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#Q-Marburg
wildwechselmagazin · 1 year
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soundjunglefan · 2 years
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shirleymerly · 2 years
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WARNING. THE 2030 agenda is implemented in every city state nation! WEF WHO UN. GREAT RESET NEW WORLD ORDER. All. The Marxist demons are planning to implement this asap
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wqaz222 · 2 years
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办理国外大学毕业证成绩单马尔堡大学文凭证书补办微信:1825214279无法正常毕业证购买德国马尔堡大学本科/硕士学位证书伪造马尔堡大学毕业文凭补办Philipps-Universitat Marburg Diploma
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wqaz111 · 2 years
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soundjunglefan · 2 years
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karlscott · 7 years
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Last night I played the penultimate concert of this run at 'Q' a nice quirky little cafe in Marburg. I plugged in and stood up! Sometimes it makes a nice change. Also if was so full of people it was needed! Really felt a great connection to you all thank you for all the encouraging words. And thank you Q for letting me play! Saturday I finish off in Düsseldorf. #marburg #düsseldorf #Q-Marburg #diymusic #diymusician #singersongwriter #moderndaytroubadour #travelingmusician #diysingersongwriter #gifteconomy #guitar #cajon #mandolin #cajon #harmonica #capos #partialcapo #multiplecapos #handmadecds #resonator #accoustic (at Marburg, Germany)
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thehomemadehooligan · 5 years
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To Do List
My turn - today’s replies
a reply for @svnliqhts from Ben Fringe
a reply for @galahadsrp from Miles O’Shaughnessy
a reply for @femmeshavemorefun from Crawford Leather
a reply for @femmeshavemorefun from Keelan Cavanaugh
a reply for @tannerandthesociety from Theo Raeken
a meme continuation for @malsrp from Riko
a meme continuation for @malsrp from Steffen Vigo
a meme continuation for @malsrp from Zinaida Kuznetsova
a meme continuation for @theheartbreakprinces from King Ben
a meme continuation for @theheartbreakprinces from Jughead Jones
a reply for @theheartbreakprinces from FP Jones
a reply for @canonbcys from Roan kom Azgeda
a starter reply for @malsrp from Elodie Irvine & Jade Tonnick
a starter reply for @malsrp from Exy Enger
a starter reply for @malsrp from Betsy Shrivatsa
a starter reply for @malsrp from Lena Crighton
a meme continuation for @deadbrcther from Scott McCall
a reply for @malsrp from Beatrice Porter
a reply for @theheartbreakprinces from Jughead Jones
a starter reply for @femmeshavemorefun from Austin DiSantos
a meme continuation for @malsrp from Steffen Vigo
a meme continuation for @malsrp from Mekhi Kennedy
a reply for @prettypinklyps from Eddie Brock
a reply for @tannerandthesociety from Jett McCreighton-Hill
a reply for @prettypinklyps from Billy Hargrove
a reply for @malsrp from Diego Hargreeves
a reply for @malsrp from Tobias Bourne
a reply for @malsrp from Archie Andrews
a reply for @svnliqhts from Jimi Mars
a reply for @femmeshavemorefun from Seb & Sam Shankarov
a reply for @malsrp from Jughead Jones
a reply for @malsrp from Maleficent
a reply for @svnliqhts from Radovan Zivkovic
a reply for @dangerousbeasts from Jon Snow
a reply for @malsrp from Caine Dunbar
a reply for @svnliqhts from Makaio Timoti
a reply for @malsrp from Lyria of Leah
My turn - In Drafts
a reply for @rebellhearted from Bellamy Blake
a reply for @rebellhearted from Bellamy Blake
a reply for @imscrry from Billy Hargrove
a reply for @rebellhearted from Bellamy Blake
a reply for @rebellhearted from Billy Hargrove
a starter reply for @halefirewarrior from Billy Hargrove
a meme continuation for @strawbcrryfanta from Turbo
a meme reply for @strawbcrryfanta from Josh Wheeler
a reply for @ohnosmallknives from Harley Keener
a reply for @ohnosmallknives from Harley Keener
a reply for @ohnosmallknives from Harley Keener
a reply for @beaconwhores from Caine Dunbar
a reply for @malsrp from Ciaran Byrne
a reply for @malsrp from Sebastian Michaelis
a reply for @malsrp from Lexa kom Trikru
a reply for @ohnosmallknives from Harry Osborn
a meme continuation for @ohnosmallknives from Harry Osborn
a reply for @malsrp from Kit Rook
a reply for @malsrp from Fievel Voelkel
a reply for @malsrp from Jefferson
a reply for @ohnosmallknives from Harry Osborn
a reply for @malsrp from Iva Malone
a reply for @malsrp from Griffin
a reply for @ohnosmallknives from Harley Keener
a reply for @malsrp from Jax Porter
a reply for @ofmenofsins from Wolfgang Bogdanow
a reply for @aprilxblooms from Steve Winchell
a reply for @theheartbreakprinces from Joaquin DeSantos
a reply for @malsrp from Arika Longan & Fin Leonidus
a reply for @malsrp from Issac Lawson
a reply for @malsrp from Andreas Vasilescu
a reply for @malsrp from Clary Helstrom
a reply for @malsrp from Switch McKenna
a reply for @malsrp from Kimril Holt
a reply for @malsrp from Kostia kom Trikru
a reply for @malsrp from Big Grant
a reply for @malsrp from Raven Reyes
a reply for @malsrp from Enzo Ferris
a reply for @malsrp from Chibs Telford
a reply for @malsrp from Prudence Night
a reply for @malsrp from Evie Grimhilde
a reply for @malsrp from Fangs Fogarty
a reply for @cvntboys from Alon Crisanto
a reply for @lewdlegion from Caspian Lance
a reply for @jigglypuffwrites from Philip Pearson
a reply for @sonsoftheking from Tig Trager
a reply for @malsrp from Ren Addington
a reply for @malsrp from Beatty Cres
a reply for @malsrp from Alastair York
a reply for @drkrooms from Steve Harrington
a reply for @malsrp from Rosalee Lette
a reply for @malsrp from Tony Stonem
a reply for @malsrp from Yuki Musume
a reply for @malsrp from Connor MacManus
a reply for @rebellhearted from Bellamy Blake
a reply for @rebellhearted from Bellamy Blake
a reply for @malsrp from Balance Grant
a reply for @malsrp from Edric Lange
a reply for @malsrp from Ink Marburg
a reply for @malsrp from Cherie Lewis
a starter reply for @malsrp from Paw Cavanaugh
a starter reply for @malsrp from Iva Malone
a starter reply for @malsrp from Jakoby Ellis
a starter reply for @fxxlssxcxld from someone
a starter reply for @malsrp from Switch McKenna
a starter reply for @assfcrdays from Tony Monroe
a starter reply for @wickcdcreations from Cherokee Cash
a starter reply for @breedables from Evgeni Shankarov
a meme reply for @imscrry from Billy Hargrove
a meme continuation for @imscrry from Billy Hargrove
a reply for @thestrangerinhawkins from Steve Harrington
a meme reply for @ahoy-dingus from Tammy Thompson
a meme reply for @aprilxblooms from Steve Winchell
a meme reply for @losingluck from Billy Hargrove
a meme continuation for @malsrp from Agron
a meme continuation for @malsrp from Aleksander Lubomirksi
a reply for @brightsidc from Billy Hargrove
a meme continuation for @malsrp from Nova
a meme continuation for @malsrp​ from Weiryn Cernonnus
a meme continuation for @malsrp​ from Steffen Vigo
a meme continuation for @malsrp​ from Jumpcut Jones
a reply for @jigglypuffwrites​ from Hayley Gold
a meme continuation for @q-makepeace​ from Eliot Waugh
a starter reply for @losingluck​ from Billy Hargrove
a meme continuation for @jocksitter​ from Billy Hargrove
a meme continuation for @jocksitter from Billy Hargrove
a meme reply for @cheapedtricks from Billy Hargrove
a meme reply for @hawkinssleuth from Billy Hargrove
a meme reply for @hawkinssleuth from Billy Hargrove
a meme reply for @hildr-daughter-of-loki from Billy Hargrove
a reply for @ahoy-dingus from Glass Baldwin
a reply for @ofmenofsins from Peter Parker
a meme reply for @beaconwhores from Wren Comescu
a meme continuation for @wallcrawlparker from Eddie Brock
a meme continuation for @wallcrawlparker from Harry Osborn
a meme continuation for @wallcrawlparker from Harley Keener
a meme continuation for @wallcrawlparker from Wade Wilson
a meme continuation for @deadbrcther from Joaquin DeSantos
a meme continuation for @deadbrcther from Sweet Pea
a starter reply for @malsrp from Polly Rise
a starter reply for @malsrp from Bridget Barker
a meme continuation for @ohnosmallknives from Harry Osborn
a starter reply for @pynkcandiies from the Cruikshanks twins
a reply for @theheartbreakprinces from Joaquin DeSantos
a meme continuation for @theheartbreakprinces from Reggie Mantle
a meme continuation for @theheartbreakprinces from Moose Mason
a starter reply for @unholyserena from Prudence Night
a meme continuation for @malsrp from Shelby Kiyaya
a meme continuation for @malsrp from Yuki Musume
a meme continuation for @malsrp from Alastair York
a meme continuation for @malsrp from Makena Kysely
a meme continuation for @malsrp from Illyiad Barakan
a meme continuation for @malsrp from Lorelai Vierra
a meme continuation for @malsrp from Baby Grant
a meme continuation for @malsrp from Jean Moreau
a meme continuation for @malsrp from Peter Burke
a meme continuation for @malsrp from Steve Jinks
