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By: John Walter Krakauer, M.A., M.D.

  • Director, the Center for the Study of Motor Learning and Brain Repair
  • Professor of Neurology

https://www.hopkinsmedicine.org/profiles/results/directory/profile/9121870/john-krakauer

Blood samples: Several choices are offered based on availability of the blood collection tubes administering medications 7th edition buy finax 1mg on line. Tiger- to treatment 02 finax 1 mg p tubes that have been centrifuged are preferred over red- to symptoms food poisoning purchase discount finax p clot tubes with serum removed from the clot treatment gout order finax with american express, but the latter will suffice. Blood culture bottles are also preferred over citrated blood for bacterial cultures. Pathology samples: routinely include liver, lung, spleen, and regional or mesenteric lymph nodes. Additional samples requested are as follows: brain tissue for encephalomyelitis cases (mortality is rare) and the adrenal gland for Ebola (nice to have but not absolutely required). The first two, along with early post exposure clinical samples, can help identify the agent in time to initiate prophylactic treatment. While the information will most likely be to o late for useful prophylactic treatment, this information along with other information may be used in the prosecution of war crimes or other criminal proceedings. However, the sample collection concerns are the same as for during or shortly after a bioaerosol attack and medical personnel may be the only personnel with the requisite training. As in any hazmat situation, a clean line and exit and entry strategy should be designed. If it is possible to have a clean line, then a three person team is recommended, with one clean and two dirty. Some of the possible samples are: • Aerosol Collections in Buffer Solutions • Soil • Swabs • Dry Powders • Container of Unknown Substance • Vegetation • Food / Water • Body Fluids or Tissues What is collected will depend on the situation. Aerosol collection during an attack would be ideal, assuming you have the appropriate collection device. Otherwise anything that appears to be contaminated can be either sampled with swabs if available, or with absorbent paper or cloth. Well after the attack, samples from dead animals or human remains can be taken (refer to Appendix F for appropriate specimens). All samples should ideally be double bagged in Ziploc bags (the outside of the inner bag decontaminated with dilute bleach before placing in the second bag) labeled with time and place of collection along with any other pertinent data. National Defense University, Center for Counterproliferation Research, Fredonia Books, 2002 3. Investigation of a ricin-containing envelope at a postal facility- South Carolina, 2003. Greek Fire, Poison Arrows & Scorpion Bombs: Biological and Chemical Warfare in the Ancient World. Missed sentinel case of naturally occurring pneumonic tularemia outbreak: lessons for detection of bioterrorism. Clinical recognition and management of patients exposed to biological warfare agents. A procedure for differentiating between the intentional release of biological warfare agents and natural outbreaks of disease: its use in analyzing the tularemia outbreak in Kosovo in 1999 and 2000. Investigation of bioterrorism-related anthrax, United States, 2001: epidemiologic findings. Increased detection of rickettsialpox in a New York City hospital following the anthrax outbreak of 2001: use of immunohis to chemistry for the rapid confirmation of cases in an era of bioterrorism. Biological warfare training: infectious disease outbreak differentiation criteria. Tularemia outbreak investigation in Kosovo: case control and environmental studies. A large community outbreak of salmonellosis caused by intentional contamination of restaurant salad bars. A field-expedient algorithmic approach to the clinical management of chemical and biological casualties. Medical management of the suspected victim of bioterrorism: an algorithmic approach to the undifferentiated patient. Postal Service workers potentially exposed to Bacillus anthracis District of Columbia, 2001-2002. Biosecurity and Bioterrorism: Biodefense Strategy, Practice and Science 2003; 1:97-110. Department of Defense preliminary evaluation of the association of anthrax vaccination and congenital anomalies. Use of anthrax vaccine in response to terrorism: supplemental recommendations of the advisory committee on immunization practices. Complications associated with Brucella melitensis infection: a study of 530 cases. Suspected brucellosis case prompts investigation of possible bioterrorism related activity New Hampshire and Massachusetts, 1999. Po-Ren Hsueh, Lee-Jene Teng, Li-Na Lee, Cheong-Ren Yu, Pan-Chyr Yang, Shen-Wu Ho, and Kwen-Tay Luh, Melioidosis: An emerging infection in Taiwanfi Cutaneous melioidosis and necrotizing fasciitis caused by Burkholderia pseudomallei. Out of hospital treatment of patients with melioidosis using ceftazidime in 24 