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Michael Weekes

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Nick K. Jones1,2*, Lucy Rivett1,2*, Chris Workman3, Mark Ferris3, Ashley Shaw1, Cambridge COVID-19 Collaboration1,4, Paul J. Lehner1,4, Rob Howes5, Giles Wright3, Nicholas J. Matheson1,4,6¶, Michael P. Weekes1,7¶1 Cambridge University NHS Hospitals Foundation Trust, Cambridge, UK2 Clinical Microbiology & Public Health Laboratory, Public Health England, Cambridge, UK3 Occupational Health and Wellbeing, Cambridge Biomedical Campus, Cambridge, UK4 Cambridge Institute of Therapeutic Immunology & Infectious Disease, University of Cambridge, Cambridge, UK5 Cambridge COVID-19 Testing Centre and AstraZeneca, Anne Mclaren Building, Cambridge, UK6 NHS Blood and Transplant, Cambridge, UK7 Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK*Joint first authorship¶Joint last authorshipCorrespondence: [email protected] UK has initiated mass COVID-19 immunisation, with healthcare workers (HCWs) given early priority because of the potential for workplace exposure and risk of onward transmission to patients. The UK’s Joint Committee on Vaccination and Immunisation has recommended maximising the number of people vaccinated with first doses at the expense of early booster vaccinations, based on single dose efficacy against symptomatic COVID-19 disease.1-3At the time of writing, three COVID-19 vaccines have been granted emergency use authorisation in the UK, including the BNT162b2 mRNA COVID-19 vaccine (Pfizer-BioNTech). A vital outstanding question is whether this vaccine prevents or promotes asymptomatic SARS-CoV-2 infection, rather than symptomatic COVID-19 disease, because sub-clinical infection following vaccination could continue to drive transmission. This is especially important because many UK HCWs have received this vaccine, and nosocomial COVID-19 infection has been a persistent problem.Through the implementation of a 24 h-turnaround PCR-based comprehensive HCW screening programme at Cambridge University Hospitals NHS Foundation Trust (CUHNFT), we previously demonstrated the frequent presence of pauci- and asymptomatic infection amongst HCWs during the UK’s first wave of the COVID-19 pandemic.4 Here, we evaluate the effect of first-dose BNT162b2 vaccination on test positivity rates and cycle threshold (Ct) values in the asymptomatic arm of our programme, which now offers weekly screening to all staff.Vaccination of HCWs at CUHNFT began on 8th December 2020, with mass vaccination from 8th January 2021. Here, we analyse data from the two weeks spanning 18thto 31st January 2021, during which: (a) the prevalence of COVID-19 amongst HCWs remained approximately constant; and (b) we screened comparable numbers of vaccinated and unvaccinated HCWs. Over this period, 4,408 (week 1) and 4,411 (week 2) PCR tests were performed from individuals reporting well to work. We stratified HCWs <12 days or > 12 days post-vaccination because this was the point at which protection against symptomatic infection began to appear in phase III clinical trial.226/3,252 (0·80%) tests from unvaccinated HCWs were positive (Ct<36), compared to 13/3,535 (0·37%) from HCWs <12 days post-vaccination and 4/1,989 (0·20%) tests from HCWs ≥12 days post-vaccination (p=0·023 and p=0·004, respectively; Fisher’s exact test, Figure). This suggests a four-fold decrease in the risk of asymptomatic SARS-CoV-2 infection amongst HCWs ≥12 days post-vaccination, compared to unvaccinated HCWs, with an intermediate effect amongst HCWs <12 days post-vaccination.A marked reduction in infections was also seen when analyses were repeated with: (a) inclusion of HCWs testing positive through both the symptomatic and asymptomatic arms of the programme (56/3,282 (1·71%) unvaccinated vs 8/1,997 (0·40%) ≥12 days post-vaccination, 4·3-fold reduction, p=0·00001); (b) inclusion of PCR tests which were positive at the limit of detection (Ct>36, 42/3,268 (1·29%) vs 15/2,000 (0·75%), 1·7-fold reduction, p=0·075); and (c) extension of the period of analysis to include six weeks from December 28th to February 7th 2021 (113/14,083 (0·80%) vs 5/4,872 (0·10%), 7·8-fold reduction, p=1x10-9). In addition, the median Ct value of positive tests showed a non-significant trend towards increase between unvaccinated HCWs and HCWs > 12 days post-vaccination (23·3 to 30·3, Figure), suggesting that samples from vaccinated individuals had lower viral loads.We therefore provide real-world evidence for a high level of protection against asymptomatic SARS-CoV-2 infection after a single dose of BNT162b2 vaccine, at a time of predominant transmission of the UK COVID-19 variant of concern 202012/01 (lineage B.1.1.7), and amongst a population with a relatively low frequency of prior infection (7.2% antibody positive).5This work was funded by a Wellcome Senior Clinical Research Fellowship to MPW (108070/Z/15/Z), a Wellcome Principal Research Fellowship to PJL (210688/Z/18/Z), and an MRC Clinician Scientist Fellowship (MR/P008801/1) and NHSBT workpackage (WPA15-02) to NJM. Funding was also received from Addenbrooke’s Charitable Trust and the Cambridge Biomedical Research Centre. We also acknowledge contributions from all staff at CUHNFT Occupational Health and Wellbeing and the Cambridge COVID-19 Testing Centre.

