Table of contents :

• e-voting : the debate centres on the use of electronic voting equipment, ATM-like machines that register votes digitally after people make their selections on a touch-screen. Nearly 30% of voters will place their ballot using these 'e-voting' machines when choosing the US president at November 2004 elections. Many watchdog groups are warning that tests conducted on e-voting hardware and software are insufficient, and that faulty machines could cause votes to be missed or registered incorrectly. It's not yet clear how serious these problems will be; early voting in a dozen or so states so far has thrown up only minor glitches. However, there is a more fundamental concern about the technology, which is that without a printed confirmation of each vote, no option is available for a reliable recount if there are technical glitches or if the result is very close, as it may well be in the upcoming election. Critics are also concerned that it offers no protection against fraud, either by somebody who might be associated with one of the companies programming the machines, or from a clever hacker off the street. Makers of e-voting machines are reluctant to incorporate technology that would produce a printed confirmation of each vote, but whether or not hard copies are generated depends mainly on the decision of each individual state. Nevada  required that all e-voting machines come with a paper trail, for example, but Maryland and Georgia remain staunch defenders of paperless elections. The most common e-voting difficulty reported as the election got under way involved cases where voters claimed that the final summary screen indicated a candidate different from the one for whom they had voted. The problem raises significant concerns because it appeared across a variety of types of touch-screen voting machine. Voters that found the summary screen displayed an inaccurate selection could go back and fix their electronic ballot. Other types of problems reported involved machines that indicated a candidate before the voter had made a choice. People also claimed to be unable to complete the voting process because the machine screens went dark. New Orleans wins the award for the worst voting situation in the country when it comes to electronic voting machines : a significant number of the city's machines did not boot up on time for a variety of reasons. It was a problem that cropped up elsewhere as well, but the difference between New Orleans and some of the other counties is that New Orleans hadn't prepared any back-up plan : as a result they didn't have paper ballots or, frankly, anything to offer to voters when their machines didn't work, and they had to turn people away. By the time polling began to wrap up on the East Coast, the Election Protection coalition says it had received over 600 reports of e-voting problems from across the country. The number of reports is very low compared with the total number of voters who used the machines, but not everyone who experiences a problem will make a complaint.

Web resources :
• Electionline.org briefing
• Electronic Freedom Foundation (EFF)
• Diebold Election Systems
• How Stuff Works: E-voting
• the 2004 second win for George W. Bush as USA President means that current US policies on a range of contentious scientific issues are likely to remain unchanged. On the subject of global climate change, Bush had emphasized the scientific uncertainties involved, whereas Kerry had called for an immediate return to international negotiations on reducing greenhouse-gas emissions. Bush's victory means that the country will probably continue its wait-and-see approach, pushing for more scientific results before enacting specific policies or regulations. His victory will also mean continued support for a national nuclear-waste repository at Yucca Mountain in Nevada. Kerry had hoped to win that state by vowing to kill the programme, which is unpopular with most Nevadans, but Bush won by a slight, 2% margin. The Bush win means that a federal ban on funding for embryonic stem-cell research is likely to remain in place. The Republican party's gains in the nation's 2 houses of Congress suggest there will be a renewed push to pass a national energy bill that has languished in committees for the past 2 years. In its present form, this bill would fund just over a billion dollars' worth of research into new types of nuclear reactor. The Republicans' victory could also lead to revised calls to open up the Arctic National Wildlife Refuge for drilling of oil and natural gas. The Bush administration may seek to reform the Endangered Species Act of 1973, to avoid what it sees as unnecessary economic burdens on landowners and industry
• psephology : the science of voting prediction. Public polling and questionnaires are notoriously difficult to assess. It seems that, when there is no objectively correct answer to a question, people are likely to be biased by what they think others will say. For example, they are more likely to give an answer that agrees with what they perceive to be the majority or 'accepted' view than an answer that truly reflects their own belief. A new method manages to give high scores to people for a truthful answer by adding a second question. This query simply asks the person what they think other people will say. A comparison of this with the average answer can reveal how truthful they are being: if people lie, their score is reduced, even though no one else would ever know that they lied. Respondents are rewarded for a high score, in whatever way is deemed appropriate. The method takes advantage of the fact that holding an opinion is a valuable clue to how common that particular opinion is likely to be in a population. It is well established that people who hold an opinion are likely to give higher estimates of the popularity of that opinion than people who do not: because they think it is a valid belief, they think that other people will hold it. Given the limited information you have (that is, you know your own opinion, but not that of anyone else), you always have reason to believe that your opinion will prove more popular than others expect. That is, you realize that you are likely to give a high estimate of your opinion's popularity and you think the rest of the population will underestimate the actual proportion of people that share it. Thus, an average of people's belief about the population will come out with a comparatively low estimate, and your (truthful) answer will be surprisingly common. For example, to find out whether people think Picasso is a great artist, you ask people whether they like Picasso, and also how many people in the population they think are likely to answer yes or no to that question. Respondents are rewarded if the answer they give to the first question turns out to be unexpectedly common compared with the overall prediction made by the group about how people are likely to answer. Obviously everyone can't be right all the time. But given the information you have about your own opinion, you are more likely to get the highest score if you answer truthfully. This method is just as effective whether the group in question is poorly informed or well informed. The technique does not just provide more accurate polls, however. It should also help to find more accurate consensus answers. That could enable companies to make better business forecasts (where managers are encouraged not to worry about whether their opinion differs greatly from those of others), better estimates of risk, better legal judgements, and perhaps even better assessments of art. For political polling, the method would work best when there is not already a lot of public information about what others think. So it would be a good way of gauging public reaction in the immediate aftermath of some event^ref. The problem with asking people what they think about art, or any other subjective question, is that whether through lack of confidence or the wish for acceptance, we tend to fall in line with what others say. Our aesthetic judgements are corrupted by other people's judgements. This can suppress unusual views, or it can also encourage them, out of a reactive impulse to 'be different'. Neither response is authentic. Every individual has the right to disagree with the consensus, and they can change it by convincing others that their evaluation is more consistent with the evidence available
• despite the age-old admonition not to “judge a book by its cover,” we routinely make important judgments about human traits based on instant, superficial impressions of peoples’ faces. Such “blink of an eye” decision-making predicted the outcome of about 70% of recent U.S. Senate races. Candidates who looked “competent” prevailed in congressional elections > 66% of the time. The outcomes were likely due to differences in the opponents’ “babyfacedness". Although the study doesn’t tell us exactly what competence is – there are many kinds, including physical strength, social dominance and intellectual shrewdness – babyfaced people are perceived to be lacking in all these qualities. What facial qualities make someone look more babyfaced and less competent? Both babies and babyfaced adults share such features as a round face, large eyes, small nose, high forehead and small chin. Competency, on the other hand, is associated with facial maturity.  The association between facial maturity and perceived competence is ubiquitous: babyfaced individuals within various demographic groups are perceived as less competent…Its impact can be seen even for famous politicians: in another study, when images of U.S presidents Reagan and Kennedy were morphed to increase babyfacedness, their perceived dominance, strength and cunning decreased significantly. Evolutionary importance of detecting attributes such as emotion, age and health is probably responsible for our strong tendency to respond to facial qualities that reveal these characteristics. With this built-in predisposition, we tend to overgeneralize facial impressions to adults whose faces, in this case, merely resemble a baby’s in certain features. The result: we often conclude that babyfaced adults are naïve, submissive and weak. In fact, babyfaced men are actually more intelligent, better educated, more assertive and apt to win more military medals than their mature-looking counterparts^{ref1, ref2, ref3, ref4, ref5, ref6, ref7, ref8}. Research in the area of facial impressions has implications for political marketing, social decision-making and even the democratic process : the data we have suggest that we’re not necessarily electing better leaders – people who are actually more competent, though we are electing people who look the part. Zebrowitz called for better understanding of appearance biases as a first step toward identifying electoral reforms that could increase the chances of electing leaders qualified by skill and experience, rather than appearance^ref.
• In 1946, the geneticist Lionel Penrose (father of physicist Roger Penrose) considered that countries with larger populations should have more votes because individual citizens in bigger countries have less say in the election of their country's representative. But Penrose showed that increasing the number of votes in proportion to the population size is over-compensating. He calculated that a citizen's say in such an election diminishes in proportion to the square root of the population size. So the best way to design a fair system is to give each country a number of votes that is proportional to the square root of its population. The present weightings used by the EU were assigned by the Treaty of Nice in 2001. They were determined rather arbitrarily by long negotiations, without any mathematical basis to them. By good fortune, they turn out to be not vastly different from those corresponding to the Penrose square-root rule. The effect the changes will have using another of Penrose's suggestions: that a country's "voting power" can be quantified by counting the number of ways a given country can form coalitions with other countries in order to secure a majority. Lawyer John Banzhaf proposed the same idea independently in 1965, so this measure is now called the Banzhaf index. The quota, or size of majority, needed to carry a vote should be altered from the present level of 71% to 62% : this is the value that makes each country's voting weight translate most directly into actual voting power^ref.