h elas to meric infusors, via peripherally inserted central catheters. Further evaluation of a rapid diagnostic test for melioidosis in an area of endemicity. Gentamicin and tetracyclines for the treatment of human plague: review of 75 cases in new Mexico, 1985-1999. Surveillance for pneumonic plague in the United States during an international emergency: a model for control of imported emerging diseases. Comparison of different antibiotic regimens for therapy of 32 cases of Q fever endocarditis. Missed sentinel case of naturally occcuring pneumonic tularemia outbreak: lessons for detection of bioterrorism. Kosoy, Gjyle Mulliqi-Osmani, Roland Grunow, Ariana Kalaveshi, Luljeta Gashi, and Isme Humolli. Immunologic responses to vaccinia vaccines administered by different parenteral routes. Virological and serological studies of Venezuelan equine encephalomyelitis in humans. The systemic pathology of Venezuelan equine encephalitis virus infection in humans. Venezuelan equine encephalitis febrile cases among humans in the Peruvian Amazon River region. Aerosol infection of cynomolgus macaques with enzootic strains of venezuelan equine encephalitis viruses. Hemorrhagic fever viruses as biological weapons: medical and public health management. Air evacuation under high-level biosafety containment: the aeromedical isolation team. Safe intensive-care management of a severe case of Lassa fever with simple barrier nursing techniques. Lassa fever in the United States: investigation of a case and new guidelines for management. Update: Filovirus infections among persons with occupational exposure to nonhuman primates. Update: Management of patients with suspected viral hemorrhagic fever United States. Botulism surveillance and emergency response: a public health strategy for a global challenge. Investigation of a ricin-containing envelope at a postal facility South Carolina, 2003. Production and purification of a recombinant Staphylococcal entero to xin B vaccine candidate expressed in Escherichia coli. Rapid and sensitive sandwich enzyme-linked immunosorbent assay for detection of staphylococcal entero to xin B in cheese. Multi to xin biosensor-mass spectrometry analysis: a new approach for rapid, real-time, sensitive analysis of staphylococcal to xins in food.

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Both calculations are based on the same test with identical sensitivity and specificity symptoms 6dp5dt order finax on line amex, however the interpretation could not be more opposite medications venlafaxine er 75mg buy 1mg finax with mastercard. The prevalence of a disease depends on various fac to medications side effects prescription drugs discount 1mg finax fast delivery rs and symptoms 4dp3dt 1mg finax sale, thus, presents a dynamic situation. Important fac to rs that are directly associated with patients include age, gender, underlying disease, life circumstances, vaccination status, other diagnostic results. Fac to rs that are associated with the pathogen include, for example, endemic regions and seasonal clustering. Below are examples of fac to rs that influence the prevalence and interpretation of the results of serological tests for infectious disease. The influencing fac to rs of symp to ma to logy, travel his to ry, vaccination his to ry: the prevalence of an acute case of hepatitis A in a non-vaccinated patient with jaundice, who has recently been to a region where hepatitis A is endemic, is considerably higher than for a healthy, vaccinated 60-year-old blood donor. It follows that a detection of hepatitis A IgM antibodies should be interpreted differently in each case. In the first case, an acute case of hepatitis A can be deduced with a high degree of certainty. Further tests should be carried out in the second case before the diagnosis of acute hepatitis A can be made. The more lab results and clinical findings there are, the easier it is to estimate the prevalence and, thus, the predictive value of a lab value, and to interpret the result. They relate to one another since increasing sensitivity leads to decreasing specificity and vice versa. Usually the values are plotted with the sensitivity appearing on the y-axis and the corresponding false positive rate (depicted as 1 specificity) on the x-axis. Screening tests are usually designed to have a high sensitivity and, in turn, often only have a moderate specificity. In contrast, the parallel use of test systems statistically increases sensitivity with a massive loss in specificity. If the initial test indicates that an infection is present, a second test is used to more precisely characterize the infection status. This diagnostic algorithm is used after detection of the positive antibody reaction to find out whether there is infectivity and/or whether treatment is required. Diagnostic algorithms can also be used to steer the diagnostics in a useful way and thus save on costs. A frequent approach, whereby the submitter haphazardly orders a range of tests offered by the lab (shotgun diagnostics), is normally