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Background and Aim: The importance and role of the pre-hospital emergency system as the frontline of treatment in reducing casualties and damage to patients, as well as the unknown nature of some biohazardous factors, should be considered. This study aims to investigate the prepared components of the pre-hospital emergency system in dealing with biological threats. Methods: This study is a two-stage qualitative research. The first stage used the critical review method, and the second used the guided qualitative content analysis method. The studied population at this stage consisted of 14 people who were experts in the field of biology. Data were collected and analyzed through semi-structured interviews. Results: After integrating the dimensions and components obtained from the literature review and interviews and based on the opinions of the supervisors and advisors and the summary of the research team, seven dimensions and 23 final components of pre-hospital preparedness in biothreat were extracted and finalized. The study's final findings include seven dimensions of disease warning and diagnosis, information and communication management, management, planning and evaluation, resources and equipment management, documenting and recording experiences, training and practice, and safety and security. Conclusion: The present study can be a reliable source for evaluating biological exercises and actual biological operations by identifying the components and dimensions required for biological exercise. Planning and implementing activities related to the role of the main elements of preparedness identified in this review can help improve the preparedness of emergency medical service systems in incidents. Also, the findings of this study provide valuable information to EMS educators, EMS managers, and researchers. [ABSTRACT FROM AUTHOR]

Background and Aim: Bioterrorist incidents and the epidemic of emerging and re-emerging diseases highlight the necessity of preparation for countries more than ever. Due to the biological threats nature, managers and employees of healthcare centers are the first people to face the consequences of a biological attack. Therefore, the healthcare system must make the necessary preparations to deal with biological threats. One way to prepare is to do various exercises in this field. The aim of the current study was to identify dimensions and components of hospital exercises to Preparedness for biological incidents and threats. Methods: Data were collected through library and internet searches in electronic sources including Science Direct, Scopus, PubMed, GoogleScholar and SID using the keywords of research, preparedness against incidents and biological threats, and hospital exercises program between 2000 and 2022. Collected data were analyzed by MAXQDA v18 software. Results: The findings of the study consist of 9 dimensions: 1) Leadership, command, and coordination, 2) Communication, information management, and information, 3) Planning and formulation of protocols, 4) Development of scenarios, training, and types of exercises, 5) Overcapacity and resource management, 6) Exercise organization and human capital, 7) Exercise implementation and response operations, 8) Safety and security, 9) Retrieval, evaluation, and lessons learned, and 31 components as well. Conclusion: According to the results obtained in this study, hospitals must implement each of the 9 dimensions and 31 sub-components carefully and in detail for the correct implementation of the biological practice. [ABSTRACT FROM AUTHOR]

The microbial pathogens Burkholderia pseudomallei and Bacillus anthracis are unrelated bacteria, yet both are the etiologic agents of naturally occurring diseases in animals and humans and are classified as Tier 1 potential biothreat agents. B. pseudomallei is the gram-negative bacterial agent of melioidosis, a major cause of sepsis and mortality globally in endemic tropical and subtropical regions. B. anthracis is the gram-positive spore-forming bacterium that causes anthrax. Infections acquired by inhalation of these pathogens are challenging to detect early while the prognosis is best; and they possess innate multiple antibiotic resistance or are amenable to engineered resistance. Previous studies showed that the early generation, rarely used aminocoumarin novobiocin was very effective in vitro against a range of highly disparate biothreat agents. The objective of the current research was to begin to characterize the therapeutic efficacy of novobiocin in mouse models of anthrax and melioidosis. The antibiotic was highly efficacious against infections by both pathogens, especially B. pseudomallei. Our results supported the concept that specific older generation antimicrobials can be effective countermeasures against infection by bacterial biothreat agents. Finally, novobiocin was shown to be a potential candidate for inclusion in a combined pre-exposure vaccination and post-exposure treatment strategy designed to target bacterial pathogens refractory to a single medical countermeasure. [ABSTRACT FROM AUTHOR]