• military devices
• space wars : Galileo, a satellite system being developed by the European Space Agency, is due to reach full operational capacity in 2008 : it will provide a global navigation system that, unlike the US-run Global Positioning System (GPS) or the Russian GLONASS network, will be under civilian rather than military control. It should help ships, aircraft and land-based transport systems to navigate and will operate a 'search and rescue' function for distress signals. The United States has done everything it can to kill the project because Galileo threatens to disrupt US dominance of space. The GPS makes no guarantee of uninterrupted service for its non-military users: the US government can jam the civilian channel at will. The prospect of a European satellite-positioning network led the US deputy secretary of defence, Paul Wolfowitz, to write to European defence ministers in December 2001, telling them in no uncertain terms how he disapproved of ESA's bid for independence. No one could claim to be surprised by Wolfowitz's position. This was the man who, in 2000, helped to prepare the report "Rebuilding America's Defenses", published by the Project for the New American Century, a right-wing think-tank that aims "to promote American global leadership". The report argued that: "For the US armed forces to continue to assert military pre-eminence, control of space must be an essential element of our military strategy." And in case anyone were to imagine that this meant simply the continued pursuit of missile defence systems, that is, Ronald Reagan's ill-fated Star Wars project, the report spelled out that "control of space" would mean thinking beyond purely defensive measures. Instead, it recommended "the application of force ... including but not limited to antimissile defenses and defensive systems". It asserted: "No system of missile defenses can be fully effective without placing sensors and weapons in space." This is not mere sabre-rattling. "Rebuilding America's Defenses" was heavily influenced not just by Wolfowitz but also by the current vice-president Dick Cheney and Donald Rumsfeld, the US defence secretary. Rumsfeld has invoked fears of a "space Pearl Harbor", if the United States does not take steps to "negate the hostile use of space against US interests". According to a report^ref by the British think-tank Demos: "Several commentators have interpreted the US withdrawal from the Anti-Ballistic Missiles Treaty in December 2001 as a first step towards the development and testing of a new generation of space weapons". That attitude is spelled out in chilling terms in a US Air Force 'doctrine document' released in August 2004, entitled "Counterspace Operations". This states that space superiority means the "freedom to attack as well as freedom from attack". Air Force undersecretary Peter Teets asks: "What will we do 10 years from now when American lives are put at risk because an adversary chooses to leverage the Global Positioning System or perhaps the Galileo constellation to attack American forces with precision?" "Controlling the high ground of space," says Teets, "will require us to think about denying the high ground to our adversaries. One begins to wonder who these adversaries are. The counterspace operations report gives the impression that they could include anyone who dares to put a device of any sort into space. The document seems to argue that it is legitimate to undermine the space programme of any nation deemed to be an adversary of the United States. Satellites that provide essential weather-forecasting capability or communication with emergency services are all considered fair game. Indeed, you don't need to be an enemy for your space resources to become a target. So if a stiff letter from Paul Wolfowitz fails to scupper Galileo, there are other measures... What would this space-based weaponry look like? Another Air Force document, the "Transformation Flight Plan", released in November 2003, lays out the proposed technology. Weapons may include items such as lasers guided by space-based mirrors "to achieve a broad range of effects from illumination to destruction" or bizarre "hypervelocity rod bundles" that have the capability to strike ground targets anywhere in the world. Almost every element of this plan violates the spirit, and sometimes the letter, of the 1967 Outer Space Treaty, signed by the United States, which states that space operations should have "peaceful purposes". "The exploration and use of outer space", it continues, "shall be carried out for the benefit and in the interests of all countries and shall be the province of all mankind... Outer space is not subject to national appropriation by claim of sovereignty, by means of occupation, or by any other means. Quite aside from violations of international agreements, scientists should be outraged by proposals to put weapons in space. Not only would such projects disrupt genuine space science (and probably deflect funding away from it), but they would turn a natural commons into a territorial battlefield. We need voices to succeed that of Carl Sagan, who was vehemently opposed to the military domination of space. NASA must resist becoming the research and development arm of the US military. The European Space Agency must stand fast to its peaceful objectives. Of course, military interests have always played a part in motivating and funding scientific research, but it seems the right moment for the scientific community to consider a professional code of conduct that will say when enough is enough. In 1985, an appeal put forward by the Union of Concerned Scientists stated that "Outer space must remain free of any weapons," and should be preserved for "peaceful cooperation, exploration, and scientific discovery among all nations". Wouldn't this be a good time for that position to be adopted by all scientific bodies? Galileo has, intentionally and inescapably, a military function. And it is being bankrolled by nations, such as China, whose strategic objectives are transparently at odds with declared US strategy. In 2001 it became apparent that Galileo might plan to use frequencies that would impinge on those already used by the GPS system. Wolfowitz wrote to EU defence ministers of his " concerns about security ramifications". He explained that the US military, which governs the GPS, were planning "spectral separation of the GPS military signals from civil signals" and that the addition of any Galileo service in the same region would make it difficult to ensure the "availability of critical GPS services in time of crisis or conflict". One can only sympathize with Wolfowitz's frustration: whereas the GPS is controlled by a small and flexible panel in the US military, the proposed administration of Galileo has all the hallmarks of EU obfuscation, inefficiency and waste. Getting the EU to agree to a split-second frequency change in a time of crisis, such as the United States might demand in time of war, would be as frustrating as trying to nail jelly to the ceiling. Put in this light, Wolfowitz's letter shows extraordinary restraint, and certainly doesn't convey any kind of threat. His letter sent the EU into a tailspin. But in 2004, the EU and the United States agreed to work together to resolve technical issues such as frequency use. Far from shooting Galileo out of the sky, the United States simply seems keen to ensure that Galileo does not impinge on its own system. But the conclusion of Ball's with which I disagree most strongly is that space is a domain of peace, which the United States alone is intent on shattering. It seems clear that the EU is playing exactly the same game. Indeed, in March 2003, the EU's Directorate-General of Energy and Transport explicitly stated that Galileo would give the Europe a military capability. This military dimension leads one to wonder why the project is run by the seemingly innocuous transport department. It is as if the EU is trying to hide its intentions. Writing on the website of the Bruges Group^ref, a right-wing Eurosceptic think-tank, Richard North notes that the most worrying aspect of the Galileo project "is the almost wilful refusal to accept publicly that there are military implications". The EU is planning to release its Public Regulated Service signal to a large number of players, without any realistic chance of controlling access or affording the USA an easy means of blocking it. This constitutes a potent weapon that could be used by enemies of EU member states, the USA and its allies. More worrying still is the fact that non-EU states whose strategic aims are at variance with those of the United States, notably China, are bankrolling Galileo. "It can only be self-deception on a colossal scale if the EU believes that China will not employ Galileo for military purposes," writes North, who goes on to depict a worrying scenario. "Since the US is a committed ally of Taiwan, and has guaranteed the security and independence of the island," writes North, "in a conflict situation the US could find itself at the receiving end of weapons or systems which utilize Galileo signals." And it might find itself compelled to take "direct action". This scenario is at least as worrying as any painted by Ball. In contrast to the nightmares of Chicken Little, it could be this kind of geopolitical nightmare that Mr Wolfowitz was keen, not to promote, but to avoid.
• the Grand Challenge, a 350-kilometre race over rough terrain from Los Angeles to Las Vegas. The event is organized by the US Defense Advanced Research Projects Agency (DARPA), which hopes it will aid the development of unmanned military vehicles for use in combat. The winner must complete the journey in less than 10 hours to claim the prize. The driverless vehicles, which travel at speeds of more than 45 kilometres per hour, will sense their way along an off-road route. The course remains a secret until 2 hours before the start to ensure that the teams cannot pre-program their droids with anything more than basic details.
• Navigator
• Terramax is a 2-tonne truck
• Cliff
• CyberRider
• Phantasm
• Sandstorm, created by professional robot designer William 'Red' Whittaker of Carnegie Mellon University in Pittsburgh
• GhostRider, the world's first autonomous motorbike is impressively stable, albeit only for about 20 m
Environmentalists are concerned that the race will disturb endangered desert tortoises and other wildlife. In response, DARPA has agreed to erect fences around tortoise burrows before the race to stop them wandering into the path of the vehicles. It has also employed tortoise marshals to comb the desert an hour before the competitors arrive and move any stragglers that are in the way.
• missile defenses : a test, which lasted just a fraction of a second, took place in a hangar at Edwards Air Force Base in California on Wed 10 November 2004. The laser (built by Northrop Grumman Space Technology, based in Redondo Beach, California, for the Airborne Laser team at Boeing Integrated Defense Systems in St Louis, Missouri) produces a beam of infrared light that is more powerful than 10,000 domestic lightbulbs and can be focused on a spot the size of a basketball, generating an intense heat that could punch through a missile's fuselage from hundreds of kilometres away. The weapon is ready to be mounted on board a modified Boeing 747 aeroplane as part of a US air defence fleet, which would make it the world's most powerful airborne laser. The laser will eventually undergo in-flight testing that includes shooting down a dummy missile over the Pacific Ocean. No date has been set for this test. The airborne laser is meant to intercept hostile missiles immediately after launch, automatically detecting and tracking them from high altitude. However, targeting missiles in this early 'boost phase' is not an effective approach for defending the USA against missile attacks. Although hitting the missiles early would prevent them from separating into multiple warheads, it requires striking them within minutes of launch. This is only feasible for extremely short-range attacks. Even if an airborne laser were already in the sky, its range would be insufficient to disable an Intercontinental Ballistic Missile used in a long-range strike against the USA.

Web resources :
• Boeing Missile Defense
• Northrop Grumman Space Technology
• Singapore defence scientists are doing genetic research to improve the eyesight of soldiers. It is estimated that > 80% of enlisted men in Singapore suffer from varying degrees of myopia. Taking aim at the enemy, even with the best weapons available, is pointless if a soldier has poor eyesight. Among the prime candidates are pilots, divers, commandos, guardsmen and armoured personnel. The problem is so serious that the SAF is even conducting trials to correct myopia, including eye surgery. The SAF is even trying a new treatment called NeuroVision where the mind is re-programmed to see through myopic eyes. The real challenge for scientists is finding the gene that causes myopia
• health consequences : medical and scientific knowledge both arise from war and influence it. Recognition of the danger of sepsis and importance of public health measures halved the death rate from infection between the American Civil War and World War I, although infectious disease remains challenging. Antibiotics slashed the risk further. And continuing analysis of health problems in Gulf War veterans is revealing potential dangers in current conflicts.