neither expedient nor economically inviable. Many labora to ries offer predefined constellations of tests (request profiles) for certain diseases in order to steer diagnostics. On the one hand, this is helpful by enabling all relevant pathogens to be identified. On the other hand, tests can be ordered for pathogens that have a very low prevalence in a specific clinical situation. Request profiles and multiplex analyses, in which tests for pathogens are au to matically carried out even when the test is not specifically requested for by the submitter, are similarly problematic. Confirma to ry diagnostic testing or a diagnostic algorithm should be used, where possible, for positive testing methods used to detect diseases with low prevalence rates in order to increase the positive predictive value of the result through further procedures. Detailed information on the test methods recommended for detecting special infectious diseases can be found in the individual sections on pathogens. Tests that have lower sensitivities and specificities than the initial tests can definitely be used as confirma to ry tests. Because the prevalence of the disease increases in the cohort being examined with every positive test, the predictive value can be considerably raised with every confirma to ry test or diagnostic algorithm, however sensitivity is statistically reduced. This au to matically improves the positive predictive values when another test is used. Class-specific immune reactions differ greatly between primary infections and those which occur in connection with reinfections and reactivation. The primary antibody response of most viral infections is characterized by a certain regularity in the immune response, with IgM reactivity followed by an IgG response and rapid abatement of the IgM response. In contrast, the immune response in bacterial infections is often considerably delayed. Furthermore, reinfections with Bordetella pertussis or Treponema pallidum, for example, can trigger a significant increase in the titers or test results of traditional titer tests, such as complement-fixation tests. For example, in the case of syphilis or borreliosis reinfections, a renewed increase in the specific IgM response normally occurs with a considerable temporal latency. When a viral infection is reactivated, for example as part of the reactivation of varicella zoster or herpes simplex, there is usually no renewed specific IgM response or else it is very weak. On the other hand, a significant increase in the specific IgG response (booster effect) can come about through the expansion of the corresponding memory cell clone. These antibodies can persist for a long time after the infection, or be induced through vaccinations, not only through infections. The importance of determining IgA is now viewed critically for many indications or only recommended as an additional test. It is no longer recommended in Chlamydia pneumoniae serology particularly since IgA assays in evaluation studies and in the framework of external quality assurance have frequently been shown to be less than reproducible. The use of umbilical cord blood is to be regarded critically as it can potentially mix with the mother’s blood during birth or as part of a placenta leak. When assessing the moni to ring of possible prenatal infections, an antigen-specific comparative assessment of the mother’s and child’s serum should be enlisted in addition to quantitative controls of the pathogen-specific antibodies. Comparing the immune response of the mother and the child enables a determination to be made as to whether it is a case of an au to chthonous specific immune response of the child, or surrogate immunity through antibodies passively passed on from the mother. These frequently occur temporarily when blood and blood products are used, for example, with intensive care patients, poly-transfused individuals and after the application of immunoglobulins. They are then falsely interpreted as an expression of an infection that has occurred in the meantime, particularly when there is a lack of sera during the course of the infection. Conversely it should be noted that, in addition to specific IgG antibody titers after vaccinations, a specific IgM or IgA response can temporarily occur. In the vast majority of cases additional clinical information or a discussion on the findings with the attending physician are required in order to conclusively interpret the findings of serological infectious disease testing and, here in particular, of meaningful results of individual sera. When possible, progression should be moni to red to enable a more precise characterization and establishment of the point of infection through significant changes in the findings during the course of the infection. This also allows interpretations to be made about the primary infection, reinfection, or surrogate immunity. In order to assess qualitative and/or quantitative serological test results with respect to treatment success, serological moni to ring of