Genome editing as a national security threat

Testimony from the intelligence community in the United States connecting genome editing with national security threats was a noted departure from past assessments of the implications of modern enabling biotechnologies. Rarely are individual biotechnologies included on lists of potential security threats. When they are, a broad range of advances are usually considered collectively - in terms of both risks and benefits. Given the classified nature of the rationale as to why gene editing tools were singled out, we are unlikely to fully understand for several decades what prompted this statement. This paper considers three ways in which these tools might impact national security: i) enabling the development of advanced biological weapons; ii) facilitating the development of new bioweapons based on ecological applications of genome editing, and iii) enhancing future generations of people in ways which could have an indirect impact on security, for example by improving a nation's cognitive ability and/or the physical endurance of its soldiers. Their implications are different and so are the possible policy and regulatory responses.

[Metal implants and airport security checks]

Orthopaedic surgeons and trauma surgeons in the Netherlands are implanting 65,000 joint replacements and treating nearly 300,000 fractures per year. For many travellers with a metal implant - but also for the physicians who are treating them - it is unclear what the consequences will be when they have to go through airport security checks. These checks follow a fixed procedure in accordance with European rules which involves travellers passing through a number of visible and invisible barriers. The first barrier is usually a metal detector or a millimetre wave scanner; when the implant has been detected, this is followed by a body search. The electromagnetic field of a metal detector penetrates into the body; the metal detector has therefore a higher detection rate for metal implants than a millimetre wave scanner, of which radio waves reach up to or just below the skin. Medical documentation can help reassure the traveller or the security officer, but possible additional checks cannot be avoided.

Multiple dimensions of violence against healthcare providers in Karachi: Results from a multicenter study from Karachi

OBJECTIVE

To investigate the causes, consequences and possible solutions for violence against healthcare.

METHODS

The qualitative study was conducted in Karachi June 2015 to December 2015 using in-depth interviews and focus groups discussions with all stakeholders. Transcription was done verbatim using both audio and videotapes of all the sessions. First open coding was done using inductive analyses by 3 researchers. After consensus, these codes were used for thematic content analysis. Interviews and discussions were stopped after saturation was reached and no new codes were identified..

RESULTS

Overall, 42 in-depth interviews and 17 focus groups discussions were held. Major forms of physical violence included beating, throwing things, abusive language, threats, harassment, damage to building, furniture, vehicles and equipment. The threshold of violence was very high for verbal violence and minor forms of physical violence. The causes were identified as behavioural (communication gap between providers and patients, attendants), institutional (capacity, resources and systems) and socio-political (growing illiteracy and intolerance). The sequelae of violence included guilt, night dreams, shame and 61.9 % (N=26/42 IDIs)% who faced violence did not report it officially.

CONCLUSIONS

Violence faced by healthcare providers was multifaceted and needs interventions at varied levels, including training of healthcare staff in dealing with violence and its aftermaths, security measures at the healthcare institutions inclusive of ambulance services and policies at the national level to manage and de-escalate violence against healthcare.

Predicting the Public Health Consequences of a Nuclear Terrorism Attack: Drawing on The Experiences of Hiroshima and Fukushima

The increasing threat of nuclear terrorism warrants consideration of the health consequences of a terrorist incident should preventive measures fail. Although there has not yet been a nuclear terrorist attack of any kind, experiences with the aftermath of the bombing of Hiroshima and the core meltdowns at Fukushima can provide useful insight and allow some inferences to be made regarding the types of casualties that might be sustained and the rescue efforts that might be required. There are many parallels between the events at Hiroshima and what might be expected from an improvised nuclear device, and there are parallels between the radioactivity released to the environment at Fukushima and the aftermath of a radiological dispersal device attack. Nevertheless, there are some unique aspects to a ground-detonated improvised nuclear device that pose health threats beyond those seen at Hiroshima (i.e., fallout). And psychological health may be impacted more than physical health in the case of a radiological dispersal device. Preparedness requires consideration of all of these various health hazards in order to determine how best to mitigate the consequences of a nuclear terrorism attack.

