Yet Again We Are Reminded To Stay Alert In The Health Sector!

 This reminder to stay alert to ‘evil-doer’ attacks appeared a day or so ago!

Cyber protection boosted in critical healthcare sector

Tom McIlroy Political correspondent

Jun 28, 2024 – 5.17pm

Australia’s healthcare sector will get increased cyber protection under an Albanese government plan to establish a new intelligence centre, using a model already in place in the banking and finance industry.

The Information Sharing and Analysis Centre (ISAC) is part of an effort to upgrade the country’s cyber safeguards at a system level, especially across high-risk industries. Home Affairs Minister Clare O’Neil announced $6.4 million in pilot funding this week.

The ISAC will host a platform for high-speed sharing of threat information. It will connect big businesses, non-profits and government organisations working in health and hospitals, speeding up indicators of cyber compromise, and spread information about successful responses and preventative measures for cybercrime.

Intelligence agency the Australian Signals Directorate hosts a national system which can feed information into the ISAC when appropriate.

Ms O’Neil said government intervention to kick-start the model for high-risk sectors was long overdue.

“Healthcare providers tend to hold highly sensitive data, and they often struggle with building and funding strong cyber protections. That’s why healthcare providers are one of the most common, and most damaging, targets of cyberattack. This is a pattern we see all over the world.”

Health care networks in Australia and overseas are clearly in the sights of hackers, with some in Ireland, North America and Europe already falling victim to debilitating attacks.

“Make no mistake – we expect Australian healthcare providers to step up and protect our citizens wherever possible. But government, too, needs to give them a hand,” Ms O’Neil said.

Labor could look to extend the model to other critical sectors in the future, include energy and water systems.

Michelle Fitzgerald, the chief digital officer at St Vincent’s Health Australia, said the industry had approached the government about boosting protections.

“There’s a lot of focus on the data but in the case of healthcare, we’re also working with patients every single day. So it’s an additional dynamic and brings additional risk.

“We need to co-operate and share knowledge because we’re up working against a very sophisticated global sector.”

In December, St Vincent’s Health revealed it had sustained a major cyberattack, losing data to cybercriminals who gained access through a compromised account.

The breach was considered similar to the one that crippled insurer Medibank almost a year earlier.

St Vincent’s operates hospitals across NSW, Victoria and Queensland, including three public and 10 private hospitals and more than 25 aged care facilities. The company employs nearly 30,000 people nationally.

Applications for the federal government’s grant round are open until late July.

Here is the link:

https://www.afr.com/politics/federal/cyber-protection-boosted-in-critical-healthcare-sector-20240627-p5jpbb

Good to see the Government has recognized that the health sector is one that requires special help and is putting its money where its mouth is!

These issues are a wake up call to everyone in the sector!

David.

I Had Not Realised That Voluntary Assisted Dying Had Become So Common.

This appeared a few days ago:

Health

More than 130 patients in NSW died through voluntary assisted dying in program’s first three months

Between the state legalising VAD in November 2023 and February 2024, 517 patients made requests to access it, official report shows

Mostafa Rachwani

Fri 28 Jun 2024 16.38 AEST Last modified on Fri 28 Jun 2024 16.40 AEST

More than 130 patients have died through New South Wales’s voluntary assisted dying program in the first three months since it was legalised.

NSW became the last state in Australia to legalise voluntary assisted dying when new legislation came into effect in November.

Between November 2023 and February 2024, 517 patients have made requests to access voluntary assisted dying and, of those, 131 completed the process.

An interim report from the NSW Voluntary Assisted Dying Board showed that in the three-month reporting period, 408 patients completed a first assessment.

Of those people, 321 completed the next step, a consulting assessment, and of those, 248 made a substance authorisation application.

Of those who died following the process, 30% self-administered the voluntary assisted dying substance.

The report also showed that of those who completed the first assessment, a majority were over the age of 60.

It said 2.5% came from Indigenous communities, while 65% lived in regional NSW.

Prof Jenni Millbank, the NSW Voluntary Assisted Dying Board chair, wrote in the report that many patients apply to receive substance authority from the board, but never use it.

“We know from the experience in other states as well as our first few months of operations that some people who receive a substance authority from the board may ultimately choose not to take the substance,” she wrote.

“Knowing the substance is available to them gives these people the power of choice, and may provide a degree of relief and comfort in their final days and weeks.”

The report showed that of the 246 patients who made successful applications for substance authorisation, 115 did not use it, while 29 died from other causes during the reporting period.

Millbank said the board meets twice weekly in person to assess applications and they are sometimes forced to meet more often in urgent cases.

“The board undertakes a high volume of work associated with its decision-making functions,” she wrote.

“We are also often required to make decisions at short notice or in urgent circumstances outside of our regular meeting schedule. This is to ensure that eligible people who are at end of life or at risk of losing decision making capacity who have applied for voluntary assisted dying are supported to access it.”

The NSW government passed voluntary assisted dying legislation in May 2022 after a marathon debate and six months after the bill passed the lower house.

The bill was spearheaded by the independent MP Alex Greenwich and limits access to voluntary assisted dying to people with terminal illnesses who will die within six months or 12 months in the case of a person with a neurodegenerative condition experiencing unbearable suffering.