progression and the categorization of the quantitative immune response specific to the immunoglobulin class and antigen are required in the clinical context. While moni to ring the treatment success of viral infections through serological testing plays a less significant role, this type of progression moni to ring makes sense and is recommended for moni to ring the successful treatment of a syphilis infection. It is unders to od that result constellations, in terms of a negation of findings or a significant decrease in the test result in a parallel assay with the previous serum, can indicate that the infection is abating or has been sufficiently treated. At the same time, 30 specific immune responses can persist for months or even years after effectively treated infections. However, problems can frequently occur with plasma as a result of coagulation fac to rs and fibrin residues (clogging the device’s capillaries or causing interactions in immunoblot assays). In order to detect intrathecal pathogen-specific antibody formation, liquor and serum should be tested in parallel, and the quotient scheme should be calculated according to Reiber (after determining albumin, and to tal IgG and, if necessary, IgM and IgA in serum and liquor). Solely determining IgG antibodies in liquor without a parallel serum value is of no value since IgG antibodies can pass through the blood-brain barrier when the meninges is inflamed. When using liquor in serological diagnostics it is important to remember that the test should be validated for the sample liquor being used and that the liquor and serum tests should be carried out using the same test approach at dilution levels that, in the case of quantitative tests, fall within the test’s linear measuring range. In special diagnostic cases, the testing of cadaver blood or intraocular fluid can be useful (endophthalmitis diagnostic testing). The latter is gaining in importance, particularly in the context of tests that are subject to the Medicines Act, such as tests for cornea donors, amnion donors, bone banks etc. Antibody determination in joint punctate is not standardized and of dubious value. The commercially available tests have usually not been validated for these samples. Detailed information about the serological diagnostic testing of the individual infectious agents can be found in the sections on the respective pathogens. The serum and plasma samples are prepared in the same way as for antibody detection tests. The indications for and the value of the specific antigen detection tests are discussed in the sections on the respective pathogens.

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This was the first time that an international scientific organisation had been asked to medications 5 rights order finax 1mg line provide input to treatment 5 alpha reductase deficiency discount finax 1 mg on line a disarmament treaty review conference treatment mrsa finax 1mg lowest price. The workshop treatment of shingles cheap finax 1 mg overnight delivery, held in Norway in 2002, brought to gether 79 participants from 34 countries, and set a number of precedents for how such events are best organised. The researchers largely were asked to talk about their work, while the implications for the Convention emerged from the discussions and interactions with the policy and security specialists. This made it easier to interest the outside scientists in taking part, since they could do something they were familiar with doing—give a technical presentation about their work—while getting to think about their work in new ways. It was also an opportunity to bring younger scientists in to the process; when a field is advancing rapidly, a number of breakthroughs may be made by emerging leaders in research. The discussions encouraged the researchers to consider key hurdles or barriers, both technical and conceptual, which might need to be overcome for a technology to reach fruition or achieve a major breakthrough. This can help bring a dose of reality to claims that may sometimes be exaggerated in the excitement of a scientific moment. One of the lessons that had been learned from the first workshop was the importance of starting early, so that the results could feed in to preparations by national governments for the Review Conferences. However, providing input from the broader biological sciences community to the Convention was a more complicated problem in this instance. In addition, instead of a single predominant International Union for Chemistry, there are perhaps a dozen international unions in the life sciences, reflecting the diversity and fragmentation of the field. The Royal Society also organized an event at the Review Conference to describe the 18 results to those taking part. Through good fortune and planning, it was held at the same time as a conference organised by the Chinese and Canadian Governments that addressed the range of issues that would come up in the Review Conference. A number of government technical experts who attended the