• public health consequences : in the first official government survey of Iraq's health since a number of countries, known as the coalition forces, invaded in March 2003, a detailed report reveals a crumbling health service unable to deal with an epidemic of typhoid, tuberculosis and other infectious diseases. Disruption to water supplies during the conflict means that roughly 20% of urban households now have no access to safe drinking water. This has led to 5,460 cases of typhoid in the first quarter of 2004. In rural areas, > 50% of households are without fresh water or adequate sanitation. More Iraqis may have died as a result of ... neglect of the health sector over the past 15 years than from wars and violence. Measles and mumps are infecting thousands of children, partly because 33% of them are chronically malnourished. There were 8,253 cases of measles reported in the first half of 2004, with Basra particularly badly hit. In 2003, there were just 454 cases. Likewise, the first 4 months of 2004 saw 11,821 cases of mumps, nearly 5,000 more cases than there were in the whole of the previous year. Although Iraq has enormously valuable oil reserves, an estimated 27% of the population live now on less than $2 a day. Life expectancy has fallen to below 60 years of age for both men and women. In the aftermath of the coalition invasion, 33% of Iraq's health centres were looted of vital equipment, with 1 in 8 hospitals suffering the same fate. The health service is being strained further by staff shortages, an unreliable electricity supply and the ongoing violence in Iraq, leaving it unable to stem the growth in infections.The violence that still rocks Iraq is also an important factor : people are afraid to go out and get health care. Currently, the emphasis in Iraq is on training clinicians in emergency care. Basic public health concerns - clean water, food and so on - are low on the priority list. Iraq's health is now comparable with countries like Sudan and Afghanistan; 15 years ago it rivalled that of rich nations such as Jordan and Kuwait. Despite the rise in infectious diseases, cardiovascular disease still ranks as the number-one killer in Iraq. This is largely owing to poor diet and a very high prevalence of smoking, but it is exacerbated by a lack of public health initiatives to change the population's lifestyle. In September 2004, scientists started assessing the environmental situation in the aftermath of the war. And on 11 October, additional concerns about security in Iraq were raised by the International Atomic Energy Agency. The agency said equipment and materials that could be used to build nuclear weapons had been lost from the country. It presented satellite photographs showing that sites relevant to Iraq's nuclear programme had been systematically dismantled, even though the Iraqi government had reported no such activity. The risk of civil death went up by 2.5 times after the invasion of Iraq in March 2003. This gives an estimate of at least 100,000 more deaths since the invasion, and possibly many more. Most of the dead were women and children killed in military activity, particularly air strikes. 2/3 of the deaths were recorded in the exceptionally violent city of Falluja : Falluja may not be representative of the rest of the country, and excluded those figures in their estimate. Including them gives a significantly higher death toll^{ref1, ref2}. The results demand a re-evaluation of the consequences of weaponry now used by coalition forces in populated areas. This result requires an urgent political and military response if the confidence of ordinary Iraqis in the mostly American-British occupation is to be restored^ref. Previous estimates of the Iraqi death toll, such as those based on collating news reports, vary from around 13,000 to more than 30,000. There were periods of mass killing before the recent Iraq war, such as during the Iran-Iraq war or in Saddam Hussein's attacks on the Kurds. It is difficult to predict whether the current conflict might have prevented similar incidents. A a necessary first step is for the occupying forces to carry out systematic body counts : it seems difficult to understand how a military force could monitor the extent to which civilians are protected against violence without systematically doing body counts or at least looking at the kinds of casualties they induce

Web resources :
• Iraqi Ministry of Health
• Iraq Body Count
• WHO on Iraq
• International Reconstruction Fund Facility for Iraq
• MEDACT
• Center for Strategic and International Studies (CSIS)
• soldiers' health consequences : new ways to predict when soldiers or pilots are mentally or physically fatigued and need to be helped, pulled off a mission or provided with back-up : a number of biological markers that could serve as indicators of hydration, salt and sugar levels, inflammation, muscle fatigue, bone health and stress could be adapted for military use (perhaps as a wristwatch device). Sports doctors gauge athlete's capacity using near-infrared light, which penetrates deep into tissue : the light can reveal oxygen levels in blood, because haemoglobin absorbs it differently when loaded with oxygen. Sweat and tears, which presumably flow on the battle-field, might also be valuable sources of biological information but they may have to be individually calibrated to each soldier's body. There are already prototype devices for gauging sleep deprivation, such as strap-on actigraphs whose microchips measure when the wearer is moving or lying still, asleep, heart rate, eye movement and EEGs : one hurdle is designing a computer algorithm that can draw such measures together to accurately assess sleep deprivation. In difficult cases, officials might use basic physiological data, like heart rate, to find out if soldiers have been injured or killed, and help them decide whether to send in rescue troops. Also long-distance truck drivers, doctors working night shifts or medical rescue teams in gruelling conditions could all benefit from biomonitors. Anyway training people to rate their own physical state often creates a far better gauge of future performance than heart rate or blood pressure^ref. Tools embedded in soldiers' clothing and watch-like meters to monitor vital signs and exposures will allow us to know what an exposure is with much more certainty than in 1991, when we had to rely on soldiers' reports on what they think they might have seen. Record keeping also applies to the environment, as evidenced by a disaster in the Gulf War, with air so foul that matching symptom to pollutant was nearly impossible. In Operation Iraqi Freedom, the darkness following the "shock-and-awe" attack echoed conditions in the first Gulf War, but with more building materials than burning oil. As the dust settled, particulates and sand emerged as the biggest threat to respiratory health, as in Afghanistan^ref. Yet the air quality problem in both places is eclipsed by contaminated food and water supplies and temperature extremes. The US Army's Warfighter Physiological Status Monitoring (WPSM) system is a wearable, lightweight suite of sensors, currently being tested in a variety of settings, will send physiological data to commanders and medics, communicating danger instantaneously. Devices track skin and core temperature, heart and respiratory rate, sleep, cognitive state, hydration, body orientation, and wartime acoustics, such as bullet impact. Data from the WPSM project are generating predictive models that will guide implementation^ref. For example, hydration data for males and females are documented for mountain climbing, arctic field training, and reconnaissance and surveillance missions. Heart rate and temperature changes in response to heat come from studies at Fort Benning, Ga. A 58-day stint at Army Ranger School in the desert, mountains, and swamps of the southeast United States tracked effects of extreme sleep deprivation.
• short-term consequences
• infection may be the greatest weapon of mass destruction.
• in 1519, 600 Spaniards unintentionally brought smallpox to the Aztecs in Mexico. The disease helped in decimating a population of 20 million down to 1.6 million. The invisible weapon must have seemed to target the natives, since the Europeans, long exposed to the virus through livestock, were immune.
• globalization has continued to fuel infection. Antibiotic-resistant gonorrhea, for example, spread from prostitutes in Vietnam to US servicemen and beyond.
Wartime infection works 2 ways: invaders
• introduce pathogens
• succumb to unfamiliar ones.
A soldier with hepatitis E moves to a new zone. If he doesn't observe strict hygiene practices or the new zone has poor sanitation facilities, the infection can be transmitted where it was nonexistent. In contrast, a soldier arriving in a malaria-endemic region who has not previously lived there is prone to contracting severe forms. Adults from the community are much less likely to develop severe malaria due to the buildup of immunity over time. Chronic effects of infection linger long after troops depart. Endemic conditions appear and epidemics rage out of control where infrastructure has collapsed. Wonder drugs are only part of the equation in infectious disease control.
• Acinetobacter baumannii was the 2nd most common cause of infection of missile-related head wounds in an Iranian report from data collected during the Iran-Iraq conflict^ref. In the 2003 Iraq conflict it was acquired in the field as well as in nosocomial settings in USA soldiers evacuated from Iraq to the USS Comfort (a hospital ship) or Landstuhl Army Medical Center (in Germany)) : the numbers were noteworthy, since the infection was not noted in the 1991 Gulf War and exceeded historical experience of the centers. Reported cases were Walter Reed Army Medical Center (Washington, DC)14, Landstuhl Army Medical Center 11, National Naval Medical Center (Bethesda, MD) 6, and Brooke Army Medical Center (TX) 3, for a total of 34. 55% of the isolates were from wounds, 20% from sputum, 10% from tissue, 7% from blood, 4% from urine and 2% each from catheter tips and drains.  97% of the cases were from action in Iraq, primarily involving the forward troops. The antimicrobial resistance pattern reported was 2% sensitive to no antimicrobials, 41% sensitive to only carbapenems, 26% sensitive to carbapenems and one other antimicrobial class, and 31% another pattern of sensitivity. There was an increasing number of A. baumannii bloodstream infections (102 from 1 Jan 2002 to 31 Aug 2004) in patients at military medical facilities in which service members injured in the Iraq/Kuwait region during Operation Iraqi Freedom (OIF) and in Afghanistan during Operation Enduring Freedom (OEF) were treated.
• acute eosinophilic pneumonia (AEP)  was diagnosed in 18 US military personnel among 183,000 deployed to Iraq between Mar 2003 and Mar 2004, yielding an AEP incidence of 9.1 per 100 000 person-years and resulted in 2 deaths^ref . The study covered only that time period and there was no indication whether cases have continued to show up since then. The 18 victims studied ranged in age from 19 to 47 and all used tobacco, with 75% recently taking up the habit. All but one reported "significant exposure to fine airborne sand or dust" while in Iraq. Inhalation of fungal glucans (made airborne by desert winds and other military maneuvers in the theater) may have been the precipitating factor, rather than new-onset smoking, a link which the authors seem to favor.
• each Tuesday, the U.S. DoD provides an online update of American military casualties (the number of wounded or dead) from Operation Iraqi Freedom and Operation Enduring Freedom^ref. According to this update, as of November 16, 2004, a total of 10,726 service members had suffered war injuries. Of these, 1361 died, 1004 of them killed in action; 5174 were wounded in action and could not return to duty; and 4191 were less severely wounded and returned to duty within 72 hours. No reliable estimates of the number of Iraqis, Afghanis, or American civilians injured are available. Nonetheless, these figures represent, by a considerable margin, the largest burden of casualties our military medical personnel have had to cope with since the Vietnam War. When U.S. combat deaths in Iraq reached the 1000 mark in September, the event captured worldwide attention. Combat deaths are seen as a measure of the magnitude and dangerousness of war, just as murder rates are seen as a measure of the magnitude and dangerousness of violence in our communities. Both, however, are weak proxies. Little recognized is how fundamentally important the medical system is — and not just the enemy's weaponry — in determining whether or not someone dies. U.S. homicide rates, for example, have dropped in recent years to levels unseen since the mid-1960s. Yet aggravated assaults, particularly with firearms, have more than tripled during that period. The difference appears to be our trauma care system: mortality from gun assaults has fallen from 16% in 1964 to 5% today. We have seen a similar evolution in war. Though firepower has increased, lethality has decreased. In World War II, 30% of the Americans injured in combat died^ref. In Vietnam, the proportion dropped to 24%. In the war in Iraq and Afghanistan, about 10% of those injured have died. At least as many U.S. soldiers have been injured in combat in this war as in the Revolutionary War, the War of 1812, or the first 5 years of the Vietnam conflict, from 1961 through 1965.