Introduction. Health care is characterized by the fact that it belongs to the major state functions and the main kinds of economic activity at the same time, as well as the fact that in contemporary conditions it provides dual-use products – use for both conventional and defense against the latest biothreats. In the course of reforming this state function in Ukraine, the main financing is provided through the National Health Service of Ukraine, where management changes relatively frequently. The purpose. Protection against biohazards, health care, health insurance requires systemic resilience and integrated management based on modern information and communication technologies. Such technologies for social insurance have been successfully developed and implemented by the V.M.Glushkov Institute of Cybernetics of the National Academy of Sciences of Ukraine. Results. A specific example of Zaporizhia region shows which health facilities are without proper government support and how to anticipate and manage distributed networks on big data. In all the above issues of protection against biohazards, health care, health insurance, government institutions cannot make rational decisions without comprehensive and accurate assessment of future gains (and losses) caused by the implementation of a particular project, as well as a comparison of such gains with the present value of costs associated with this project. It is important for decision makers to measure gains and costs in the same units applying the known principle «Who can?t measure cannot manage». Since project costs are usually measured in monetary terms, it makes sense to measure all gains in monetary terms as well. Different approaches to economic assessment of health status compare the benefits from a medical intervention with the costs of that intervention. Conclusions. Gains from medical intervention can be measured in physical units on a one-dimensional scale, monetary units, units of cardinal utility function, reflecting the multidimensional concept of health via the scalar index or key performance indicator. Nowadays multiple dimensions mentioned are gradually developing into big data for each node and link of the health care grid.

The microbial pathogens Burkholderia pseudomallei and Bacillus anthracis are unrelated bacteria, yet both are the etiologic agents of naturally occurring diseases in animals and humans and are classified as Tier 1 potential biothreat agents. B. pseudomallei is the gram-negative bacterial agent of melioidosis, a major cause of sepsis and mortality globally in endemic tropical and subtropical regions. B. anthracis is the gram-positive spore-forming bacterium that causes anthrax. Infections acquired by inhalation of these pathogens are challenging to detect early while the prognosis is best; and they possess innate multiple antibiotic resistance or are amenable to engineered resistance. Previous studies showed that the early generation, rarely used aminocoumarin novobiocin was very effective in vitro against a range of highly disparate biothreat agents. The objective of the current research was to begin to characterize the therapeutic efficacy of novobiocin in mouse models of anthrax and melioidosis. The antibiotic was highly efficacious against infections by both pathogens, especially B. pseudomallei. Our results supported the concept that specific older generation antimicrobials can be effective countermeasures against infection by bacterial biothreat agents. Finally, novobiocin was shown to be a potential candidate for inclusion in a combined pre-exposure vaccination and post-exposure treatment strategy designed to target bacterial pathogens refractory to a single medical countermeasure.

The objective of this study was to describe the clinical characteristics and outcomes of adult coronavirus disease 2019 (COVID-19) patients admitted to a pediatric intensive care unit (PICU), with assessment of respiratory clinical severity and outcomes when cared for by pediatric intensivists utilizing specific care processes. We conducted a retrospective cohort study of adult patients admitted to the 14-bed PICU of a quaternary referral center during the COVID-19 surge in Boston between April and June 2020. A total of 37 adults were admitted: 28 tested COVID-19 positive and 9 tested COVID-19 negative. Of the COVID-19-positive patients, 21 (75%), were male and 12 (60.7%) identified as Hispanic/Latino. Comorbidities in the patients included diabetes mellitus (39.3%), hyperlipidemia (39.3%), and hypertension (32.1%). Twenty-four (85.7%) required mechanical ventilation, in whom the lowest median ratio of arterial oxygen partial pressure to fractional inspired pressure was 161.5 (141.0 to 184.5), the median peak positive end-expiratory pressure (PEEP) was 14 (12.0 to 15.8) cmH2O and 15 (62.5%) underwent an optimal PEEP maneuver. Twelve (50%) patients were proned for a median of 3.0 (3.0 to 4.8) days. Of the 15 patients who were extubated, 3 (20%) required reintubation. Tracheostomy was performed in 10 patients: 3 after extubation failure and 7 for prolonged mechanical ventilation and weakness. Renal replacement therapy was required by 4 (14.3%) patients. There were 2 (7.1%) mortalities. We report detailed clinical outcomes of adult patients when cared for by intact pediatric critical care teams during the COVID-19 pandemic. Good clinical outcomes, when supported by adult critical care colleagues and dedicated operational processes are possible. [ABSTRACT FROM AUTHOR]