science and technology-focused workshop were able to stay for the Chinese-Canadian event, which increased their representation at the meeting. Abstracts of the presentations were produced in time for the treaty’s Prepara to ry Committee meeting in April 2011, and the final report was released during a side 19 event at the United Nations in Oc to ber. The report was organised around three themes, which can be found in many of the chapters in this textbook: i. The increasing diffusion of life sciences research capacity and its applications, both internationally and beyond traditional research institutions; and iii. The extent to which additional scientific and technical disciplines beyond 20 biology are increasingly involved in life sciences research. Participants are drawn from a number of countries and organisations, reflecting the fact that advances in science come from multiple disciplines, and that the life sciences community is global. Workshop sessions mix plenary presentations with small-group discussions on how scientific and technical developments can benefit the Convention’s implementation, such as through improved disease surveillance and treatment; whether new developments could pose potential risks for misuse in ways contrary to the Convention; drivers moving science forward; and technical hurdles that remain to be overcome. A timeline showing examples of activities that have been undertaken by international scientific networks to contribute to biological and chemical security discussions is shown in Figure 10. A working group discussion and plenary session from a workshop held in China (2010). Whatever process may be chosen, contributions from the broader scientific community will likely continue to have a role in understanding research advances. More information about the 2005 Biological Weapons Convention meeting may be found at. Among the “Obligations to the Public” described in the code for the union’s members is that “They will not engage knowingly in research that is intended for the production of agents of biological warfare or bioterrorism, nor promote such agents. The final report, from which the summary provided to the Biological Weapons Convention was taken, is National Research Council, Life Sciences and Related Fields: Trends Relevant to the Biological Weapons Convention. The deputy of the Biological Weapons Convention’s Implementation Support Unit also served as a member of the temporary working group. Chapter 11: Review of science and technology: a case study on the Biological and Toxin Weapons Convention Implementation Support Unit Piers Millett Key learning objectives i. Discuss how an international policy process identifies scientific and technological developments that might be of relevance; ii. Understand the obligations on different ac to rs to help ensure developments in science and technology are not used to cause deliberate harm, in particular the role of scientists as part of responsible conduct; iii. Identify opportunities for scientists to contribute to the work of the Biological and Toxin Weapons Convention – both as channels of outreach and also to help shape international policy; iv. Understand the evolving nature of institutional arrangements to address this issue – both the need for support and the arrangements in place to service that need may change over time. Under the international regimes in place to deal with nuclear or chemical weapons, international organisations provide substantive support in implementing Convention obligations. The Unit does not provide substantive assistance, but rather acts as a central hub, facilitating communication amongst the community that supports the work of the Convention. Of particular relevance here, is the Unit’s role as a conduit to facilitate the flow of information between the science and security communities. They provide the Chairs and Vice-Chairs with substantive support and advice, oversee procedural components, and gather and process input from participants. They are at the end of a phone, fax or email to assist State Parties and deal with enquiries from international and non-governmental sources. The Unit acts as an institutional memory for the Convention, and helps shape the content and outcome of its processes. Increasingly, there is demand for the Unit to engage at a regional, sub-regional, national or sub-national level. These events allowed the Unit to interact with representatives of over 130 States. The Unit has played an important role in increasing awareness of the Convention and its provisions in policy, technical and public forums. The role of the Biological and Toxin Weapons Convention Implementation Support Unit in reviewing science and technology Review Conferences 4. Although no specific time is set aside for reviewing developments in science and technology, each Review Conference has instructed its successor to take them in to account. As a result, relevant developments in science and technology are considered as part of the review of the Convention’s first