This can no longer be described as a small or contained conflict. But a far larger proportion of soldiers are surviving their injuries. It is too early to make a definitive pronouncement that medical care is responsible for this difference. With the war ongoing and still intense, data on the severity of injuries, the care provided, and the outcomes are necessarily fragmentary. But from the data made available for this report and discussions with surgical teams that have returned home, a suggestive picture has emerged. It depicts a military medical system that has made fundamental — and apparently effective — changes in the strategies and systems of battle care, even since the Persian Gulf War. One key constraint for planners has been the limited number of medical personnel available in a voluntary force to support the 130,000 to 150,000 troops fighting in Iraq. The Army is estimated to have only 120 general surgeons on active duty and a similar number in the reserves. It has therefore sought to keep no more than 30 to 50 general surgeons and 10 to 15 orthopedic surgeons in Iraq. Most have served in Forward Surgical Teams (FSTs) — small teams, consisting of just 20 people: 3 general surgeons, 1 orthopedic surgeon, 2 nurse anesthetists, 3 nurses, plus medics and other support personnel. In Vietnam, only 2.6% of the wounded soldiers who arrived at a surgical field hospital died, which meant that, despite helicopter evacuation, most deaths occurred before the injured made it to surgical care^ref. The recent emphasis on leaner, faster-moving military units added to the imperative to push surgical teams farther forward, closer to battle. So they, too, were made leaner and more mobile — and that is their fundamental departure from previous wars. Each FST is equipped to move directly behind troops and establish a functioning hospital with four ventilator-equipped beds and two operating tables within a difficult-to-fathom 60 minutes. The team travels in six Humvees. They carry three lightweight, Deployable Rapid Assembly Shelter ("drash") tents that can be attached to one another to form a 900-ft2 facility. Supplies to immediately resuscitate and operate on the wounded arrive in five backpacks: an ICU pack, a surgical-technician pack, an anesthesia pack, a general-surgery pack, and an orthopedic pack. They hold sterile instruments, anesthesia equipment, medicines, drapes, gowns, catheters, and a handheld unit allowing clinicians to obtain a hemogram and measure electrolytes or blood gases with a drop of blood. FSTs also carry a small ultrasound machine, portable monitors, transport ventilators, an oxygen concentrator providing up to 50% oxygen, 20 units of packed red cells, and six roll-up stretchers with their litter stands. Teams have forgone angiography and radiography equipment. (Orthopedic surgeons detect fractures by feel and apply external fixators.) But they have sufficient supplies to evaluate, and perform surgery on, as many as 30 wounded soldiers. They are not equipped, however, for more than six hours of postoperative intensive care. The 274th FST is led by a 42-year-old surgical oncologist who was my chief resident when I was a surgical intern. He went to West Point, Johns Hopkins Medical School in Baltimore, Brigham and Women's Hospital in Boston for surgical residency, and then M.D. Anderson Cancer Center in Houston for a fellowship. He was known in training for three things: his unflappability, his intellect (he'd already published 17 papers on work toward a breast-cancer vaccine), and the five children he and his wife had during residency. He owed the Army 18 years of service when he finally finished his training, and neither I nor anyone I know ever heard him bemoan that commitment. In 1998, he was assigned to Walter Reed Army Medical Center in Washington, D.C., where he practiced surgical oncology. Then, in October 2001, after the September 11 attacks on the World Trade Center and the Pentagon, he and his team were sent with the first troops into Afghanistan. He returned after service there only to be sent to Iraq, in March 2003, with ground forces invading from Kuwait through the desert to Baghdad. The 274th FST traveled 1100 miles with troops over the next four months, setting up in Nasiriyah, Najaf, Karbala, and points along the way in the southern desert, then in Mosul in the north, and finally in Baghdad. According to its logs, the unit cared for 132 U.S. and 74 Iraqi casualties during that time (22 of the Iraqis were combatants, 52 civilians). Some days were quiet. Others, overwhelming. On one day in Nasiriyah, the team received 10 critically wounded patients, among them 1 with right-lower-extremity shrapnel injuries; 1 with gunshot wounds to the stomach, jejunum, and liver; another with gunshot wounds to the liver, gallbladder, and transverse colon; 1 with shrapnel in the neck, chest, and back; 1 with a gunshot wound through the rectum; and 2 with extremity gunshot wounds. The next day, 14 more casualties arrived. On the arrival of the wounded, teams carry out the standard Advanced Trauma Life Support protocols that civilian trauma teams follow. However, because of the high incidence of penetrating wounds — 80% of casualties seen by the 274th FST had gunshot wounds, shrapnel injuries, or blast injuries — lifesaving operative management is required far more frequently than in civilian trauma centers. Today, military surgical strategy aims for damage control, not definitive repair, unless it can be done quickly. Teams pack off liver injuries, staple off perforated bowel, wash out dirty wounds — whatever is necessary to stop bleeding and control contamination without allowing the patient to lose body temperature or become coagulopathic. Surgeons seek to limit surgery to two hours or less, and then ship the patient off to a Combat Support Hospital (CSH), the next level of care. Abdomens can be left open, laparotomy pads left in, bowel unanastomosed, the patient paralyzed, sedated, and ventilated. For this approach to be successful, however, control of air space and major roadways and establishment of the next-level hospital (achieved early in Iraq but delayed in Afghanistan) are essential. 2 CSHs with 4 sites now exist in Iraq. These are 248-bed hospitals with six operating tables, some specialty surgery services, and radiology and laboratory facilities. Mobile hospitals, too, they arrive in modular units by air, tractor-trailer, or ship and can be fully functional in 24 to 48 hours. Even at the CSH level, the goal is not necessarily definitive repair. The maximal length of stay is intended to be three days. The policy is to transfer any American soldier who requires more to a level IV hospital — one was established in Kuwait, one in Rota, Spain, and one in Landstuhl, Germany. If expected to require more than 30 days of treatment, wounded soldiers are to be transferred home, mainly to Walter Reed or to Brooke Army Medical Center in San Antonio, Texas. (Iraqi prisoners and civilians, on the other hand, receive all their care in Iraq.) It is a system that took some getting used to. Surgeons at every level initially tended to hold on to their patients, either believing that they could provide definitive care themselves or not trusting that the next level could do so. According to statistics from Walter Reed, during the first few months of the war, it took an injured soldier an average of eight days to go from the battlefield to a U.S. facility. Gradually, however, surgeons have embraced the wisdom of the system. The average time from battlefield to arrival in the United States is now less than four days. (In Vietnam, it was 45 days.) One airman with devastating injuries from a mortar attack outside Balad on September 11, 2004, was on an operating table at Walter Reed just 36 hours later. In extremis from bilateral thigh injuries, abdominal wounds, shrapnel in the right hand, and facial injuries, he was taken from the field to the nearby 31st CSH in Balad. Bleeding was controlled, volume resuscitation begun, a guillotine amputation at the thigh performed. He underwent a laparotomy with diverting colostomy. His abdomen was left open, with a clear plastic bag as covering. He was then taken to Landstuhl by an Air Force Critical Care Transport team. When he arrived in Germany, Army surgeons determined that he would require more than 30 days' recovery, if he made it at all. Therefore, although resuscitation was continued and a further washout performed, he was sent on to Walter Reed. There, after weeks in intensive care and multiple operations, he did survive. This is itself remarkable. Injuries like his were unsurvivable in previous wars. The cost, however, can be high. The airman lost one leg above the knee, the other in a hip disarticulation, his right hand, and part of his face. How he and others like him will be able to live and function remains an open question. As lifesaving as the new strategies have been, teams have been forced to confront numerous unanticipated circumstances. The war has gone on far longer than planned, the volume of wounded soldiers has increased, and the nature of the injuries has changed. Blast injuries from suicide bombs and land mines — improvised explosive devices (IEDs), in military lingo — have increased substantially and have proved particularly difficult to manage. They often combine penetrating, blunt, and burn injuries. The shrapnel include not only nails, bolts, and the like, but also dirt, clothing, even bone from assailants. Victims of IED attacks can exsanguinate from multiple seemingly small wounds, even those in the back. Teams have therefore learned to pack the bleeding sites before laparotomy or other interventions are performed. And they are now performing serial operative washouts to ensure adequate removal of infectious debris. Surgeons also discovered a dismayingly high incidence of blinding injuries. Soldiers had been directed to wear eye protection, but they evidently found the issued goggles too ugly. As some soldiers put it, "They look like something a Florida senior citizen would wear." So the military bowed to fashion and switched to cooler-looking Wiley-brand ballistic eyewear. The rate of eye injuries has since decreased markedly. Still, for many new problems, the answers remain unclear. Early in the war, for example, Kevlar vests proved dramatically effective in preventing torso injuries. Surgeons, however, now find that IEDs are causing blast injuries that extend upward under the armor and inward through axillary vents. Blast injuries are also producing an unprecedented burden of what orthopedists term "mangled extremities" — limbs with severe soft-tissue, bone, and often vascular injuries. These can be devastating, potentially mortal injuries, and whether to amputate is one of the most difficult decisions in orthopedic surgery. Military surgeons have relied on civilian trauma criteria to guide their choices, but those criteria have not proved reliable in this war. Possibly because the limb injuries are more extreme or more often combined with injuries to other organs, attempts to salvage limbs following the criteria have frequently failed, with life-threatening blood loss, ischemia, and sepsis. Every other Thursday, surgeons at Walter Reed hold War Rounds by telephone conference with surgeons in Baghdad to review the American casualties received in Washington during the previous two weeks. The case list from October 21 provides a picture of the extent of the injuries. There was one gunshot wound, one antitank-mine injury, one grenade injury, three rocket-propelled–grenade injuries, four mortar injuries, eight IED injuries, and seven patients with no cause of injury noted. The least seriously wounded of these patients was a 19-year-old who had sustained soft-tissue injuries to the face and neck from a mine and required an exploration of the left side of the neck. Other cases involved a partial hand amputation; a hip disarticulation on the right, through-knee amputation on the left, and open pelvic débridement; a left nephrectomy and colostomy; an axillary artery and vein reconstruction; and a splenectomy, with repair of a degloving scalp laceration and through-and-through tongue laceration. None of the soldiers were more than 25 years of age. Late complications have emerged as a substantial difficulty as well. Surgeons are seeing startling rates of pulmonary embolism and deep venous thrombosis, for example, perhaps because of the severity of the extremity injuries and reliance on long-distance transport in management. Initial data show that 5% of the wounded at Walter Reed have had a pulmonary embolism, resulting in two deaths. The solution is not obvious. Using anticoagulants in patients with fresh wounds and in need of multiple procedures would seem unwise. On the other hand, there is no facility or expertise in Iraq for the routine placement of inferior vena cava filters. Injured soldiers from Iraq have also brought an epidemic of multidrug-resistant Acinetobacter baumanii infection to military hospitals. It is not known how this has occurred. No such epidemic appeared among soldiers from Afghanistan, and whether the drug resistance is being produced by antibiotic use or is already carried by the strains colonizing troops is still being debated. Regardless, data from 442 medical evacuees seen at Walter Reed showed that 37 (8.4%) were culture-positive for acinetobacter — a rate far higher than any previously experienced. The organism has infected wounds and prostheses and caused catheter-related sepsis in soldiers and, through nosocomial spread, in at least three other hospital patients. Medical evacuees from Iraq are now routinely isolated on arrival and screened for the bacteria. These are just the medical challenges. Perhaps the most pressing difficulties arise from the changing conditions of the war. Medical teams were designed and outfitted for lightning-quick, highly mobile military operations. The war, however, has proved to be slow-moving and protracted. To adapt, CSHs have had to be converted into fixed facilities. In Baghdad, for example, the 28th CSH took over and moved into an Iraqi hospital in the Green Zone. This shift has brought increasing numbers of Iraqi civilians seeking care, and there is no overall policy about providing it. Some hospitals refuse to treat civilians for fear that some may be concealing bombs. Others are treating Iraqis but find themselves overwhelmed, particularly by pediatric patients, for whom they have limited personnel and few supplies. Requests have been made for additional staff members and resources at all levels. As the medical needs facing the military have increased, however, the supply of medical personnel has gotten tighter. Many surgeons have been on a second deployment or an extended deployment, and even this has not been sufficient. As a result, military urologists, plastic surgeons, and cardiothoracic surgeons have been tasked to fill some general surgeon positions. Planners are having to contemplate pressing surgeons into yet a third deployment. Compounding the difficulties, none of these realities have made it appealing to sign up as a military surgeon. Interest in joining the reserves has dropped precipitously. President George W. Bush has flatly declared that there will be no draft. However, the Selective Service, the U.S. agency that maintains draft preparations in case of a national emergency, has recently updated a plan to allow the rapid registration of 3.4 million health care workers 18 to 44 years of age. The Department of Defense has indicated that it will rely on improved financial incentives to attract more medical professionals. Whether this strategy can succeed remains unknown. The pay has never been competitive. One now faces a near-certain likelihood of leaving one's family for duty overseas. And without question, the work is dangerous. The nation's military surgical teams are under tremendous pressure, but they have performed remarkably in this war. They have transformed the strategy for the treatment of war casualties. They have saved the lives of an unprecedented 90% of the soldiers wounded in battle. And they have done so under extraordinarily difficult conditions and with heroic personal sacrifices. One surgeon deserves particular recognition. Dr. Mark Taylor began his Army service in 2001, to fulfill the terms of his military scholarship to attend medical school several years before. He, like many, was deployed twice to Iraq — first from February through May 2003 and then from August 2003 through the following winter. On March 20, 2004, outside Fallujah, four days from returning home to Stockton, California, the 41-year-old surgeon was hit in a rocket-propelled–grenade attack while making a telephone call outside his barracks. Despite his team's efforts, he could not be revived. None among us have paid a greater price^ref.