Guangming Wang

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Tam Hunt

and 1 more

Tam Hunt [1], Jonathan SchoolerUniversity of California Santa Barbara Synchronization, harmonization, vibrations, or simply resonance in its most general sense seems to have an integral relationship with consciousness itself. One of the possible “neural correlates of consciousness” in mammalian brains is a combination of gamma, beta and theta synchrony. More broadly, we see similar kinds of resonance patterns in living and non-living structures of many types. What clues can resonance provide about the nature of consciousness more generally? This paper provides an overview of resonating structures in the fields of neuroscience, biology and physics and attempts to coalesce these data into a solution to what we see as the “easy part” of the Hard Problem, which is generally known as the “combination problem” or the “binding problem.” The combination problem asks: how do micro-conscious entities combine into a higher-level macro-consciousness? The proposed solution in the context of mammalian consciousness suggests that a shared resonance is what allows different parts of the brain to achieve a phase transition in the speed and bandwidth of information flows between the constituent parts. This phase transition allows for richer varieties of consciousness to arise, with the character and content of that consciousness in each moment determined by the particular set of constituent neurons. We also offer more general insights into the ontology of consciousness and suggest that consciousness manifests as a relatively smooth continuum of increasing richness in all physical processes, distinguishing our view from emergentist materialism. We refer to this approach as a (general) resonance theory of consciousness and offer some responses to Chalmers’ questions about the different kinds of “combination problem.”  At the heart of the universe is a steady, insistent beat: the sound of cycles in sync…. [T]hese feats of synchrony occur spontaneously, almost as if nature has an eerie yearning for order. Steven Strogatz, Sync: How Order Emerges From Chaos in the Universe, Nature and Daily Life (2003) If you want to find the secrets of the universe, think in terms of energy, frequency and vibration.Nikola Tesla (1942) I.               Introduction Is there an “easy part” and a “hard part” to the Hard Problem of consciousness? In this paper, we suggest that there is. The harder part is arriving at a philosophical position with respect to the relationship of matter and mind. This paper is about the “easy part” of the Hard Problem but we address the “hard part” briefly in this introduction.  We have both arrived, after much deliberation, at the position of panpsychism or panexperientialism (all matter has at least some associated mind/experience and vice versa). This is the view that all things and processes have both mental and physical aspects. Matter and mind are two sides of the same coin.  Panpsychism is one of many possible approaches that addresses the “hard part” of the Hard Problem. We adopt this position for all the reasons various authors have listed (Chalmers 1996, Griffin 1997, Hunt 2011, Goff 2017). This first step is particularly powerful if we adopt the Whiteheadian version of panpsychism (Whitehead 1929).  Reaching a position on this fundamental question of how mind relates to matter must be based on a “weight of plausibility” approach, rather than on definitive evidence, because establishing definitive evidence with respect to the presence of mind/experience is difficult. We must generally rely on examining various “behavioral correlates of consciousness” in judging whether entities other than ourselves are conscious – even with respect to other humans—since the only consciousness we can know with certainty is our own. Positing that matter and mind are two sides of the same coin explains the problem of consciousness insofar as it avoids the problems of emergence because under this approach consciousness doesn’t emerge. Consciousness is, rather, always present, at some level, even in the simplest of processes, but it “complexifies” as matter complexifies, and vice versa. Consciousness starts very simple and becomes more complex and rich under the right conditions, which in our proposed framework rely on resonance mechanisms. Matter and mind are two sides of the coin. Neither is primary; they are coequal.  We acknowledge the challenges of adopting this perspective, but encourage readers to consider the many compelling reasons to consider it that are reviewed elsewhere (Chalmers 1996, Griffin 1998, Hunt 2011, Goff 2017, Schooler, Schooler, & Hunt, 2011; Schooler, 2015).  Taking a position on the overarching ontology is the first step in addressing the Hard Problem. But this leads to the related questions: at what level of organization does consciousness reside in any particular process? Is a rock conscious? A chair? An ant? A bacterium? Or are only the smaller constituents, such as atoms or molecules, of these entities conscious? And if there is some degree of consciousness even in atoms and molecules, as panpsychism suggests (albeit of a very rudimentary nature, an important point to remember), how do these micro-conscious entities combine into the higher-level and obvious consciousness we witness in entities like humans and other mammals?  This set of questions is known as the “combination problem,” another now-classic problem in the philosophy of mind, and is what we describe here as the “easy part” of the Hard Problem. Our characterization of this part of the problem as “easy”[2] is, of course, more than a little tongue in cheek. The authors have discussed frequently with each other what part of the Hard Problem should be labeled the easier part and which the harder part. Regardless of the labels we choose, however, this paper focuses on our suggested solution to the combination problem.  Various solutions to the combination problem have been proposed but none have gained widespread acceptance. This paper further elaborates a proposed solution to the combination problem that we first described in Hunt 2011 and Schooler, Hunt, and Schooler 2011. The proposed solution rests on the idea of resonance, a shared vibratory frequency, which can also be called synchrony or field coherence. We will generally use resonance and “sync,” short for synchrony, interchangeably in this paper. We describe the approach as a general resonance theory of consciousness or just “general resonance theory” (GRT). GRT is a field theory of consciousness wherein the various specific fields associated with matter and energy are the seat of conscious awareness.  A summary of our approach appears in Appendix 1.  All things in our universe are constantly in motion, in process. Even objects that appear to be stationary are in fact vibrating, oscillating, resonating, at specific frequencies. So all things are actually processes. Resonance is a specific type of motion, characterized by synchronized oscillation between two states.  An interesting phenomenon occurs when different vibrating processes come into proximity: they will often start vibrating together at the same frequency. They “sync up,” sometimes in ways that can seem mysterious, and allow for richer and faster information and energy flows (Figure 1 offers a schematic). Examining this phenomenon leads to potentially deep insights about the nature of consciousness in both the human/mammalian context but also at a deeper ontological level.