The person must be found to have capacity to make the decision to go ahead voluntarily without duress and the application would be assessed by two medical practitioners.

Patients can choose whether they want to take the medication themselves orally or for it to be injected by a doctor.

Here is the link:

https://www.theguardian.com/australia-news/article/2024/jun/28/nsw-voluntary-assisted-dying-laws-statistics-report

Clearly this is an important reform for those who need to take advantage of the freedom to decide your fate for yourself when faced with such difficult circumstances.

For myself I am certainly happy the freedom now exists in NSW, but I hope I do not ever need to take advantage of it!

Well done to the NSW Government for giving us all the right to make up our own minds on this crucial and existential matter…

David.

AusHealthIT Poll Number 753 – Results – 30 June 2024.

Here are the results of the poll.

Should Social Media Carry Cigarette-Like Mental Health Warnings?

Yes                                                                                13 (50 %)

No                                                                                 11 (42 %)

I Have No Idea                                                              2 (8%)

Total No. Of Votes: 26

A mixed vote but seemingly of little interest considering the vote count! People seem comfortable to have social media just roll on….

Any insights on the poll are welcome, as a comment, as usual!

A poor voting turnout. 

2 of 26 who answered the poll admitted to not being sure about the answer to the question!

Again, many, many thanks to all those who voted! 

David.

I Really Hope They Avoid Any Damage While Working Out How To Read These Scrolls!

This appeared a day or so ago

Inside the library of Vesuvius’s secret scrolls

By Tom Kington

The Times

11:07PM June 22, 2024

The three rooms in a Naples library that hold secrets about the origins of Western civilisation are deceptively simple, lined with wood and grey metal cabinets and smelling of old books.

Opening the door of a cabinet, Giovanni Bova slowly pulls out a drawer to check on nine black carbonised lumps of papyrus scroll resting on translucent Japanese paper and cotton wool.

“The scrolls are safe, barring earthquakes bringing down the ceiling,” said Bova, the head of the collection.

Burnt and buried by the massive eruption of Mount Vesuvius in AD79, the scorched scrolls are part of a library dug up during excavations of a wealthy villa at Herculaneum, Pompeii’s smaller neighbour, in 1752.

Stored at the National Library of Naples since the 1920s and believed to be the world’s only surviving ancient Roman library, the scrolls are making headlines as high-powered CT scans and artificial intelligence are successfully used to decipher them for the first time without unrolling them.

Until now, efforts to unroll the scrolls have mostly produced shredded, crumbling fragments, so historians are drooling at the possibility that AI can find unknown, intact works by Sophocles, Sappho or Aristotle, revolutionising our knowledge of the genesis of western art, science and philosophy.

It is a prospect that makes the hushed, book-lined home of the scrolls a surreal contrast to the explosive works they may contain.

During a visit this month, The Times was escorted through the labyrinthine, frescoed corridors of the library, which is housed in the 18th-century former royal palace in the heart of the city.

Up sweeping staircases, past sleepy students studying the library’s thousands of works and balconies offering stunning views over the bay of Naples, the scrolls are tucked away in three marble floored rooms where six-metre-high ceilings and the solid palace walls keep out the summer heat.

Without climate-controlled, locked vaults, Bova leads a team guarding wooden cabinets installed in the 1920s that hold about 500 still rolled scrolls and metal cabinets containing 1840 fragments left over from attempts to unroll another 300.

In the corner of one room stands the machine invented by a priest in the 18th century that used hooks to slowly unroll them, often destroying them in the process.

“You can still see the membrane from animal guts they used to try and keep the papyrus from disintegrating as it unrolled,” Bova said.

Occasionally it worked. A cabinet in holds an intact, four-metre stretch of unrolled papyrus containing ruminations on rhetoric by Philodemus, the epicurean philosopher who created the library while he was living at the villa of the Roman aristocrat Lucius Calpurnius Piso at Herculaneum.

But the cabinets are also packed with shelves containing torn and crumbling fragments, among them a poorly preserved work with geometric triangle designs by Demetrius of Laconia, a 2nd-century BC Greek epicurean philosopher.

While most works are in Greek, 80 fragments are in Latin, including a description by Seneca the Elder of the 31BC Battle of Actium between the forces of Octavian and Cleopatra. “This could be part of Seneca’s lost history of Rome and the rest may be in there somewhere,” Bova said, waving at the cabinets.

Down the corridor an infra-red microscope set up Graziano Ranocchia, of Pisa University, is used to glean new words from fragments of Demetrius’s treatise On the Shape of God.

Using the technique infrared hyperspectral imaging, Ranocchia has this year boosted the legibility of fragments to discover the exact burial spot of Plato in Athens.

But the headline-grabbing breakthrough last year was the use of a CT (computed tomography) scanner in Oxfordshire by a Kentucky University computer scientist, Brent Seales, to peer inside an untouched, 13-metre long rolled scroll.

He obtained data which was unscrambled this year using AI by researchers who earned a $US700,000 ($1.05m) prize funded by Silicon Valley investors. They discovered 15 columns of text by Philodemus in which he ponders what makes something desirable, writing: “We do not immediately believe things that are scarce to be absolutely more pleasant.”