• long-term consequences
• infertility : few questions of fertility surrounded the return of WWII veterans, who promptly seeded a baby boom. But in the wake of the Vietnam War, anecdotal reports of a link between exposures and infertility contradicted conclusions from the National Academy of Sciences. Since 1975 hundreds of patients thought they were infertile because of exposures in Vietnam, either to Agent Orange or sustained trauma, stepping on a mine, or an illness. And so in 1990 and 1991, California Cryobank in Los Angeles offered soldiers discounted sperm storage : not many guys availed themselves of the offer. But in 2004, announcement of a discount brought hundreds of requests, and prompted other cryobanks to follow^ref. The reasons: fear of chemical and biological weapons and a link, after all, between infertility and exposures in the Gulf. 10,465 Gulf War veterans trying to conceive and 7,376 matched controls in the military but not the Gulf were queried and results revealed more infertility and delayed conceptions for the vets. Data on a number of self-reported exposures, including petrochemicals, pesticides, depleted uranium, as well as information on multiple vaccinations and pyridostigmine bromide, an anti-nerve gas agent were collected. In the future, biomonitoring data teamed with information from particulate monitoring devices and biosensors for biological weapons will pinpoint threats to fertility^ref.
• autoimmune/psychiatric disorders : Gulf War syndrome (GWS) (chronic fatigue syndrome (CFS), posttraumatic stress disorder (PTSD), fibromyalgia)
• environmental extremes : soldiers in Iraq describe the punishing heat; those in Afghanistan, the treacherous and frigid mountains. Effects of extreme temperature on ion-channel functioning are being assessed in human cortical neurons and in mini-swine. Research using hypobaric chambers identifies susceptibility to mountain sickness. Modern research into adaptation to extreme environments began at the Harvard Fatigue Laboratory in 1927. The field, which had morphed into exercise physiology, relocated to university laboratories and the Department of Defense. A soldier fighting is not as simple a situation as an athlete running a marathon : the athlete is in good condition and knows the outcome. The soldier is exposed to the environment not knowing for how long, with minimal food and water. Soldiers suffer tremendous sleep deprivation, fear, hard work, and exposure to heat and/or cold. The WPSM project is proceeding with these extremes in mind. A "sleep watch, for example, tracks wrist movements that foretell stage of awareness. A swallowed 3-ounce, jellybean-shaped pill continuously transmits core body temperature readings, courtesy of the space program. And the WPSM recently added to its evolving ensemble the LifeShirt, from Ventura-based VivoMetrics, already used in exercise physiology studies. It weighs 8 ounces, is machine washable, and feels like Lycra. Embedded wires detect heart rate, blood oxygen saturation, blood pressure, carbon dioxide level, and coughing. Just as WWII-era findings found their way to athletics and health care, so too will the fruits of biomonitoring in the battlefield yield valuable information on physiology under stress, even if it seems as if a future soldier won't be able to belch without setting off alerts miles away. But the incoming data may make the combat theater a safer place
A brief history of military medicine :
• 1860-1865 : civil war
• infection/combat deaths = 2:1
• problems: malaria, yellow fever, scurvy, smallpox, typhoid, dysentery
• medical advances : management of mass casualties, anesthesia, very limited pharmacopeia
• 1866 -- Italian monk Montegazza uttered idea for cryobanks: "A man dying on a battlefield may beget a legal heir with his semen frozen and stored at home."
• 1867 : Joseph Lister promotes carbolic acid as antiseptic
• 1900 : Karl Landsteiner lays groundwork for blood transfusions
• 1902 : United States begins manufacturing vaccines
• 1914-1918 : WWI
• infection/combat deaths = 1:1
• medical advances : triage, prosthetics, plastic surgery, public health, antisepsis medicines, vaccines
• 1930s : sulfa drugs
• 1939-1945 WWII
• infection/combat deaths = <1:1
• medical advances : Improved sanitation, better vaccines, whole-blood transfusions
• 1949-1953 : Korean War
• medical advances : helicopter evacuation, refined triage, cold-weather effects studied, plasma- volume expanders, mobile army surgical hospitals (MASH)
• 1960s-1975 Vietnam
• problems : quinine-resistant malaria
• medical advances : recognition of "biological acclimatization" period of 6 weeks, trauma care in field, evacuation refined
• 1990-1991 : Gulf war (Desert Storm)
• problems: Norwalk virus, Shigella, malaria, leishmaniasis (transmitted by sand flies), pollutants, irritants, pesticides, Gulf War syndrome (GWS) (chronic fatigue syndrome (CFS), posttraumatic stress disorder (PTSD), fibromyalgia, multiple chemical sensitivities), inhibited red fuming nitric acid from scud missiles, uranium from munitions, smoke from burning oil fields, sarin.
• medical advances : studies on multiple chemical sensitivities
• 2003-? : the war in Iraq (Iraqi Freedom)
• problems: "Uxo" (unexploded ordnance), suicide bombings, beheadings on the Internet, blowing sand
• medical advances : automated real-time biomonitoring and health records, one-handed tourniquet, bandages with built-in clotting factors or chitosan gel
• landmines

Prevention : currently, one person can check and clear just 2 m² of land a day. A transgenic version of thale cress (Arabidopsis thaliana), activates the anthocyanin-making apparatus (normally switched off during most of the year except autumn) in the presence of NO₂ gas, which is released by underground landmines. The leaves of the plant change from green to red after 3-5 weeks of growth in the presence of this gas : the plant is quite shallow-rooted, and so will only detect mines near the surface, but this is where most landmines are found. Aresa is now developing spray guns that can sow the seeds cheaply and safely. They are also working on plants that will respond to other environmental pollutants such as cadmium and nickel, so that soil can be cleaned up once these heavy metals have been detected. The team has also taken steps to ensure that the genetically engineered plant won't spread in the wild. They have removed the gene for an important growth hormone, so that the plant needs a specially designed fertilizer in order to grow.
Web resources :
• Adopt a minefield
• International Campaign to Ban Landmines (ICBL)
• Landmine Survivors Network (LSN)
• Campagna Italiana contro le Mine - ONLUS
• Campagna Italiana per la messa al bando delle mine antiuomo
• Geneva International Centre for Humaniatarian Demining (GICHD)
• Handicap International
• InterSos
• La bonifica umanitaria dei territori by Fernando Termentini
• Mines Advisory Group (MAG)
• Safelane : Canada's guide to the global ban on landmines
• Vietnam Veterans of America Foundation (VVAF) - Campaign for a Landmine Free World
• chemical, biological, radiological, nuclear or high explosive (CBRNE) weapons of mass destruction (WMD) / nuclear, biological and chemical (NBC) weapons^ref
• biological weapons (bioweapons / BW) / bioterrorism

Key features of biologic agents used as bioweapons :
• high morbidity and mortality
• potential for person-to-person spread
• low infective dose and highly infectious by aerosol
• lack of rapid diagnostic capability
• lack of universally available effective vaccine
• potential to cause anxiety
• availability of pathogen and feasibility of production
• environmental stability
• database of prior research and development
• potential to be "weaponized"
Timelines :
• 1925 : Geneva Protocol forces adhering countries not to use BW in war, but doesn't ban development, production and stockpiling
• mid-1930s : Wickham Steed charges German BW testing in the Paris Metro
• the secret Biopreparat (The System) program directed by Yuri Kalinin involved 35,000 workers, including 9,000 scientists working at laboratories at 47 sites across the former Soviet Union, including Obolensk (with the "Corpus One" containment building), Oblask, Sverdlovsk (since 1946), Stepnagorsk, Kirov (since 1953), and Omutninsk. Open-air testing of the pathogens produced was carried out at Vozrozhdeniye (Renaissance) Island and Rebirth Island, in the Aral sea. Vozrozhdeniye, whose summer heat of > 100 °F, dry climate and distance from population centers made it ideal to test deadly germs on animals. First used in 1936, the island was abandoned by the Soviet army when the Soviet Union dissolved in 1991. It become the property of Kazakhstan and Uzbekistan. But because of its remoteness, neither country sent forces to guard it, and scavengers have been picking it of valuable materials every summer since 1996. In 1988 the anthrax was buried there after Soviet President Mikhail Gorbachev became concerned that the stockpile — produced and stocked at Zima, near Irkutsk — would be an embarrassment if Western countries asked to inspect the plant. So the Soviets sent 100 and 200 tons of spores by train to Aralsk, then by ship to the island, according to Kazakhstan officials. The anthrax was buried at a depth of 5 to 8 feet. The British and American governments learned of the Soviet-era BW program between very late 1989 and 1992. The first break was the evidence that began to be published in the USSR in 1991-1992. In 2002 an American team digged trenches in the vicinity of each of the 11 pits where the anthrax had been buried : the trench was lined with thick plastic, filled with calcium hydrochloride, and the contaminated earth was covered with water there for 6 days and then re-buried after testing found no live spores.
• 1936-1945 : the Japanese program included large-scale open-air testing of live pathogens, including anthrax as bacterial slurry in bombs at its experimental station in Pingfan, Manchuria, China. Unit 731 was a Japanese biological warfare unit led by General Ishii Shirou that carried out experiments on 3,000-12,000 local Chinese and allied prisoners of war. In November 1941 Japonese airplanes spread Yersinia pestis in Changte, China. US military officials worried by the contemporaneous British BW program saved Unit 731 members from Tokyo trial (1946-48) to get their knowledges.
• 1942 : British evacuated Gruinard island to use it as a BW trial land. In 1943 trials were stopped after a Bacillus anthracis outbreak in cattle living on Scottish coasts near Gruinard island. The island was drained by spreading a formaldehyde solution on the whole land.
• 1950 : Joint Army-Navy-CIA experiments are conducted in which tens of thousands of people in New York and San Francisco (1953) bay are exposed to the airborne germs Serratia marcescens and Bacillus glogigii, infecting 800,000 people. 239 populated areas had been contaminated with biological agents between 1949 and 1969. Some of the areas included San Francisco, Washington, D.C., Key West, Panama City, Minneapolis, and St. Louis.
• night between April 14 and 15, 1952 : during Korean war, an American F-82 airplane spreads Yersinia pestis-infected rats in Min-Chung, Kan-Nan region, North Korea.
