The neuroweapons threat

JAMES GIORDANO: James Giordano is a professor of neurology, chief of the Neuroethics Studies Program, and co-director of the O’Neill-Pellegrino Program in Brain Science and Global Health Law and Policy at...More

Nearly two years ago, Juliano Pinto, a 29-year-old paraplegic man, kicked off the World Cup in Brazil with the help of a brain-interface machine that allowed his thoughts to control a robotic exoskeleton. Audiences watching Pinto make his gentle kick, aided as he was by helpers and an elaborate rig, could be forgiven for not seeing much danger in the thrilling achievement. Yet like most powerful scientific breakthroughs, neurotechnologies that allow brains to control machines—or machines to read or control brains—inevitably bring with them the threat of weaponization and misuse, a threat that existing UN conventions designed to limit biological and chemical weapons do not yet cover and which ethical discussions of these new technologies tend to give short shrift. (It may seem like science fiction, but according to a September 2015 article in Foreign Policy, “The same brain-scanning machines meant to diagnose Alzheimer’s disease or autism could potentially read someone’s private thoughts. Computer systems attached to brain tissue that allow paralyzed patients to control robotic appendages with thought alone could also be used by a state to direct bionic soldiers or pilot aircraft. And devices designed to aid a deteriorating mind could alternatively be used to implant new memories, or to extinguish existing ones, in allies and enemies alike.”)

Despite the daunting complexity of the task, it’s time for the nations of the world to start closing these legal and ethical gaps—and taking other security precautions—if they hope to control the neuroweapons threat.

The technology on display in SĂŁo Paulo, pioneered by Miguel Nicolelis of Duke University, exhibited the growing capability of neurorobotics—the study of artificial neural systems. The medical benefits for amputees and other patients are obvious, yet the power to read or manipulate human brains carries with it more nefarious possibilities as well, foreshadowing a bold new chapter in the long history of psychological warfare and opening another front in the difficult struggle against the proliferation of exceptionally dangerous weapons.

The full range of potential neuroweapons covers everything from stimulation devices to artificial drugs to natural toxins, some of which have been studied and used for decades, including by militaries. Existing conventions on biological and chemical weapons have limited research on, and stockpiling of, certain toxins and “neuro-microbiologicals” (such as ricin and anthrax, respectively), while other powerful substances and technologies—some developed for medical purposes and readily available on the commercial market—remain ungoverned by existing international rules. Some experts also worry about an ethics lag among scientists and researchers; as the September 2015 Foreign Policy article pointed out, a 200-page report put out last spring on the ethics of the Obama administration’s BRAIN Initiative didn’t once mention “dual use” or “weaponization.” In America, federally funded medical research with potential military applications can be regulated by Dual-Use Research of Concern policies at the National Institutes of Health, which reflect the general tenor of the Biological and Toxin Weapons Convention and the Chemical Weapons Convention. Yet these policies do not account for research in other countries, or research undertaken (or underwritten) by non-state actors, and might actually create security concerns for the United States should they cause American efforts to lag behind those of other states hiding behind the excuse of health research or routine experimentation, or commercial entities sheltered by industry norms protecting proprietary interests and intellectual property.

In addition to a more robust effort on the part of scientists to better understand and define the ethics of neuroscience in this new era, one obvious solution to the neuroweapons threat would be progress on the bioweapons convention itself. In preparation for the biological weapons convention’s Eighth Review Conference at the end of this year, member states should establish a clearer view of today’s neuroscience and neurotechnology, a better understanding of present and future capabilities, and a realistic picture of emerging threats. They should also revise the current definitions of what constitutes a bioweapon, and what is weaponizable, and set up criteria to more accurately assess and analyze neuroscience research and development going forward.

I would also argue that the United States and its allies should take the proper security precautions in the form of increased surveillance of neuroscience R&D around the world. As a preliminary measure, government monitors can develop a better understanding of the field by paying attention to “tacit knowledge”—the unofficial know-how that accumulates among individuals in labs and other venues where a particular science is practiced or studied. (For more on tacit knowledge and arms control, see Sonia Ben Ouagrham-Gormley’s recent Bulletin article about its crucial importance for the bioweapons convention.) In a similar vein, authorities should also follow the neuroscience literature in an effort to assess trends, gauge progress, and profile emerging tools and techniques that could be enlisted for weaponization.

Of course these are only preliminary measures, easily stymied by proprietary restrictions in the case of commercial research and state-secret classifications in the case of government work. Thus deeper surveillance will require a wider effort to collect intelligence from a variety of sources and indicators, including university and industrial programs and projects that have direct dual-use applications; governmental and private investment in, and support of, neuroscience and neurotech R&D; researchers and scholars with specific types of knowledge and skills; product and device commercialization; and current and near-term military postures regarding neurotechnology. This type of surveillance, while requiring more nuanced and more extensive investigations, could produce highly valuable empirical models to plot realistic possibilities for the near future of neuroscience and neurotechnology. These could then be used to better anticipate threats and create contingency plans.