a meme continuation for @malsrp from Nova
a meme continuation for @malsrp from Jeremiah Fenrirson
a meme continuation for @malsrp from Greyson Rutherford
a meme continuation for @malsrp from Will Herondale
a meme continuation for @malsrp from Lykaios Godfrey
a meme continuation for @malsrp from Revolver
a meme continuation for @malsrp from Remington Goldwyn-Mayer
a reply for @ovcrtly-sexual from Nia Bradbury 
Others Turn
Billy & Max @cheapedtricks
Billy & Steve @imscrry
Billy &  Steve @imscrry
Billy &  Steve @jocksitter
Billy &  Steve @jocksitter
Billy &  Steve @jocksitter
Billy &  Steve @jocksitter
Billy &  Steve @jocksitter
Billy &  Steve @jocksitter
Billy &  Steve @jocksitter
Eddie & Peter @ohnosmallknives 
Eddie & Peter @theheartbreakprinces
Eddie & Peter @supercvnts
Eddie & Peter @supercvnts
Roman & Peter @writteninthestcrs
Simon & Jace @jigglypuffwrites
Simon & Jace @dangerousbeasts
Leonard & Barry @prettypinklyps
Clint & Pietro @prettypinklyps
Paul & Ashley @cvntboisandfems4u
Nysse & Madelaine @malsrp
Zyla & Zoe @malsrp
Morbid & Ink & Nadia @beaconwhores
Murphy & Someone @touchfelt
Murphy & Bellamy @malsrp
Bellamy & Murphy @rebellhearted
Bellamy & Murphy @rebellhearted
Bellamy & Murphy [Archived] @floatmenow
Bellamy & Clark @canonbcys
Nick & Ambrose @accidentallymagic 
Theo & Talia @beaconwhores 
Stirling & Lori @beaconwhores 
Miles & Joaquin @malsrp 
Ian & Mickey @malsrp 
Nick & Harvey @dangerousbeasts 
Nick & Harvey @theheartbreakprinces 
Ian & Mickey @glassmenagerieofmuses 
Bellamy & Murphy @sarcasiisms 
Crawford & Annie @femmeshavemorefun 
Keelan & Macie @femmeshavemorefun 
Bellamy & Murphy @sarcasiisms 
Theo & Scott @dangerousbeasts 
Peter & Liam @malsrp 
Spot & Race @malsrp 
Roman & Peter @malsrp 
Derek & Stiles @malsrp 
Nick & Harvey @theheartbreakprinces  
Derek & Stiles @deadbrcther 
Elijah & Kol @dangerousbeasts 
Billy & Marcus @killreagan 
Madrigan & Noah @tannerandthesociety 
Sicario & Rachel @femmeshavemorefun 
Sicario & Laurie @femmeshavemorefun 
Damon & Laurie @cvntboisandfems4u 
Elijah & Laurie @cvntboisandfems4u 
Ambrose & Nick @accidentallymagic 
Xalvador & Finn @accidentallymagic 
Javan & Mike @accidentallymagic 
Steve & Robin @ahoy-dingus 
Steve & Billy @thedisasterboys 
Archie & Hiram @canonbcys 
Steve & Billy @thedisasterboys 
Ben & Harry @malsrp 
Blaise & Jojo @prettypinklyps 
Brody & Linda @cvntboisandfems4u 
Carl & Kammy @malsrp 
El & Max @cheapedtricks 
Betty & Veronica @malsrp 
Erasyl & Austin @malsrp 
Faraday & Calvin @prettypinklyps 
Gryphon & Sascha @malsrp 
Hayley & Carlos @jigglypuffwrites 
Jasper & Bellamy @canonbcys 
Jett & Keltie @pynkcandiies 
Murphy & Dyson @touchfelt 
Murphy & Bellamy @touchfelt 
Murphy & Bellamy @touchfelt 
Murphy & Bellamy @touchfelt 
Murphy & Someone @touchfelt 
Roan & Octavian @canonbcys 
Jace & Clary @claryiisms 
Ladon & Brandon @cvntboys 
Lucilla & Aluzka @heartonanoose 
Mae & Aluzka @heartonanoose 
Magnus & Alec @malsrp 
Matilda & Corey @malsrp 
Mick & Bambi @cvntboisandfems4u 
Ivy & Harley @malsrp 
Ravi & Leo @cvntboys 
Steve & Nancy @hawkinssleuth 
Steve & Nancy @hawkinssleuth 
Steve & Billy @savehargrove 
Steve & Jonathan @drkrooms 
Steve & Billy @savehargrove 
Steve & French @jigglypuffwrites  
Lilah & Ava @malsrp 
Teasaidh & Daemon @jigglypuffwrites 
Face & HM @malsrp 
Tex & Kellan @prettypinklyps 
Win & Laurie @cvntboisandfems4u 
Walker & Beau @malsrp 
Wolfgang & Alcide @ofmenofsins 
Yancy & Louie @nighttideboys 
Open Starters
Eddie Brock starter
Present Day Billy starter
Theo Raeken starter
Paul Tristan starter
Hades starter
Simon Lewis starter
Roman Godfrey starter
Clint Barton starter
Nysse Hamilton starter
Nick St North starter
Zyla Folsom starter
Elijah Mikaelson starter
Ink Marburg starter
Billy Hargrove starter
Morbid Kitchell starter
Tony Monroe starter
Miles O’Shaughnessy starter
Eddie Brock starter
Billy Bennett starter
Peilani Salvatore starter
Eli Cardashyan starter
Mick Sweeney starter
Noah Bello starter
Burke starter
Pyro starter
Damon Salvatore starter
Murphy starter
Quentin Quire starter
Leonard Snart starter
Jean Moreau starter
Keelan Cavanaugh starter
Sicario Montoya starter
Prudence Night starter
Peter Hale starter
Elijah Mikaelson starter
Ink Marburg starter
Billy Hargrove starter
Tony Monroe starter
Miles O’Shaughnessy Hogwarts starter
Jimi Mars starter
Stirling Argent starter
Eddie Brock starter
Jon Snow starter
Ian Gallagher starter
Iva Malone starter
Theo Raeken starter
Paul Tristan starter
Robin Locksley starter
St.John Allerdyce starter
Harry Hook starter
Pegasus Simon starter [Third Version]
Pegasus Simon starter [Femme Version]
Crawford Leather starter
Roman Godfrey starter
Peter Hale starter 
Spot Conlon starter
Stirling Argent starter
Derek Hale starter
Bellamy Blake starter
Keelan Cavanaugh starter
Miles O’Shaughnessy starter
Elijah Mikaelson starter
Sicario Montoya starter
Iva Malone starter
Ian Gallagher starter
Theo Raeken starter
Pegasus Simon starter
Diego Hargreeves starter
Cooper Rose starter
Court Silver starter
Jughead Jones starter
Pretty punk Murphy starter
Street kid Murphy starter
Diego Hargreeves starter
Closed Starters
Raven Reyes for @malsrp 
Starters for me to do
Sicario Montoya for @theownerslove
Eddie Brock for @spiderprodigy
Billy Hargrove for @femmantics
Ian Gallagher for @sarcasiisms
Eddie Brock for @speedsterandweedster
Paul Tristan for @theheartbreakprinces
Peter Hale for @theheartbreakprinces
Jon Snow for @theheartbreakprinces
Robin Locksley for @ranodo
Tate Harrington for @everlcstinq
Carl Grimes for @everlcstinq
Carl Grimes for @spiderprodigy
Ron Anderson for @everlcstinq
Randall Carpio for @fvckingmagic
Morbid Kitchell for @malsrp
Dove Finch for @malsrp
Dove French for @diviinitism
Dove Finch for @dangerousbeasts
Dove Finch for @rebellhearted
Cherokee Cash for @theheartbreakprinces
Billy Hargrove for @h010type
Billy Hargrove for @halefirewarrior
Roman Godfrey for @maleshaven 
Javan Bengal for @ranodo 
Sam & Seb for @mxleshxven
Sam & Seb for @tcnebris 
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findasongblog · 5 years
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A different experience: Seed To Tree at Schick & Schön, Mainz (DE), 15.04.2019
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When adding a link for the German tour dates to my review of the album release show three weeks ago, I suddenly realized that they were all during school vacation 😃 (the last time going to a gig included a long drive in the middle of a normal week, I swore I won’t do that again – guess I’m getting old LOL) It was also the chance for Mel, who couldn’t come with me to the release show, to finally hear some of the songs from the new album live for the first time.
Dear German (and/or living in Germany) readers, I made sure this review was posted extra fast so you can get your tickets for one of the remaining shows:
TODAY (April 16th) – Dortmund / FZW Wednesday, April 17th – Köln / Stereo Wonderland Thursday, April 18th – Berlin / Monarch Bar Friday, April 19th – Marburg / Q-Café.Club.Kultur. Saturday, April 20th – Friesoythe / Holla Die Waldfee Sunday, April 21st – Kiel / FahrradKinoKombinat Monday, April 22nd – Hamburg / Astra Stube Tuesday, April 23rd – Oldbenburg / umBAUbar
(one hell of a schedule, actually 😮)
Before the gig, we had time to discover that Mainz is a lovely city (albeit with shops closing half an hour earlier than what we are used to). At least, that meant we were at the venue early and could secure a nice and cosy spot in front of the stage. Cosy as in seated, which was a first for a Seed To Tree show. It felt a bit strange to keep the seats during the performance, but we had a good view and didn’t want to block that of the people behind us. It was, of course, a very different experience from the show at the Rockhal, yet one I woudn’t like to miss.
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In addition to two songs from the debut album Wandering and two from the Unconcerned EP, nearly all songs from the new album Proportions were played (strange, the evening seemed to go by so fast?!). Allow me to copy and paste my short review for one last time:
“Proportions will be released on March 22nd and the four songs which are already available now  (Integrity + I Wouldn’t Mind, Within Me and Lack of Proportion) give you an accurate idea of what to expect from the record as a whole (I can tell because I was finally able to listen to it): music ranging from dreamy to catchy, combined with thought provoking lyrics – indie pop with depth.
The Unconcerned EP released in 2017 already hinted at what is confirmed by the new full length: that the band have come a long way from their indie folk roots. While the now four years old debut album Wandering was pretty straightforward music and lyric wise, the new songs offer layers to be explored and lyrics which, while asking universal questions (the search for identity in our modern world is a recurrent theme), invite the listener to find their own answers and meaning. Of course, you can also just get lost in the music if you prefer that.”