• 1955 : at Tampa Bay an outbreak of Bordetella pertussis (including 12 deaths)
• 1956-1958 : yellow fever virus-infected mosquitoes are spread via airplanes over Afroamerican communities in Savannah (Georgia) and Avon Park (Florida)
• Johnston Atoll was a U.S. open-air biological weapons test facility 1,000 km S-W of Hawaii
• 1954-1973 : Operation Whitecoat. The US Army Medical Institute in Fort Detrick, MD, experimented the biological agents which could be potentially bioweaponized by exposing healthy volunteers (mostly belonging to the Seventh-Day Adventist (SDA) Church, who refused to use arms but wanted to be patriots the same) to sublethal aerosols sprayed into a giant stainless steel sphere termed the "Eight Ball".
• June 7-10, 1966 : > 1,000,000 people are infected by Bacillus subtilis spores spread in New York subway
• 1967 : U.S. military releases clouds of zinc cadmium sulfide gas over Winnipeg, St. Louis, Minneapolis, Fort Wayne, the Monocacy River Valley in Maryland, and Leesburg, Virginia. Their intent is to determine how efficiently they could disperse chemical agents.
• April 10, 1972 : 70 countries signed on the Biological and Toxin Weapons Convention (BTWC), which bans the development, production, and stockpiling of BW, as well as BW research for offensive purposes. United States, one of the 2 superpowers that did possess biological weapons, gave them up and destroyed them in 1969. The treaty came into force on March 16, 1975, when the United States, the USSR, and the United Kingdom deposited their instruments of ratification for the convention. Contrary to the nuclear Nonproliferation Treaty (NPT) of 1968, in the BTWC there was to be no preferred group of countries that would continue to retain the weapons.
• 1995 : Larry Wayne Harris, member of Aryan Nation, is stopped while buying Yersinia pestis samples. He was arrested in February 18, 1998, accused to have spread Bacillus anthracis vaccine in Las Vegas
• Slaman Pak and Al Hakam were an Iraqi biological weapons facilities
• WGE-6 is a NATO term for Working Group of Experts. It includes three groups PG-31, PG-32, PG-33 which specialize in defence against biological weapons. Canada is a member of both PG-32 and PG-33.
• January 28, 2003 : US announces Project BioShield, a new10-year, $6-billion, Department of Homeland Security and Department of Health and Human Services (presumably NIH) joint program to develop and produce new vaccines and countermeasures against potential bioweapons.
• Umatilla Chemical Depot consists of igloo-like bunkers in the high desert that house 12% of USA's deadly nerve gas and blistering agents. The corrosive components have eaten through some of the M-55 rockets, mines and bombs that contain 3,700 tons of deadly nerve agent. More than 100 rockets are already classified as "leakers," meaning vapor has already been detected outside the steel casings. Chemicals are already being burned at Tooele, Utah, and Johnston Island, 800 miles southwest of Hawaii.
Agents : are B. anthracis or F.tularensis present as background organisms?  If so, are they background everywhere or only in certain environments? If this information is not available, what is considered "normal" or "safe"? What levels of organism require remediation? Without answers to these and multiple other thorny questions, the USA is at risk for a situation that terrorizes the public for no reason other than a lack of knowledge regarding natural background
• category A
• easily disseminated or transmitted from person to person
• high mortality rates and have the potential for major public health impact
• might cause public panic and social disruption
• require special action for public health preparedness
• Bacillus anthracis
• it was part of the Biopreparat program in the former USSR
• Alibekov anthrax is weaponized anthrax (spores mixed with 2 unrelated ingredients to make it more volatile) developed by Dr.Ken Alibek (Kanatjan Alibekov), is said to be 4 times more deadly than natural anthrax.
• the unintended release of Anthrax spores over a 50-60 km area from a facility in Sverdlovsk in the Ural Mountains in April 1979 (now Yekaterinburg, Russia), killed 66 of 77 human cases (85% case fatality) as well as the majority of exposed livestock. The affected area covered approximately 900 sq. km.. In the spring of 1992 President Yeltsin’s admitted that the outbreak had been due to an accidental release from a Soviet Ministry of Defense R&D facility "Compound 19" in the city, causing 68 deaths (and hundreds of died animals) from inhalatory anthrax in a 4 km-wide leeward zone.
• since October 4, 2001 several cases of anthrax have been reported in Florida, USA : there were 19 disease cases and 5 fatalities in total. Persons on the East Coast, including 2 postal workers in Washington, have died, while government sites on Capitol Hill have been contaminated. The Ames strain was used. Since the 2001 anthrax attacks, the Postal Service has spent $1.4 billion to install a biohazard detection system at 283 mail facilities; the federal government has spent $370 million to boost state and local public health labs, the backbone of the CDC's 140 bioterror Laboratory Response Network; and Homeland Security has launched a $60 million-plus BioWatch system to monitor air in more than 30 U.S. cities. All rely on the same CDC protocols. But the Defense Department has not signed a federal memorandum of understanding that standardizes alerts, terminology, data sharing and response when biohazard systems at military sites within the United States are triggered, a senior federal health official said. The Pentagon is spending $1 billion on a 5-year program to develop biohazard warning systems and procedures at 185 U.S. and 15 overseas bases. The BioWatch system has gone 2 years without a false positive. The Postal Service's system has reviewed 500 000 samples without a false positive. A false alarm event began on Mar 10, 2005 when one of 4 swab samples taken daily from sensor filters at the Pentagon delivery facility tested positive for anthrax at Commonwealth Biotechnologies Inc. in Richmond, a Pentagon subcontractor. The finding was confirmed by a highly accurate PCR test and forwarded on Mar 11 to the prime contractor. Pentagon officials say they were notified on Mar 14 morning of the finding : what if it had been a public holiday

Monday? Or had involved the dispersal of a '2001' product. The mind boggles. That afternoon -- apparently by coincidence -- a machine on the 8th floor of the Fairfax complex that receives mail from the Pentagon sounded an airborne biohazard alarm. Military officials said that although Army scientists at Fort Detrick confirmed the initial positive finding, quality control problems at the lab probably spoiled the sample. Commonwealth Biotechnologies Inc. has processed 2000 samples from the Pentagon over 2 years. The Postal Service reopened its main government mail processing center at V Street NE at noon of 16 Mar and advised about 200 employees that they could stop taking antibiotics. The Pentagon expected to reopen its intake facility on 17 Mar. The Fairfax buildings will reopen today except for a suite in one of the towers, where more testing will be done. Anyway anthrax was detected independently by 2 government laboratories in samples collected from the 2 Pentagon mail facilities that were at first closed last week and then declared free of the pathogen : anthrax found was the same genetic strain used in the 2001 attacks. There has since -- on Fri 18 Mar 2005-- been a 3rd alert at Bolling Air Force Base triggered by automatic sensors, which is located along the Anacostia River in Washington, in a mail-handling facility used by the Defense Intelligence Agency, which apparently is now regarded as a negative after FBI testing. The Pentagon is working to gather more than 8000 pieces of mail that moved through its detached facility between 10 and 14 Mar 2005.
• Clostridium botulinum toxin : a paper that analyses a hypothetical poison attack on the USA has been published despite the government's objections. The paper's authors modelled the health and economic losses that would result if a terrorist poisoned the US milk supply with the botulinum toxin. The Proceedings of the National Academy of Sciences (PNAS) originally said it would publish the paper on 25 May, but it delayed publication to address concerns from the US health department. After consideration, the journal has decided to publish the paper without any substantive changes. Bruce Alberts, president of the National Academy of Sciences, which publishes PNAS, explained the journal's decision in an editorial, which was posted with the paper online^ref. It is important to recognize that publishing terrorism-related analysis in the open scientific literature can make the nation safer. But Stewart Simonson, assistant secretary for public health emergency preparedness at the health department, was critical. The assistant secretary respects the decision, but he doesn't agree with it. The episode raises thorny issues about the proper handling of 'dual use' scientific research. This is research that aims to bolster defence but that could be used maliciously. Scientists and security experts have been wrestling over what to do with dual-use research and information since the terrorist attacks on 11 September 2001. The PNAS paper, by Lawrence Wein and graduate student Yifan Liu from Stanford University, California, considers what might happen if botulinum toxin were poured into a milk tanker on its way to a holding tank. The toxin is a potent nerve poison that is sometimes used in very low doses in plastic surgery to smooth the skin. Wein and Lu calculate that, when diluted, this would deliver potentially lethal doses to about 568,000 people. They then estimate the number who would fall ill, with symptoms ranging from cramps to paralysis, depending on factors such as when the poison is detected and whether the milk is pasteurised. In some scenarios, the great majority of these people could fall ill or die. Health officials contend that the paper amounts to a blueprint for terrorists. But Alberts and the paper's authors say that much of the information is readily available on the Internet, so it does not provide any new ideas. Instead, they said, it will inform the nation's defences. Wein notes that publications on vulnerabilities can help the government to strengthen the nation against attacks, and can help the public put pressure on policy-makers when they drag their feet. There has been no perceptible move in the food industry or in the government to shift from a food safety to a food security mentality. In a free society, the notion that we become more secure through transparency is important. The government needs to be reminded of that from time to time. The PNAS episode raises the profile of these issues at a crucial time, occurring just before the first meeting of a US government group that has been set up to tackle difficult issues in science and security. The National Science Advisory Board on Biosecurity (NSABB), based in Bethesda, Maryland, was created in March 2004 and is scheduled to hold its first meeting on 30 June. In his editorial, Alberts suggested that the board use the botulism paper as a case study for further analysis. In 2003, many journals, including PNAS, said they would specially review dual-use research papers for security concerns, and PNAS did follow this procedure for the botulism paper. But Elisa Harris, an analyst at the Center for International and Security Studies at the University of Maryland in College Park, says the dispute over this paper shows that the scientific community needs more guidance. I think this whole exercise demonstrates that the publishers' statement from 2003 is not sufficient. We need real guidelines for PNAS, other scientific journals and scientists to use in assessing the biosecurity risks of a given manuscript.