Performance Testing of Criticality Accident Detectors with the Godiva Burst Reactor

Criticality accident detectors are required for all operations involving fissile materials in which a criticality accident can occur and cause personnel to receive unacceptable exposure to radiation (ANSI/ANS 8.3-R2012). Recently, the U.S. Department of Energy Y-12 National Security Complex tested six criticality accident detectors and eight Portable Radiation Detection Instruments (PRDIs) to verify their performance under actual criticality conditions. The tests were performed by Los Alamos National Laboratory using the Godiva critical assembly located at the National Criticality Experiments Research Center at the U.S. Department of Energy Nevada National Security Site. All six criticality accident detectors and eight Portable Radiation Detection Instruments passed the performance tests. The test results provide reasonable assurance that the Y-12 criticality accident detectors and PRDIs will detect a criticality accident and warn workers to evacuate the area to minimize their exposure to this life-threatening hazard.

Beakers and Borders: Export Controls and the Life-sciences under the Defence Trade Controls Act 2012

Aware of the risk to human development from public health emergencies, governments and international organisations have adopted regulatory measures designed to prepare for and mitigate the risk of global pandemics. However, as the development of the Australian Defence Trade Controls Act 2012 Cth reveals, choices in regulatory measures can have profound effects on the delivery of public health and the practice of medical research. Introducing a new regulatory regime for researchers engaged in dual-use research, the Defence Trade Controls Act 2012 Cth (DTCA) seeks to control a variety of research and teaching activities. This article uses the DTCA as a case study of the securitization of infectious diseases, the mechanisms by which biosecurity rules are becoming globalised and the clash of principles that can arise for public health researchers. With the DTCA scheduled for a legislated review in 2018, an awareness of the wider constellation of international and domestic rules restricting dissemination of research findings with national security implications is imperative for public health researchers.

The agitated patient: Steps to take, how to stay safe

Situations involving agitated patients are not uncommon in health care settings. And no matter where on the spectrum an incident involving an agitated patient falls, it can leave those involved with various levels of physical, emotional, and psychological harm. It can also leave everyone asking themselves: "How can I better prepare for such occurrences?" This article offers some answers by providing tips and guidelines for handling agitated and/or violent patients in various settings.

Predicting Airport Screening Officers' Visual Search Competency With a Rapid Assessment

Objective The study's objective was to assess a new personnel selection and assessment tool for aviation security screeners. A mobile app was modified to create a tool, and the question was whether it could predict professional screeners' on-job performance. Background A variety of professions (airport security, radiology, the military, etc.) rely on visual search performance-being able to detect targets. Given the importance of such professions, it is necessary to maximize performance, and one means to do so is to select individuals who excel at visual search. A critical question is whether it is possible to predict search competency within a professional search environment. Method Professional searchers from the USA Transportation Security Administration (TSA) completed a rapid assessment on a tablet-based X-ray simulator (XRAY Screener, derived from the mobile technology app Airport Scanner; Kedlin Company). The assessment contained 72 trials that were simulated X-ray images of bags. Participants searched for prohibited items and tapped on them with their finger. Results Performance on the assessment significantly related to on-job performance measures for the TSA officers such that those who were better XRAY Screener performers were both more accurate and faster at the actual airport checkpoint. Conclusion XRAY Screener successfully predicted on-job performance for professional aviation security officers. While questions remain about the underlying cognitive mechanisms, this quick assessment was found to significantly predict on-job success for a task that relies on visual search performance. Application It may be possible to quickly assess an individual's visual search competency, which could help organizations select new hires and assess their current workforce.

Assessing national nutrition security: The UK reliance on imports to meet population energy and nutrient recommendations

Nutrition security describes the adequacy of the food supply to meet not only energy but also macronutrient and micronutrient requirements for the population. The aim of this study was to develop a method to assess trends in national nutrition security and the contribution of imports to nutrition security, using the UK as a case study. Food supply data from FAO food balance sheets and national food composition tables were used to estimate the nutrient content of domestically produced food, imported food and exported food. Nutrition security was defined as the total nutrient supply (domestic production, minus exports, plus imports) to meet population-level nutrient requirements. The results showed that the UK was nutrition secure over the period 1961–2011 for energy, macronutrients and key micronutrients, with the exception of total carbohydrates and fibre, which may be due to the loss of fibre incurred by processing cereals into refined products. The supply of protein exceeded population requirements and could be met with domestic production alone. Even excluding all meat there was sufficient protein for population requirements. The supply of total fat, saturated fat and sugar considerably exceeded the current dietary recommendation. As regards nutrition security in 2010, the UK was reliant on imported foods to meet energy, fibre, total carbohydrate, iron, zinc and vitamin A requirements. This analysis demonstrates the importance of including nutrients other than energy to determine the adequacy of the food supply. The methodology also provides an alternative perspective on food security and self-sufficiency by assessing the dependency on imports to meet population level nutritional requirements.