Susanne Schilling*^

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Jessica mead

and 6 more

The construct of wellbeing has been criticised as a neoliberal construction of western individualism that ignores wider systemic issues including increasing burden of chronic disease, widening inequality, concerns over environmental degradation and anthropogenic climate change. While these criticisms overlook recent developments, there remains a need for biopsychosocial models that extend theoretical grounding beyond individual wellbeing, incorporating overlapping contextual issues relating to community and environment. Our first GENIAL model \cite{Kemp_2017} provided a more expansive view of pathways to longevity in the context of individual health and wellbeing, emphasising bidirectional links to positive social ties and the impact of sociocultural factors. In this paper, we build on these ideas and propose GENIAL 2.0, focusing on intersecting individual-community-environmental contributions to health and wellbeing, and laying an evidence-based, theoretical framework on which future research and innovative therapeutic innovations could be based. We suggest that our transdisciplinary model of wellbeing - focusing on individual, community and environmental contributions to personal wellbeing - will help to move the research field forward. In reconceptualising wellbeing, GENIAL 2.0 bridges the gap between psychological science and population health health systems, and presents opportunities for enhancing the health and wellbeing of people living with chronic conditions. Implications for future generations including the very survival of our species are discussed.  

Mark Ferris

and 14 more

IntroductionConsistent with World Health Organization (WHO) advice [1], UK Infection Protection Control guidance recommends that healthcare workers (HCWs) caring for patients with coronavirus disease 2019 (COVID-19) should use fluid resistant surgical masks type IIR (FRSMs) as respiratory protective equipment (RPE), unless aerosol generating procedures (AGPs) are being undertaken or are likely, when a filtering face piece 3 (FFP3) respirator should be used [2]. In a recent update, an FFP3 respirator is recommended if “an unacceptable risk of transmission remains following rigorous application of the hierarchy of control” [3]. Conversely, guidance from the Centers for Disease Control and Prevention (CDC) recommends that HCWs caring for patients with COVID-19 should use an N95 or higher level respirator [4]. WHO guidance suggests that a respirator, such as FFP3, may be used for HCWs in the absence of AGPs if availability or cost is not an issue [1].A recent systematic review undertaken for PHE concluded that: “patients with SARS-CoV-2 infection who are breathing, talking or coughing generate both respiratory droplets and aerosols, but FRSM (and where required, eye protection) are considered to provide adequate staff protection” [5]. Nevertheless, FFP3 respirators are more effective in preventing aerosol transmission than FRSMs, and observational data suggests that they may improve protection for HCWs [6]. It has therefore been suggested that respirators should be considered as a means of affording the best available protection [7], and some organisations have decided to provide FFP3 (or equivalent) respirators to HCWs caring for COVID-19 patients, despite a lack of mandate from local or national guidelines [8].Data from the HCW testing programme at Cambridge University Hospitals NHS Foundation Trust (CUHNFT) during the first wave of the UK severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic indicated a higher incidence of infection amongst HCWs caring for patients with COVID-19, compared with those who did not [9]. Subsequent studies have confirmed this observation [10, 11]. This disparity persisted at CUHNFT in December 2020, despite control measures consistent with PHE guidance and audits indicating good compliance. The CUHNFT infection control committee therefore implemented a change of RPE for staff on “red” (COVID-19) wards from FRSMs to FFP3 respirators. In this study, we analyse the incidence of SARS-CoV-2 infection in HCWs before and after this transition.

