Sustavi zaštite hrane kao odgovor na potencijalni teroristički čin putem hrane

Terrorist attacks on critical infrastructures can cause problems to a national stability and functioning. Food and water supply chains are some of the most important infrastructures, and it is the country’s (government’s) obligation to provide sufficient quantities of food and water to its population. Intentional food contamination can, among other motives, originate from an act of terrorism (with political or ideological motives) with the aim of causing fear (terror) among people. Food defence systems can help assess vulnerabilities, determine mitigation strategies for terrorist attack, estimate risks, and prevent a terrorist attack. Risk assessment and prevention also include control over the production and distribution of potential chemical, biological, radiological or nuclear (CBRN) agents or their related materials. When a terrorist attack occurs, rapid and organised response is essential in terms of determining the type of agent used, managing the diseased, ensuring the functioning of the food and water supply, and the recovery of the infrastructure system under attack. Food defence planning as part of a food counterterrorism strategy should include considerations regarding the global food market and the fact that ingredients are supplied from all over the world (vendor certificates). Preventing terrorist attacks on sources of food and water is a far better option than crisis management once an attack had already been committed, but governments should have a response to any scenario.Potencijalni teroristički napad na kritične infrastrukture može prouzročiti problem za stabilnost i funkcioniranje države. Opskrbni lanci hranom i vodom važne su državne infrastrukture, stoga država ima obvezu osigurati dovoljne količine hrane i vode svom pučanstvu. Namjerno trovanje hrane kazneno je djelo koje nastaje terorističkim činom (politički i ideološki motivi) ili izazivanjem straha (terora) među ljudima. Sustavi zaštite hrane mogu pomoći pri procjeni ranjivosti, određivanju strategija ublažavanja terorističkoga napada te pri procjeni rizika i sprječavanju rizika od terorističkoga napada. U procjenu i sprječavanje rizika pripada i kontrola prometa i proizvodnje potencijalnih kemijskih, bioloških, radioloških i nuklearnih (KBRN) agensâ ili srodnih materijala u državi i izvan nje. Kada se teroristički napad dogodi, bitan je brz i organiziran odgovor države u smislu određivanja vrste korištenog agensa, zbrinjavanja oboljelih, nastavka funkcioniranja opskrbe hranom i vodom nakon napada te oporavka napadnutoga sustava. Planiranje zaštite hrane kao dio strategije za borbu protiv terorizma hranom odnosno agroterorizma treba uključiti razmatranje globalnoga lanca opskrbe sastojcima hrane koja se nabavlja diljem svijeta (proizvođački certifikati). Prevencija terorističkoga napada na hranu bolji je izbor nego upravljanje kriznim događajem (počinjeni napad), ali država bi trebala imati spreman odgovor na sve opcije

Period and Cohort Changes in Americans’ Support for Marijuana Legalization: Convergence and Divergence across Social Groups

We cast fresh light on how and why Americans’ views on marijuana legalization shifted between 1973 and 2014. Results from age-period-cohort models show a strong negative effect of age and relatively high levels of support for legalization among baby boom cohorts. Despite the baby boom effect, the large increase in support for marijuana legalization is predominantly a broad, period-based change in the population. Additional analyses demonstrate that differences in support for legalization by education, region, and religion decline, that differences by political party increase, and that differences between whites and African Americans reverse direction. We conclude by discussing the implications of these findings and by identifying promising directions for future research on this topic

Albiglutide and cardiovascular outcomes in patients with type 2 diabetes and cardiovascular disease (Harmony Outcomes): a double-blind, randomised placebo-controlled trial