Exploring the role of voluntary disease schemes on UK farmer bio-security behaviours: Findings from the Norfolk-Suffolk Bovine Viral Diarrhoea control scheme

The article describes the influence of a disease control scheme (the Norfolk-Suffolk Bovine Viral Diarrhoea Disease (BVD) Eradication scheme) on farmers' bio-security attitudes and behaviours. In 2010, a survey of 100 cattle farmers (53 scheme members vs. 47 out of scheme farmers) was undertaken among cattle farmers residing in Norfolk and Suffolk counties in the UK. A cross-sectional independent measures design was employed. The main analytical tool was content analysis. The following variables at the farmer-level were explored: the specific BVD control measures adopted, livestock disease priorities, motivation for scheme membership, wider knowledge acquisition, biosecurity behaviours employed and training course attendance. The findings suggest that participation in the BVD scheme improved farmers' perception of the scheme benefits and participation in training courses. However, no association was found between the taking part in the BVD scheme and livestock disease priorities or motivation for scheme participation, or knowledge about BVD bio-security measures employed. Equally importantly, scheme membership did appear to influence the importance accorded specific bio-security measures. Yet such ranking did not appear to reflect the actual behaviours undertaken. As such, disease control efforts alone while necessary, are insufficient. Rather, to enhance farmer bio-security behaviours significant effort must be made to address underlying attitudes to the specific disease threat involved.

A Systems Approach to Agricultural Biosecurity

This article highlights the importance of systems approaches in addressing agricultural biosecurity threats. On the basis of documentary analysis and stakeholder interaction, a brief survey of agricultural biosecurity threats and vulnerabilities from global and Indian perspectives is provided, followed by an exploration of technological and institutional capabilities. Finally, a perspective on the agricultural disease diagnostic networks is provided, drawing instances from global developments. Technical barriers to agroterrorism are lower than those to human-targeted bioterrorism, and the sector is unique as even a very small disease outbreak could prompt international export restrictions. Key vulnerabilities in the agriculture sector stem from, among others, the structure of agricultural production; insufficient monitoring, surveillance, and controls systems at the borders and in the food chain; inefficient systems for reporting unusual occurrences and outbreaks of disease; and lack of sufficiently trained human resources capable of recognizing or treating transboundary pathogens and diseases. An assessment of technology and institutions pertaining to crop and animal protection management suggests certain gaps. Investment in developing new technologies for civilian application in agriculture, as well as for legitimate actions pertaining to defense, detection, protection, and prophylaxis, and in upgrading laboratory facilities can increase the agricultural sector's level of preparedness for outbreaks. To address potential threats and vulnerabilities of agroterrorism effectively requires the development of a comprehensive strategy and a combined, interagency approach, ideally on an international level. It is proposed that a systems-oriented approach for developing knowledge and innovation networks and strengthening skills and capacities would enable a more resilient agricultural biosecurity system.

Unhealthy complacency: The vulnerability of US hospitals to direct terrorist attacks

Since the attacks of September 11, 2001, terrorists have demonstrated both the intent and capability to execute direct attacks on US public hospitals. Nonetheless, hospital administrators have basically ignored this threat, as they do not view hospitals as likely targets. Unfortunately, it may take a catastrophic event before policymakers appreciate this threat enough to take appropriate actions. However, analyzing and managing these threats is just another part of risk management, as the cost of doing so up front to protect against such loss is no different than other risk management assessments. While the threat may never be completely eradicated, failing to implement reasonable security measures to specifically address the threat of direct terrorist attacks leaves hospitals vulnerable to severe loss.

[From OPG to REMS: the role of a territorial health service in the implementation of security and non-custodial measures towards offenders with psychological problems]

AIMS

Managing health care for people suffering from mental illness is undergoing deep changes in recent years in Italy. The purpose of this study is to describe the progressive process of overcoming the Forensic Hospitals in Italy (OPGs) and to identify the necessary care and rehabilitation pathways in this process, in the experience of the territorial health service in Salerno, Italy.

