 consecutive laparoscopic restrictive bariatric procedures performed within 15 months at a Department of Defense hospital was conducted. Of these 108 patients, 69 had undergone laparoscopic vertical SG and 39 LAGB. A validated quality of life questionnaire (Bariatric Quality of Life) was conducted a mean of 9.3 Ϯ 3.2 months (range 5-16) postoperatively. The weight loss and standard laboratory parameters were measured at 0, 1, 3, 6, and 12 months. Results: The quality of life assessment revealed significantly better scores after SG than after LAGB (66.5 versus 57.9, P ϭ .0002). The excess weight loss and excess body mass index loss at 3, 6, and 12 months postoperatively were significantly greater in the laparoscopic SG group. The patients demonstrated a clear preference over time for SG once it was offered. Conclusion: Early postoperative quality of life was superior after SG than after LAGB. SG also resulted in superior early excess weight loss. In a practice not constrained by reimbursement, these findings were associated with increased patient choice of SG after it began to be offered. (Surg Obes Relat Dis 2012;8:31-40.

A review of photovoltaic module technologies for increased performance in tropical climate

The global adoption and use of photovoltaic modules (PVMs) as the main source of energy is the key to realising the UN Millennium Development Goals on Green Energy. The technology – projected to contribute about 20% of world energy supply by 2050, over 60% by 2100 and leading to 50% reduction in global CO2 emissions – is threatened by its poor performance in tropical climate. Such performance discourages its regional acceptance. The magnitude of crucial module performance influencing factors (cell temperature, wind speed and relative humidity) reach critical values of 90 °C, 0.2 m/s and 85%, respectively in tropical climates which negatively impact module performance indices which include power output (PO), power conversion efficiency (PCE) and energy payback time (EPBT). This investigation reviews PVM technologies which include cell, contact and interconnection technologies. It identifies critical technology route(s) with potential to increase operational reliability of PVMs in the tropics when adopted. The cell performance is measured by PO, PCE and EPBT while contacts and interconnections performance is measured by the degree of recombination, shading losses and also the rate of thermo-mechanical degradation. It is found that the mono-crystalline cell has the best PCE of 25% while the Cadmium Telluride (CdTe) cell has the lowest EPBT of 8-months. Results show that the poly-crystalline cell has the largest market share amounting to 54%. The CdTe cell exhibits 0% drop in PCE at high-temperatures and low irradiance operations – demonstrating least affected PO by the conditions. Further results establish that back contacts and back-to-back interconnection technologies produce the least recombination losses and demonstrate absence of shading in addition to possessing longest interconnection fatigue life. Based on these findings, the authors propose a PVM comprising CdTe cell, back contacts and back-to-back interconnection technologies as the technology with latent capacity to produce improved performance in tropical climates

Mini-laparoscopy, laparoendoscopic single-site surgery and natural orifice transluminal endoscopic surgery-assisted laparoscopy : novice surgeons’ performance and perception in a porcine nephrectomy model

Study Type--Therapy (case series) Level of Evidence 4. What's known on the subject? and What does the study add? Over the last few years, minimally invasive urological surgery has evolved towards less invasive, 'scarless' procedures. New surgical concepts, such as those of natural orifice transluminal endoscopic surgery (NOTES) and laparoendoscopic single-site surgery (LESS) have been introduced. Mini-laparoscopy has been rediscovered in an attempt to reduce the invasiveness of standard laparoscopy. This study is the first to compare the perception of surgeons when first facing three different scarless options for performing a porcine nephrectomy and when dealing with the constraints of each technique. The study findings suggest that: (i) when first approaching these techniques, surgeons tend to perform equally well under expert guidance in the porcine model; (ii) mini-laparoscopy is perceived as less difficult to perform; (iii) for all the techniques, surgeon's impressions are in line with their expectations. OBJECTIVE: • To evaluate the perception and performance of urological surgeons when first applying scarless surgical techniques. METHODS: • The study was conducted during the 2(nd) Minimally Invasive Urological Surgical Week annual course in Braga, Portugal. • Fourteen attendees performed three porcine nephrectomies by using each of the following techniques: mini-laparoscopy, laparoendoscopic single-site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES)-assisted laparoscopy. • Peri-operative data were recorded, and operating performance was scored by one experienced surgeon for each working station, using a global rating scale. • The surgeons' subjective perceptions of degree of difficulty were graded and their expectations before the procedures were recorded. RESULTS: • Forty-two porcine nephrectomies were performed. • There were no differences in overall operating time, or time to dissect and manage the renal vascular hilum, whereas time to gain access was faster for LESS than for mini-laparoscopy or NOTES-assisted laparoscopy (mean [sd] 8 [6] min vs 10.2 [5.3] min vs 9.9 [5.3] min, respectively; P = 0.59). • A better visualization of the surgical field was obtained with mini-laparoscopy and there was a higher degree of difficulty of bimanual dexterity for LESS, but no significant differences were found among the three techniques for any variable (operating field view: P = 0.52; bimanual dexterity: P = 0.49; efficiency: P = 0.77; tissue handling: P = 0.61; autonomy: P = 0.2). • Subjective perception of the degree of difficulty trended in favour of mini-laparoscopy (P= 0.17), but no significant difference was found in terms of surgeons' impression as compared with their expectations (P = 0.34). CONCLUSIONS: • When first approaching new scarless techniques, surgeons tend to perform equally well under expert guidance in the porcine model. • Mini-laparoscopy is perceived as less difficult to perform and, for all the techniques, surgeons' impressions are in line with their expectations.The authors appreciated the support and participation of the MIUSW course attendees for participating in this study and The Research Endoscopic Laboratory at the University of Minho, as well as, the support of Karl Storz, Germany for providing instrumentation used in the study