So - now get your tickets and tell the guys I sent you ☺️
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eksopolitiikka · 3 years
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Bioaseet, bioterrorismi ja rokotteet
Bioaseet, bioterrorismi ja rokotteet
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Terroristien tai kansallisten voimien biologinen hyökkäys voi tuntua action-elokuvan juonikuviolta eikä niinkään realistiselta uhalta. Ja todellakin, mahdollisuus sellaiselle hyökkäykselle on varsin pieni. Biologisia hyökkäyksiä, kuitenkin, on tehty aiemmin, niinkin tuoreeltaan kuin vuonna 2001. Yhdysvaltain eri virastojen joukko oli mukana suunnittelemassa sitä miten toimia biologisten hyökkäyksien tapauksessa.
Bioasehyökkäyksessä hyökkääjä voi tarkoituksella vapauttaa taudinaiheuttajia, jotka saavat aikaan yhden tai useamman eri taudin. Terveysviranomaiset ovat kehittäneet järjestelmän, jolla priorisoidaan biologisia taudinaiheuttajia niiden kansanterveydelle aiheuttamien riskien perusteella. Kategorian A taudinaiheuttajat ovat korkeimpaa prioriteettia, ja nämä taudinaiheuttajat ovat riski kansalliselle turvallisuudelle, koska ne leviävät henkilöltä toiselle ja/tai johtavat suureen kuolleisuuteen, ja/tai niillä on suuri potentiaali saada aikaan yhteiskunnallista disruptiota. Näihin kuuluu pernarutto, botulismi (botuliinin avulla, joka ei siirry henkilöltä toiselle), rutto, isorokko, tularemia ja joukko muita viruksia, jotka aiheuttavat aivoverenvuotokuumetta, kuten Ebola, Marburg, Lassa ja Machupo. Nämä taudinaiheuttajat ovat olemassa luonnossa (poislukien isorokko, jota ei enää esiinny luonnossa), mutta niitä voidaan manipuloiden muokata vaarallisemmiksi.
Kategorian B taudinaiheuttajat ovat suhteellisen helppoja levittää ja johtavat matalaan kuolleisuuteen. Näihin kuuluu bruselloosi, räkätauti, Q-kuume, risiini, pilkkukuume ja muita taudinaiheuttajia. Kategorian C taudinaiheuttajiin kuuluu tulevaisuuden taudinaiheuttajia, joita voidaan geneettisesti manipuloida massalevitykseen, kuten Nipah-virus. (Tässä mahdollisten uhkien lista CDC:ltä, joka listaa kategorian A, B ja C taudinaiheuttajat. Huomaa kemialliset aseet, kuten ei-biologisia aineita kuten kloriinikaasua käyttävät, jotka puuttuvat listalta.)
Tehokkaiden rokotteiden käyttö todennäköisesti suojaisi elämiä ja rajoittaisi sairauksien leviämistä biologisen aseen aiheuttamassa hätätilassa. Lisensoituja rokotteita tällä hetkellä on saatavilla vain harvoihin uhkiin, kuten pernaruttoon ja isorokkoon, ja tutkimusta tehdään rokotteiden kehittämiseksi muita uhkia varten, kuten tularemia, Ebola-virus ja Marburg-virus. Monilta bioaseuhkilta puuttuu kuitenkin rokote, ja hätätilanteessa sellaisten rokotteiden käyttö, joita tiettyihin tauteihin on olemassa, on merkittävien haasteiden takana.
Mikä on bioterroriuhka?
Vuoden 2001 Model State Emergency Health Powers Act, joka on kansanterveydellisten kriisien lakeja säätävien lainsäädännöllisten elinten ohjaukseen tarkoitettu dokumentti, on määritellyt bioterrorismin olevan “minkä tahansa mikro-organismin, viruksen, tartuntatauteja aiheuttavan aineen tai biologisen tuotteen tarkoituksellista käyttöä, joka joko esiintyy luonnossa tai jota voidaan tuottaa bioteknologialla, joka aiheuttaa kuoleman, sairauden tai muun biologisen toimintahäiriön ihmisessä, eläimessä, kasvissa tai muussa elävässä organismissa, jolla vaikutetaan valtion toimintaan tai uhkaillaan tai pakotetaan siviiliväestöä.” Biologista sodankäyntiä ja bioterrorismia käytetään usein terminä samasta ilmiöstä, mutta bioterrorismi usein viittaa jonkin valtion sisällä toimivan tahon toimintaan, eikä niinkään valtion toimintaan.
Miten todennäköistä biologinen hyökkäys on?
Biologisen hyökkäyksen todennäköisyydestä esiintyy asiantuntijoiden keskuudessa erimielisyyttä. Yhdysvaltain Office of the Director of National Intelligence ja National Intelligence Council esittivät vuonna 2008, että bioterrorismi on todennäköisempi uhka kuin ydinaseterrorismi. Samana vuonna Yhdysvaltain kansallisen tiedustelun johtaja Mike McConnell paljasti, että kaikista massatuhoaseista biologiset aseet olivat hänen henkilökohtaisesti suurin huolenaiheensa (McConnell, 2008). Muut maanpuolustuksen asiantuntijat ja tieteentekijät ovat sitä mieltä, että minkään hyökkäyksen mahdollisuus, erityisesti laajamittaisen hyökkäyksen mahdollisuus, on pieni ottaen huomioon haasteet biologisten taudinaiheuttajien kehittämisessä, aseistamisessa ja niiden käyttämisessä. Esimerkiksi tekniset vaikeudet taudinaiheuttajien aerosoliksi tuottamisessa ja sen levittämisessä tarkasti ja laajalti, samalla kun koitetaan ylläpitää virulenssia, ovat kovin suuria. Tästä huolimatta useimmat bioturvallisuuden asiantuntijat tunnustavat, että hyökkäyspotentiaalia ei tulisi sivuuttaa. Lisäksi biologisen hyökkäyksen valmistelu auttaa todennäköisesti varautumaan muunlaisiin kansanterveysuhkiin.
Historiaa
Biologiset aseet
Biologiset aseet eivät ole vain 2000-luvun huoli: ihmiset ovat käyttäneet tarttuvia taudinaiheuttajia konflikteissa satoja vuosia. Tässä muutama esimerkki.
Vuonna 1336 pyrkimyksenään tartuttaa kaupungissa asuvat, mongolihyökkääjät nykyisessä Ukrainassa käyttivät katapultteja sinkoamaan ruttoisia ruumiita Caffan kaupungin muurien sisälle.
Tunisialaiset joukot käyttivät ruttoista vaatetusta aseena vuoden 1785 La Callen taistelussa.
Britannian upseerit keskustelivat suunnitelmista tarkoituksella tartuttaa isorokko Amerikan intiaanipopulaatioon Pontiacin vallankumouksen aikaan Fort Pittissa (nykyisessä Pittsburhissa, Pennsylvaniassa) vuonna 1763. Ei ole selvää saivatko he toteutetuksi aikeitaan oikeasti. Mutta kuitenkin isorokko levisi intiaaneihin alueella pian tämän jälkeen.
Japanilaiset käyttivät ruttoa biologisena aseena Japanin ja Kiinan välisessä sodassa 1930- ja 40-luvuilla. He täyttivät pommeja ruttokirpuilla ja tiputtivat niitä lentokoneista kahteen kiinalaiskaupunkiin; he myös käyttivät koleraa ja shigellaa aseina toisissa hyökkäyksissä. Arviolta 580 tuhatta kiinalaista kuoli japanilaisten bioaseohjelman seurauksena (Martin et al., 2007).
Amerikkalaiset kehittivät biologisia aseita ja tutkivat niiden vaikutuksia 1900-luvulla. Yhdysvaltain armeijan biologisen sodankäynnin laboratoriot Camp (myöhemmin Fort) Detrickissa, Marylandissa pyörittivät bioaseohjelmaa vuosina 1949-1969. Ohjelma tuotti ja aseisti useita biologisia taudinaiheuttajia, mm. pernaruttoa ja botuliinia, vaikka aseita ei konflikteissa käytettykään. Presidentti Nixon lopetti ohjelman vuonna 1969, ja amerikkalaisten bioaseet tuhottiin. Yhdysvaltain bioasetutkimus on siitä lähtien keskittynyt puolustustoimiin, kuten immunisaatioon ja vastatoimiin.
Vuonna 1975 Biological and Toxin Weapons Convention (BTWC) tuli voimaan. Yli 100 maata, mm. Yhdysvallat, olivat ratifioineet sopimuksen, joka pyrki lakkauttamaan bioaseiden kehittämisen. Huolimatta sopimuksesta, bioaseiden uhka laitapuolen ryhmittymiltä, terroristeilta ja sopimuksen ulkopuolisilta mailta jatkoi viranomaisten kalvamista.
Entisen Neuvostoliiton tiedetään tuottaneen suuria määriä isorokkovirusta ja monia muita taudinaiheuttajia sen bioaseohjelmassa kauan sen BTWC:n allekirjoittamisen jälkeen. 1970-luvulla se hamstrasi isorokkovirusta suuria määriä ja ylläpiti tuotantokykyä ainakin vuoteen 1990 asti. Neuvostoliitto sponsoroi myös pernaruttoaseohjelmaa; vahingossa luontoon päässyt aseistettu pernarutto armeijan tutkimuslaboratoriosta vuonna 1979 johti ainakin 70 ihmisen kuolemaan. Neuvostoliitto väitti tuhonneensa sen bioasevarastot ja lopettaneen bioaseohjelman 1980-luvun loppupuolella, mutta useimmat asiantuntijat ovat skeptisiä sen suhteen että kaikki varastot, laitteet ja tiedot olisi tuhottu. He pitivät sitä mahdollisuutena, että biologisen materiaalin tai sitä koskevan tiedon siirtoa olisi tapahtunut laittomasti. Joten, vaikka olemassaolevia isorokkoviruslähteitä tunnetaan ainoastaan kaksi, molemmat ovat WHO:n referenssilaboratorioissa, monet uskovat että toiset ryhmät — kansalliset tai pienemmät — saattavat pitää hallussaan tuntemattomia määriä isorokkovirusta sekä muita jäänteitä Neuvostoliiton ajan bioaseohjelmasta.