The text came from one of two scrolls Seales obtained from Paris, where they had been kept since they were sent to Napoleon in 1802 by the then Bourbon ruler of Naples.

To keep the discoveries coming, Bova flew to the UK in October with three never-unrolled scrolls from the cabinets. “We 3D-printed cases that fit exactly, booked two tickets and they travelled on the plane on the seat next to me, never leaving my sight,” he said.

Competitors are now trying to crack the data from the scans of the three new scrolls as well as from the second, unstudied scroll from Paris.

Like last year, the initial prize will be for the AI expert who can decipher one word, followed by another prize for finding entire tracts.

“There are 4000-5000 people working on this and we are very close to getting a word,” said Seales, who was in Naples this week to meet the director of the library, Silvia Sciponi.

“I have been watching the interior of a scroll emerge from the mist – it’s imminent. Once you see a word, you are 90 per cent there, it’s like the rollercoaster is over the top and rushing down,” added Seales, who hopes to scan all 500 intact scrolls in Naples and has $US2 million in funding from Elon Musk, making the Tesla and Twitter/X tycoon the project’s biggest backer.

While historians around the world are on tenterhooks to know if Philodemus’s library will reveal lost Greek tragedies and never-read ruminations by the founders of western philosophy, Seales said he was hoping for something about the early years of Christianity.

Sciponi said: “The huge responsibility we have looking after the scrolls is matched by our curiosity as technology now gives us back works we thought were lost. We also need to consider protecting them better from volcanic dust because Vesuvius may erupt again.” BURIED TREASURES

AD79

The eruption of Mount Vesuvius buries Pompeii in pumice stones and ash, and engulfs Herculaneum in super-heated, boiling mud that instantly seals scrolls kept in the library of a wealthy family’s villa, carbonising them but keeping out the oxygen that would have allowed them to burn completely.

1752

Workmen hired by the Bourbon rulers of Naples discover what is today (Saturday) known as the Villa of the Papyri.

1756

Antonio Piaggio, a Vatican priest, uses a machine equipped with hooks and silk thread to slowly unroll scrolls, a few millimetres a day, inadvertently damaging many of them.

1802

King Ferdinand IV of Naples gives six rolls to Napoleon, which are taken to France.

1810

Eighteen scrolls are given to the future George IV. The king gives four to the University of Oxford’s Bodleian Library. The others are in the British Library.

2023

The Silicon Valley investors Nat Friedman and Daniel Gross join Brent Seales, a computer scientist, to launch the Vesuvius Challenge, awarding more than $US1 million over the year to competitors deciphering data from scans of scrolls.

Here is the link:

https://www.theaustralian.com.au/world/the-times/inside-the-library-of-vesuviuss-secret-scrolls/news-story/d02ab9aa3ef5fc47eab21b1ada36dcee

Can I say I am drooling too to see what is eventually revealed as the scrolls are hopefully read!

David.

I Think We Are At Risk Of Forgetting Just How Terrible The Influenza Epidemic Of 1918-20 Was

This appeared last week:

Unlocking the secrets of a pandemic that killed 50 million

When an 18-year-old soldier tragically died in 1918, a sample of his lung tissue locked away for over a century, forgotten. A team of Brisbane-based scientists scoured the globe to find it and are now using it to supercharge the quest for a cure – before the next worldwide pandemic hits.

By Natasha Robinson

From The Weekend Australian Magazine

June 22, 2024

In a small, windowless laboratory deep inside a hospital next to the Brisbane River, a group of scientists are huddled around a large monitor, collectively holding their breath. A piece of ­precious lung tissue, preserved in ­formaldehyde and paraffin, has been sourced from a European museum where it had been stored for over a ­century, virtually forgotten. A sliver of the tissue – taken from the lungs of an 18-year-old German soldier who died of Spanish flu – has been prepared on a slide, and slipped under the gaze of an ultra-modern microscope. If this bold experiment comes off, it will be the first time in ­history that the microbiological secrets of one of the world’s most devastating pandemics have ever been revealed.

For the past hour, Dr Arutha Kulasinghe and his team have been painstakingly staining this sliver of lung tissue with over 100 colourful “markers” that bind to and identify certain ­proteins, attracting a cocktail of antibodies and revealing the intricate architecture of the cells within. If this experiment works, fluorescent DNA strands on the nanoscale will light up this century-old biological specimen like a disco.

A switch is flipped on the microscope and in seconds, thousands of pink, blue, brown and green dots appear on the monitor – a kaleidoscope of cells. As those on the Zoom link squint into their screens, the jubilant exclamation of Kulasinghe punctures the pregnant silence in the stuffy laboratory and blasts through headphones across the country. “It works!” he cries. “The bloody experiment works!”

Until very recently, no scientist would have dreamt that a human tissue sample that had been out on the lab bench for even a day could be viable, let alone a piece of lung dating from 1919. But an extraordinary collaboration in Brisbane between intensivists, virologists and experts in cutting-edge digital pathology was the impetus for this bold experiment unfolding at the Wesley Research Institute.

“This is a medical Tardis moment,” says the scientific director of the project, the irrepressibly inventive Scottish-born clinician Professor John Fraser. “We’ve got a scientific time machine. To be looking back at tissue from someone that died during the Spanish flu, and to be able to tell what every cell in that tissue is doing – this is exactly like going back in time through a microscope and seeing tissue exactly as it was at the moment this poor person died 105 years ago. It’s goosebumps.”