METHODS

An analysis of the recent laws related to the ongoing process and an analysis of epidemiological and structural data referring to the time interval between 2010 and 2017 concerning the OPGs/Residential Services for the Execution of Security Measures (RSESM)/Mental Health System in Campania, Italy and in the territory of Salerno in particular.

RESULTS

The acts governing the transition from OPG to RSESM include DPCM 1/4/2008 and subsequent "Conferenza Unificata" agreements, other laws and regional health organizational regulations. A thorough restructuring of the National Health Service is required. A substantial path in Campania has been completed, with the closure of OPGs, the realization of definitive RSESM, the Departments for Mental Health Care in prison, the Regional Technical Group for overcoming the OPGs, the territorial Services for overcoming the OPGs and for Mental Health in Prison. The result of these transformations is a deep change in the health care approach, as evidenced by the current changes in action in indicative parameters of care pathways and their outcomes.

CONCLUSIONS

The new approach shows both improvement features and totally or partially unaddressed problematic features. As for the actual management issues, improvements in communication between Mental Health Care and the magistracy. The overall evaluation of the transformations in progress is positive. At this stage, it is crucial to identify and monitor indicators of the pathways of care and their outcomes and to implement synergies among the systems involved.

Resilient patriarchy: public authority and women's (in)security in Karamoja, Uganda

This paper draws on fieldwork conducted in 2011 and 2016 to explore the differing experiences of Karamojong women following the Government of Uganda's most recent disarmament programme. Besides being deprived of their guns, Karamojong communities have lost most of the cattle on which their livelihoods and way of life were centred. The study assesses whether or not women's experience of patriarchy has changed in these new circumstances, and, if so, how this impacts on their security and control of resources, or the absence of them. It maps, using information primarily supplied by women, public authorities from below, and evaluates if and how they respond to women's protection and survival needs, as well as if current development/humanitarian interventions are of sustainable benefit to Karamojong women. The paper concludes that apparent shifts in gender relations are probably superficial, contingent on continuing food aid, and that economic development and positive social change for women remain elusive.

Policing men: militarised masculinity, youth livelihoods, and security in conflict-affected northern Uganda

Relations between militaries and masculinities-and hegemonic masculinity and the state-are well-established in the literature on gender and development. However, there is less research on how militarised masculinities relate to state governance strategies. This paper, based on qualitative research conducted in northern Uganda between 2014 and 2017, offers a gender analysis of youths participating in informal security arrangements. Civilian male youths accept poorly paid or unpaid work in the informal security sector in the hope of gaining access to livelihoods that will enable them to fulfil masculine ideal-types. However, this arrangement denies them the resources necessary to achieve the ideal-type of civilian masculinity, as well as the state's military masculinity, which produces young men as subjects of the ruling regime. To reconfigure this relationship between civilian and militarised masculinities, one should understand informal security organisations in the context of alternative livelihood arrangements and take a long-term approach to the demilitarisation of the Ugandan state.

'Lowering the threshold of effective deterrence'-Testing the effect of private security agents in public spaces on crime: A randomized controlled trial in a mass transit system

Supplementing local police forces is a burgeoning multibillion-dollar private security industry. Millions of formal surveillance agents in public settings are tasked to act as preventative guardians, as their high visibility presence is hypothesized to create a deterrent threat to potential offenders. Yet, rigorous evidence is lacking. We randomly assigned all train stations in the South West of England that experienced crime into treatment and controls conditions over a six-month period. Treatment consisted of directed patrol by uniformed, unarmed security agents. Hand-held trackers on every agent yielded precise measurements of all patrol time in the stations. Count-based regression models, estimated marginal means and odds-ratios are used to assess the effect of these patrols on crimes reported to the police by victims, as well as new crimes detected by police officers. Outcomes are measured at both specified target locations to which security guards were instructed to attend, as well as at the entire station complexes. Analyses show that 41% more patrol visits and 29% more minutes spent by security agents at treatment compared to control stations led to a significant 16% reduction in victim-generated crimes at the entirety of the stations' complexes, with a 49% increase in police-generated detections at the target locations. The findings illustrate the efficacy of private policing for crime prevention theory.