It’s important to note the danger of this type of surveillance as well. As a 2008 reportby the National Academies in Washington warned, increased surveillance could lead to a kind of arms race, as nations react to new developments by creating countering agents or improving upon one another’s discoveries. This could be the case not only for incapacitating agents and devices but also for performance-enhancing technologies. As a 2014 report by the National Academies readily acknowledged, this type of escalation is a realistic possibility with the potential to affect international security.

The United States and its allies should therefore be cautious if they deem it necessary to establish this kind of deep surveillance. And on the international front, they should simultaneously support efforts to improve the Biological Weapons Convention to account for neuroweapons threats in the offing.

Finally, they should keep in mind just how hard it is to regulate neuroscience and neurotechnology during this time of great discovery and expansion. Ethical ideals can be developed to shape guidelines and policies that are sensitive to real-world scenarios, but the flexibility of these approaches also means that they are not conclusive. Those charged with monitoring potential threats must be constantly vigilant in the face of changing technologies and fuzzy distinctions between medical and military uses, all while navigating the complexities of the health-care industry, political and military ethics, and international law. In light of the work ahead, it remains to be seen just how well the nations of the world will rally to face the neuroweapons threat.

Author’s note: The views expressed in this article do not necessarily reflect those of DARPA, the Joint Staff, or the United States Department of Defense. Source: https://thebulletin.org
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How to Do CPR on an Adult: 16 Steps

Do CPR on an Adult
In 2010, the American Heart Association made a radical change to the recommended CPR process for victims of cardiac arrest [1] after studies showed that compression-only CPR (no mouth-to-mouth breathing) is as effective as the traditional approach. Here's how to perform both methods of CPR on an adult. Steps: (1) Check the scene for immediate danger. Make sure you're not putting yourself in harm's way by administering CPR to someone unconscious. Is there a fire? Is the person lying on a
roadway? Do whatever is necessary to move yourself and the other person to safety. If there is anything that could endanger you or the victim, see if there is something you can do to counteract it. Open a window, turn off the stove, or put out the fire if possible. However, if there is nothing you can do to counteract the danger, move the victim. The best way to move the victim is by placing a blanket or coat underneath their back and dragging it. 2 Assess the victim's consciousness. Gently tap his or her shoulder and ask "Are you OK?" in a loud, clear voice. If he or she responds, CPR is not required. Instead, undertake, basic first aid and take measures to prevent or treat shock [1], and assess
whether you need to contact emergency services. If the victim does not respond, continue with the following steps. 3. Send for help. The more people available for this step, the better. However, it can be done alone. Send someone to call for emergency medical services (EMS).
(a) Call 911 in North America, 000 in Australia, 112 by cell phone in the EU (including the UK) and 999 in the UK. (b) Give the dispatcher your location, and notify him or her that you're going to perform CPR. If you're alone, get off the phone and start compressions after that. If you have someone else with you, have him or her stay on the line while you do CPR on the victim. 4. Do not check for a pulse. If you're not a trained medical professional, odds are you'll spend too much valuable time looking for a pulse when you should be doing compressions.[2] 5 Check for breathing. Put your ear close to the victim's nose and mouth, and listen for slight breathing. If the victim is coughing or breathing normally, do not perform CPR. Doing so could cause the heart to stop beating. [3] 
6 Place the victim on his or her back. Make sure he or she is lying as flat as possible - this will prevent injury while you're doing chest compressions. 
7 Place the heel of one hand on the victim's breastbone, exactly between the nipples.
8 Place your second hand on top of the first hand, palm-down.
9 Position your body directly over your hands, so that your arms are straight & somewhat rigid.
10 Perform 30 chest compressions. Press down with both hands directly over the breastbone to perform a compression, which helps the heart beat. Chest compressions are more critical for correcting abnormal heart rhythms (ventricular fibrillation or pulseless ventricular tachycardia).
(a) You should press down by about 2 inches (5 cm).[4] (b) Do the compressions in a relatively fast rhythm. Some agencies recommend doing compressions to the beat of the chorus of "Stayin' Alive," a 1970s disco hit, or at roughly 103 beats per minute. (You can listen to it here.) 11Minimize pauses in chest compression that occur when changing providers or preparing for a shock.[1] Attempt to limit interruptions to less than 10 seconds. [4] 
12. Make sure the airway is open. Place your hand on the victim's forehead and two fingers on their chin and tilt the head back to open the airway.
(a) If you suspect a neck injury, pull the jaw forward rather than lifting the chin. If jaw thrust fails to open the airway, do a careful head tilt and chin lift. (b) If there are no signs of life, place a breathing barrier (if available) over the victim's mouth. 13 Give two rescue breaths (optional). The American Heart Association no longer considers rescue breaths necessary for CPR, as the chest compressions are more important. You can give them if you choose to, though. 
(a) Keeping the airway open, take the fingers that were on the forehead and pinch the victim's nose closed. Make a seal with your mouth over the victim's mouth and breathe out for about one second. Make sure you breathe slowly, as this will make sure the air goes in the lungs and not the stomach. (b) If the breath goes in, you should see the chest slightly rise and also feel it go in. Give a second rescue breath. If the breath does not go in, re-position the head and try again. (c) If it does not go in again, the victim may be choking. Do abdominal thrusts (the Heimlich manuever) to remove the obstruction. 14 Repeat the cycle of 30 chest compressions. If you're also doing rescue breaths, keep doing a cycle of 30 chest compressions and 2 rescue breaths.
(a) You should do CPR for 2 minutes (5 cycles of compressions to breaths) before checking for signs of life. 15 Continue CPR until someone takes over for you, emergency personnel arrive, you are too exhausted to continue, an AED is available for immediate use, or signs of life return.
16 Use an AED (automated external defibrillator). If an AED is available in the immediate area, use it as soon as possible to jump-start the victim's heart. [5]
(a) Make sure there are no puddles or standing water in the immediate area. (b) Turn on the AED. It should have voice prompts that tell you what to do. (c) Fully expose the victim's chest. Remove any metal necklaces or underwire bras. (d) Check for any body piercings, or evidence that the victim has a pacemaker or implantable cardioverter defibrillator (should be indicated by a medical bracelet). (e) Make sure the chest is absolutely dry. Note that if the person has a lot of chest hair, you may need to shave it. Some AED kits come with razors for this purpose. (f) Attach the sticky pads with electrodes to the victim's chest. Follow the instructions on the AED for placement. Move the pads at least 1 inch (2.5 cm) away from any metal piercings or implanted devices. (g) Make sure no one is touching the person. (h) Press analyze on the AED machine. (I) If a shock is needed, the machine will notify you. If you do shock the victim, make sure no one is touching him or her. (J) Remove the electrode pads and resume CPR for another 5 cycles before using the AED again.
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Tips, (A) If you must move the victim, try to disturb the body as little as possible. (B) You can get guidance on correct CPR technique from an emergency services operator if needed. (C) Get proper training from a qualified organization in your area. Training from an experienced instructor is the best way to be prepared in an emergency. (D) Always call Emergency Medical Services. (E) If you are unable or unwilling to perform rescue breathing, engage in compression-only CPR with the victim. This will still aid the victim in recovering from cardiac arrest.[1],
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Warnings, (a) Do not move the patient unless he or she is in immediate danger or are in a place that is life-threatening. (b) Remember, if some one is not in your care, you must ask permission of the responsive victim if you can help. If they are unresponsive, you have implied consent. (c) Remember that CPR is different for adults, children and infants; this CPR is meant to be administered to an adult. (d) If possible, wear gloves and use a breathing barrier when possible to make transmission of diseases less likely. If the person has normal breathing, coughing, or movement, do not begin chest compressions. Doing so may cause the heart to stop beating. [6]Source: WikiHow
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Blood serum from animals can slash Covid severity: ICMR