Samalla tavoin 1990-luvun Irak myönsi YK:n tarkkailijoille, että se oli tuottanut tuhansia tonneja botuliinikonsentraattia, ja oli kehittänyt pommeja joilla suuria määriä botuliinitoksiinia ja pernaruttoa levitettäisiin. Vaikka Irakin valtio jätti bioaseohjelman taakseen ensimmäisen Irakin sodan jälkeen, suurten määrien sijainti tarttuvaa materiaalia, jotka he olivat tuottaneet, on edelleen tuntematon.
Bioturva-asiantuntijoiden toinen huoli on Al Qaeda, jolla oli suuria määriä bioasetoimintaa Afganistanissa. Tämä tuhottiin kun USA pommitti heidän laitoksia ja koulutusleirejä vuonna 2001. Al Qaedan ohjelma nykyään on todennäköisesti paljon pienimuotoisempi, koska iso osa sen materiaalista ja aineettomasta pääomasta tuhoutui. Useimmat asiantuntijat pitävät Al Qaedan nykyisiä yrityksiä ottaa aseita edelleen käyttöön liittyvän kemiallisiin aseisiin eikä niinkään biologisiin aseisiin. Kansallisella tasolla vuoden 2007 USA:n armeijan arvio biologisten aseiden uhkista sisälsi seuraavat arviot bioaseohjelmista, “Julkisen vuonna 2005 tehdyn USA:n ulkoministeriön raportin mukaan, BWC:ta [biologisten aseiden vastainen konventti] rikkovia hyökkäystoimintaa jatkavia bioaseohjelmia on mm. Kiinassa, Iranissa, Pohjois-Koreassa, Venäjällä, Syyriassa ja mahdollisesti Kuubassa” (Martin et al., 2007).
Nykyajan hyökkäyksen USA:ssa
Intialaisen gurun Bhagwan Shree Rajneeshin oregonilaiset seuraajat tekivät hyökkäyksen, joka sairastutti lähes 800 ihmistä pilkkukuumeeseen vuonna 1984. Kultin jäsenet levittivät bakteereita salaattipöytiin ja muuhun ravintolaruokaan sen jälkeen kun he olivat yrittäneet kontaminoida paikalliset vesivarannot ja epäonnistuivat. He toivoivat vaikuttavansa kuntavaalituloksiin estämällä äänestäjiä äänestämästä. Vaikka 43 ihmistä joutui sairaalaan, kukaan ei kuollut ja väärintekijät joutuivat oikeuden eteen.
Tuoreempi biologinen hyökkäys USA:ssa tapahtui juuri ennen syyskuun 11. päivän 2001 Al Qaedan iskuja WTC:hen ja Pentagoniin. Tuntematon toimija lähetti jauhekirjeen, jossa oli tarttuvaa pernaruttoa, kahdelle amerikkalaissenaattorille ja useaan mediataloon. Viisi ihmistä kuoli altistuttuaan kirjeiden materiaalille, ja 17 sairastui. Lääkintähenkilöstö tarjosi pernaruttorokotetta altistumisen jälkeisenä profylaksiana (PEP) 1727 potentiaalisesti altistuneelle ihmiselle, jotka ottivat myös antibiootteja pernaruttoa vastaan. Noista ihmisistä 199 suostui ottamaan rokotteen ja sai kaikki piikit siitä.
Lainvalvojat tulivat tulokseen, että USA:n biopuolustustutkija, joka oli työskennellyt armeijalle Fort Detrickin laboratoriossa, oli tehnyt iskut. Tutkija Bruce Ivins tappoi itsensä vuoden 2008 tutkimuksien aikaan. Ivins kuitenkaan ei koskaan saanut virallisesti syytteitä rikoksesta, eikä suoraa kytköstä hyökkäyksiin saatu osoitettua. Spekulaatio hänen motiiveistaan keskittyi Ivinsin mielenkiintoon pernaruttorokotteen parissa työskentelyssä, sekä hänen ilmeiseen henkiseen epävakauteensa. Itse asiassa, voisi jopa esittää että näitä hyökkäyksiä voitaisiin pitää enemmänkin biorikoksena eikä bioterrorismina mikäli motiivi ei ollut yrittää vaikuttaa valtion toimintaan tai pelotella siviilipopulaatiota.
Biologisiin hyökkäyksiin varautuminen
Vuonna 2001, ennen 9/11 -iskuja, useat amerikkalaisvirastot ja akateemiset tutkimusryhmät pitivät simuloidun biohyökkäyksen harjoitukset, koodinimi Dark Winter, jossa isorokkovirus oli aseena. Harjoitus, joka toimi oletuksella siitä että rokotetta on saatavilla arviolta 12 miljoonaa annosta, perustui silloiseen saatavilla olevaan isorokkorokotteen varastoihin, “näkyi vakava julkisen terveydenhuoltojärjestelmän heikkous, joka voisi olla esteenä bioterrorismiin tai luonnollisesti esiintyvään vakavaan infektiosairauteen varautumiselle” (“Overview of Potential Agents of Biological Terrorism,” Southern Illinois University School of Medicine).
Yksi keskeinen heikkous, joka harjoituksessa paljastui, oli rokotteiden kesken loppuminen; tämä on korjattu sen jälkeen, ainakin isorokon tapauksessa, kun rokotteita tuotettiin satoja miljoonia annoksia USA:n rokotevarastoihin. Muita paljastuneita ongelmia olivat konfliktit liittovaltiollisen ja osavaltiollisen resurssienhallinnon kesken, lääketieteellisen infrastruktuurin puutteet käsiteltäessä joukoittain saapuvia uhreja, ja amerikkalaisten kriittinen tarve luottaa ja toimia yhdessä johtajien kanssa. Pernarutolle 9/11:n jälkeisten hyökkäyksien aikana altistuneiden reaktiot kertovat ongelmasta: vuonna 2008 julkaistu tutkimus vihjaa, että monien altistuneiden pidättyväisyys pernaruttorokotteen ottamisesta kertoi heidän rokotteen sivuvaikutuksien peloistaan sekä epäluottamuksesta lääkintähenkilöstöä kohtaan (Quinn, 2008). Kaikissa suuren mittaakaavan bioterroritapauksissa tämä epäluottamus voi olla tehokkaan taudinaiheuttajan eristämisen suuri este.
Viranomaiset toivovat, että katastrofitoimien suunnittelu ja tehokkaiden lääkinnällisten vastatoimien kehittely biologisia hyökkäyksiä vastaan sekä minimoi sellaisten hyökkäysten vaikutukset että toimii myös pelotteena sellaisia hyökkäyksiä suunnittelevia vastaan. Jos hyökkäys voidaan helposti eristää ja siihen vastata, silloin terroristi- tai vihollisvaltiolla voi olla vähemmän insentiiviä tehdä sellaisia.
Bioasevastatoimissa mukana olevat virastot
Monet liittovaltion, osavaltioiden ja paikallistason virastot ovat mukana kansanterveyskriisejä vastaan varautumisessa ja toiminnassa. Yhdysvaltain kongressi rahoittaa CDC:tä ja Prevention’s Office of Public Health Preparedness and Responsea (PHPR) joilla rakennetaan ja vahvistetaan kansallista valmiutta terveyskriisejä vastaan, joita aiheuttavat luonnolliset, vahingossa tapahtuneet tai tarkoitukselliset tapahtumat. Rahoituksesta osa tukee Strategic National Stockpilea, joka hallinnoi rokotteiden, lääkkeiden ja lääketieteellisten tarvikkeiden varastointia kriisitilanteiden varalta. (Katso alhaalta lisää SNS:stä.)
Yhdysvaltain Department of Health and Human Services (HHS) sisältää useita virastoja, jotka ovat mukana kansanterveyden kriisitoimissa. Office of the Assistant Secretary for Preparedness and Response (ASPR) luotiin hurrikaani Katrinan jälkeen ja sen vastuulla on luonnonkatastrofien ja terveyskriisien estämisen, niiden varalta valmistelun ja vastatoimien toteuttamisen johtaminen. ASPR tekee tutkimusta ja rakentaa liittovaltiollisia lääketieteellisiä hätätoimikyvykkyyksiä. ASPR:n sisällä Biomedical Advanced Research and Development Authority (BARDA) on vastuussa tarpeellisten rokotteiden, lääkkeiden, terapioiden ja diagnostisten työkalujen kehittämisestä ja ostamisesta terveydenhuollon kriisejä varten.
Yhdysvaltain Department of Homeland Security sisältää useita ryhmiä, jotka toimivat bioaseuhkia vastaan. National Biodefense Analysis and Countermeasures Center (NBACC) tarkastelee biologisten uhkien aiheuttamien riskien tieteellistä perustaa. NBACC:n National Biological Threat Characterization Center (NBTCC) tekee tutkimuksia ja kokeita nykyisillä ja tulevilla biologisilla uhilla, arvioi haavoittuvuuksia ja tekee riskiarvioita, ja tutkii potentiaalisia impakteja vastatoimien ohjaamiseksi, kuten sensorit, lääkkeet, rokotteet ja dekontaminaatioteknologiat. Toiset virastot ovat vastuussa bioasehyökkäysten analysoinnista ja niihin vastaamisesta sen jälkeen kun ne ovat tapahtuneet, ja auttavat tutkijoita identifioimaan rikolliset ja määrittämään hyökkäyksen alkuperän ja käytetyn menetelmän.
Osavaltion ja paikallistason virastot, sekä julkiset ja yksityiset sairaalat ja paikallinen lainvalvonta ova myös mukana bioasehyökkäyksen aiheuttaman terveyskriisin hoidossa. Heidän roolinsa määritellään kansallisissa vastasuunnitelmissa ja yksityiskohtaisemmin organisaatiotason suunnitelmissa.