But this scientific quest launched by the Queensland Spatial Biology Centre (QSBC) is no mere historical frolic. Having just lived through a pandemic that began without notice and brought a daily avalanche of fear, exhaustion, helplessness and sometimes grief, this team, a collaboration between St Andrew’s War Memorial Hospital and the University of Queensland, and funded by the Wesley Research Institute, is hunting through history in an effort to alter the course of the future.

“If you don’t understand the past, you’re doomed to repeat it,” says Associate Professor Kirsty Short, a virologist at the University of Queensland. “There will be another pandemic, without a doubt, within my lifetime. It’s so ­important that we understand past pandemics to prepare for the next one.

“What this project is doing is really going back in history to prepare for the future. And the power of that is just phenomenal.”

From the first months of Covid-19 in early 2020, then for three relentless years, like most scientists and doctors at the frontline of ­responding to a novel coronavirus, Short worked long hours attempting to understand the nature of SARS-CoV-2 (the virus that causes Covid-19), the wide plethora of effects it had on the body’s systems, and how it might be treated. Scientific understanding of Covid-19 developed relativly quickly amid extraordinary worldwide collaboration. Vaccine science catapulted forward at warp speed. Yet still, treatments remained elusive. Even in the modern metropolis of New York City, ambulances ­containing refrigerated bodies lined the streets, unable to offload the victims to overloaded morgues. To date at least seven million people worldwide have died of Covid-19, and still there’s little remedy at hand. Mass mortality was not the only devastation: the pandemic brought the world economy almost to its knees, triggering one of the largest global economic crises since the Great Depression. Travel ceased, and airlines went bust as their planes sat idle; India burned its dead in collective pyres. Children experienced social and academic isolation during the formative years of their lives. The elderly in nursing homes spent countless months locked away from their families, many simply perishing from loneliness.

As Australia shut borders and then locked down in the early months, Fraser – Director of Intensive Care at St Andrew’s War Memorial Hospital, and Director of the Critical Care Research Group at The Prince Charles Hospital – found himself in the discombobulating position of having no patients across the Brisbane public and private hospitals he worked within, but a flood of reports and panicked updates from the world’s worst-hit hotspots, from Italy to Brazil. With the virus spreading fast around the world, Fraser co-founded the Covid-19 Critical Care Consortium, headquartered in Brisbane, an international research and data-sharing group assembled to harness the cumulative experience of intensive care units worldwide.

The response by medical science to the Covid-19 pandemic came at a time in history when technology was already rapidly transforming the fields of immunology, genetics, digital pathology and cell biology. As the virus spread across borders and millions fell sick, doctors were sharing clinical information in real time as the world united to learn all it could about this novel coronavirus. As deaths mounted, scientists began sending tissue samples from victims by courier and by post to their international colleagues with special expertise.

“Being a doctor during Covid-19 was petrifying,” recalls Fraser. “This was a brand new thing. There were lots of human jigsaw puzzle pieces of data coming in. And all the doctors were just desperate. People were phoning each other and sending each other WhatsApp messages because there was no instruction book. We didn’t know what we were doing. It was a brand new virus, and there was no vaccine.

“It was a little bit like driving down the highway at breakneck speed with a blindfold on – we knew that we didn’t have the information to go on. We had no roadmap. We normally have a rough idea of how to manage severe illness by first principles. We had a massive responsibility, but people were dying in our hands and we were helpless. When patients die, you take it home. You don’t leave it at the door.”

Even as a vaccine hit chemists in lucky ­countries, in terms of treatments there was very little progress made as the pandemic wore on. Monoclonal antibodies were developed, but ­remained expensive and inaccessible for most. The old drug dexamethasone was also repurposed as a crude remedy for hyperinflammation – one of the hallmarks of the body’s response to SARS-CoV-2. As immune cells flood the victim’s lungs to fight the virus, the body over-reacts, triggering in some individuals what’s known as a cytokine storm – a systemic inflammatory syndrome that can be life-threatening or deadly. It’s hyperinflammation that often kills patients with Covid-19.

Now, with predictions of a 70 per cent chance of a pandemic in the next 25 years killing 10 million people or more, the QSBC team is determined that doctors will never again fly so blind. Being able to map the pathophysiology of the Spanish flu in mind-boggling detail is extraordinary in itself, but that’s not the endgame for this highly unusual cross-disciplinary experiment. The vision of these Australian ­scientists is much greater. They’re on a quest to ensure no doctor or nurse will ever again have to hold the hand of a ventilated patient as they lie slowly dying, with no panacea and scant hope, isolated and alone.

You might call this crack team – led by Fraser, spatial biologist Kulasinghe and virologist Short – forensic biologists, or even pandemic hunters. If that’s what they are, their most ­important foot soldier is 29-year-old PhD ­student Lauren Steele, who was analysing host responses to severe disease when the pandemic hit. In August 2022 Steele flew to ­Vienna to meet the curator of Austria’s ­renowned Natural History Museum, the Naturhistorisches Museum Wien. The institution was one of several that had replied affirmatively to an email from her asking if they possessed preserved lungs or lung samples of people who were likely to have been victims of a pandemic.