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The Indian Council of Medical Research (ICMR) in collaboration with a Hyderabad-based pharmaceuticals and biologics company, has introduced a well-established treatment modality to control the severity of COVID-19 disease, the apex research institute informed on Thursday.

"The ICMR along with Biological E. Limited have developed "highly purified antisera (raised in animals) for prophylaxis and treatment of the viral disease," it said.

Antisera are blood serum derived from animals which contain antibodies against specific antigens. They are injected to treat or protect against specific diseases. After plasma therapy, it is the latest therapy to be used to treat and prevent the severity of COVID-19 disease among the patients.

While plasma therapy could not derive a satisfactory result in reducing mortality of the severe patients of COVID-19, the ICMR has high hopes riding on the antisera therapy. "Although, plasma recovered from patients experiencing COVID-19 could serve a similar purpose, the profile of antibodies, their efficacy and concentration keep varying from one patient to another and therefore make it an unreliable clinical tool for patient management," the ICMR stated.

However, the therapeutic use of antisera is not new to medical science. The ICMR said that it has been used to control many viral and bacterial infections. Besides, the World Health Organisation (WHO) has listed it as a life-saving medicine.

"Such measures have previously been used in medical science to control many viral and bacterial infections such as Rabies, Hepatitis B, Vaccinia virus, Tetanus, Botulism and Diphtheria," the ICMR stated.

While the use of convalescent plasma as a treatment modality for COVID-19 has received authorisation for off-label use in India, a study conducted by the ICMR suggested that its administration did not reduce mortality or progression to severe COVID-19 condition among the patients.

The study, published on September 8, was conducted in 39 tertiary care hospitals across the country.

A total of 464 participants were enrolled between April 22 and July 14 in the trial which was aimed to investigate its effectiveness for treatment of COVID-19.

However, the ICMR did not share particulars related to clinical testing and trials of the antisera therapy on humans. Source: https://southasiamonitor.org
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