Article (on its scope). State Parties may provide details of relevant developments in science and 4 technology. Initially, contributions were restricted to the Convention’s three Deposi to ries (Russia, the United Kingdom, and the United States). Seventh (2011) Sixth (2006) Fifth(2001-2) Fourth (1996) Third (1991) Second (1986) First (1980) 0 2 4 6 8 10 12 % of States Parties No. Topic State(s) Advances in manipulation of genetic material and United States of America microorganisms and in understanding of pathogenicity Antiviral peptides discovery Poland Awareness-raising communication, confidence-building, United States of America and scientific conduct Bioinformatics Germany, United Kingdom, United States of America Biological production technologies United Kingdom Bioreac to rs South Africa Biosensors Czech Republic, South Africa Convergence of biology and chemistry Australia Creation of man-made pathogens China De novo synthesis of organisms South Africa Decontamination United Kingdom Diagnostics and epidemiology South Africa Disease detection, identification and moni to ring technology Czech Republic Disease surveillance, sensor and detection technologies United Kingdom, United States of America Dispersal technology South Africa, United Kingdom Drug delivery systems Germany, United Kingdom, United States of America Export control and border security technologies United States of America Genetic engineering of viruses Poland Genomics laying the foundations for pathogen China transformation Genomics, proteomics and other ‘-omics’ United Kingdom High-throughput whole-genome sequencing Sweden Improvements in biosafety and biosecurity practices United States of America Industrial application of biotechnology – disposable United States of America equipment Medical countermeasures United Kingdom, United States of America Microbial forensics China, Czech Republic, Sweden, United Kingdom, United States of America Nanotechnology Czech Republic, Netherlands, South Africa, United Kingdom, United States of America Neuroscience South Africa, United Kingdom Novel therapeutics Czech Republic Population-specific genetic markers China Simulants and software Portugal Specific experiments of concern South Africa Strengthening labora to ry capacity Portugal Synthetic biology China, Germany, Netherlands, South Africa, United Kingdom Systems biology China, South Africa, United Kingdom Targeted drug-delivery technology making it easier to China spread pathogens Vaccine development Poland, South Africa Visualization technology Czech Republic 7. More recently, such science and technology reviews have been supported by contributions from professional scientific organisations and industry (see Chapter 10 for more details). Prior to the 2006 and 2011 Review Conferences, workshops were convened to identify relevant trends and developments. The 2006 report was distributed to States Parties and introduced in an informal side 5 6 meeting. In addition, the report’s executive summary was included in official documentation of the meeting, as 7 part of a background information document compiled by the Unit. Earlier arrangements only resulted in the compilation of information provided by States Parties. Things began to evolve in 2006, when State Parties requested the Review Conference secretariat to provide a background information document on developments in science and technology. Although the resulting document drew upon contributions by State Parties and information provided by international organisations (including scientific organisations), in format it was a single synthesis summarising individual contributions (which were all still available online). The document covered a broad range of specific advances and developments, an overview of how to identify experiments of dual-use concern, and a list of actual experiments often quoted as being particularly relevant to 8 the Convention. Over the next three years, the Unit produced a series of background document covering specific developments, outreach, as well as oversight information (Table 11. The Unit, when putting to gether its paper, was now able to draw upon its own in-house expertise and a catalogue of past publications, as well as contributions by international organisations. Summary of developments with potential negative implications for the Convention: fi Specific research and projects of interest; fi Advances with potential for weapon applications; fi Enhancing or producing a biological weapon agent; fi Circumventing existing control mechanisms; fi Neurobiology. Review of developments with possible beneficial consequences: fi Detection; fi Diagnostics; fi Prevention and prophylaxis; fi Therapeutics: fi Response capacity. Overview of enabling technologies: fi Characterising biological systems and networks; fi Manipulating biological systems and networks; fi Engineering biological systems and networks; fi Gathering and manipulating biological information; fi Converting it in to digital data and back; fi Generic enabling technologies.