Food and Drug Administrationin rooli
Yhdysvaltain FDA kontrolloi rokotteiden, hoitojen, diagnostisten testien ja muiden biouhkiin vastaamiseen tarkoitettujen työkalujen lisensointia. Lisenssivaatimukset rokotteille ovat monimutkaisia ja pätevät monen vaiheen turvallisuutta, immunogeneettisyyttä ja tehokkuuden testausta ja lisensoinnin jälkeistä valvontaa sisältävään prosessiin. (Katso Vaccine Development, Testing, and Regulation ja lue lisää tästä hyväksyntäprosessista.) Tyypillisesti rokotteen kehittäminen ja testaaminen kliinisesti kestää 10-20 vuotta ennen lisenssin saamista.
Tilanteissa joissa uusi rokote tarvitaan nopeasti, FDA on kehittänyt vaihtoehtoisia ohituskaistoja lisensseille. Yksi vaihtoehto, jolloin kiihdytetty hyväksyminen saatetaan ottaa käyttöön, on silloin kun tauti uhkaa elämää ja on olemassa lisensoimaton rokote, jolla on merkittävä terapeuttinen vaikutus verrattuna muihin vaihtoehtoihin. Toinen vaihtoehto, pahempien uhkien alla, on ottaa käyttöön niinsanottu eläinsääntö — jos tutkimus rokotteen tai hoidon kehittämiseksi vaatisi ihmisten altistamista toksisille uhille, silloin eläinkokeet, eikä niinkään aiemmat ihmisillä suoritetut kokeet, voivat riittää hyväksynnän saamiseksi. Tähän päivään asti näitä ohituskaistoja ei ole käytetty rokotteille. Lisäinfoa Critical Path Initiativesta on saatavilla FDA:lta.
Yhdysvaltain Emergency Use Authorization (EUA) on vaihtoehto pandemian tai bioaseen uhatessa sekä siviili- että sotilaspopulaatioita. Kun Department of Health and Human Servicesin viranomainen on julistanut hätätilan, tämä ohjelma sallii lääketuotteen käytön ilman hyväksyntää (tai tuotteen joka on hyväksytty mutta ei kyseistä hätätilannetta varten) joka on paras saatavilla oleva hoito tai ehkäisy kyseistä uhkaa vastaan. EUA:t on myönnetty virushoitoihin, hengityskoneeseen ja PCR-diagnostiikkatestiin vuoden 2009 A/H1N1 -pandemian aikaan.
Eräs haaste rokotteiden lisensoinnille bioaseiden uhkan vastatoimeksi on joidenkin taudinaiheuttajien esiintymättömyys luonnonmaailmassa. Rokotteiden tehokkuus on vaikeampaa arvioida kun luonnollista altistumista patogeenille ei esiintty (kuten isorokon ja muiden uhkien tapauksessa) ja kun ihmistutkimukset eivät päde. FDA hyväksyy eläinkokeet todisteiksi tällaisissa tapauksissa.
Syksyllä 2011 kansallinen keskustelu keskittyi bioaserokotteiden hätätilakäyttöön. Simuloitu pernaruttohyökkäys koodinimellä Dark Zephyr pidettiin helmikuussa 2011 ja se herätti kysymyksiä pernaruttorokotteen käytöstä PEP:na lapsilla. Tutkijat eivät olleet testanneet pernaruttorokotteen turvallisuutta tai tehokkuutta lapsilla, vaikka sitä oltiinkin tutkittu laajalti aikuisilla ja se oltiin annettu miljoonille amerikkalaisille. Dark Zephyrin jälkimainingeissa asiaa tutkailtuaan National Biodefense Science Board, liittovaltiollinen neuvoa antava elin HHS:lle, päätti että rokotteen testaaminen lapsilla on eettisesti oikeutettua, kun ottaa huomioon että se tarjoaisi tietoja jotka olisivat tärkeitä lapsiuhrien terveydelle ja hyvinvoinnille hyökkäystapauksessa. Kriitikot ovat kiistäneet sen, sanoen että mahdollisuus pernaruttohyökkäykselle on liian pieni että voitaisiin oikeuttaa lasten altistaminen millekään riskille. HHS ei ole luonut minkäänlaista aikataulua pernaruttorokotteen tutkimiselle lapsilla.
Jos bioasehyökkäys pernarutolla tapahtuisi, aikuisille annettaisiin kolme annosta rokotetta sekä antibiootteja PEP-toimena EUA:n alaisuudessa, sillä rokote ei tällä hetkellä ole lisensoitu PEP-käyttöön eikä kolmen annoksen käyttöön. Lapset saattaisivat saada rokotetta FDA:n hyväksynnällä uuden lääkkeen protokollan avulla. Pernaruttorokotteen antaminen lapsille protokollan alaisuudessa ei ole ideaalia, sillä protokolla sopii enemmän kliinisiin kokeisiin tai yksittäisen potilaan hätätilanteeseen.
Bioaseuhkiin vastaaminen rokotteella
Laajamittaisessa hätätilassa, jossa rokote on saatavilla tai potentiaalisesti saatavilla, suuri määrä rokotetta olisi tarpeen saada nopeasti. Tällä hetkellä Strategic National Stockpilella (SNS) on riittävästi isorokkorokotetta jolla rokottaa jokainen ihminen maassa bioasehyökkäyksen varalta. Varastossa on myös miljoonia annoksia pernaruttorokotetta, muita rokotteita, viruslääkkeitä ja muita lääketarvikkeita. Nopea rokotteen käyttöönotto on olennaista taudin ehkäisyn varalta: joillekin taudeille rokottaminen altistuksen jälkeen ei ehkäise tautia mitenkään, ja toisille taas rokottaminen on pakko tehdä erittäin nopeasti profylaksian toimimiseksi. Isorokon tapauksessa POP todennäköisimmin toimii neljän päivän sisällä altistumisesta virukselle. Suunnitelmissa on tarjota isorokkorokotetta heti ensimmäisestä hyökkäyspäivästä lähtien, ja sitä toimitettaisiin varastosta ympäri maata tarvittaessa viidestä kuuteen päivään hyökkäyksen jälkeen.
Bioturva-asiantuntijat ovat ehdottaneet, että taudinaiheuttajien käyttö passiiviseen immunisaatioon voisi toimia tiettyjä bioaseita vastaan. (Passiivinen immunisaatio tarkoittaa vasta-aineiden antamista, jotka on otettu immuuneilta lahjoittajilta, ei-immuuneille henkilöille. “Lainatut” vasta-aineet tarjoavat lyhytaikaista suojaa tiettyjä tauteja vastaan. Katso artikkeli Passive Immunization ja lue lisää.) Vasta-aineiden käyttö rokotteiden sijaan bioterroritapauksessa on edullisempaa silloin, kun vasta-aineet tarjoavat välitöntä suojaa, kun taas rokotteiden suoja ei ole välitön ja joissain tapauksissa rokotteita pitää antaa useampia.
Passiivisen immuniteetin potentiaaliset käyttökohteet ovat mm. botuliini, tularemia, pernarutto ja rutto. Näissä tapauksissa kokeita on tehty ainoastaan eläimillä, ja niinpä passiivisen immuniteetin käyttö bioasetapauksessa on edelleen kokeiluvaiheessa.
Lopuksi
Terroristien tai vihollisvaltion tekemä biologinen hyökkäys on epätodennäköinen, mutta kuitenkin vaatii kansanterveydellistä hätätilasuunnittelua. Useat monen viraston simulaatiot ovat paljastaneet heikkouksia systeemissä, jonka tarkoitus on vastata biologisiin hätätilanteisiin. Nämä harjoitukset ovat auttaneet suuntaamaan hätätilasuunnittelua vastaamaan potentiaalisesti suureen bioasehyökkäykseen, joka ylittää sairaanhoitokapasiteetin, saa aikaan laajamittaista sairautta ja kuolemaa ja johtaa taloudelliseen ja yhteiskunnalliseen disruptioon. Rokotteiden, vasta-aineiden ja muiden lääkkeiden onnistunut antaminen bioaseiden käyttötapauksessa riippuu useasta tekijästä, kuten siitä miten monta ihmistä hyökkäys mahdollisesti vahingoittaa, liikennejärjestelmän vakaus hätätilassa, saatavilla olevien rokotteiden ja lääkkeiden määrä sekä julkisen terveydenhuollon valmiusaste kommunikoida ja saada rokotteet ja lääkkeet toimitetuksi niitä tarvitseville.
Lähteet
Arnon, S.A., et al. Botulinum as a biological weapon: Medical and public health management. JAMA 2001;285(8):1059-1070. Accessed 01/10/2018.
BARDA Strategic Plan. (337 KB). Accessed 01/10/2018.
Ben Ouagrham, S. Biological weapons threats from the former Soviet Union. Working Paper Series on Russia and the Former Soviet States. Liechtenstein Institute on Self-Determination at Princeton University. August 2003.
Department of Health and Human Services. Challenges in the use of anthrax vaccine adsorbed (AVA) in the pediatric population as a component of post-exposure prophylaxis (PEP): A Report of the National Biodefense Science Board. [PDF File]. October 2011. (1.3 MB). Retrieved from Homeland Security Digital Library. Accessed 01/10/2018.
Fenn, E.A. Biological Warfare in eighteenth-century North America: beyond Jeffery Amherst. Politics and the Life Sciences. Accessed 01/10/2018.
Henderson, D.A., Inglesby, T.V., Jr. O’Toole, T., Mortimer, P.P. Can postexposure vaccination against smallpox succeed? Clin In Dis. (2003) 36 (5); 622-629. Accessed 01/10/2018.
Global Trends 2030: Alternative Worlds. A publication of the National Intelligence Council. December 2012. (20.5 MB). Accessed 01/10/2018.
Martin, J.W., Christropher, G.W., Eitzen, E.M., Jr. History of biological weapons: from poisoned darts to intentional epidemics. [PDF]. Medical Aspects of Biological Warfare. Accessed 01/10/2018.
McConnell, M. Remarks and Q&A by the Director of National Intelligence. December 2, 2008. (111 KB). Accessed 01/10/2018.
McIsaac, J.H. Preparing hospitals for bioterror: a medical and biomedical systems approach. Burlington, Mass.: Academic Press, 2006.