• Yersinia pestis : such an aerosol would likely be used in an indoor setting to avoid the outdoor UV radiation inactivation of the organism. The paragraphs below are the abstract and edited summary of an article in Clinical Infectious Diseases 2005; 40:1644-8, entitled "Destroying the Life and Career.of a Valued Physician-Scientist Who Tried to Protect Us From Plague: Was It Really Necessary?" Thomas Campbell Butler, at 63 years of age, is completing the 1st year of a 2-year sentence in federal prison, following an investigation and trial that was initiated after he voluntarily reported that he believed vials containing Yersinia pestiswere missing from his laboratory at Texas Tech University. We take this opportunity to remind the infectious diseases community of the plight of our esteemed colleague, whose career and family have, as a result of his efforts to protect us from infection by this organism, paid a price from which they will never recover. Dr. Thomas C. Butler has had a long and successful career that has focused on problems and illnesses of underprivileged persons, including those in the developing world and indigent patients in this country. His curriculum vitae lists >170 published peer-reviewed articles, reviews, and chapters, with his most important contributions being made in the areas of diarrheal diseases, typhoid fever, plague, and relapsing fever, as well as investigations of therapeutic modalities for other infectious diseases. His work in the late 1960s on oral rehydration therapy in Dhaka and Calcutta, India, resulted in one of the earliest articles describing the important clinical applications of basic physiologic studies of patients with cholera and led to the 1st use of oral rehydration solution in a refugee camp in Calcutta in 1971. Although the agent of plague, Yersinia pestis, is a potential weapon of bioterrorism, it is also endemic in the United States and many other parts of the world, as pointed out in all major texts and reviews, including some written by Tom Butler. Indeed, as pointed out in Butler's 1983 monograph about plague, "In the United States during these same years (1970s), the

number of human cases of plague increased several fold", and, on average, there are 2-15 known cases reported each year in the United States, with >40 cases occurring in some years. Butler's work on plague, which includes published chapters, peer-reviewed articles, and reviews, goes back 35 years, to his service in the Vietnam War. In 2000, he began a collaboration with colleagues at the University of Tanzania in which he served as a consultant and provided a reference laboratory for a study designed to compare the efficacy of gentamicin and doxycycline therapy in clinically ill patients with _Y. pestis_ infection. The study was reviewed by Tanzania's medical research review board and was conducted at the University of Tanzania and under government authority; the institutional review board at Texas Tech University apparently exempted the project from review, because Dr. Butler was serving only as a consultant, without direct patient care responsibilities. The study was successfully completed; samples were provided to the US Army at Fort Detrick, Maryland, and the Centers for Disease Control and Prevention Laboratory in Fort Collins, Colorado; data were provided to the Food and Drug Administration; and a manuscript awaits publication. Because Dr. Butler's laboratory acted as a reference laboratory for the study, clinical and laboratory specimens were exchanged, and all original specimens were returned to Tanzania, as per contractual agreements. In January 2003, Dr. Butler could not locate 30 vials of plague specimens and reported this to the safety officer at Texas Tech University; the Federal Bureau of Investigation (FBI) was notified by Texas Tech University, which resulted in  60 FBI agents rapidly descending upon Texas Tech University and the briefing of government officials, apparently up to the level of President George W. Bush. According to reliable sources, Butler was questioned by FBI agents without legal counsel which he waived, because he felt he had nothing to hide, he had worked with the military and federal agencies for years on this and other projects, and he genuinely wanted to help the FBI allay public fears. Testimony at the trial indicates that, after many hours of interrogation without sleep, and with the assurance that such interrogation would prevent any legal action, he signed a statement to the effect that the vials may have been autoclaved. He was then put in handcuffs and jailed, having been accused of lying to the FBI (a charge for which he was later acquitted). Jonathan Turley, an attorney
for Butler and a professor at George Washington University School of Law, noted that "this made no sense. He would never have created a controversy to conceal the accidental destruction of vials". After being incarcerated for 6 nights in county jail without bail, Butler was allowed to post bail of US$100 000 (which was later increased to $250 000) but remained under house arrest, with electronic monitoring. He was not to contact colleagues who were on a witness list, and he had no access to his computer or e-mail for many months, despite having worked as Chief of the Infectious Diseases Department at Texas Tech University and having lived in Lubbock for 16 years, where he and his wife were raising 4 children and enjoying much respect in the community. Butler was offered a plea bargain which involved pleading guilty to lying and spending 6 months in jail but declined and chose to risk trial by jury to clear his name. Although the original concerns of bioterrorism were not supportable, multiple additional charges largely unrelated to the disappearance of the vials containing _Y. pestis_ were filed (i.e., "piled on"), including illegal transportation of plague bacteria, tax evasion, embezzlement, and fraud, for a total of some 69 charges carrying a maximum sentence of 469 years in prison and US$17 million in fines. Many of the charges had to do with contract disputes Butler had with his university (which are normally handled through civil, not criminal, proceedings) and
were unrelated to the original charges associated with the disappearance of the vials. During the trial, prosecutors described Dr. Butler as an "evil genius" and compared him to "a cocaine dealer smuggling illegal drugs," and they emphasized the accusations of lying to the FBI and endangering the public and made repeated references to terrorism, actions many felt were designed to create an atmosphere of fear in the conservative West Texas courtroom. Ultimately, a jury acquitted Butler of most of the original charges, including lying to the FBI, and the charge of tax evasion; he was convicted of charges related to one overseas shipment of an express-mail package containing "lab specimens" originally from Tanzania (a technical violation) back to his collaborators in Tanzania and of charges concerning contracts and indirect administrative charges associated with grants received from pharmaceutical companies. However, the former dean of Texas Tech University who had helped recruit Butler, was aware of Dr. Butler's grants and consultancies and had encouraged him to finance his research and fund his salary with them. Testimony also indicated that others at Texas Tech University were aware of and/or had signed his contracts; there were apparently no rules against such arrangements at the time. During his trial, members of the Texas Tech University administration testified against Butler, despite strong support from his colleagues and friends. The role of the Texas Tech University administration in the prosecution of Dr. Butler has been of great concern to faculty throughout the nation and is considered by many to be unprecedented. In attempts to explain this behavior toward a prominent and respected tenured faculty member, questions have been raised about pressures that may have been exerted on the university through its biodefense contracts with the Department of Defense. The judge (who was obviously sympathetic) imposed a sentence of 2 years (to run concurrently), rather than the 10-year sentence corresponding to his conviction, and a payment of approximately US$38 000 to Texas Tech University, rather than $1 million. Many wrote to the judge urging a suspended sentence with community service; rumor has it that the judge did not do so out of concern that this would result in an automatic federal appeal for an even longer sentence. Reactions in favor of Butler and expressions of concern about the handling and impact of the case have been strong, including comments from the Human Rights Committee of the National Academy of Sciences (NAS), the Institute of Medicine (IOM), the National Academy of Engineering, and the New York Academy of Sciences. The presidents of the NAS, the IOM, and the European Society of Clinical Microbiology and Infectious Diseases, as well as many prominent scientists and physicians, wrote to then Attorney General John Ashcroft to express their concern about the impact of the prosecution of Dr. Butler (the presidents of the NAS and the IOM had written only once before to an attorney general, Janet Reno, and their letter was concerned with the prosecution of Los Alamos National Laboratory scientist Wen Ho Lee). 4 academy members who are Nobel Laureates wrote, on behalf of themselves, that "this respected colleague has been subjected to unfair and disproportionate treatment." Media coverage has been extensive; Science, The Scientist, The New York Times, The Los Angeles Times, The Baltimore Sun, BBC, CBS, and many other news sources have run stories suggesting that Butler may have been a victim of the widespread fear about (bio)terrorism and may have been singled out, presumably to serve as an example, as part of a flawed strategy to fight bioterrorism. Dr. Tom Butler, a physician-scientist and member of the IDSA, respected by all colleagues who know him and his work, has been stripped of his professorship, tenure, salary, and medical license and has spent his life savings and retirement to defend himself. He and his family have no sources of income. His situation is a cautionary tale to all of us, especially those who work with biological agents with potential for use in bioterrorism, even if in collaboration with governmental laboratories and scientists. Can we help Butler's situation? All concerned individuals can help Dr. Butler and discourage misuse of current laws designed to defend us against terrorism by writing to members of Congress, to the Department of Justice, or to the newly confirmed Attorney General Alberto Gonzales. Dr. Butler's appeal is currently pending in the US Court of Appeals for the 5th Circuit.. He has exhausted his personal savings and retirement funds. If you wish to assist his defense by providing expenses for his appeal, donations to the Thomas Butler Legal Defense Fund may be sent to Daniel C. Schwartz, c/o Bryan Cave LLP, 700 Thirteenth St. NW, Washington, D.C. 20005. There but for the the roll of the dice could go any one of us (unless of course we had the good fortune to work with non-communicable agents instead of an agent like Y. pestis). We at ProMED-mail consider what has happened to Dr. Thomas Butler to be unconscionable and on a par with events that occurred in China and Cuba. In the past we have posted on these human rights abuses and called for assistance in putting pressure on the offenders.  By posting this article we are doing just that, calling upon ProMED-mail subscribers to assist in putting pressure on the judicial system in the USA for permitting this injustice and abuse of the legal system to go forward.
• variola major virus :
• 1763 : sir Jeffrey Amherst, British governator of New Scotland, spread among native Canadian Indians (suspected to flank French troops) blankets coming from an hospital, infected with smallpox, decimating Indian communities
• 1971 an open air test on Aral Sea in the Soviet Biopreparat program caused death of 2 infants and 1 young woman
• the only currently declared stocks of live variola virus are nowadays preserved in 5 WHO-approved high-security labs at Center for Disease Control (CDC) (Atlanta, Georgia, USA) and at the Russian State Center for Research on Virology and Biotechnology in Koltsovo facilities (Novosibirsk, Siberia, Russia) to allow further research projects monitored by WHO. The Research Institute of Viral Preparations in Moscow, Russia, collects 120 different strains. According to the Weapons Intelligence Nonproliferation and Arms Control Center (WINPAC) of CIA, Iraq, North Korea, Russia, and the Jean Merieux Laboratoires in Lyon, France have undeclared smallpox samples.
• the re-emergence of smallpox is possible from many sources (for example, from bodies of smallpox victims that are frozen in the permafrost, inadvertent laboratory stocks that were never recognized during the WHO-directed centralization of variola virus stocks in the 1970s and 1980s, and rogue sources) and by many scenarios (biowarfare, bioterrorism, ...)
Assuming a transmission rate of 3 (from 2 to 5) new cases per infected person, calculations indicate that a single focal outbreak would result in the spread of infection for up to 1 year, until vaccination and quarantine strategies caught up. On June 22-23, 2001 the Johns Hopkins Center for Civilian Biodefense Studies, in conjunction with the Center for Strategic and International Studies, the ANSER Institute for Homeland Security, and the Oklahoma National Memorial Institute for the Prevention of Terrorism, held an exercise at Andrews Air Force Base in Washington, DC entitled "Dark Winter" simulating a single release of variola virus in Oklahoma City, modelled as an initial outbreak of 20 cases : unresolved jurisdiction issues and unpredictable individual actions of citizens in quarantine scenarios lead to a failure in response capacities of the health-care sector. For further timelines see here. Bioengeneering of variola virus to weaponize it includes :
• variant that is sufficiently different in terms of surface proteins to escape the immune response that is induced by the smallpox vaccine (difficult to accomplish due to many highly conserved envelope proteins)
• introducing a T_h2 cytokine gene
• Francisella tularensis strain Schu 4. Aerosol dispersal is considered the most hazardous mode of transmission, as it would affect the most people. This claim was recently reported by the Working Group on Civilian Biodefense, a group of 25 specialists in the fields of medicine, public health, the military, and various governmental agencies convened to provide recommendations for management of a biological attack^ref. According to their model, onset of abrupt cases of acute, nonspecific febrile illness would be expected to occur in a large number of people beginning 3 to 5 days after aerosol release of F tularensis in a densely populated area. Over the next several days and weeks, a significant number of people would predictably develop pleuropneumonitis. Only a relatively small amount of F tularensis would be needed to cause this, as reported over 3 decades ago by the World Health Organization (WHO), which estimated that 50 kg of F tularensis spread through aerosolization over an urban area would result in substantial casualties, including thousands of deaths (Health Aspects of Chemical and Biological Weapons. Geneva, Switzerland: World Health Organization; 1970:105-107). In a so-called "contained casualty setting," the Working Group on Civilian Biodefense recommends parenteral antimicrobial treatment for tularemia. Use of the existing LVS vaccine would require FDA approval for an emergency-use IND. The DoD is drafting a protocol for emergency use for the military and the public. Under this IND, military personnel could be vaccinated with informed consent or with presidential waiver in the event or evidence of a biowarfare attack. Use of this IND vaccine for the public at large is contingent upon an initiative from the Department of Health and Human Services^{ref1, ref2, ref3, ref4, ref5, ref6}. Soviet and Russian bioweapons scientists reportedly developed and tested virulent transgenic tularemia bioweapon strains that had been genetically engineered to possess vaccine-subverting and/or antibiotic-resistance properties (Non-Proliferation Review 6, Sunshine Project). Russian officials announced on 22 Dec 2004 that security officials had successfully prevented efforts by foreign spies to "seize control" of the research in "especially dangerous pathogens" being conducted at the Vektor State Scientific Virology and Biotechnology Center (Lenta). Vektor is a former Soviet bioweapons research facility that currently houses one of the world's most extensive collections of potential bioweapon pathogens -- including but not limited to the smallpox, Marburg, and Ebola viruses -- which was the site of a recent fatal laboratory accident involving the Ebola virus. In 1969, the World Health Organization estimated an aerosol dispersal of 110 pounds of virulent tularemia in a city of 5 million would cause 250 000 illnesses, including 19 000 deaths.