Steele was interested not just in the Spanish flu, which erupted in 1918 and quickly spread during the final stretch of World War I amid mass troop movements, raging until 1920, but also the flu pandemics of 1957 and 1968. The Spanish flu killed an estimated 50 million people worldwide, disproportionately the young. At the time it wasn’t even understood to be a virus. A bacterial cause was widely ­suspected, and people turned to all manner of bizarre remedies – even drinking snake oil, bloodletting and inhaling gas fumes – to try to ward off the terrifying illness.

When Steele arrived at the Vienna museum, the curator explained that the organs it held were kept in the nearby University of Vienna. But the records weren’t up to date and they didn’t really know what they had. Some samples were whole lungs fixed in formaldehyde sitting forlornly in jars; others were formaldehyde-fixed, paraffin-embedded tissue boxes stored in archives. At the University of Vienna there were two and a half rooms full of lungs. Steele spent days scouring the museum database, which tracked dates of death, to isolate potential pandemic victims, and then cross-checked any samples that possibly related to a pandemic illness against handwritten autopsy records held in enormous bound book volumes. Many of those who died of flu throughout much of the 20th century were marked as ­having succumbed to pneumonia, bronchitis or grippe, the earlier French descriptor for flu. “One of the samples labelled the cause of death as ‘cheesy, gelatinous pneumonia’,” Steele says. “There were some very descriptive terms.”

At the end of the Vienna detective work, Steele had identified two certain pandemic victims, with the museum agreeing to provide her with a small slice of those preserved lungs, as well as arranging ethics approval. In the meantime, the team in Queensland had gained agreement to obtain slices of tissue from two Spanish flu victims held by a German genetics researcher who had also obtained lung samples via the Berlin Museum of Medical History.

When Steele returned home, she discovered to her amazement that a museum in Sydney, the Ainsworth Interactive Collection of Medical Pathology, held a preserved lung of an ­Australian Spanish flu victim, a young WWI soldier, along with 15,000 other tissue samples that Steele spent weeks sorting and cross-checking against autopsy records in a dusty inner city attic, netting further precious slices of pandemic tissue.

“We’ve had four pandemics now since the [beginning of the] 20th century,” she says. “And we can kind of see patterns that happen within them. But nobody has been able to ­answer the questions before about the how and why.”

After Steele had returned home from Europe, Kulasinghe – who with his colleagues at the Frazer Institute across the Brisbane River had already amassed a sizeable Covid-19 biobank of tissue samples – swung into action. Kulasinghe was the key local figure with expert knowledge in the cutting-edge field of spatial omics, an emerging method of digital pathology in which unique neighbourhoods of millions of cells and their interactions with pathological biomarkers can be mapped in astonishing three-dimensional detail.

“Generally, when you cut tissue and leave it on the bench, it oxidises and it’s destroyed – it generally doesn’t preserve over time,” says ­Kulasinghe. “If you go into a pathology bank or a hospital, tissues are generally kept for about 10 years and thrown away.

“It should not be possible to get signal off 100-year-old tissues. Most scientists think what we are doing here is not conceivable. Running this experiment live, we’re seeing what a disease that is 100 years old did to people’s bodies, for the first time. It is incredible.”

The power to travel back in time via next-­generation microscopy has its genesis in an ­innocuous-looking blue and white machine that sits in the corner of the QSBC lab. The ­device was recently purchased by the Wesley Research Institute, which realised such technology could bring ­together the power of its significant stores of clinical data paired with its trove of pathology specimens amassed over the course of the Covid-19 pandemic.

The million-dollar machine, dubbed the PhenoCycler, enables what is known as spatial phenotyping of countless cells at an unprecedented scale and speed. It augmented the work in this emerging field by Kulasinghe, who had set up a spatial biology lab at the Frazer ­Institute. Spatial biology is a new field of ­research which allows scientists to map cells within tissue in a level of detail and complexity that is revolutionary for science. Millions of cells can be mapped in vivid 3D detail from a single specimen slide, not only individually but also in terms of their cell neighbourhoods – or how they communicate with each other. Further, complex cell interactions can now be plotted against pathological biomarkers such as a virus, giving unprecedented insight as to how the body reacts to a particular pathogen.

Without technology like this, it is impossible to understand the three-dimensional relationships of cells and other processes occurring in the tissues, such as inflammation, which is a key factor in pandemic illnesses. Through a process of staining and “barcoding” individual cells and molecules, scientists are able to build a three-dimensional picture of an immune battlefield. As many as 100 different elements – cells, molecules and other tissue elements marking out the inflammatory battlefield – can be individually identified, yielding 3D images rich in detail.

What has never been appreciated about this cutting-edge application of spatial biology until now is that it could be used on organs soaked in formaldehyde and sitting in jars, or tissue ­samples stored for decades in museums.

“We realised during Covid, we were shipping tissues around at room temperature, just sending slides around the world,” Kulasinghe says. “And we were getting really good signal. Kirsty [Short] came to us and said, ‘Look, here’s a crazy idea – we’ve got this collaboration in Europe and these tissues that have been collected from 1918. Can we get signal?’ I knew the instruments we now have use a different chemistry, which allows us to look at degraded samples. So I was like, ‘Hold on, let’s just give it a go’.”