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Hanna Berggren

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Bailin Tu

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Ahmed A

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FEV 1/FVC normally decreases through childhood, increases briefly during early adolescence, and then declines throughout life. The physiology behind this temporary increase during early adolescence is not well understood. The objective of this study was to determine if this pattern also occurs in children with asthma. Design: Single-center, cross-sectional, retrospective analysis of pulmonary function tests (PFTs) obtained over a 5-year period in children 5 to 18 years of age with persistent asthma. Results: 1,793 patients satisfied all inclusion and exclusion criteria. Mean age (± SD) was 10.4 ± 3.8 years. 48% were female. Mean FEV 1 /FVC was 0.83 ± .09. FEV 1 /FVC in children with persistent asthma declined from age 5 to age 11 by 5.7 % compared to 7.3% in healthy girls, and 5.8% compared to 9.4% in healthy boys. FEV 1/FVC increased by 1.2% until age 16 in children with asthma, compared to 2.2% in healthy girls, and 2.5% compared to 2.3% in healthy boys. The ratio was lower in obese children with asthma at all ages but demonstrated the same curvilinear shape as in healthy children. In absolute terms, FEV 1 grew proportionately more than FVC during early adolescence, so the ratio of FEV 1/FVC increased during that period. The curvilinear shape of the curve remained in postbronchodilator testing, though significantly blunted. Conclusions: The “Shepherd’s Hook” pattern in the FEV 1/FVC curve is preserved in children with persistent asthma. This was also true in obese patients with asthma, although their FEV 1/FVC ratios were lower throughout all stages of childhood and adolescence.

