The Complete Terrorism Survival Guide
Biological agents that might be used for bioterrorism have been categorized as A, B, or C (76). Class A agents are easily disseminated or transmitted from person to person, cause high mortality, might cause public panic and social disruption, and require special action for public preparedness. Category B agents are moderately easy to disseminate, cause moderate morbidity and low mortality, and require special enhancement of Centers for Disease Control's diagnostic capacity and disease surveillance activity. Category C agents are those that could be used because of their availability, ease of production, and potentially high morbidity and mortality. Category A agents include Bacillus anthracis, Franciscella tularensis, Yersinia pestis. Category B agents are C. burnetii, Brucella spp., Burkholderia mallei. Category C currently consists of multidrug-resistant Mycobacterium tuberculosis, Nipha virus, Hantavirus, Yellow fever virus, and tick-borne hemorrhagic fever viruses (76).
The care of the critically ill has changed radically during the past 10 years. Technological advances have improved monitoring, organ support, and data collection, while small steps have been made in the development of drug therapies. Conversely, new challenges (e.g. severe acute respiratory syndrome SARS , multiple antimicrobial resistance, bioterrorism) continue to arise and public expectations are elevated, sometimes to an unreasonable level. In this book we summarize some of the most important medical advances that have emerged, concentrating particularly on those relevant to the growing numbers of respiratory physicians who pursue a subspecialty interest in this clinical arena.
As it has the most serious epidemic potential of all rickettsiae, louse-borne epidemic typhus should be considered a serious threat, even in developed countries (26-32), when body lice are prevalent. Epidemic typhus is currently considered as a potential bioterrorism agent (category B, Centers for Disease Control and Prevention).
Human diseases (cholera, anthrax, whooping cough, tetanus, botulism, diptheria, clostridial gas gangrenes, severe diseases caused by superantigenic toxins, Helicobacter pylori-associated peptic ulcers and carcinomas, food poisons, etc.). In this respect, the targeting of immune system cells by various toxins led to a better evaluation of both their beneficial effects (for example as immunomodulators in the case of cholera toxin B subunit) and pathophysiolgical effects in certain diseases in connection with the immune system. Finally, the past years witnessed considerable progress on toxin applications in vaccinology, tumor therapy, and new approaches in the treatment of various diseases. Whether some wild-type toxins can be directly used as therapeutic agents, protein engineering permits us to model more specific and efficient molecules or molecules with a novel activity, or to target a restricted subset of cell population. Novel recombinant toxins are already proposed in the...
By using potassium iodide, we can prevent thyroid cancer from radioactive iodine fallout. Potassium iodide blocks radioactive iodine from being absorbed by the thyroid gland by providing so much iodine that it overwhelms the ability of the gland to take up radioactive iodine. This is the only specific way to protect against thyroid cancer triggered by radioactive iodine fallout potassium iodide has no protective effect against any other kind of radiation. Potassium iodide is available through pharmacies. In the event that there is an alert about a potential nuclear attack (such as a terrorist threat), ask your doctor about the best way to obtain potassium iodide.
The position and nature of carcinogen-induced DNA adducts dictate the type of mutation that can result (Dogliotti, 1996). For example, small alkylating agents will adduct to guanine at the N7 position owing to the highly nucleophilic nature of the site. In contrast, other more bulky aromatic amine agents will attack the purine ring preferentially, such as the C8 position of guanine and others such as diol epoxides of PAHs bind to the N2 and N6 positions. The adduct products of these reactions are converted to mutations when the cell attempts to repair the damage or replicate itself. These include point mutations, frameshifts involving loss or gain of either a single or multiple bases, chromosomal aberrations, anueploidy or polyploidy. Once introduced, the mutation becomes fixed within the DNA sequence and therefore heritable. The type of mutation that a chemical induces is dependent upon the way in which the chemical interacts with the DNA. The site of chemical attack is important but...
Interest in multicultural counseling grew out of the Civil Rights and feminist movements in the 1950s and the community mental health movement of the 1960s, which affirmed that mental health care was the right of all citizens. Popular dissent from the anti-Vietnam War movement and issues of feminism promoted discontent, while protest against inequity was accepted and encouraged by the media. By the 1970s, underuse of mental health services by minorities had become a serious issue. By the 1980s, large numbers of refugees further demonstrated the importance of a multicultural global perspective in counseling. By the 1990s, the rapidly changing demographic balance predicted that one third or more of the nation's school students would be non-White by the turn of the century. The war against terrorism since the year 2001 has further highlighted the lack of understanding among different cultures and countries.
Avoidance of contaminated water would prevent infection with schistosomes and is a relatively simple thing for occasional visitors to endemic areas to achieve. Control and prevention of infection in the community, however, where residents do not always have the luxury of avoiding contact with contaminated water, are complex. Many countries have initiated control programs involving a many pronged approach, including (1) the use of chemotherapy to remove adult worms, (2) elimination of the snail intermediate hosts by habitat modification or chemical attack, (3) changing human behaviour through health education and (4) providing safe water supplies and sanitation.