But it’s not the machine alone that provides the critical insights. A team of cross-disciplinary experts including immunologists, virologists and computational analysts must interpret the images via painstaking scientific work. Some things are immediately apparent, though. In this first look at the lung tissue of the young German soldier who contracted Spanish flu, it’s clear from the intense clusters of a type of ­immune cell called macrophages that crowd the image that this was a patient who experienced a hyperinflammatory immune response within his lungs shortly before dying.

The key now is to work out which exact ­alveolar cells or structures were infected by the 1918 influenza virus, and then to overlay that with the types of immune cells that rushed to the body’s defence. If this can be established, the exact mechanism of the body’s immune ­response can be ascertained. When compared to other known pandemics, if similarities in the body’s immune response are found to exist, as suspected, it will form the basis for the world’s first evidence-based understanding of the host response to pandemic illness, and how that differs between age groups; it will also give key clues as to how drugs may provide a remedy.

It’s been postulated for many decades that hyperinflammation characterised the lungs’ response to Spanish flu. But the theory has always been a hypothesis largely based on anecdote.

“A lot of the 1918 information has just come from personal diaries and people’s accounts,” Short says. “Those lived experiences are obviously very powerful. But to understand something mechanistically you need more than that. So these tissue sample images really take things from conjecture to evidence-based.

“I guess one of my fundamental hypotheses is that in 1918, you had this hyperinflammatory response in young individuals. So we can see that straight away on our images. But we can now go into so much more detail. We can ­quantify the cell types. We can quantify which one of those inflammatory cells is producing each inflammatory molecule – because coming up with a therapy might not be about blocking that cell, it might be about blocking the ­inflammatory molecule that it produces in that cell-to-cell interaction.

“So maybe it’s about one specific immune cell rushing into the lung, and then interacting with another one, and that causing an inflammatory storm. It’s about understanding the ­detail to ensure that any target that we find is really valid and robust.”

Halting the hyperinflammation process is the endgame of this whole endeavour – a panacea for every pandemic. If the QSBC team can identify similarities in the immune response that are replicated across pandemics, whether the virus is influenza or a coronavirus, it may be possible in the next pandemic to develop a universal therapy that could protect the population, especially young people who are often wiped out in the largest numbers in pandemics (Covid-19 was an anomaly in this regard; it largely killed the elderly). Such a therapy may be in the form of an antibody injection that could block a particular target cell type or ­signalling molecule in order to prevent the overactivation of the immune system.

As the team narrows focus to a pandemic panacea, they are tantalisingly aware that the scope of what spatial biology technology could assist scientists to do could be limitless.

“What we have done here defies the dogma,” Short says. “I think what could flow from this project would be a new dogma for what is and is not possible with tissue analysis.

“If this works on 100-year-old tissue, maybe it works if we got tissue from somebody who died during the plague; maybe it even works on the ancient Egyptians. It just opens up a whole new area of scientific discovery.”

Kulasinghe says tissues probably have to have been preserved in formaldehyde to be ­viable for analysis. That’s been standard ­practice for only about a century. But the scope to re-open clinical trials and subject stored tissues to new, much richer analysis in cancer, neurodegenerative disease and countless other conditions is vast. “It’s not just about 1918, this opens up the whole hospital pathology biobanking system, which has been keeping tissues in [formaldehyde] for hundreds of years,” he says. “We can go back to a clinical trial that might have been run for breast cancer 10 years ago that had exceptional responses to chemotherapy. And we can go pull those tissues, and we can ask the question, ‘What is in this patient cohort that defined sensitivity to a drug that might be 20 years old? And what can we learn from that?’ We’ve never pushed the boundary this far.”

Fraser, incidentally, is travelling to Egypt later this year. “Serendipity is this wonderful word in medicine,” the professor says. “Penicillin was discovered by a Scotsman by mistake, Barry Marshall discovered Helicobacter pylori bacteria by mistake. But it’s not a mistake, it’s just that these people work the hardest. And the more work you put in, the luckier you get.

“Could we find things out from the ancient Egyptians? Who knows? Could we have a ­Jurassic Park moment, like the mosquito that got preserved in amber? I don’t know, but I would not be averse to speaking to the Egyptian government when I’m over there in September. Never accept ‘no’ until you’re proven wrong.”

Here is the link:

https://www.theaustralian.com.au/weekend-australian-magazine/most-scientists-think-what-were-doing-is-not-conceivable-pandemic-detectives-on-a-quest-for-a-cure/news-story/841ad99e0c98d0909c8b57c2079c1f7d

A great yarn and an ageless truth in the second last paragraph!

David.

No Matter What Your Politics We Need A Working And Solvent Private Health System

 This appeared last week:

Private health sector on life support as patients’ care delayed

EXCLUSIVE

By Natasha Robinson - Health Editor

8:24PM June 21, 2024

The health insurance industry is facing the growing prospect of unprecedented government intervention in its contracting with hospitals, as doctors complain patients are being denied surgery or inpatient care even if they have top cover, with hundreds of private facilities around the nation on the brink of bankruptcy.