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Following the use of nuclear weapons against Japan in 1945 medications ibs buy finax online, the international community moved to treatment jammed finger finax 1mg cheap limit the development and use of weapons of mass destruction by states symptoms joint pain fatigue 1 mg finax free shipping. In the United Nations the Committee on Disarmament turned its attention to 4 medications at walmart discount generic finax canada chemical and biological weapons in 1968-69. While a number of states possessed chemical weapons at the time, few were believed to have biological weapons programmes. Moreover, verification of chemical weapons disarmament, a requirement for the United States because of the known existence of chemical weapons arsenals, was rejected by the Soviet Union, thus making any agreement on chemical weapons unlikely. However, with the United States under political and moral pressure related to its use of defoliants in the Vietnam War – namely Agent Orange and other herbicides – and concern among the public and some policymakers about the safety of the United States’ chemical and biological weapons programmes (following an accident that resulted in the death of a large number of sheep), the United States accepted a proposal from the United Kingdom to negotiate a biological weapons treaty, leaving chemical weapons off the agenda to be dealt with in future negotiations. In addition, a high-level policy review in the United States led to the unilateral renunciation of biological and to xin weapons by the United 7 States in 1971. Finally, following that unilateral decision, the Soviet Union accepted the proposal to separate chemical and biological weapons controls in to two different treaties (Conventions). The cumulative impact of these changes resulted in the Soviet Union and the United States circulating identical draft treaties in the summer of 1971 in a ‘take-it-or leave-it’ deal to the other states of the Conference on Disarmament. Despite some concerns about the absence of verification provisions within the Convention, the draft text was accepted and the Biological and Toxin Weapons Convention was opened for 8 signature in 1972. The his to rical record indicates that the negotiations were not to o difficult: while a significant number of states preferred a chemical and biological weapons Convention, the deal between the United States and the Soviet Union rendered such preferences irrelevant. Neither the United States nor the Soviet Union envisaged a requirement for verification provisions, given the difficulty of addressing the dual-use dilemma and the disagreement over on-site inspections of facilities. As a result, the Convention’s key weakness at the time of its negotiation was the lack of detailed and agreed provisions to implement its legal obligations and, through such provisions, ensure compliance with its obligations. However, over time States have adopted additional understandings and developed other mechanisms within the Convention, as well as outside of it, to mitigate some of these issues and concerns. How, and why, States have undertaken those measures is at the heart of the evolution and development of the Convention over the last forty years. That procedure – the Review Conference – has evolved in to one of the most significant mechanisms available to all States Parties to reaffirm, as per the Preamble of the Convention, that States Parties remain determined “for the sake of all mankind, to exclude completely the possibility of bacteriological 10 (biological) agents and to xins being used as weapons. Such a review shall take in to account any new scientific and technological developments 11 relevant to the Convention. Among other things, it was agreed by the Review Conference that a second review would be undertaken within six years and, since that time, each Review Conference has mandated a further review at approximately five-yearly intervals. As a result, seven Review Conferences have been held to date in 1980, 1986, 1991, 1996, 2001-02, 2006, 2011, and the eighth such Conference is scheduled for 2016. This procedure has allowed States Parties to discuss and address many different challenges to biological disarmament. In many respects that basic objective has been achieved, but disarmament is a process, and the problem of biological weapons predominantly manifests itself as the management of the dual-use problem. How do States Parties “ensure that states do not use such capabilities for offensive programs’fi In simple terms the review allows States Parties to respond to events and incidents and agree upon responses to strengthen the Convention. Since 1975, Arabic has become an accepted and recognised language at the United Nations. To acknowledge Arabic as an official language and incorporate that change in practice at the United Nations, in 2006 (Sixth Review Conference) the States Parties agreed by consensus “that as well as the five languages listed in this Article, Arabic shall be considered an official language for the purposes of any meetings of the States Parties and other formal communications concerning the operation of the Convention. It does, however, change the practice and expectations of States Parties, because the consensus decision to recognise Arabic as an official language is a politically binding agreement among, and between, all States Parties. It is what has become known as an ‘Additional Understanding’ or ‘Additional Agreement’. As the background documentation for the Seventh Review Conference (2011) 13 outlines: “an ‘additional agreement’ is one which: (a) interprets, defines or elaborates the meaning or scope of a provision of the Convention; or (b) provides instructions, guidelines or recommendations on how a provision should be implemented. However, its purpose is to note and draw attention to a procedure that has evolved in to a very important practice that has substantive implications: namely, States Parties can agree to alter how they implement and interpret the fifteen Articles of the Convention under two conditions. Condition one is where such agreements can be reached; condition