Background: Glucagon-like peptide 1 receptor agonists differ in chemical structure, duration of action, and in their effects on clinical outcomes. The cardiovascular effects of once-weekly albiglutide in type 2 diabetes are unknown. We aimed to determine the safety and efficacy of albiglutide in preventing cardiovascular death, myocardial infarction, or stroke. Methods: We did a double-blind, randomised, placebo-controlled trial in 610 sites across 28 countries. We randomly assigned patients aged 40 years and older with type 2 diabetes and cardiovascular disease (at a 1:1 ratio) to groups that either received a subcutaneous injection of albiglutide (30–50 mg, based on glycaemic response and tolerability) or of a matched volume of placebo once a week, in addition to their standard care. Investigators used an interactive voice or web response system to obtain treatment assignment, and patients and all study investigators were masked to their treatment allocation. We hypothesised that albiglutide would be non-inferior to placebo for the primary outcome of the first occurrence of cardiovascular death, myocardial infarction, or stroke, which was assessed in the intention-to-treat population. If non-inferiority was confirmed by an upper limit of the 95% CI for a hazard ratio of less than 1·30, closed testing for superiority was prespecified. This study is registered with ClinicalTrials.gov, number NCT02465515. Findings: Patients were screened between July 1, 2015, and Nov 24, 2016. 10 793 patients were screened and 9463 participants were enrolled and randomly assigned to groups: 4731 patients were assigned to receive albiglutide and 4732 patients to receive placebo. On Nov 8, 2017, it was determined that 611 primary endpoints and a median follow-up of at least 1·5 years had accrued, and participants returned for a final visit and discontinuation from study treatment; the last patient visit was on March 12, 2018. These 9463 patients, the intention-to-treat population, were evaluated for a median duration of 1·6 years and were assessed for the primary outcome. The primary composite outcome occurred in 338 (7%) of 4731 patients at an incidence rate of 4·6 events per 100 person-years in the albiglutide group and in 428 (9%) of 4732 patients at an incidence rate of 5·9 events per 100 person-years in the placebo group (hazard ratio 0·78, 95% CI 0·68–0·90), which indicated that albiglutide was superior to placebo (p<0·0001 for non-inferiority; p=0·0006 for superiority). The incidence of acute pancreatitis (ten patients in the albiglutide group and seven patients in the placebo group), pancreatic cancer (six patients in the albiglutide group and five patients in the placebo group), medullary thyroid carcinoma (zero patients in both groups), and other serious adverse events did not differ between the two groups. There were three (<1%) deaths in the placebo group that were assessed by investigators, who were masked to study drug assignment, to be treatment-related and two (<1%) deaths in the albiglutide group. Interpretation: In patients with type 2 diabetes and cardiovascular disease, albiglutide was superior to placebo with respect to major adverse cardiovascular events. Evidence-based glucagon-like peptide 1 receptor agonists should therefore be considered as part of a comprehensive strategy to reduce the risk of cardiovascular events in patients with type 2 diabetes. Funding: GlaxoSmithKline

Meeting the mental health needs of people with chronic obstructive pulmonary disease: A qualitative study

Objectives: This study aimed to understand the mental health needs of people living with chronic obstructive pulmonary disease: what they were experiencing, what they wanted (or did not want) which might be described as ‘felt need’, what they had accessed or received (‘expressed need’) and how, from their perspective, their emotional needs might be more effectively met by health care services. Methods: Qualitative study with 14 patients with a confirmed diagnosis of chronic obstructive pulmonary disease, where a member of the clinical team had recognised that the patient was suffering from associated emotional distress. Results: Three themes emerged: a sense of assuming a different identity as the disease challenged abilities, the experience of social isolation with fear of dependence and barriers the participants encountered acting as obstacles to coping, adapting and accessing treatments. There were mixed feelings about the value of talking about problems, with both psychological and physical barriers strongly militating against both expression of need and utilization of care offered. Conclusions: Innovative research and clinical care should be aimed towards development of skills, strategies and systems required to engage sensitively and negotiate needs for care, in a patient-centred manner, with people who do not necessarily see the need to ask for emotional support. </jats:p

Implementation of Virtual Reality for Neurodivergent Individuals: Perspectives of Disability Care Staff

Although there is a growing body of evidence demonstrating the potential of Virtual Reality (VR) for neurodivergent individuals, its adoption into disability organizations is lagging behind. This study investigated disability service staff perspectives on the adoption of VR for neurodivergent individuals and examines the viewpoints across clinical and non-clinical roles. An online survey gathered insights from 41 staff members in Australia, the United Kingdom, and the United States. Results revealed widespread optimism about VR's potential benefits, yet highlighted notable barriers to adoption, including financial constraints, ethical concerns, and gaps in knowledge about VR's application. Crucially, the study emphasizes the need for education on VR, robust evidence of its effectiveness, and the importance of addressing ethical and safety issues to foster broader adoption. In response to these findings, we propose five recommendations: enhancing the evidence base through further research, addressing financial and resource barriers with cost-effectiveness studies and clear reimbursement models, developing comprehensive training programs, establishing continuous learning resources, and setting realistic expectations for VR's capabilities. These steps aim to facilitate VR's wider adoption in disability services, capitalizing on its promise to support neurodivergent individuals more effectively