Abstract The Mid-Atlantic Microbiome Meet-up (M3) organization brings together academic, government, and industry groups to share ideas and develop best practices for microbiome research. In January of 2018, M3 held its fourth meeting, which focused on recent advances in biodefense, specifically those relating to infectious disease, and the use of metagenomic methods for pathogen detection. Presentations highlighted the utility of next-generation sequencing technologies for identifying and tracking microbial community members across space and time. However, they also stressed the current limitations of genomic approaches for biodefense, including insufficient sensitivity to detect low-abundance pathogens and the inability to quantify viable organisms. Participants discussed ways in which the community can improve software usability and shared new computational tools for metagenomic processing, assembly, annotation, and visualization. Looking to the future, they identified the need for better bioinformatics toolkits for longitudinal analyses, improved sample processing approaches for characterizing viruses and fungi, and more consistent maintenance of database resources. Finally, they addressed the necessity of improving data standards to incentivize data sharing. Here, we summarize the presentations and discussions from the meeting, identifying the areas where microbiome analyses have improved our ability to detect and manage biological threats and infectious disease, as well as gaps of knowledge in the field that require future funding and focus.

Bioethics, as a discipline, has developed mainly, but not exclusively, around themes of moral importance for the medical practice, such as abortion and euthanasia, a never ending discussion that has been shaped by social mores and influenced by scientific and technological advance. However, in the past 20 years an important shift has been taking place, one where bioethical issues and their discussion are starting to being driven by the so-called emerging biotechnologies, from cloning to genome sequencing and editing. If Bioethics is concerned with human beings, and their interaction with other living beings and the environment, it makes sense for Biotechnology, by definition the use of living systems or organisms to develop products, to become an important, if not the most important, source of bioethical conflicts in modern era and for future society. As Biotechnology keeps expanding and becomes entangled in everyday life, so does the need for ethical competent biotechnologists, with competencies built not only on ethical principles but also on a realistic grasp of the impact these technologies could have on human society and the world we inhabit.

Abstract Background The paucity of licensed monoclonal antibodies (mAbs) in the infectious diseases arena strongly contrasts with the ready availability of these therapeutics for use in other conditions. Aims This narrative review aims to assess the potential of monoclonal antibody-based interventions for infectious diseases. Sources A review of the literature via the Medline database was performed and complemented by published official documents on licensed anti-infective mAbs. In addition, ongoing trials were identified through a search of the clinical trial registration platform ClinicalTrials.gov. Content We identified the few infections for which mAbs have been added to the therapeutic armamentarium and stressed their potential in representing a readily available protection tool against biothreats and newly emerging and reemerging infectious agents. In reviewing the historical context and main features of mAbs, we assert a potentially wider applicability and cite relevant examples of ongoing therapeutic developments. Factors hindering successful introduction of mAbs on a larger scale are outlined and thoughts are offered on how to possibly address some of these limitations. Implications mAbs may represent important tools in treating or preventing infections occurring with reasonably sufficient prevalence to justify demand and for which existing alternatives are not deemed fully adequate. Future initiatives need to address the prohibitive costs encountered in the development process. The feasibility of more large-scale administration of alternative modalities merits further exploration. In order to ensure optimal prospect of regulatory success, an early dialogue with competent authorities is encouraged. [ABSTRACT FROM AUTHOR]