Center for Law and Public Health. Model State Emergency Health Powers Act. A Draft for Discussion Prepared by The Center for Law and the Public’s Health at Georgetown and Johns Hopkins Universities. (88.8 KB). Accessed 01/10/2018.
Nightingale, S.L., Prasher, J.M., Simonson, S. Emergency Use Authorization (EUA) to enable use of needed products in civilian and military emergencies, United States. Emerg Infect Dis [serial on the Internet]. 2007 Jul. Accessed 01/10/2018.
O’Tool, T., Michael, M., Inglesby, T.V. Shining light on “Dark Winter.” CID 34:7, 972-983. Accessed 01/10/2018.
Quinn, S.C., Thomas, T., Kumar, K. The anthrax vaccine and research: reactions from postal workers and public health professionals. Biosecur Bioterror. 2008 December; 6(4): 321–333. Accessed 01/10/2018.
Southern Illinois University School of Medicine. Overview of potential agents of biological terrorism. Accessed 01/10/2018.
Stein, R. Possible study of anthrax vaccine’s effectiveness in children stirs debate. Washington Post, 10/13/11.  Accessed 01/10/2018.
Tucker, J.B. Scourge: the once and future threat of smallpox. New York: Grove Press, 1992.
Wheelis, M. Biological warfare at the 1346 siege of Caffa. Emerg Infect Dis [serial online] 2002 Sep. Accessed 01/10/2018.
Wilkening, D.A. Sverdlovsk revisited: Modeling human inhalation anthrax. PNAS 103;20:7589-7594. Accessed 01/10/2018.
Päivitetty 10. tammikuuta 2018
  Artikkelin julkaissut historyofvaccines.org
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soundjunglefan · 2 years
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Rola Top Act 'THREE FOR SILVER' (US doomfolk) Album VÖ 12.4.
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THREE FOR SILVER sind derzeit einer unserer TOP ACTS - derzeit auf Europa Tour und präsentieren ihr neues Album BLUE RUIN (VÖ 12.4.) Wir bekommen ständig großartige Resonanz aus den Konzertorten - Im Herbst steht bereits die nächste Europa Tour an, weil die Nachfrage so hoch ist (eine weitere Platte wird auch dabei sein) – wir freuen uns sehr J Schon reinhören können? Live wie erwähnt eine besonderes Ereigniss J https://www.youtube.com/watch?v=CzvOPx2rXzg&feature=youtu.be TOUR: Do 28.03. Folknight | Pfarrkirchen (DE) Fr 29.03. 7180 Bar | Crailsheim (DE) Sa 30.03. Scruffys | Karlsruhe (DE) So 31.03. The Shakespeare Pub | Herdecke (DE) Mo 01.04. Inspire | Chemnitz (DE) Di 02.04. Kasarna Karlin | Prag (CZ) Mi 03.04. Schloßcafe | Rottenburg (DE) Do 04.04. Anziehbar | Dornbirn (AT) Fr 05.04. Kulturhaus Caserne | Friedrichshafen (DE) Fr 05.04. Im Viadukt | Zürich (CH) Sa 06.04. Kreuzkultur | Solothurn (CH) Mo 08.04. Monomontag | Winterthur (CH) Di 09.04. Franzis | Wetzlar (DE) Mi 10.04. Timberjacks | Kassel (DE) Do 11.04. Timberjacks | Göttingen (DE) Fr 12.04. Kulturfabrik | Hoyerswerda (DE) Sa 13.04. Nellie Nashorn | Lörrach (DE) So 14.04. A Small Town Music Walk | Hoorn (NL) Do 25.04. Orpheum | Graz (AT) Fr 26.04. Club Glam | Feldbach (AT) Sa 27.04. Roter Gugl | Hartberg (AT) So 28.04. Lendhafen Cafe | Klagenfurt (AT) Mo 29.04. Academy | Salzburg (AT) Di 30.04. Q | Marburg (DE) Mi 01.05. Hafen 2 | Offenbach (DE) Do 02.05. Bar Gabanyi | München (DE) Fr 03.05. K9 Kulturzentrum | Konstanz (DE) Sa 04.05. Bahnhof | Würzbach (DE) Seit ihrer ersten Tournee (zum Album The Way We Burn) im Frühjahr 2018 ist die Band unaufhaltsam unterwegs und erobert dabei Europa. Wir lehnen uns nicht weit aus dem Fenster, wenn wir behaupten THREE FOR SILVER vereinen Elemente von Tom Waits, Nick Cave mit einer Brise Balkan Charme ala Gogol Bordello. Jedoch fand die Band eine ganz eigene Mischung, die seinesgleichen sucht. Die Stimme von Lucas Warford und seine lässigen Basslines stechen hierbei hervor. Das Trio schafft es in einer minimalen Besetzung großen Sound zu erzeugen und dabei die Leute mit Leichtigkeit zum Tanzen zu bringen. rolamusic Read the full article
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The Indian perspective of COVID-19 outbreak
Abstract
The emerging infection of COVID-19 was initiated from Wuhan, China, have been spread to more than 210 countries around the globe including India. The clinical symptoms of COVID-19 are very similar to other respiratory viruses. The number of laboratory-confirmed cases and associated deaths are increasing regularly in various parts of the World. Seven coronaviruses (229E, NL63, OC43, HKU1, SARS, MERS and, COVID-19) can naturally infect human beings. Out of these four (229E-CoV, NL63-CoV, OC43-CoV, HKU1-CoV) are responsible for mild upper respiratory infections, while SARS-CoV, MERS-CoV, and COVID-19 are well known for their high mortality. Few mild strains of coronaviruses are circulating in India but there is no evidence of SARS and MERS outbreaks. The COVID-19 is an emerging viral infection responsible for pandemics. Fortunately, the mortality of COVID-19 is low as compared with SARS and MERS, the majority of its cases are recovered. The death toll of COVID-19 is high even after its low mortality because COVID-19 causes a pandemic while SARS-CoV and MERS-CoV cause epidemics only. COVID-19 influenced the large segments of the world population, which led to a public health emergency of international concern, putting all health organizations on high alert. COVID-19 is the first coronavirus after Spanish Flu 1918–1919, who has extremely influenced the health system, economy, and psychology of India. The present study review is on the general continent, virology, pathogenesis, global epidemiology, clinical presentation, diagnosis, treatment and control of COVID-19 with the reference to India.
Introduction
Our health and wealth are highly influenced by various emerging viral diseases. The viral outbreaks like Crimean Congo hemorrhagic fever, Ebola, Lassa fever, Marburg virus, SARS- CoV, MERS-CoV, Nipah, Zika virus, Rift Valley fever virus and COVID-19 are some evidence of our disaster. Some of these outbreaks are highly influenced global life, WHO declared them as a public health emergency of international concern, H1N1 (2009), Polio (2014), Ebola in West Africa (2014), Zika (2016) and Ebola in Congo (2019). Just recently, in December 2019, a novel coronavirus (2019- nCoV), now COVID-19 has emerged in Wuhan, China and spread its wing over the whole globe [18]. A large segment of the world population can be affected by it. Therefore, the WHO declared the COVID-19 pandemics on 30 January 2020. Adaptations to human infection, easy way of transmission, and absence of immunity make the COVID-19 highly contagious in nature. Modern transport systems, convert the world into a global village is helpful for the quick spreading of any contagious agents like COVID-19 viruses. The COVID-19 was successful to spread the infection in more than 210 countries and responsible for 15, 21, 966 laboratory-confirmed cases with 88, 659 deaths up to 09 April, 2020. Fortunately, the death rate of COVID-19 (5.82%) is low as compared with SARS-CoV (10%), MERS-CoV (37.1%). (https://www.worldometers.info/coronavirus/seen on 09 April 2020). The COVID-19 was also entered in Indian boundaries through the various international travels and they handover it to the local population. The first laboratory-confirmed case of COVID-19 was a student returning from Wuhan, China on 30 January 2020. She was studying in Wuhan, return to her home in Kerala, admitted in the hospital for cure and quarantine, discharge after proper recovery. According to the Ministry of Health and Family Welfare, a total of 5734 laboratory-confirmed cases of COVID-19, out of which 473 (8.25%) recovered, while 166 (2.9%) deaths are in the India (https://www.mohfw.gov.in/seen on 09 April 2020). The mortality rate of COVID-19 in India is almost half of the global rate. Now, COVID-19 spread in almost every part of India. Therefore, health workers, governments and the public are needed to co-operate national as well as globally to prevent it from further spread [38].
Virus, and pathogenesis
Coronaviruses are a large group of viruses that causes respiratory and enteric infections in both animals and humans. The virions are large in size (100–160 nm), spherical in shape and have an envelope. There is a capsid of 27–32 kb, which contained a single-stranded RNA genome with positive polarity protected by the envelope [13]. Coronaviruses contain four types of spikes; many long (20 nm) glycoprotein S-spikes in all the coronaviruses, small hemagglutinin-esterase (HE) spikes in some viruses, few transmembrane glycoproteins and envelope protein spikes [8, 16]. The Coronaviruses can be classified into three serogroups on the basis of their genome structure. Serogroups 1 and 2 viruses can infect mammalian and seven of them (229E-CoV, NL63-CoV, OC43-CoV, HKU1-CoV, SARS-CoV, MERS-CoV and, COVID-19) can infect man while serogroups 3 contains avian viruses only. The 229E-CoV, NL63-CoV, OC43-CoV, HKU1-CoV are responsible for 30% or more mild upper respiratory tract illnesses in human, while SARS-CoV, MERS-CoV and, COVID-19 are well known for serious humans infection. Recently, adapted animal coronaviruses causes a more fatal infection in humans [32, 33]. The majority of coronavirus are species-specific. They can expand their genetic diversity by nurturing recombination and mutation during peridomestic animal infections and sometimes a virus can jump a species barrier and start an infection in humans also [22]. The COVID-19 may be animal originated virus as majorities of its initial cases were associated with local fish and wild animal market of Wuhan, China. Some early local studies suggested the possibility of human-to-human transmission via droplets or direct contact and nosocomial infection [2, 3, 15, 34]. The incidences of COVID-19 infections are rapidly increasing, due to transmission from symptomatic/asymptomatic carriers, high mobility rate and rapid expansion through the world travel system. High transmission power and considerable mortality rate are responsible for the high potential of COVID-19 to become a pandemic agent [1, 20, 39]. In India, the majority of COVID-19 cases have travel history in the infected parts or close contact with an infected person, community transmission is doubtful till now.