Posttraumatic Stress Disorder (PTSD) is an extreme psy-chobiological reaction to a psychologically traumatic event characterized by profound disturbances in cognitive, behavioral, and physiological functioning. The diagnosis is applied when an individual has experienced, witnessed, or been confronted with an event involving perceived or threatened loss of life, serious injury, or loss of physical integrity and which evoked intense fear, helplessness, or horror. The types of events that may cause PTSD include sexual or physical assault, military combat, motor vehicle accidents, major disasters, and acts of terrorism.
Executive processes, which often operate on the contents of short-term working memory, are also managed in the frontal lobes, primarily in prefrontal cortex. Executive cognition (1) focuses attention on relevant information and inhibits irrelevant stimuli (2) manages tasks, which may require switching or dividing attention from one task or stimulus to another (3) plans the sequence of subtasks that may accomplish a goal and (4) codes time and place and monitors the steps of a working memory task.349 Prefrontal cortex extracts information about the regularities across experiences, integrates relationships among inputs, and then imparts rules that guide subsequent thoughts and actions. These processes are especially vulnerable to a traumatic brain injury. Normal pre-frontal cortex and its connections create much of what is most human, from an imaginative hypothesis of a neuroscientist to the skewed beliefs of a terrorist.
2001 World Trade Center terrorist attack in New York, inhalation injury was the most frequent reason that survivors sought medical attention.41 Inhalation injury predisposes burn patients to pneumonia, respiratory failure, and death.42 Most burn patients who die have multiple organ failure43 in one study mortality was 67 in patients with isolated pulmonary failure but 92 when pulmonary failure was complicated by failure of at least one other system.44 The incidence of ARDS complicating burns is 2-7 ,45 but is significantly higher in patients with inhalation injury.42 In a review of 529 burn patients admitted over a 4 year period, patients with inhalation injury had a 73 incidence of respiratory failure and a 20 incidence of ARDS.42 Advances in the treatment of burn victims have reduced mortality to 2-3 in those without respiratory complications compared with 46 in those with concomitant inhalation injury.46
Likewise, witnesses of a deadly explosion in Texas in the 1940s (Ruskin, Beard, and Schaffer, 1948) and bombings of Leningrad during World War II (Miasnikov, 1961) exhibited elevated blood pressures for various durations of time following exposure to these life-threatening events. Recently, comparable blood pressure elevations were observed in a man residing in New York City who witnessed the tragedy of September 11, 2001, in which thousands were killed in the terrorist attacks on the World Trade Center towers (Lipsky, Pickering, and Gerin, Some stressful life events are more chronic in nature. For example, the amount of stress experienced in an individual's residential neighborhood is endured on a daily basis, often for periods of years or even decades. Some neighborhoods are characterized by stable single family dwellings, good school systems, and low crime rates, while others are much less stable and have higher crime rates. To examine the effects of living in stressful...
Forts, different and new types of ethnocentric conflicts keep cropping up in many places all around the world, as it recently did in the form of terrorism. The inherent differences in the worldviews, cultural values, and belief systems are always vying for legitimization. In spite of the importance of the subject of ethnocentrism, the research on this topic is surprisingly sparse so far.
The mechanism whereby innovations are rapidly copied modified multiplied is at work even when they are harmful for human society. The history of modern terrorism, which grew out of enormous political extremism, furnishes a cautionary tale. It was discovered that due to the manipulability of the human brain suicide killers - the cheap nasty, but very efficient human bomb -can be prepared, then used as a means of political pressure. The developed world felt compelled to wage war against this dreadful method. This is an ongoing problem. In the beginning the group(s) responsible for a terror attack could usually be precisely identified. What we see now is that lines between organizations are blurring, with old groups disbanding and re-emerging under new names. It is a further example of the eternal fate of inventions.
Which it was suggested that teenagers were being deliberately exposed to subliminal stimuli in musical recordings, which were placed there by revolutionaries and terrorists who wanted to stir aggressive responses in them. Some religious groups claimed that subliminal messages in films, television, and musical recordings were being used by devil worshippers to undermine the morals of the public and to gain them new converts. Such suggestions could never be convincingly substantiated, however these apparent associations with fringe groups and marginalized social activities, plus a lot of bad science, brought the whole topic into disrepute for many years.
The differential diagnosis of a patient with an eschar encompasses various infectious and noninfectious syndromes, including trauma, spider bite, erythema gangrenosum, factitial dermatitis, herpes simplex, herpes zoster, aspergillosis, and several diseases caused by agents associated with bioterrorism (e.g., Francisella tularensis, Yersinia pestis, Burkholderia pseudomallei, and B. anthracis) (13,20,22,93). Occasionally, rickettsialpox may even mimic some sexually transmitted diseases. Shankman described a patient with an ulcerated lesion on his penis and bilateral inguinal adenopathy for whom his initial differential diagnosis included chancroid, granuloma inguinale, syphilis, and herpes simplex however, a papular rash appeared three days later and allowed Shankman to establish the diagnosis of rickettsialpox (8). The eschar of rickettsialpox is indistinguishable from the primary lesions associated with many other rickettsioses, including African tick bite fever, boutonneuse fever,...