Pathogens are various organisms, such as viruses, bacteria, fungi, and protozoa, which can cause severe illnesses to their hosts. Throughout history, pathogens have accompanied human populations and caused various epidemics. One of the most significant outbreaks was the Black Death, which occurred in the 14th century and caused the death of one-third of Europe’s population. Pathogens have also been studied for their use as biological warfare agents by the former Soviet Union, Japan, and the USA. Among bacteria and viruses, there are high priority agents that have a significant impact on public health. Bacillus anthracis, Francisella tularensis, Yersinia pestis, Variola virus, Filoviruses (Ebola, Marburg), Arenoviruses (Lassa), and influenza viruses are included in this group of agents. Outbreaks and infections caused by them might result in social disruption and panic, which is why special operations are needed for public health preparedness. Antibiotic-resistant bacteria that significantly impede treatment and recovery of patients are also valid threats. Furthermore, recent events related to the massive spread of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are an example of how virus-induced diseases cannot be ignored. The impact of outbreaks, such as SARS-CoV-2, have had far-reaching consequences beyond public health. The economic losses due to lockdowns are difficult to estimate, but it would take years to restore countries to pre-outbreak status. For countries affected by the 2019 coronavirus disease (COVID-19), their health systems have been overwhelmed, resulting in an increase in the mortality rate caused by diseases or injuries. Furthermore, outbreaks, such as SARS-CoV-2, will induce serious, wide-ranging (and possibly long-lasting) psychological problems among, not only health workers, but ordinary citizens (this is due to isolation, quarantine, etc.). The aim of this paper is to present the most dangerous pathogens, as well as general characterizations, mechanisms of action, and treatments.

Bacillus anthracis (B. anthracis) is a gram-positive bacterium responsible for the acute disease anthrax. Rapid and reliable identification of pathogenic B. anthracis is important in the detection of natural infectious disease cases or bio-threats. Herein, a DNA endonuclease targeted CRISPR trans reporter (DETECTR) detection platform based on recombinase polymerase amplification (RPA) was studied. The DETECTR system targeted three sequences from B. anthracis (the BA_5345 chromosomal specific marker, the protective antigen gene pag A from pXO1 plasmid and the capsule-biosynthesis-related gene cap A from pXO2 plasmid). We developed a rapid (<40 min), easy-to-implement and accurate identification method for of B. anthracis nucleic acid with near two-copies sensitivity. The combination of tripartite primer sets is effective for the reliable identification of B. anthracis but also for fast screening of pathogenic strains. More importantly, DETECTR correctly detected simulated clinical blood samples and firstly detected positive samples collected from the location of world War-II site, preserved at north-east China (45°36′55.940″ N, 126°38′33.738″ E) with high sensitivity and specificity. Our study provides insight into the DETECTR-based detection of B. anthracis. We present a novel screening and diagnostic option for pathogenic B. anthracis that can be performed on a user-friendly portable device. Based on its proven reliability, sensitivity, specificity and simplicity, our proposed method can be readily adapted to detect pathogenic B. anthracis , anthrax and biothreats. [Display omitted] • A novel DETECTR-based pathogenic B. anthracis detection method with three targets was developed. • The method was capable of pathogenic B. anthracis detection with proved ultrasensitive, rapid and specificity. • We firstly use DETECTR to detect B. anthracis genomic DNA from soil samples collected from the world War-II site in China. [ABSTRACT FROM AUTHOR]