Xiaodong Lu

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The pedunculopontine tegmental nucleus of the brainstem (PPTg) has extensive interconnections and neuronal-behavioural correlates. It is implicated in movement control and sensorimotor integration. We investigated whether single neuron activity in freely moving rats is correlated with components of skilled forelimb movement, and whether individual neurons respond to both motor and sensory events. We found that individual PPTg neurons showed changes in firing rate at different times during the reach. This type of temporally specific modulation is like activity seen elsewhere in voluntary movement control circuits, such as the motor cortex, and suggests that PPTg neural activity is related to different specific events occurring during the reach. In particular, many neuronal modulations were time-locked to the end of the extension phase of the reach, when fine distal movements related to food grasping occur, indicating strong engagement of PPTg in this phase of skilled individual forelimb movements. In addition, some neurons showed brief periods of apparent oscillatory firing in the theta range at specific phases of the reach-to-grasp movement. When movement-related neurons were tested with tone stimuli, many also responded to this auditory input, allowing for sensorimotor integration at the cellular level. Together, these data extend the concept of the PPTg as an integrative structure in generation of complex movements, by showing that this function extends to the highly coordinated control of the forelimb during skilled reach to grasp movement, and that sensory and motor-related information converges on single neurons, allowing for direct integration at the cellular level.
AbstractThis article seeks to examine the consequences of the global war on terror (GWT) in the Horn of Africa. The focus is on the various implications to individual countries and the region as a whole. It therefore, critically interrogates what the consequences are and how they manifested. The interplay between internal and external factors compounding the consequences are critically analysed. Militarisation in the service of geo-strategic and geopolitical interests through creation of division of states into friendly and non-friendly and construction of unholy alliances hinders cooperation and regional integration. The politics of creation of pariah states, related to the GWT, engenders fragility, internal instability, and failed states. This in turn exposes societies to all sorts of pathologies, distorting the process of state and nation formation. The paper interrogates these intertwined variables. The paper contends that the GWT aggravated the precarious state of peace and stability in the Horn region causing far-reaching structural, political, social, economic, security, inter-state relation, integration and diplomatic damages still reverberating even after the GWT has been jettisoned. The study of the consequences of the GWT still remains scanty. The paper hopes to contribute to the dearth of knowledge on the consequence of GWT.Key words : global war on terror, Horn region, militarisation, proxy warsIntroductionAfter decades of Cold War interventions that transformed the Horn of Africa region (HOAR) into a theatre of war for superpower rivalry (Yordanov, 2016), it got respite in 1990 in tandem with the demise of the Soviet Bloc that heralded the end of the Cold War. The end of Cold War and collapse of state socialism spurred triumphalist hasty statements such as end of history (Fukuyama, 1992), prophesy of clashes of civilisations (Huntington, 1996). This respite, however, did not last long. A new era of external intervention, in the form of global war on terror (GWT), commenced. The GWT coupled with the war against piracy has attracted various international forces to the HOAR. The last form in a litany of external interventions pertain to what goes commonly under the designation of scramble for resources. Today, although terrorism and piracy has subsided, several dozens of naval forces from West, East, North and South of the glob are still active in the region. Following the Gaza war sparked by the Hamas action on October 7, 2023, and subsequent Houthi retaliatory attacks on ships destined to or connected with Israel passing through Bal El Mandab, disrupting trade have heightened further the insecurity of the region. What is the underlying rational behind the huge military presence in the HOAR? What are the implications of GWT driven interventions? Is there any mitigation to the interventions? This article seeks to provide answers to these questions. More specifically, it argues that the GWT has caused irreparable damages in the region in terms of structure, socio-economic development, inter-state relation, democratisation, regional integration, nation and state formation.Temporality wise the GWT succeeded the Cold War. Nevertheless, there is similarity between the two. If not in form in content, the Cold War and GWT are identical. Both engage in the creation of friends and non-friends and militarisation of the HOAR. They also entrench proxy wars. The international interventions do cause conflicts, instability and mistrust within states as well as among states of the region perpetrating the cycle of conflicts. There is growing suspicion that the international involvement in the region has less to do with terror and piracy but rather is driven by scramble for resources and strategic positioning (Keenan, 2008, Volman and Jeremy, 2010, Aning at al, 2008). One of the contentions behind this suspicion is that in spite of the huge presence of international military forces, with all the accompanying modern sophisticated technology of warfare, it has not been possible to resolve one of the raison d’etre for its presence, defeating the rag-tag militias of Al Shebab completely.This led to some to argue that the prevalence of terrorist acts and piracy is somehow tolerated because they legitimise the continuous presence of these international actors (Keenan, 2008). The proponents of such argument opine that the less commitment and dedication by international actors to rout out the malice ravaging Somalia is an illustration of the tolerance. Many therefore contend that the superpower rivalry for geo-strategic influence during the Cold War era is now replaced by West-East rivalry for the scramble for natural resources (Abrahamsen, 2013, Schmidt, 2013). The recent discovery of huge biofuel and other mineral resources in the region coupled with the new phenomenon of land grabbing thus lends further currency to the apprehension that it creates a kind of Eldorado where states, transnational corporations and extractive companies are vying for those precious untapped resources. The war in Gaza and the Houthi’s retaliatory measure in the Bal El Mandab chock point is a new addition to the misery of the region.This article seeks to examine the multiple implications of GWT driven, geo-strategic calculations of interventions and geopolitics in the HOAR. Therefore, it critically interrogates what the consequences are, how they are manifested and the mechanisms involved. It has two primary objectives. First, it will interrogate the trajectory of the GWT in the HOAR. Secondly, it seeks to examine the multiple implications caused by the GWT to the HOAR. The article contends the GWT caused irreparable political, social, economic, security, integration and diplomatic damages derailing developmental process in the region.The article consists of seven sections. Section two analyses militarisation and conflicts in the region concomitants of GWT. Section three discusses the politics of producing pariah states. Section four analyses proxy wars. Section five analyses international peace mediation and GWT. Section six examines regional integration, development and legitimacy under the GWT regime. The final section provides concluding remarks.Militarisation and ConflictsMilitarisation and conflicts are two concepts that are intimately connected, albeit not in a unilinearity correlation mode. The interconnection is not a simple manifestation of military as a source of conflict, military could also serve as mechanism of conflict mitigation and deterrence. A circumstance where militarisation would serve as a function of conflict deterrence is when a considerable symmetry in military prows prevails. A second condition is when militarisation at the centre succeeds in pacification of society through taming centripetal forces (Callaghy, 1984, Chabal and Daloz, 1999, Young, 1994). In the case of the latter, it relates to the Weberian notion of state monopoly of the legitimate means of violence (Weber, 1984). Societal pacification presupposes a developmental imperative in which societal groups are not in a position to challenge the state through the possession of the means of violation. There emerges a pacified and peaceful society. Conversely, the state submits itself to the societal control, as ultimate power lies on society. The state represents the interests of and is owned by all societal groups, emancipation of the state. Emancipation of state presupposes its standing above all societal groups. Succinctly, state emancipation entails: (i) autonomy of the state, (ii) the state stands above societal groups, (iii) establishment of state harmony over society (Bereketeab, 2011). The pacification of society and emancipation of state represents peace and peacefulness. This also indicate to another development, “The development of a modern state depends above all on the gradual emancipation of established political structure from society” (Chabal and Daloz, 1999: 4-5). This pacification of society and emancipation of state would eventually produce a condition that render militarisation and violent conflicts within society unnecessary.It is common knowledge that, militarisation, because of its very nature of provision and making available of the very tools of mortality is anti-peace and peacefulness. Therefore, it is associated with conflicts, destruction and wars. Militarisation in the sense of widespread availability of the means of destruction harbours propensities that easily evolve into conflicts. This is further accentuated when militarisation takes place as an outcome of geo-strategically driven external intervention. Militarisation serves as means for economic, political, cultural and ideological domination. At the end, its primary contribution could be understood as opposition of state emancipation and societal pacification.Noting the institutionalisation mechanism, Volman and Keenan (Keenan, 2008) write, ‘Militarization of Africa