While some strides have been made in understanding the nature of the SARS virus, a great deal is left unanswered. In a world that has recently begun to consider bioterrorism a very possible threat, the SARS virus has demonstrated how vulnerable life is in the face of a new and contagious disease, and how societies, governments, and economies can be rattled by the tiniest of microbes.
Paternal toxicological screening could provide the means to intercede before repercussions originating from paternal exposures become apparent in the next generation. Because spermatogenesis is a process of continuous self-renewal, a transcriptome-based assay system such as a microarray provides the means to monitor and diagnose exposures, as well as provide a history of previous exposure. For example, collection of samples at regular intervals for 60 to 80 days (time to complete one round of spermatogenesis) and comparison of their RNA profiles to a normal fingerprint could be used to establish the type and severity of an exposure and subsequent detoxification. The value in our ability to identify, screen, and intercede is not limited to current environmental exposure. The significance and need to develop this capability are now reinforced by the threat of an unwarranted biological and chemical terrorist attack on the mass population. With this new diagnostic capacity we could ensure...
The financial trouble experienced by the biotech and pharmaceutical companies was caused in part by a general decline in economies all over the world, the ever-present threat of war, and the escalation of terrorists' attacks against the Western world, culminating in the destruction of New York's World Trade Center in 2001. Investor confidence in the stock market as a whole was also badly shaken by a number of accounting frauds that attempted to make certain companies' products look better than they really were. One such case, affecting the biotech sector, involved a company called ImClone Systems Incorporated, which claimed to have developed a very effective drug to fight cancer. Government investigators discovered, however, that the claims were groundless, and the company's chief executive officer (CEO) was tried and convicted of securities fraud. Before the scandal was exposed in early 2002, ImClone's stock sold for 80 share, dropping to less than 10 share by the end of the year....
However, some scientists recently created a deadly version of mouse smallpox in the laboratory by accident. Lethal human viruses could be created in a similar way, either accidentally by scientists or deliberately by terrorists. of people on Earth today have not been vaccinated against smallpox, even the ordinary strain could pose great danger if it fell into the hands of terrorists.
Hong Kong is not the only place where strategies have been mapped out in the event that SARS returns. In the United States, where only a handful of confirmed cases were verified, health officials have taken inventory in various cities, making certain that there are enough respirators and other tools needed to care for victims. Many experts say that even before the SARS outbreak worldwide, the United States was already fairly organized for a large outbreak of some infectious disease. The terrorist attacks of September 11, 2001, had alerted the nation that its procedures for a bioterrorist attack needed to be shored up.
Trauma can be conceptualized as both an event and a reaction. A traumatic event is one in which an individual experiences actual or threatened serious injury or death (American Psychiatric Association ApA , 2000). Examples of traumatic events include military combat, sexual assaults (e.g., rape or child sexual abuse), interpersonal physical assaults (e.g., a mugging), natural or manmade disasters, terrorist attacks, and motor vehicle accidents (ApA, 2000 Kessler, Sonnega, Bromet, Hughes, & Nelson, 1995).
In response to the anthrax letter attacks in 2001 and other bioterrorism threats, many microbiologists and scientists in the United States have been looking for ways of using biologic or genetic markers to trace the origins of the microorganism. The scientific community in the United States as well as in many other countries has formulated a system of microbial forensics for investigation and attribution purposes in a bioterrorism event.3,4 The basic principles of microbial forensics are useful not only in tracing bioterrorism agents but also in retrospectively and forensically determining fungal growth in relation to the chronology of water damage events indoors. The article by Budowle et al.4 also highlighted the need for microbial forensic analysis to encompass sample identification, handling, collection, preservation and storage, method selection, casework analysis, interpretation of results, validation, and quality assurance.
Isolation of rickettsiae is of great importance, as the ultimate goal is recovery of the bacterial agent from a patient or an arthropod vector. However, this approach is reserved to specialized laboratories with cell-culture facilities and equipped with biohazard facilities. Currently, R. rickettsii and R. prowazekii have been recognized as potential agents of bioterrorism. Thus, their isolation must be performed only in Biosafety Level 3 laboratories. Rickettsiae have been isolated using different methods. For a long time, animal inoculation has been performed with guinea pigs. Embryonated eggs have also been used. Presently, cell culture is the most frequent system used for the primary isolation. The shell-vial cell culture is a microculture system which has been shown to be highly efficient for obtaining rickettsial isolates from various specimens (12,114,115). Each sample is assayed in cell culture in triplicate. This method comprises a cen-trifugation step, which is critical as...
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