• viral hemorrhagic fevers (HF)
• Filoviruses
• Ebola virus. The Aum Shinrikyo sect, the Japanese group responsible for the 1995 sarin gas attack in the subways of Tokyo, is reported to have sent members to Africa during the 1992 Ebola outbreak to obtain samples^ref
• Marburg virus (named "Variant U" after death of Dr.Nikolai Ustinov on April 30, 1988). The former Soviet Union is known to have successfully developed a weapon for Marburg virus, with less effective efforts using Ebola virus (Alibeck K. Biohazard. New York, NY: Random House; 1999). Variant U likely arised from Mr.Popp, a survivor of the 1967 outbreak at a Marburg vaccine farm. A pathology team removed Ustinov's liver and his spleen. They sucked a quantity of his destroyed blood out of a leg vein using large syringes. They froze the blood and the body parts. They kept the Ustinov strain alive and continually replicating in the laboratories at Vector and learned how to mass-produce it in simple bioreactors, flasks used for growing viruses. They dried Variant U, and processed it into an inhalable dust. The particles of Variant U were coated to protect them in the air so that they would drift for many miles. In late 1990, Biopreparat researchers tested airborne Variant U on monkeys and other small animals in special explosion-test chambers at the Stepnagorsk plant. Marburg Variant U proved to be extremely potent in airborne form : just 1-5 microscopic particles of Variant U lodged in the lungs of a monkey were almost guaranteed to make the animal crash, bleed, and die. With normal weapons-grade anthrax, in comparison, it takes about 8,000 spores lodged in the lungs to pretty much guarantee infection and death. By the fall of 1991, just before Boris Yeltsin came to power, Marburg Variant U was on the verge of becoming a strategic/operational biological weapon, ready to be manufactured in large quantities and loaded into warheads on MIRVs. These warheads are sinister things. Ten separate cone-shaped warheads, each targeted on a different location, sit atop a missile. Special cooling systems inside each warhead keep the virus alive during the heat of reentry through the earth's atmosphere. The biowarheads are parachuted over a city, and at a certain altitude they break apart. Out of each warhead bursts a spray of more than a hundred oval bomblets the size of small cantaloupes. The cantaloupes fly out a distance and then split in overlapping patterns, releasing a haze of bioparticles that quickly becomes invisible. Variant U never became part of the Soviets' strategic arsenal
• Arenaviruses
• Lassa virus
• Machupo virus
According to America’s resident expert, Dr. Ken Alibek (Kanatjan Alibekov), defector and former assistant director of Biopreparat program, chimeric viruses would have been produced :
• veepox would be a genetic combination of Venezuelan equine encephalitis virus (VEEV) and variola major virus developed by Russian biological weapons experts in 1990-1991 by grafting parts of the reversely transcribed VEEV genome into a smallpox virus
• ebolapox would be a genetic combination of Ebola virus and variola major virus developed by Russian biological weapons experts by grafting parts of the reversely transcribed Ebola virus genome into a smallpox virus. Blackpox would be much harder than Ebola hemorrhagic fever, more like hemorrhagic smallpox, with much more resistance to sunlight, heat, cold, drying, and humidity. Like smallpox, it could lie dormant for weeks in the air. In the 10 deaths (including 4 children) and 25 hospital admission in the villages of Moro and Malik, Pakistan, near the Indus River, there was blackening of the skin in hands and feet, facial edema and severe fever, but the skin does not develop blisters. The inhabitants while giving details said that they were using water from a tap installed in their village
The reported "suicide" and then "accidental death" of noted Harvard biophysics scientist and anthrax, Ebola, AIDS, herpes, and influenza expert, Dr. Don C. Wiley, on the Interstate 55 Hernando De Soto Bridge that links Memphis to West Memphis, Arkansas, in January 2002 was probably a well-planned murder, according to local law enforcement officials in Tennessee and Arkansas.
• category B
• moderately easy to disseminate
• moderate morbidity rates and low mortality rates
• require specific enhancements of CDC's diagnostic capacity and enhanced disease surveillance.
• Brucella spp.
• e toxin of Clostridium perfringens : Clostridium spp. and any of the 12 different protein toxins produced by them can affect any species. Clostridium has been listed as a potential bioterrorism weapon, because the toxin can be easily manufactured and can be aerosolized easily, causing serious acute pulmonary disease. In addition, it can cause hemolysis, vascular leaking, thrombocytopenia and

liver damage, tissue hypoxia and shock, any of which may be incapacitating or fatal. The toxin could also be put into water and food. Indeed, the possible effects of e toxin in humans are, based on published data available to me, suppositions. What may be known by some is unpublished and is not available to us. In vitro very few human cell lines are susceptible to the effects of epsilon toxin. -
• food safety threats
• Salmonella spp. (placed on food in salad bars, by the Rajneesh group in The Dalles, Oregon, in 1984. This resulted in 751 recorded instances of illness, with no mortality.)
• Escherichia coli O157:H7
• Shigella spp.
• Burkholderia mallei (used by Germans in WWI and by Soviets in Afghanistan in 1982 to kill enemy horses)
• Burkholderia pseudomallei
• Chlamydophila psittaci
• Coxiella burnetii : although not thought to be related to bioterrorism, was spread by mail in a post office in the UK in 1987 (Winner SJ, Eglin RP, Moore VI, Mayon-White RT: An outbreak of Q fever affecting postal workers in Oxforshire. J Infect 1987; 14:255-61).
• ricin. Bulgarian dissident Georgi Markov was killed by poison dart filled with ricin and fired from the tip of an umbrella in London in 1978^ref. In recent years, ricin has become a favorite tool of extremist individuals or groups who seek to harm others, as the following examples demonstrate:
• 2 tax protesters were convicted in February 1995 of possessing ricin as a biological weapon. This was the first case of prosecution under the 1989 Biological Weapons Anti-terrorism Act.
• a retired electrician who had worked on the trans-Alaska pipeline recently committed suicide in an Arkansas jail after being arrested under the antiterrorism act for possessing castor beans. 2 years before, a large quantity of ricin toxin and weapons, ammunition, and gold were found in his car by Canadian customs officials as he crossed the border from Alaska to Canada
• on Feb 3 white powder has been also discovered in a postal facility in Wallingford, CT but its identity is not yet known.
• staphylococcal enterotoxin B (SEB) from Staphylococcus aureus. Money that has been contaminated with a biological toxin is a whole new possible direction for bioterrorism. It is a case that the FBI terrorism unit has taken over from state police that involves several cities, including Philadelphia. As CBS 3's Tamsen Fadal reports, the unit is trying to determine whether or not a toxin was actually placed over money to protect the interest of the Russian mob. In an exclusive investigation, CBS 3 has obtained documents detailing a bizarre criminal plot involving a toxin, suspected drug money, and the Russian mob in Northeast Philadelphia. Earlier in January 2005, Pennsylvania State Troopers intercepted USD 250 000 during a routine traffic stop. The alleged drug money, which had been sealed in plastic, was being driven from Columbus, Ohio to Northeast Philadelphia. According to law enforcement sources, after counting the seized cash, troopers began feeling ill, and one trooper was even hospitalized with flu-like symptoms. Sources tell CBS 3 that tests on the cash counter revealed the presence of a toxin derived from the bacterium Staphylococcus. It may be a new application of terrorism, although this time, it was used as a deterrent among thieves. A warning has been issued, at both the state and federal level, recommending that officers should take extra precaution, and wear protective masks when handling suspected drug money, now more than ever. Not enough information is available regarding the incubation period of illness in the state troopers, and the manifestations of this illness, to assess the biological plausibility of this report. In addition, the type and amount of toxin is not mentioned. Influenza-like illnesses can occur after aerosol exposure to staphylococcal enterotoxin B (SEB), as reported by the USA Army Medical Research Institute of Infectious Diseases at Fort Detrick in Maryland. In one episode, which occurred in 1964^ref, at least 9 laboratory workers were exposed to aerosolized staphylococcal enterotoxin B, following what was described as an accident in a lab. The ensuing illness was heralded by rigors and fever with readings as high as 106°F. The onset of the fever averaged 12 hours after the exposure (range 8-20 hours), and the febrile period lasted from 12-76 hours (mean duration 50 hours). The fever was associated with muscle aches and headache. Respiratory symptoms began about the same time as the fever and muscle pain as a nonproductive cough. Of the 9, 5 had an abnormal lung exam associated with shortness of breath, and 3 had shortness of breath at rest. One of these had "profound" shortness of breath for the 1st 12 hours of symptoms and exertional shortness of breath for 10 days. Chest x-rays obtained during this sublethal exposure were abnormal. Chest pain, described as moderately intense, also occurred with the respiratory symptoms, lasting an average of one day (range 4 hours to 4 days). Vomiting and loss of appetite developed in most, with a mean onset of 17 hours (8-24 hour range), with the anorexia lasting several days and the vomiting limited to a mean of 9 hours (4-20 hour range). In a 2nd, more recently reported laboratory event (in which the timing of the events involved are not noted)^ref, ocular exposure with purified toxin occurred, resulting in conjunctivitis with periorbital swelling 1-9 hours after exposure; subsequent gastrointestinal symptoms followed. This report also summarized 16 cases of aerosolized SEB occurring in 1963 and 1964 which included reference 1. Exposure to the usual inoculum of staphylococcal enterotoxin (there are at least 15 antigenically distinct toxins) by the usual route (enteric) produces a short incubation, self-limited (usually < 24 hours) primarily afebrile illness with vomiting. M