is being co-ordinated by AFRICOM’. Indeed, the region has experienced a great deal of such kinds of militarisation over several decades with concomitant dire consequences the most obvious one being the Cold War (Yordanov, 2016). The US need of African oil necessitated that “the Bush administration decided to use military structure to secure access to and control over African oil and opted to use the GWOT as a justification, rather than acknowledging that US military intervention in Africa was about resource control” (Keenan, 2008: 635). The GWT as a strategy and justification for the exploitation of resources rests on militarisation of the region. This militarisation is not limited only to international big powers but also to regional states who willingly jump on the bandwagon of the campaign of GWT to repress their own people. It is not rare that regimes deploy the politics of GWT to repress opposition. For instance, the EPRDF government in Ethiopia introduced draconian laws in 2009 that included anti-terror law, Proclamation No. 652/2009, “that prevented opposition political parties, the media and Civil Society organizations working on democratisation from accessing donor funding” (Mulugeta, 2024: 85).The GWT driven militarisation has at least two dimensions notably arming of client states and presence of foreign armed forces. In terms of the former client states are provided with armaments that are utilised against internal opposition as well as in the inter-state conflicts (Woodward, 2006, Cliffe, 2004, Schmidt, 2013, Keenan, 2008, Yordanov, 2016). This militarisation through supporting tyrant governments therefore is serving as obstacle to democratisation, respect of human rights, peace, security and development in HOAR. Indeed, the ready availability of the means of warfare is a cause to the rampant wars ravaging the region. Even pastoralists who often engage in cattle rustling, equipped with AK-47, instead of traditional bows and arrows, could inflict immense devastation. The region is hosting several dozens of military organisations.The US tendency to arrogate to itself the right to interfere and enforce its strategic interests and values (Keller, 2006, Geis and Wunderlich, 2014) often coated in the slogan of protecting global interest and security and their friends is a factor of militarisation in the region. The following are some of the current external military forces actively operating or operated in the region.Combined Joint Task Force-Horn of Africa (CJTF-HOA),Africa Command (AFRICOM),Partnership for Regional East Africa Counter-Terrorism (PREACT),Drones base at Port Lemonnier (Djibouti) and Arba Minch (Ethiopia, until January of 2016),France, Germany, Japan, Dutch, Mission Atalanta (EU), USA, China (have military bases in Djibouti),Private Military Companies (PMCs) that are not accountable to neither home governments nor host governments (Keenan, 2008: 642, Aning et al, 2008). Therefore, lack transparency and accountability to host countries (Aning et al, 2008),In the hinterland, the tiny state of Djibouti hosts most of the military forces. Indeed, the constellation of Western military force has led some to call it “Horn of Africa NATO” (Sun and Zoubir, 2016: 115). This militarisation of Djibouti may serve well the Ismail Omar Guelleh government, but it seems that it is inducing increasing internal divisions and dissatisfaction as expressed in incidents such as the bombing in July 2014 of a restaurant that is frequently visited by Westerners, and the August 25, same year, attempt on the life of the President. It has also contributed to complications of relation between Djibouti and Eritrea.The Politics of Producing Pariah StatesTwo notions with the same meaning are invariably employed to label certain actors. These are ‘pariah’ and ‘rogue’. The meaning invoked by the notions is that “states or non-state actors as being outside the normative structure of international society” (Geis and Wunderlich, 2014: 459). This definition of course begs explanation of its presumption of existence of consensually agreed upon “international norms” and “international society”. In addition, “Penguin Dictionary of International Relations (1998) define Pariah States as international States/actors which by virtue of their political systems, ideological postures, leadership or general behaviour suffer from diplomatic isolation and widespread global moral opprobrium” (Lawal, 2012: 227). International community, international values and norms are most abused terminologies. In reality they are used to mean Westerns norms and Western societies. In practice therefore it means arbitrary imposition of those norms and values.The notion of pariah states as academic subject is not well developed in social sciences. It is rather, purposely employed by big powers, particularly the USA, to designate states considered none compliant with its global war on terror policies (Litwak, 2000). As Rotberg, 2007: 7) notes, “They [pariahs] disregarded Washington’s predominant military might and followed autarkic rather than collegial, consensual, or respectful policy trajectories”. This makes it subject to the politics of arbitrary construction. The politics of construction of pariahs is usually characterised by an ideology that fosters the need of a concerted and systematic demonization and dehumanisation campaigns (Geis and Wunderlich, 2014: 463). Once the label sticks not only it becomes legitimate to take any measure against the target state but also becomes hard to remove the designation for a long time to come. This political ideology is quietly infiltrating academia where academic discourse is highly influenced by it (Geis and Wunderlich 2014: 459-460). Western mainstream media driven by disseminating Western values have further promoted the politics of construction of pariahood. In its ideological underpinning the politics of pariahood is an attempt of cultivating Western value, particularly US value (Keller, 2006) thereby denigrating and depreciating the values and norms of targeted societies (a reminiscence of the civilising mission: civilising the savages, barbarians, the dark continent). The concept is uncritically deployed in academic works and by researchers too. Books like ‘Worst of the Worst’, edited by Robert I. Rotbert (2007), uncritically echo what White House officials utter. Lawal (2012: 227) notes, ‘big power alliance structure determines Pariahood, but that they also compensate or punish States according to their whims and caprice’. What this indicates is that the categorisation of pariah is rather driven by big power geo-strategic interests and considerations devoid of any rigorous scientific interrogation. The US by its sheer power of influence singlehandedly inserted the doctrine of pariah state at the centre of academia and policymaking. It has also become fashionable that scholars, donors, policymakers, Western media, human rights organisations and activists uncritically mimic the designation.Recently, the concept of pariah states has been popularised under the GWT regime. The label of rogue state was rigorously pursued by the American administration, particularly by G.W. Bush, following the terrorist attack of 11 September 2001 (Geis and Wunderlich, 2014, Preble, 2005). The main components of the Bush Doctrine are pre-emption, democratisation and dominance. Pre-emption alludes to the logic of attacking before being attacked. While democratisation become euphemism to regime change, dominance refers to ensuring US global hegemony (Dresner, 2009). The imperative urge of confronting global terrorism as defined by the US administration has therefore brought the concept to centre of policymaking, international relation, diplomacy and to certain degree academia. The outcome of pervasive utility of the concept in the HOAR is dividing the states into pariah (non-friendly) and friendly and has brought serious multidimensional policy implications.One of the consequences of the GWT driven intervention in the region is the division of the states into friendly and none-friendly ones. The division seems to be based on arbitrary and subjective criteria. Big powers divide at whim states into those who are willing to serve the GWT and those who are not. The designation has become controversial. If they fail to fall in line with the US interpretation of GWT, are categorised as enemies, “either you are with us or with the enemy”.As will be detailed blow while the non-friendly countries are Sudan, UIC-Somalia and Eritrea; the friendly countries are Ethiopia, Djibouti, Kenya, South Sudan and Uganda. A critical question is what is the implication of this division to peace, security, stability and regional integration? The most obvious upshot of the designation of the friendly state for incumbents is they can get away with whatever violation whereas non-friendly states are sanctioned harshly. Big powers seem to gloss over or even defend actions of their close allies. A case in point is the Assistant Secretary of State, Jandayi Frazer, in the US Congressional Hearing, defending the Ethiopian government’s action against the ethnic Somali Ethiopians that was labelled by many humanitarian organisations as crime against humanity (HRW, 2008). This kind of blatant defence of friendly states by White House officials undermines US advocacy of universal human rights value.Moreover, friendly states are rewarded economically, politically, militarily and diplomatically. Ethiopia, for instance, received about US$ 3.5 billion annually, followed by Kenya with 2.6 billions and Uganda 1.7 billions from the West. The three countries also received weapons, particularly from the US as rewards for their involvement in Somalia, for instance (Burgess, 2013). Non-friendly states on the other hand are placed under economic, political, military and diplomatic sanctions. Rebellions to depose the governments are frequently supported and at times even incited to destabilise them. The Sudan is a good example of how the US armed opponents of the government (Nmoma, 2006: 55-6). These societies are extremely fragile, suffer of variety of pathologies. The external interventions therefore further aggravate the already precarious situation. States are pushed to failed status with all the accompanying consequences. The division into friendly and non-friendly states also adversely affects regional integration. A survival instinct will bring those who are designated “pariahs” together. This will therefore compartmentalise the states into opposing groups affecting the long-term sustainable and functional regional integration. Below, we will examine the case of three cases designated as pariah.