As concern grows over the shaky viability of the private health system, the nation’s top surgical college has revealed that some privately insured patients are being left in pain and uncertainty as specialists’ theatre lists are cancelled or hospitals abandon completely certain surgeries deemed too unprofitable.

Many other consumers who have taken out top cover are finding they can’t obtain private ­maternity care or mental health inpatient care amid multiple systemic pressures on the private system that health leaders say is compounding the burden on already critically overloaded public hospitals.

Private hospitals provide one-third of all hospital admissions and 60 per cent of all surgery nationwide. The commonwealth is carrying out a rapid viability review of the $22bn private hospital system, with recent economic analysis revealing 70 per cent of private hospital groups are currently loss-making and the industry as a whole is operating at a profit margin of just 1 per cent.

More than 70 private facilities – including day hospitals, overnight hospitals, psychiatric hospitals and rehabilitation hospitals – have closed nationwide since 2019, according to the Australian Private Hospitals Association.

Private hospitals have not yet recovered from the severe impacts of the Covid-19 pandemic, with the benefit payments being provided to operators under contracts with private health insurers lagging well below health inflation and the rising costs of staff and equipment.

“There has been a cumulative impact in terms of eroding private hospital earnings,” said APHA chief executive Michael Roff.

“I think a lot of people have described this as the most challenging times for private hospitals in living history.

“There is now a significant proportion of private hospitals that are not generating sufficient returns to fund business as usual capital expenditure. We’re really at a crunch time for the industry.”

The private hospital sector is warning it is approaching a “critical mass of private beds disappearing, undermining the value proposition of private health insurance and raising the unprecedented prospect of waiting lists for surgery in the private system.

The denial of theatre time to surgeons in private hospitals has for the past year been mainly affecting specialist reconstructive, surgery especially in Perth, and oral and maxillofacial surgery across the country.

But surgeons say the problem is becoming more widespread, and it is now a growing reality that some privately insured patients are unable to use their health cover for a wider array of operations in the private system.

The issue was raised at a top-level Royal Australasian College of Surgeons meeting of councillors from every surgical speciality this week, where there was white-hot anger over the issue.

“In every state the profitable procedures in private hospitals are being prioritised over the ones which are less profitable,” said specialist plastic surgeon and professor Mark Ashton, an office holder on the RACS council who chairs the college’s fellowship services. “Hip and knee replacement surgeries are being preferentially given theatre time ahead of others. This is now affecting gynaecological surgery across several hospitals in Adelaide. Some surgeons, if they’ve got three lists a week it’s being reduced to two, some surgeons are having their lists completely removed.

“From a public community perspective, if you suddenly say well we’re not going to perform gynaecology surgery in Adelaide in the private health system, where is it going to get done?

“The issue is not only do patients have an out-of-pocket expenditure to get that surgery. The issue is they can’t get the surgery at all. This isn’t on. It isn’t ethical.”

Australian Society of Plastic Surgeons president David Morgan said some specialists were being asked to promise a co-payment to the hospital from the surgeon’s practice to make particular surgical lists viable for private hospitals. He said vested interests in the sector were “pulling in different directions”, and the private health system as a whole was “marginally viable”.

“I think there needs to be some sort of oversight that makes sure patients with all medical requirements are treated relatively equitably, and there aren’t these perverse drivers of higher-paying or more profitable procedures being given preference over others that are just as worthy,” Dr Morgan said.

The call echoes that of the Australian Medical Association, which is campaigning for an independent regulator to govern the private health sector. “The private hospital sector in Australia is so important – it’s too big to fail,” AMA president Steve Robson said.

Private Healthcare Australia chief executive Rachel David said insurers were committed to keeping private hospitals viable and of a high quality, as it was a major part of the value proposition of the entire private health sector.

She said the financial problems facing private hospitals had been triggered in large part by the pandemic and were now being addressed through the health insurance contracting process.

“But what the health funds can do in the contractual process is completely limited by the ability of consumers to pay, and the willingness of the government to approve higher-than-inflation pre­mium increases,” Dr David said.

She also disputed that the health insurance industry was banking “super-profits”, as alleged by private hospitals.

The prospect of greater regulation by the government in the contracting process could affect insurance premiums, she said.

“If we are required to pay more to hospitals, then there must be savings made elsewhere in the claims process,” Dr David said. “Our position is that the consumer needs to be protected.”

Here is the link:

https://www.theaustralian.com.au/nation/patients-care-delayed-as-private-hospitals-pushed-to-the-wall/news-story/e7e2ac6c2adcee3bdbffb9e0a0c0bb46

I have to say that with our mixed private/public system it is vital we keep the private hospital sector healthy and viable.

Overall the mixed system seems to work pretty well and right now there is apparently some risk of major problems emerging. My view is that we need to keep both the private and public systems working well and to avoid any decay of the present systems that is not carefully planned and implemented. If indeed the private hospital sector is under more than reasonable stress this should be corrected.

Do you disagree?

David.

I Wonder Just Why It Is The Nuclear Debate Is So Unhinged?

 

This appeared last week:

Coalition nuclear power plants could host multiple reactors, O’Brien reveals

The Coalition’s energy spokesman Ted O’Brien has revealed a surprising new detail for the opposition’s nuclear energy plan.

