NorthAm Fest : fostering a North American continent approach to countering terrorism.

On September 14-16, 2004, the Advanced Concepts Group of Sandia National Laboratories in conjunction with the University of Texas at El Paso and the North American Institute hosted a workshop (fest) designed to explore the concept of a North American continental approach to countering terrorism. The fest began with the basic premise that the successful defense of North America against the threat of terrorism will require close collaboration among the North American allies--Canada, Mexico and the U.S.--as well as a powerful set of information collection and analysis tools and deterrence strategies. The NorthAm Fest recast the notion of ''homeland defense'' as a tri-national effort to protect the North American continent against an evolving threat that respects no borders. This is a report of the event summarizing the ideas explored. The fest examined the uniqueness of dealing with terrorism from a tri-national North American viewpoint, the role and possible features of joint security systems, concepts for ideal continental security systems for North America, and the challenges and opportunities for such systems to become reality. The following issues were identified as most important for the advancement of this concept. (1) The three countries share a set of core values--democracy, prosperity and security--which form the basis for joint interactions and allow for the development of a culture of cooperation without affecting the sovereignty of the members. (2) The creation of a continental defensive strategy will require a set of strategic guidelines and that smart secure borders play a pivotal role. (3) Joint security systems will need to operate from a set of complementary but not identical policies and procedures. (4) There is a value in joint task forces for response and shared information systems for the prevention of attacks. (5) The private sector must play a critical role in cross-border interactions. Finally, participants envisioned a ''Tri-National Security Laboratory'' to develop and test new counter-terrorism technologies and processes. The fest was an important first step in developing a tri-national approach to continental security and very different approaches to countering terrorism were explored. Participants came to the conclusion that continental security would be easier to achieve if the focus were on broader security issues, such as transnational crime, with terrorism being only a part of the focus. A series of fledgling relationships were begun between individuals and organizations through which actions can occur. A first commitment is the publication by a set of participants representing the three countries of a joint paper outlining the elements of a Continental Security approach

Taking stock after a decade: Does the ‘thresholds of potential concern’ concept need a socio-ecological revamp?

The concept of thresholds of potential concern (TPCs) as implemented for the last decade in strategic adaptive management in South African National Parks (SANParks), has proved workable in practice in a number of instances, but in others appears beset by conceptual and practical limitations or barriers. Three common challenges relate to (1) situations where there is uncertainty about whether and where real thresholds exist, (2) whether and how preferences and other social constructs, as opposed to what were seen as objective biophysical variables only, can be used for TPCs and (3) whether it is admissible to adjust TPCs to allow for variations in societal behaviour, in particular rate of management response. All three challenges arise in the face of TPC objectivity implied by the original definition, and in the light of the original view that TPCs be set some distance prior to a presumed ecological threshold. This paper suggests that the three challenges can be partly or largely dealt with by the use of a wider socio-ecological view, rather than seeing TPCs in isolation or as being only biophysical. Also, while detection of abrupt changes is helpful, it makes little practical difference if some TPCs happen to describe linear processes. The very decision to intervene can induce an abrupt change. Once a wider socio-ecological approach is employed, it becomes necessary for the user to specify the particular usage envisaged for the TPC, for instance, whether it is considered a preference and whether that preference is believed in any way to be related to an ecological threshold. In all cases, it is recommended that some form of explicit representation of the socio- ecological view is constructed – we suggest a cause-and-effect diagram (and give an example generated through a thought experiment) which describes presumed relationships in the subsystem of interest. This provides a broader systemic context and a shared understanding, and has implications for considering scenarios and management alternatives. For practical reasons, from the several states and processes in such a subsystem, only a few links can be chosen on which to base particular TPCs. If we have understood the subsystem well enough, these few links, at each of which a TPC is developed, will act as diagnostic points at which we can monitor the performance of the subsystem adequately. A broadened definition of a TPC is presented, supporting this approach. Conservation implications: The concept of thresholds (initially ecological thresholds) has started influencing conservation management practice, a commonly-used formulation for management decision-making being the threshold of potential concern (TPC). Practical TPC usage can often be improved by moving away from its initially pure ecological outlook, rather framing understanding through an interlinked socio-ecological view

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19).

The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p  Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situation

Characteristics and predictors of death among 4035 consecutively hospitalized patients with COVID-19 in Spain.

To analyse the characteristics and predictors of death in hospitalized patients with coronavirus disease 2019 (COVID-19) in Spain. A retrospective observational study was performed of the first consecutive patients hospitalized with COVID-19 confirmed by real-time PCR assay in 127 Spanish centres until 17 March 2020. The follow-up censoring date was 17 April 2020. We collected demographic, clinical, laboratory, treatment and complications data. The primary endpoint was all-cause mortality. Univariable and multivariable Cox regression analyses were performed to identify factors associated with death. Of the 4035 patients, male subjects accounted for 2433 (61.0%) of 3987, the median age was 70 years and 2539 (73.8%) of 3439 had one or more comorbidity. The most common symptoms were a history of fever, cough, malaise and dyspnoea. During hospitalization, 1255 (31.5%) of 3979 patients developed acute respiratory distress syndrome, 736 (18.5%) of 3988 were admitted to intensive care units and 619 (15.5%) of 3992 underwent mechanical ventilation. Virus- or host-targeted medications included lopinavir/ritonavir (2820/4005, 70.4%), hydroxychloroquine (2618/3995, 65.5%), interferon beta (1153/3950, 29.2%), corticosteroids (1109/3965, 28.0%) and tocilizumab (373/3951, 9.4%). Overall, 1131 (28%) of 4035 patients died. Mortality increased with age (85.6% occurring in older than 65 years). Seventeen factors were independently associated with an increased hazard of death, the strongest among them including advanced age, liver cirrhosis, low age-adjusted oxygen saturation, higher concentrations of C-reactive protein and lower estimated glomerular filtration rate. Our findings provide comprehensive information about characteristics and complications of severe COVID-19, and may help clinicians identify patients at a higher risk of death