Synthetic Biology, Genome Editing, and the Risk of Bioterrorism

The SynBioSecurity argument says that synthetic biology introduces new risks of intentional misuse of synthetic pathogens and that, therefore, there is a need for extra regulations and oversight. This paper provides an analysis of the argument, sets forth a new version of it, and identifies three developments that raise biosecurity risks compared to the situation earlier. The developments include (1) a spread of the required know-how, (2) improved availability of the techniques, instruments and biological parts, and (3) new technical possibilities such as "resurrecting" disappeared pathogens. It is first shown that the general argument from SynBioSecurity needs to be qualified and that many improvements to biosecurity have already been implemented, most notably in the United States. Second, I suggest a new strain of the argument: the situation that most branches of synthetic biology fall under the gene technology regulation in the European Union and that this regulation in its current form does not adequately address SynBioSecurity risks together provide a weighty reason to review and possibly refine the legislation as well as the supervisory practices. Ethically speaking, the rise in the relative risk of bioterrorism brings to the fore new extrinsic issues.

Public Health and the Pope's Visit to Philadelphia, 2015

Pope Francis visited Philadelphia for 2 days during September 2015. Preparedness functions managed by the Philadelphia Department of Public Health (PDPH) were similar to those of other mass gatherings but also required accommodation of special security arrangements and the location of public events in central areas of the city. Public health planning involved collaborations with multiple city, state, and federal agencies and neighboring jurisdictions. PDPH preparations encompassed incident command procedures, contingency planning, disease surveillance and prevention, food safety, vector control, BioWatch air sampling, volunteer management for first-aid services, and continuity of operations. These were based on, or informed by, existing emergency plans and prior experiences in responding to public health crises, supporting large public events, managing regional preparedness exercises, engaging Medical Reserve Corps volunteers, and executing routine functions. Although the papal visit concluded without the occurrence of a substantial public health or healthcare emergency, lessons learned have and will continue to improve coordination with partner agencies in planning and executing large-scale events, as well as managing regional disease surveillance procedures and medical volunteer engagement. Another area identified for improvement concerns enhancing the role of local health departments in planning for responses to possible BioWatch alerts.

Effectiveness of household lockable pesticide storage to reduce pesticide self-poisoning in rural Asia: a community-based, cluster-randomised controlled trial

BACKGROUND

Agricultural pesticide self-poisoning is a major public health problem in rural Asia. The use of safer household pesticide storage has been promoted to prevent deaths, but there is no evidence of effectiveness. We aimed to test the effectiveness of lockable household containers for prevention of pesticide self-poisoning.

METHODS

We did a community-based, cluster-randomised controlled trial in a rural area of North Central Province, Sri Lanka. Clusters of households were randomly assigned (1:1), with a sequence computer-generated by a minimisation process, to intervention or usual practice (control) groups. Intervention households that had farmed or had used or stored pesticide in the preceding agricultural season were given a lockable storage container. Further promotion of use of the containers was restricted to community posters and 6-monthly reminders during routine community meetings. The primary outcome was incidence of pesticide self-poisoning in people aged 14 years or older during 3 years of follow-up. Identification of outcome events was done by staff who were unaware of group allocation. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT1146496.

FINDINGS

Between Dec 31, 2010, and Feb 2, 2013, we randomly assigned 90 rural villages to the intervention group and 90 to the control group. 27 091 households (114 168 individuals) in the intervention group and 26 291 households (109 693 individuals) in the control group consented to participate. 20 457 household pesticide storage containers were distributed. In individuals aged 14 years or older, 611 cases of pesticide self-poisoning had occurred by 3 years in the intervention group compared with 641 cases in the control group; incidence of pesticide self-poisoning did not differ between groups (293·3 per 100 000 person-years of follow-up in the intervention group vs 318·0 per 100 000 in the control group; rate ratio [RR] 0·93, 95% CI 0·80-1·08; p=0·33). We found no evidence of switching from pesticide self-poisoning to other forms of self-harm, with no significant difference in the number of fatal (82 in the intervention group vs 67 in the control group; RR 1·22, 0·88-1·68]) or non-fatal (1135 vs 1153; RR 0·97, 0·86-1·08) self-harm events involving all methods.

INTERPRETATION

We found no evidence that means reduction through improved household pesticide storage reduces pesticide self-poisoning. Other approaches, particularly removal of highly hazardous pesticides from agricultural practice, are likely to be more effective for suicide prevention in rural Asia.

FUNDING

Wellcome Trust, with additional support from the American Foundation for Suicide Prevention, Lister Institute of Preventive Medicine, Chief Scientist Office of Scotland, University of Copenhagen, and NHMRC Australia.