After entry into a suitable host, the first step of the viral replication cycle is the binding of the virion to the receptors on the target cells in the human respiratory tract. The genomic analysis suggests that COVID-19 will utilize similar receptors that were used by SARS-CoV [19]. The COVID-19 will be attached to the angiotensin-converting enzyme 2 (ACE-2) receptor, which is expressed in the lungs, heart, kidney, small intestine and other tissues, while MERS-CoV uses the dipeptidyl peptidase 4 (DPP4), a transmembrane glycoprotein as a receptor [14, 17, 25, 26]. After binding with a specific receptor, it will enter into host cells via fusion of viral envelope with the plasma membrane or endosomal membranes. After entry, the viral genome RNA is released in the cytoplasm and translates into, pp1a and pp1ab polyproteins [6]. The translation produced the non-structural proteins and form replication-transcription complex (RTC) in double-membrane vesicles [28]. The RTC replicates continuously and synthesizes a nested set of sub-genomic RNAs that encode accessory and structural proteins [11, 23]. The newly formed genomic RNA, nucleocapsid proteins and envelope glycol-proteins assemble and form viral particle buds. At last, the virion-containing vesicles fuse with the plasma membrane to release the virus. Coronavirus infections were responsible for a variety of cytopathic effects (CPE), which depend upon the viral strains and host cells. The mechanism of CPE attributed to a variety of causes; interfere with signal pathway, derangement of cellular function, enhanced cytokine/chemokine expression, inhibition of transcription and translation of cellular proteins. Some coronaviruses cause cell fusion while many others induced apoptosis.
Global epidemiology
COVID-19 has a capacity for human-to-human transmission, the public has no hard immunity against it, a high mortality rate, which makes it suitable agents for pandemic potential and the modern transport system also helps in its rapid expansion. Easy mode of transmission, nature of the virus, population density, environmental condition, social culture (like handshaking, etc.) are major contributors to its rapid spreading. Therefore, COVID-19 turned into a global health concern since its inception from Wuhan, China. Like other respiratory viruses, coronavirus is also contagious and easily spread from one person to another. Many viruses produced similar clinical symptoms; therefore COVID-19 cannot be differentiating on the basis of their clinical symptoms, for its accurate diagnosis a sensitive and specific assay always required. Unfortunately, only a few countries have a capacity for proper viral diagnosis or surveillance by laboratory assays. Without laboratory-confirmed assay or under the capacity of viral diagnosis or surveillance system can decreases the authenticity and accuracy of data. The Basic Reproductive Number (R0) can be utilized to calculate averaging the number of infections produced by infected individuals in susceptible populations. Basic Reproductive Number (R0) is for the SARS-CoV (1.4–5.5), MERS–CoV (< 1), COVID-19 (2.2–2.6) and Influenza viruses (5–25). The members of the coronaviridae are less contagious than influenza viruses [24, 27]. Although, COVID-19 is a slow virus than influenza viruses, but even then spread in the 210 countries within 120 days and caused a large number of infections. In these hundred days, COVID-19 causes the 15, 21, 966 laboratories confirmed cases and 88, 659 (5.82%) deaths worldwide till 09 April 2020. The USA (4, 35, 160), Spain (1, 48, 220), Italy (1, 39, 422), Germany (1, 13, 296) and France (1, 12, 950) are top five infected countries have 9, 49, 048 (62.35%) of total laboratories confirmed cases of COVID-19. Italy (17, 669), USA (14, 797), Spain (14,792), France (10, 869) and United Kingdom (7097) are the top five affected countries have 65, 224 (73.56%) of total deaths due to COVID-19. The mortality rate (%) of top ten countries on the basis of their laboratory-confirmed cases are Italy (12.67%), UK (11.68%), Spain (9.98%), France (9.62%), Belgium (9.57%), Iran (6.18%), China (4.07), USA (3.40%), Turkey (2.12%), and Germany (2.07%) (https://www.worldometers.info/coronavirus/seen on 09 April 2020).
Clinical symptoms
The clinical symptoms of COVID-19 are very similar to influenza and other respiratory viruses. The clinical symptoms and severity of COVID-19 may be variable. Three relatively large-scale studies done on 278 pooled patients in Wuhan, China suggesting that COVID-19 causes viral pneumonia. All of the patients were adults with more than 18 years of age, consist of 172 (61.9%) males and 106 (38.1%) females [4, 10, 35]. A recent study in Beijing reported that 2 of the 13 patients with COVID-19 pneumonia were children aged 2–15 years [3]. Co-morbidity like cardiovascular, hypertension, diabetes and age of patients also plays a crucial role in disease output. An adult person without any serious co-morbidity was recovered easily while aged person co-morbidity with required intensive care and a ventilator [3, 35]. Similar observations were noted in Indian patients also. The patients come with unexplained upper respiratory viral infection. The majority of patients have symptoms of fever, cough, sore throat, nasal congestion, malaise, and headache. The elderly and other immunocompromised patients have more and severe atypical symptoms. Although, dehydration, sepsis or shortness of breath are absent in these patients [12].
Diagnosis
All coronavirus infections need not be diagnosed as they are self-limited and cause mild upper respiratory infection only. Clinical symptoms of coronavirus and other respiratory viruses are very mimic. Their accurate diagnosis is possible by laboratory-based assays. Initially, coronavirus can be diagnosis by virus-isolation, electron microscopy, serological methods and in later stages (after genomic sequences), molecular assays are priority. Virus isolation is a gold standard but time-consuming and high containment level required. Virus isolation is not a good method of diagnosis but produced a good amount of viruses at the end, which can be utilized for further antigenic and molecular characterizations. Electrons microscopy is costly and highly expert persons required for viral identification. Serological methods are good but pair serum required for confirmation. In the modern era of time, molecular diagnosis assays are more rapid, sensitive, specific and cost-effective for viral diagnosis [7, 29]. COVID-19 was diagnosis by Real-time RT-PCR after the availability of the full genomic sequence of the viruses [5, 37]. In India, the suspected patients are select as per country and/or WHO guidelines; the appropriate samples should be collected in the early phase of infection. The samples should collect after proper wearing of personal protective equipment (PPE) [36]. The collected samples should be transported in the virology laboratory in cold conditions. In the virology laboratory, the sample will be processed and standardized assay will be applied for the diagnosis. In India, All the COVID-19 diagnoses done in more than a hundred NABL accredits virology laboratories. COVID-19 is diagnosis by the Real-time RT-PCR by following the WHO protocol and ICMR guidelines.
Prevention and treatment
A reliable vaccine or antiviral could be the best answer for any virus. In the absence of these, prevention is only the choice. The outbreaks of MERS, SARS, Nipah [30], Zika [31], give a lesson to us that social distance, frequent hand-washing, avoiding contact of animals and infected persons will protect us. The COVID-19 is similar to other respiratory viruses, can be transmissions from infected to susceptible persons, via droplets, contaminated body parts, and objectives. A susceptible person got the infection through these contaminated objectives, amplify the virus and spread to other persons. The infected or suspected person should follow the cough etiquette, maintain distance, cover coughs/sneezes via tissues or clothing, frequently wash their hands and safe dispose-off infected material to a reduced viral transmission. The hospital, diagnostic laboratory, emergency departments, and other health care facilities should follow standard infection prevention and control practices to avoid nosocomial infections [21]. In India, COVID Care Centres (CCC) is set up in public or private hostels, hotels, schools, stadiums, lodges etc. COVID suspected patients can be divided into three; Groups a): These are suspect cases with mild fever and upper respiratory tract infection. They may be admitted and screen for COVID-19. Negative patients should discharge after the symptomatic management while COVID-19 positive patients need to be admitted to CCC. Their health monitor regularly and symptomatic treatment will be given. Group b): Suspect pneumonia with respiratory rate 15–30/min and SpO2 90–94% come under moderate categories. They will be admitted as suspect cases in section of dedicate COVID-19 health centre and screen for infections of COVID-19. Negative patients transfer to Non-COVID hospital/block and manage according to clinical assessment and discharge as per clinical assessment. While COVID-19 positive need to shift into the confirmed case section of CCC. Monitor for clinical severity can be shift to COVID-19 dedicated hospital. Their health monitor regularly and symptomatic treatment will be given. Group c): COVID-19 suspect patient with pneumonia and respiratory rate more than 30/minute and SpO2 more than 94% come under severe categories. They will be admitted to dedicating COVID-19 health centres with ICU facilities and screen for infections of COVID-19. Negative patients should be a shift to Non-COVID hospital/block. While COVID-19 positive patients should be remain in ICU and their management will be done according to clinical assessment. They can be discharged as per clinical assessment after their negative reports (https://www.mohfw.gov.in). In case of absence treatment, quarantine and supportive care (oxygen therapy, fluid management, antimicrobials antibiotic, etc. can be given to the patients. Some antiviral like Remdesivir, lopinavir-ritonavir and interferon-α 2b and other drug was tried to control the 2019-nCoV but expecting results were not obtained. There is no specific antiviral available against CVID-19. Hydroxychloroquine (Dose 400 mg BD for 1 day followed by 200 mg BD for 4 days) with the combination of Azithromycin (500 mg OD for 5 days) can be given under the close medical supervision (https://www.mohfw.gov.in). The government should do continuous surveillance, screening the traveler comes from infected areas; develop timely diagnostics, therapeutics, vaccines [9].