Improving human welfare is a global concern, but not always easy to achieve. In this regard, challenges have been faced by the states of the Former Soviet Union (FSU), where socialist institutions have disappeared, and the transition to a market economy has been slow. Economic adjustments have been difficult in the new nations of central Asia, including Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. Here, a severe climate limits agriculture, and industrialization has been inhibited by a lack of infrastructure, human capital, and financial resources. These conditions are aggravated by the fact that the central Asia is mostly landlocked, far from market centers. Despite these barriers, development potential exists, and the goal of the paper is to consider central Asia’s pastoral economy, with a focus on Kazakhstan, which stands poised to become a regional growth pole. The article pursues its goal as follows. It first addresses the biothreat situation to central Asian livestock herds, a significant impediment to realizing the market potential of the region’s animal products. It next provides an outline of interventions that can reduce risk levels for key biothreats impacting central Asia, namely foot and mouth disease (FMD) and Brucellosis. Included is a success story involving FMD eradication in Brazil, which enabled an export boom in beef. After this comes a description of the epidemiological situation in Kazakhstan; here, the article considers how wildlife might act as a disease reservoir, which presents a conservation issue for the Kazakhstani case. This is followed by a discussion of the role of science in threat reduction, particularly with respect to the potential offered by geospatial technologies. The article concludes with an assessment of the research that would be necessary to identify pathways to developing the economic potential of central Asia, as changes in policy are implemented and livestock health improves.

The coronavirus disease 2019 (COVID-19) pandemic rocked the world, spurring the collapse of national commerce, international trade, education, air travel, and tourism. The global economy has been brought to its knees by the rapid spread of infection, resulting in widespread illness and many deaths. The rise in nationalism and isolationism, ethnic strife, disingenuous governmental reporting, lockdowns, travel restrictions, and vaccination misinformation have caused further problems. This has brought into stark relief the need for improved disease surveillance and health protection measures. National and international agencies that should have provided earlier warning in fact failed to do so. A robust global health network that includes enhanced cooperation with Military Intelligence, Surveillance, and Reconnaissance (ISR) assets in conjunction with the existing international, governmental, and nongovernment medical intelligence networks and allies and partners would provide exceptional forward-looking and early-warning and is a proactive step toward making our future safe. This will be achieved both by surveilling populations for new biothreats, fusing and disseminating data, and then reaching out to target assistance to reduce disease spread in unprotected populations.

Abstract: Development of antiviral products for certain highly pathogenic viruses with limited available treatments, such as viruses that may have biothreat potential, is critically important and challenging. The mission of the FDA is to protect the public health by assuring the safety, efficacy and quality of such products. Human clinical trials are critically important whenever relevant naturally occurring diseases can appropriately be studied. In selected situations when clinical studies are not ethical and field efficacy studies are not feasible, the Animal Rule (67 FR 37988, 2002) introduces the possibility of drug/biologic approval/licensure based on efficacy studies in animals, and appropriate human safety and pharmacokinetic information. This approach necessitates the development of well-delineated animal models predictive of human disease and treatment responses, and plans for adding human information if suitable circumstances arise. Efficient development of therapeutics against these agents requires collaborative efforts among industry, academia and federal agencies. [Copyright &y& Elsevier]

Mobile phones are used the world over, including in healthcare settings. This study aimed to investigate the viable microbial colonisation of mobile phones used by healthcare personnel. Swabs collected on the same day from 30 mobile phones belonging to healthcare workers from three separate paediatric wards of an Australian hospital were cultured on five types of agar plate, then colonies from each phone were pooled, extracted and sequenced by shotgun metagenomics. Questionnaires completed by staff whose phones were sampled assisted in the analysis and interpretation of results. All phones sampled cultured viable bacteria. Overall, 399 bacterial operational taxonomic units were identified from 30 phones, with 1432 cumulative hits. Among these were 58 recognised human pathogenic and commensal bacteria (37 Gram-negative, 21 Gram-positive). The total number of virulence factor genes detected was 347, with 1258 cumulative hits. Antibiotic resistance genes (ARGs) were detected on all sampled phones and overall, 133 ARGs were detected with 520 cumulative hits. The most important classes of ARGs detected encoded resistance to beta-lactam, aminoglycoside and macrolide antibiotics and efflux pump mediated resistance mechanisms. Mobile phones carry viable bacterial pathogens and may act as fomites by contaminating the hands of their users and indirectly providing a transmission pathway for hospital-acquired infections and dissemination of antibiotic resistance. Further research is needed, but meanwhile adding touching mobile phones to the five moments of hand hygiene is a simple infection control strategy worth considering in hospital and community settings. Additionally, the implementation of practical and effective guidelines to decontaminate mobile phone devices would likely be beneficial to the hospital population and community at large. [ABSTRACT FROM AUTHOR]