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Karma Norbu

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Introduction: Scrub typhus is a neglected life threatening acute febrile illness caused by bacteria Orientia tsutsugamushi and it is a vector-borne zoonotic disease. In 2009, scrub typhus outbreak at Gedu has awakened Bhutan on the awareness and testing of the disease.Information and data of the study highlights the need for in depth surveillance, awareness among prescribers and initiate preventive measures in the country. Methods: We used retrospective descriptive study through review of laboratory registers across three health centres in Zhemgang district, south central Bhutan. The laboratories registers have been transcribed into CSV file using Microsoft excel. Variables of interest were collected from the registers and then analysed using open statistical software R, (R Core Team (2020). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria.) And use of mStats package, (MyoMinnOo (2020). mStats: Epidemiological DataAnalysis. R package version 3.4.0.) Results: Of the total 922 tests prescribed for suspected scrub typhus in the three health centers in Zhemgang, only 8.2 % (n=76) were tested positive. Of these, Panbang Hospital had highest reported positive for scrub typhus with 56.6 %( n=43) followed by Yebilaptsa Hospital 35.5 %( n=27) and Zhemgang Hospital with 7.9 %( n=6). The female gender is comparably more affected as opposed to male with 57.9% (n=44) of the positive cases being female. The prevalence of scrub typhus seems to be affected by the seasonal variation as the months of Spring, Summer and Autumn together accounts for 98.7%(n=75) of total positive cases. The year 2019 noted significant scrub typhus cases accounting to 89.5 %(n=68) of the total positive cases over the two years. Conclusions:The overall tests tested positive of the scrub typhus infection within two years was 8.2%.