by Arijit Prasad
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itswallstreetpr · 4 years
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Moderna, Inc. (NASDAQ: $MRNA), Q BioMed Inc (OTC: $QBIO) and Gilead Sciences (NASDAQ: $GILD) are getting a lot of attention now
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Biotech stocks have continued to be market-leading targets for investors through the coronavirus stock market crash and rebound. Moderna, Inc. (NASDAQ: $MRNA), Q BioMed Inc (OTC: $QBIO) and Gilead Sciences (NASDAQ: $GILD) are getting a lot of attention now. Having been the first group to start testing a vaccine against SARS-CoV-2, Moderna inc (NASDAQ: MRNA) is now on the cusp of phase 2. With the FDA having completed its review of the IND, Moderna expects to start the 600-subject phase 2 “shortly.” “The imminent Phase 2 study start is a crucial step forward as we continue to advance the clinical development of mRNA-1273, our vaccine candidate against SARS-CoV-2,” said Stephane Bancel, Moderna’s chief executive officer in a press release issued by the company on Thursday. Moderna has a goal of starting a pivotal phase 3 study in the summer and could have its first biologics license application approved as soon as next year, Bancel’s statement said. “We are accelerating manufacturing scale-up and our partnership with Lonza puts us in a position to make and distribute as many vaccine doses of mRNA-1273 as possible, should it prove to be safe and effective,” said Bancel. Last month, Q BioMed inc (OTC: QBIO) announced that together with its technology partner, Mannin Research, they are accelerating the rapid development of novel drugs for the treatment of life-threatening complications caused by COVID-19 and other viral infections. This novel drug program is being evaluated by government programs for funding and accelerated development under various COVID-19 response initiatives. Q BioMed and Mannin hope to have at least one treatment in human trials this year. The accelerated development is the result of a joint venture (JV) between Mannin, with its Tie2 based small molecule platform that addresses vascular leakage, and Cyclica, a Toronto, Canada based biotechnology company that has a proprietary AI-augmented drug discovery platform, Ligand Design and Ligand Express. The JV agreement will deploy Cyclica’s unique AI platform to accelerate the development of new treatments based on Mannin’s Tie2 based platform. Gilead Sciences  (NASDAQ: GILD) has received approval from the Japanese Ministry of Health, Labour and Welfare (MHLW) for its antiviral drug remdesivir, under the brand name Veklury, to treat Covid-19 infection. The decision falls under an exceptional approval pathway, which is similar to emergency use authorisation in the US. Remdesivir is an experimental nucleotide analogue that showed broad-spectrum antiviral activity against various viral pathogens, including Ebola, Marburg, MERS and SARS, in-vitro and in-vivo in animal models. In-vitro testing found that the drug is active against SARS-CoV-2, the novel coronavirus that causes Covid-19. The drug is currently being assessed in several Phase III clinical trials. Read the full article
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mastcomm · 5 years
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Coronavirus Outbreak Risks Reviving Stigma for China
SARS. Bird flu. And now a new coronavirus.
A lot of epidemics seem to come out of China, leading some to point accusing fingers. President Trump’s trade czar, Peter Navarro, for one, once went so far as to describe the country as a “disease incubator,” and that was before the latest outbreak.
But those perceptions are outdated.
While some of the most serious outbreaks have been traced to Chinese origins, others associated with China may have started elsewhere.
Old stereotypes have also contributed to unfounded portrayals of China as a source of contagion, when in fact it has progressed further than many countries in eradicating scourges that can flourish in developing regions.
Still, China’s recent history of what are known as zoonotic infections — viruses, bacteria and parasites that spread between animals and humans — have raised questions about public-health practices in the world’s most populous country.
And while the Chinese government has strengthened disease detection and monitoring capabilities, its tendency to play down or even cover up mass outbreaks may play a role in their severity and scope.
Dr. Jennifer Huang Bouey, an epidemiologist and senior policy researcher at the RAND Corporation, a research organization, said China had become a leader in the study of contagious disease. The flu vaccines provided in the United States, for example, are often traced to research done in China.
At the same time, Dr. Bouey said, China remains somewhat of a laboratory itself.
“There is quite a fair amount of epidemics originating in China or passing through China,” she said.
Here are five basic questions and answers on China and infectious diseases.
Q: What epidemics have been traced to China?
Two of the devastating flu pandemics of the 20th century — the Asian flu of 1957 and the Hong Kong flu of 1968 — both originated in China and left a trail of about three million deaths worldwide.
The 2003 epidemic of Severe Acute Respiratory Syndrome, or SARS, which killed 774 people, nearly all of them in mainland China, was traced to palm civets sold as exotic meat in southern Chinese food markets.
Updated Feb. 10, 2020
What is a Coronavirus? It is a novel virus named for the crown-like spikes that protrude from its surface. The coronavirus can infect both animals and people, and can cause a range of respiratory illnesses from the common cold to more dangerous conditions like Severe Acute Respiratory Syndrome, or SARS.
How contagious is the virus? According to preliminary research, it seems moderately infectious, similar to SARS, and is possibly transmitted through the air. Scientists have estimated that each infected person could spread it to somewhere between 1.5 and 3.5 people without effective containment measures.
How worried should I be? While the virus is a serious public health concern, the risk to most people outside China remains very low, and seasonal flu is a more immediate threat.
Who is working to contain the virus? World Health Organization officials have praised China’s aggressive response to the virus by closing transportation, schools and markets. This week, a team of experts from the W.H.O. arrived in Beijing to offer assistance.
What if I’m traveling? The United States and Australia are temporarily denying entry to noncitizens who recently traveled to China and several airlines have canceled flights.
How do I keep myself and others safe? Washing your hands frequently is the most important thing you can do, along with staying at home when you’re sick.
The virus behind a deadly 1997 bird flu outbreak that fatally infected at least 18 people in Hong Kong is believed to have originated among fowl raised in southern mainland China — the source of virtually all poultry in the Chinese territory.
Last year, nearly half of China’s pigs were wiped out by a virus that causes African swine fever, an incurable disease. While the virus does not sicken humans and did not originate in China, critics say Chinese government policies and mismanagement may have inadvertently helped the epidemic accelerate through the country’s pig population — the world’s largest — and spread elsewhere in Asia.
And as of Monday, the new coronavirus traced to a live-animal market in the central Chinese city of Wuhan had killed 908 people and infected more than 40,000 in China and two dozen other countries and territories. The coronavirus, so named because of its spiky halo look under a microscope, may have originated in bats.
Q: Why might China be at special risk for zoonotic infections?
Many epidemiologists point to some fundamental facts about China: its population of 1.4 billion people, the proximity of urban and rural dwellers, as well as the slaughterhouses and urban markets where animals are freshly butchered. Fourteen of the world’s 50 most populous metropolitan areas are in China.
“The Chinese economy, combined with the Chinese population, have experienced so much growth that you are looking at putting large numbers of people in close contact with large numbers of animals in a confined space,” said Sean Beckmann, a disease ecologist and biology professor at Stetson University in DeLand, Fla.
Dr. Beckmann called China “the perfect storm” for zoonotic diseases to flourish. “It gives lots of opportunity for these viruses to cross a species boundary,” he said.
Q: Is China the only source of zoonotic infections?
No.
The Ebola virus, for example, which has ravaged parts of central and Western Africa, is named after the Ebola River in what is now the Democratic Republic of Congo, where the virus was discovered. It may have been transmitted by fruit bats.
The Marburg virus, which causes a hemorrhagic fever similar to Ebola’s, was also traced to a virus that resides in African fruit bats. It was named after a town in Germany where it was first detected in laboratory workers in 1967.
A flu pandemic in 2009, which killed 17,000 people, was traced to a pig farm in central Mexico.
And Middle East Respiratory Syndrome, or MERS, has been traced to camels and bats in Saudi Arabia. It is similar to SARS and has killed at least 858 people and sickened nearly 25,000 in 27 countries since it was first reported in 2012.
Q: Has China been unfairly singled out?
Chinese officials say yes, and point to what they call an overreaction by the United States and other countries to the coronavirus epidemic. Those countries have imposed virtual travel bans to China and evacuated citizens.
The Chinese government also has denounced incidents of anti-Chinese hostility linked to the epidemic.
“I do not want to see this,” Huang Ping, China’s consul general in New York, said at a news conference last week. “The virus is the enemy, not the Chinese people.”
There is, in fact, a long history of China being stigmatized over disease.
In the 19th century, a wave of immigration from Asia prompted warnings of a “yellow peril” and a supposed threat to public health.
Echoes of that are still sometimes heard. In late January, a French newspaper ran a Page 1 story headlined “yellow alert” about the “Chinese coronavirus.” It later apologized.
There are those who have tried to blame China for some of the biggest public health calamities of all time.
Some historians claimed that China was the likely source of the deadliest flu pandemic in history, the 1918 Spanish Flu — a misnomer itself. The effects of that flu were global. It was associated mainly with Spain because Spanish news reports about the disease, unlike those in countries fighting in World War I, were not censored.
In fact, the origin of the pandemic remains a mystery. Some research suggests that it may have been a United States military training base in Kansas, Camp Funston.
Q: Why has the Chinese government tended to minimize or even cover up outbreaks?
The Chinese Communist Party is most fearful of the sort of chaos that has historically destabilized China. Party officials tend to prioritize stability, even if it means suppressing important information that, critics say, the public needs to know.
The latest example of this may be Dr. Li Wenliang, a Wuhan physician who was punished for having warned early in the outbreak about what he saw as SARS-like cases — and who died last week from the infection. And until very recently, the government also declined repeated offers by international disease experts to send teams to China to help battle the outbreak.
Many infectious disease experts say they hope the leaders in Beijing learn from Dr. Li’s death.
“You want to have doctors who are empowered and encouraged,” said Dr. Amesh Adalja, a senior scholar at Johns Hopkins University. “You want to reward these types of people. In their effort to manage chaos and silence astute doctors, I would argue the government took a shortsighted action and it had a cascading impact.”
Some remain skeptical that the central authorities in Beijing will change their behavior.
Yanzhong Huang, a senior fellow for global health at the Council on Foreign Relations, said the official tendency to control and suppress remained strong.
“This is a pattern,” he said, “essentially, fundamentally the same: cover-up, inaction, then the central government steps in and takes draconian measures. This is like a Greek tragedy.”
Donald G. McNeil Jr. contributed reporting.
from WordPress https://mastcomm.com/coronavirus-outbreak-risks-reviving-stigma-for-china/
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