two is how such agreements are adopted. They can reach agreements at only one place, a Review Conference, and only when there is consensus among all States Parties at the Review Conference. That consensus, and any additional agreements, is contained in the Final Declaration of any, and each, Review Conference. Charles Flowerree, an experienced United States diplomat, noted that arms control agreements need procedures and mechanisms that allow States Parties to cope with both extraordinary events and more routine issues related to compliance, including changes in international conditions: to resolve ambiguities; to deal with new scientific and technological developments; to interpret treaty language over time; and to develop 14 implementation procedures. Over time, this approach has allowed implementation of the Convention to evolve and new politically binding commitments to be agreed, developed, and implemented by States Parties. These examples serve to illustrate the importance of this procedure and the scope of its use related to a wide variety of Articles under the Convention. However, it should be noted that, as of 2012 and implementation of the Final Declaration of the Seventh Review Conference, there are over 100 15 additional understandings in place among States Parties. Year Additional Agreement Implication 1980 Article V: development of Empowered states to call a meeting of procedures on Consultation and experts to address any challenges to Cooperation. Assistance in the event Noted States Parties were willing to of use of biological weapons. The Convention and its core obligations are, in effect, still valid, despite scientific and technological developments that have emerged since 1975. Over time, what changes is not the text of the Convention, but implementation of it by States Parties by “a process of cumulative diplomacy and accretion” whereby “each Review Conference 16 built on its predecessor. Nicholas Sims has characterised this evolution as the emergence of different regimes within the Convention; namely, a regime of compliance, a regime of development, and a regime of permanence, with each regime evolving somewhat independently from the others and all at different paces, yet all overlapping with each 18 other. The core of the regime of compliance is contained within the additional agreements reached at successive Review Conferences. In addition, four other measures and activities have attempted to expand and enhance the regime of compliance. The Confidence Building Measures, adopted in 1986 at the Second Review Conference and expanded at the Third Review Conference (1991), encourage States Parties to share information with each other on facilities, activities, and events that are deemed to be highly relevant to the Convention (see Table 6. The information sharing was intended to allow States Parties to provide detail and context on activities and events of direct relevance to the Convention: for example, exchange of data, including the name, location, and a general description of activities undertaken at research centres and labora to ries with very high national or international safety standards. The annual information exchange proved to be much less successful than proponents envisaged, because few States Parties submitted returns on a regular 19 basis. Despite continued efforts to improve both the submission rate and the quality of the information within the Confidence Building Measures, they remain only of limited usefulness. This is not to claim they are without any value or purpose, but in the thirty year period since they were first agreed, they have failed to keep pace with the globalisation of the life sciences, and States Parties have never, collectively, assessed the information submitted by other States with respect to its accuracy, completeness, or relevance. The Ad Hoc Group of Governmental Experts to identify and examine potential verification measures from a scientific and technical standpoint was established in 1991. That is to say, formal legally-binding declarations, routine inspections of facilities declared, investigation of alleged use and non compliance activities, and an international organisation to oversee the new verification regime. Political disputes between States Parties prevented agreement on the opening of negotiations, and the compromise was a technical study of the possibilities of verification. The expert group reported in late 1993 and, in a complex report, essentially concluded that some measures in combination with each other would contribute to strengthening the Convention. A Special Conference in 1994 considered the report and established an Ad Hoc Group to develop measures and procedures for all aspects of the Convention, in order to strengthen its effectiveness and enhance confidence in compliance with the undertakings of States Parties. The Ad Hoc Group convened in 1995 and at the Fourth Review Conference (1996) it was encouraged to speed up its work. The negotiations, covering all the key Articles of the Convention, were difficult and States Parties could not agree on many key features of the Pro to col. By 2001 the text of the draft Pro to col was contained in one single document, but in July 2001 the United States informed other States Parties that it could not accept the proposed text, and that it viewed the effort as fundamentally flawed. In effect, the United States prevented the continuation of the negotiations, though it was not the only State Party that had concerns about the scope and 20 usefulness of the Pro to col. The collapse of the Ad Hoc Group negotiations in the summer of 2001 divided States Parties, and the Fifth Review Conference in late 2001 collapsed in to acrimony 21 and had to be suspended. When it reconvened in late 2002 States Parties adopted a programme of work that has become known as the “intersessional process”, whereby meetings of experts are held in the summer of each year and annual meetings of States Parties take place in December of each year. Each year focuses on different, specific to pics, as determined by the Review Conference.

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