Pathogens are various organisms, such as viruses, bacteria, fungi, and protozoa, which can cause severe illnesses to their hosts. Throughout history, pathogens have accompanied human populations and caused various epidemics. One of the most significant outbreaks was the Black Death, which occurred in the 14th century and caused the death of one-third of Europe's population. Pathogens have also been studied for their use as biological warfare agents by the former Soviet Union, Japan, and the USA. Among bacteria and viruses, there are high priority agents that have a significant impact on public health. Bacillus anthracis , Francisella tularensis , Yersinia pestis , Variola virus, Filoviruses (Ebola, Marburg), Arenoviruses (Lassa), and influenza viruses are included in this group of agents. Outbreaks and infections caused by them might result in social disruption and panic, which is why special operations are needed for public health preparedness. Antibiotic-resistant bacteria that significantly impede treatment and recovery of patients are also valid threats. Furthermore, recent events related to the massive spread of Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are an example of how virus-induced diseases cannot be ignored. The impact of outbreaks, such as SARS-CoV-2, have had far-reaching consequences beyond public health. The economic losses due to lockdowns are difficult to estimate, but it would take years to restore countries to pre-outbreak status. For countries affected by the 2019 coronavirus disease (COVID-19), their health systems have been overwhelmed, resulting in an increase in the mortality rate caused by diseases or injuries. Furthermore, outbreaks, such as SARS-CoV-2, will induce serious, wide-ranging (and possibly long-lasting) psychological problems among, not only health workers, but ordinary citizens (this is due to isolation, quarantine, etc.). The aim of this paper is to present the most dangerous pathogens, as well as general characterizations, mechanisms of action, and treatments.

The challenges faced by the emergency physician with recognizing and treating category A biothreat agents and emerging infectious disease are summarized and reviewed., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Improving human welfare is a critical global concern, but not always easy to achieve. Complications in this regard have been faced by the states of the Former Soviet Union, where socialist-style economic institutions have disappeared, and the transition to a market economy has been slow in coming. Lack of capital, ethnic conflict, and political instability have at times undermined the institutional reform that would be necessary to enable economic efficiency and development. Nowhere are such challenges more pronounced than in the new nation states of central Asia, including Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan, and Uzbekistan. Here, a severe climate limits agriculture, and industrialization has been inhibited by lack of infrastructure, low levels of human capital, and a scarcity of financial resources. These conditions are aggravated by the fact that the central Asian states are landlocked, far from centers of market demand and capital availability. Despite these daunting barriers, development potential does exist, and the goal of the paper is to consider central Asia's pastoral economy, with a focus on Kazakhstan, which stands poised to become a regional growth pole. The article pursues its goal as follows. It first addresses the biothreat situation to central Asian livestock herds, the most significant existing impediment to realizing the full market potential of the region's animal products. Next, it provides an outline of interventions that can reduce risk levels for key biothreats impacting central Asia, namely foot and mouth disease (FMD), which greatly impacts livestock and prohibits export, and Brucellosis, a bacterial zoonosis with high incidence in both humans and livestock in the region. Included is an important success story involving the FMD eradication programs in Brazil, which enabled an export boom in beef. After this comes a description of the epidemiological situation in Kazakhstan; here, the article considers the role of wildlife in acting as a possible disease reservoir, which presents a conservation issue for the Kazakhstani case. This is followed by a discussion of the role of science in threat reduction, particularly with respect to the potential offered by geospatial technologies to improve our epidemiological knowledge base. The article concludes with an assessment of the research that would be necessary to identify feasible pathways to develop the economic potential of central Asian livestock production as changes in policy are implemented and livestock health improves.