Selahattin Semiz

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Monoclonal antibodies (MAbs) are powerful therapeutic tools in modern medicine and represent a rapidly expanding multi-billion USD market. While bioprocesses are generally well understood and optimized for MAbs, online quality control remains challenging. Notably, N-glycosylation is a critical quality attribute of MAbs as it affects binding to Fcγ receptors (FcγR), impacting the efficacy and safety of MAbs. Traditional N-glycosylation characterization methods are ill-suited for online monitoring of a bioreactor; in contrast, surface plasmon resonance (SPR) represents a promising avenue, as SPR biosensors can record MAb-FcγR interactions in real-time and without labelling. In this study, we produced five lots of differentially glycosylated Trastuzumab (TZM) and finely characterized their glycosylation profile by HILIC-UPLC chromatography. We then compared the interaction kinetics of these MAb lots with four FcγRs including FcγRIIA and FcγRIIB at 5 oC and 25 oC. When interacting with FcγRIIA/B at low temperature, the differentially glycosylated MAb lots exhibited distinct kinetic behaviours, contrary to room-temperature experiments. Galactosylated TZM (1) and core fucosylated TZM (2) could be discriminated and even quantified using an analytical technique based on the area under the curve (AUC) of the signal recorded during the dissociation phase of a SPR sensorgram describing the interaction with FcγRIIA (1) or FcγRII2B (2). Because of the rapidity of the proposed method (less than 5 minutes per measurement) and the small sample concentration it requires (as low as 30 nM, exact concentration not required), it could be a valuable process analytical technology for MAb glycosylation monitoring.

Ivy Bourgeault

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The global health workforce crisis, simmering for decades, was brought to a rolling boil by the COVID-19 Pandemic in 2020. With scarce literature, evidence, or best practices to draw from, countries around the world moved to flex their workforces to meet acute challenges of the pandemic, facing demands related to patient volume, patient acuity, and worker vulnerability and absenteeism. One early hypothesis suggested that the acute, short-term pandemic phase would be followed by several waves of resource demands extending over the longer term. However, as the acute phase of the pandemic abated, temporary workforce policies expired and others were repealed with a view of returning to “normal”. The workforce needs of subsequent phases of pandemic effects were largely ignored despite our new equilibrium resting nowhere near our pre-COVID baseline. In this paper, we describe Canada’s early pandemic workforce response. We report the results of an environmental scan of the early workforce strategies adopted in Canada during the first COVID wave of the COVID 19 pandemic. Within a three-part framework for supporting a sustainable health workforce, we describe 470 strategies and policies that aimed to increase the numbers and flexibility of health workers in Canada, and to maximise their continued availability to work. These strategies targeted all types of health workers and roles, enabling changes to the places health work is done, the way in which care is delivered, and the mechanisms by which it is regulated. Telehealth strategies and virtual care were the most prevalent, followed by role expansion, licensure flexibility, mental health supports for workers, and return to practice of retirees. We explore the degree to which these short-term, acute response strategies might be adapted or extended to support the evolving workforce’s long-term needs.

Tara Lamont

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There is a gap between healthcare workforce research and decision-making in policy and practice. This matters more than ever given the urgent staffing crisis, with shortfalls of key workers and increasing service pressures. As a national research network, we held the first ever UK forum on health and care workforce research and evidence in March 2023 which aimed to bridge this gap. We brought together clinical and system leaders, policymakers and regulators with workforce researchers. Fifteen sessions convened by leading experts combined knowledge exchange with deliberative dialogue over two days. Topics ranged from workforce analytics, forecasting, international migration to interprofessional working. In these small groups, important knowledge gaps were identified, where existing research had not reached decision-makers. Managers were not aware of accepted high quality evidence in areas like the relationship between registered nurse staffing levels and patient outcomes. Participants also identified important gaps in research, both topic area and study design. More work is needed to engage new disciplines, from labour economics and occupational health to academic human resources. Mobilising knowledge across disciplines will strengthen the quality and range of research as well as identifying relevant and novel interventions. Discussion at the forum highlighted a number of national and local workforce initiatives which had been implemented at pace, from virtual wards to e-rostering and apprentice levies, without a good evidence base or concurrent evaluation. The pandemic had accelerated many changes, including important shifts in skill mix and new roles with little learning from other countries and systems. Existing evaluations were often small-scale or focused on individual, rather than organisational, solutions in areas such as staff wellbeing. The paper provides a summary of an emerging UK workforce research agenda developed at the forum meeting, together with actions to build workforce research capacity and increase reach of findings into policy and practice.

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