Jack Quail - June 23, 2024 - 8:37AM

Opposition energy spokesman Ted O’Brien has flagged an evolution in the Coalition’s nuclear power policy, revealing that each of the seven sites could host multiple reactors.

But in a major concession, Mr O’Brien said on Sunday the Coalition would not go to the election announcing the estimated generation capacity of its nuclear power plan, leaving this decision to an independent body until after the election.

“One of the lessons we learned from overseas, in order to get prices down, you need multi-unit sites,” Mr O’Brien told the ABC’s Insiders program.

“Let’s say the small modular reactors … When you talk about a nuclear plant, these are modularised compartments. You can add another 300, add another 300.

“You’re talking about multi-unit plants.”

An independent nuclear energy coordinating authority would make recommendations on the number and type of reactors per site, Mr O’Brien said, which would then determine the final generation capacity.

“The independent body would look at each plant, and come up with a recommendation as to what sort of technology should be used,” he said.

“From there, it would be exactly what capacity based on that technology.

“Only from there can you come down to a specific number of gigawatts”.

Last week the Coalition unveiled plans to build seven nuclear power plants by 2050 with the first reactor slated to be operational in just over a decade in a move designed to deliver cheaper, zero-emissions and reliable power supply.

The large-scale and small modular generators would be Commonwealth-owned, similar to arrangements governing the Snowy Hydro 2.0 scheme, requiring a multibillion-dollar funding commitment from taxpayers.

The Coalition has proposed to locate the reactors in Queensland, NSW, Victoria, South Australia and Western Australia.

Estimates from the Smart Energy Council and the Grattan Institute had placed the combined output of seven reactors at up to 11GW, or less than 4 per cent of the total generation capacity in the national energy market (NEM) by 2050.

While hosting more than one reactor at each site would increase the share of generation from nuclear power, it would significantly drive up the cost incurred by taxpayers and place further pressure on the already tight deadline to have the reactors online by mid-century.

With energy policy set to be a key battleground in the next election, Mr O’Brien said the Coalition would not go to the poll detailing a specific amount of nuclear power it expected, but would rather indicate the share of the total energy generation in the NEM “in due course”.

“Until we release renewables policy and gas policy, I won’t be talking about the proportion of the mix,” he said.

“We’ll be clear as to what we believe the potential capacity could be through to 2050.”

While committing that renewable generation would remain under the Coalition’s proposal, Mr O’Brien also declined to reveal what proportion it would contribute.

Plibersek takes aim at lack of cost, detail

Also speaking on Sunday, Labor frontbencher Tanya Plibersek added her voice to the tirade of criticism against the Opposition’s nuclear energy push, criticising the Coalition for its refusal to detail the estimated cost to add nuclear generation to the national electricity market in the biggest overhaul of energy policy in decades.

“He’s saying to Australians: ‘I don’t trust you. I don’t trust you with the costing we’ve done,’ if he’s got costings,” Ms Plibersek told Sky News.

“On every analysis internationally, renewables are cheaper, nuclear is the most extensive.

“What is it going to do to pay for his power bills if the government is recouping the very expensive cost of building and running those nuclear reactors?”

Last the week Coalition unveiled plans to build seven nuclear power plants by 2050 with the first reactor slated to be operational in just over a decade in a move designed to deliver cheaper, zero-emissions and reliable power supply.

The large-scale and small modular generators would be Commonwealth-owned, similar to arrangements governing the Snowy Hydro 2.0 scheme, requiring a multibillion-dollar funding commitment from taxpayers.

Asked why Australia had eschewed nuclear power when many other advanced economies had adopted the technology, Ms Plibersek pointed to Australia’s comparative advantage in renewable power generation.

“We’ve got the room, we’ve got the resources, we’ve got the critical minerals we need, battery manufacturing, we’re investing in green hydrogen,” Ms Plibersek said.

“We can be a renewable energy superpower and instead Peter Dutton wants to slam the brakes on, instead of leading the world with renewable energy investment.

“He wants to fast track nuclear, and put us on the slow lane when it comes to renewables. It’s just mad.”

Here is the link:

https://www.news.com.au/national/politics/completely-irrational-plibersek-takes-aim-at-coalition-over-uncosted-nuclear-push/news-story/c197973cd95492f10acf285ee81fd126

I really am just amazed how irrational this whole debate is! I think it reveals a level of national scientific literacy which is frankly terrifying! How can it be news you can have 2 (or more) reactors on the same site!

The facts are that nuclear reactors are used all over the world for power generation for decades and the technology is proven to be very safe, a country as large as ours can find a spot to store nuclear waste safely and we have excellent access to all the fuel we need from a multitude of mines. We also are developing our own nuclear technology expertise via AUKUS. Whether we go down the nuclear power-generation path is a purely economics driven decision IMVHO.

Right now solar, hydro and wind energy are cheaper as emission free sources of power and so the questions are around continuity and reliability of supply from what we presently use and may have and whether nuclear makes economic sense to develop.

Despite the apparent public hysteria the technologies are safe, proven but pretty expensive and we have cheaper options for the present. Whether this changes at some point I have no idea!

Anyway if we are going down the nuclear submarine route some stationary reactors are hardly a stretch. The main limitation will be water for cooling, of which a lot is needed!

Can we have a properly informed debate on all this please!

David.