Journal articles on the topic 'Medicina dei disastri'

AbstractIn recent years, effective models of disaster medicine curricula for medical schools have been established. However, only a small percentage of medical schools worldwide have considered at least basic disaster medicine teaching in their study program. In Italy, disaster medicine has not yet been included in the medical school curriculum. Perceiving the lack of a specific course on disaster medicine, the Segretariato Italiano Studenti in Medicina (SISM) contacted the Centro di Ricerca Interdipartimentale in Medicina di Emergenza e dei Disastri ed Informatica applicata alla didattica e alla pratica Medica (CRIMEDIM) with a proposal for a nationwide program in this field. Seven modules (introduction to disaster medicine, prehospital disaster management, definition of triage, characteristics of hospital disaster plans, treatment of the health consequences of different disasters, psychosocial care, and presentation of past disasters) were developed using an e-learning platform and a 12-hour classroom session which involved problem-based learning (PBL) activities, table-top exercises, and a computerized simulation (Table 1). The modules were designed as a framework for a disaster medicine curriculum for undergraduates and covered the three main disciplines (clinical and psychosocial, public health, and emergency and risk management) of the core of “Disaster Health” according to the World Association for Disaster and Emergency Medicine (WADEM) international guidelines for disaster medicine education. From January 2011 through May 2013, 21 editions of the course were delivered to 21 different medical schools, and 524 students attended the course. The blended approach and the use of simulation tools were appreciated by all participants and successfully increased participants’ knowledge of disaster medicine and basic competencies in performing mass-casualty triage. This manuscript reports on the designing process and the initial outcomes with respect to learners' achievements and satisfaction of a 1-month educational course on the fundamentals of disaster medicine. This experience might represent a valid and innovative solution for a disaster medicine curriculum for medical students that is easily delivered by medical schools.Table 1List of Modules and TopicsModuleTopics1. Introduction to disaster medicine and public health during emergencies- Modern taxonomy of disaster and common disaster medicine definitions- Differences between disaster and emergency medicine- Principles of public health during disasters- Different phases of disaster management2. Prehospital disaster management- Mass-casualty disposition, treatment area, and transport issues- Disaster plans and command-and-control chain structure- Functional response roles3. Specific disaster medicine and triage procedures in the- Mass-casualty triage definitions and principlesmanagement of disasters- Different methodologies and protocols- Patient assessment, triage levels and tags4. Hospital disaster preparedness and response- Hospital disaster laws- Hospital preparedness plans for in-hospital and out-hospital disasters with an all-hazard approach- Medical management for a massive influx of casualties5. Health consequences of different disasters- Characteristics of different types of disasters- Health impact of natural and man-made disasters- Disaster-related injury after exposure to a different disasters with an all-hazard approach6. Psychosocial care- Techniques to deal with psychic reactions caused by exposure to disaster scenarios- Treatment approaches to acute and delayed critical incident stress reactions7. Presentation of past disasters and public health emergencies, andCase study:review of assistance experiences- Haiti earthquake- Cholera outbreaks in Haiti- National and international disaster response mechanismIngrassiaPL, RagazzoniL, TengattiniM, CarenzoL, Della CorteF. Nationwide program of education for undergraduates in the field of disaster medicine: development of a core curriculum centered on blended learning and simulation tools. Prehosp Disaster Med. 2014;29(5):1-8.

Background Although both disaster management and disaster medicine have been used for decades, their efficiency and effectiveness have been far from perfect. One reason could be the lack of systematic utilization of modern technologies, such as eHealth, in their operations. To address this issue, researchers’ efforts have led to the emergence of the disaster eHealth (DEH) field. DEH’s main objective is to systematically integrate eHealth technologies for health care purposes within the disaster management cycle (DMC). Objective This study aims to identify, map, and define the scope of DEH as a new area of research at the intersection of disaster management, emergency medicine, and eHealth. Methods An extensive scoping review using published materials was carried out in the areas of disaster management, disaster medicine, and eHealth to identify the scope of DEH. This review procedure was iterative and conducted in multiple scientific databases in 2 rounds, one using controlled indexed terms and the other using similar uncontrolled terms. In both rounds, the publications ranged from 1990 to 2016, and all the appropriate research studies discovered were considered, regardless of their research design, methodology, and quality. Information extracted from both rounds was thematically analyzed to define the DEH scope, and the results were evaluated by the field experts through a Delphi method. Results In both rounds of the research, searching for eHealth applications within DMC yielded 404 relevant studies that showed eHealth applications in different disaster types and disaster phases. These applications varied with respect to the eHealth technology types, functions, services, and stakeholders. The results led to the identification of the scope of DEH, including eHealth technologies and their applications, services, and future developments that are applicable to disasters as well as to related stakeholders. Reference to the elements of the DEH scope indicates what, when, and how current eHealth technologies can be used in the DMC. Conclusions Comprehensive data gathering from multiple databases offered a grounded method to define the DEH scope. This scope comprises concepts related to DEH and the boundaries that define it. The scope identifies the eHealth technologies relevant to DEH and the functions and services that can be provided by these technologies. In addition, the scope tells us which groups can use the provided services and functions and in which disaster types or phases. DEH approaches could potentially improve the response to health care demands before, during, and after disasters. DEH takes advantage of eHealth technologies to facilitate DMC tasks and activities, enhance their efficiency and effectiveness, and enhance health care delivery and provide more quality health care services to the wider population regardless of their geographical location or even disaster types and phases.

Neutrophil Gelatinase-Associated Lipocalin (NGAL) è uno dei più promettenti biomarcatori utilizzati nella diagnosi di “Acute Kidney Injury” (AKI), dal momento che il suo incremento è un buon predittore a breve termine dello sviluppo di insufficienza renale acuta in notevole anticipo rispetto all'incremento dei valori della creatinia sierica. Riportiamo la nostra esperienza di un caso di Crush Syndrome di due pazienti vittime dell'alluvione che ha coinvolto Messina. Lo sviluppo di AKI in seguito a Crush Syndrome è la seconda causa più comune di morte in seguito a terremoti o altri disastri naturali ma allo stesso tempo è una complicanza disastro-correlata che può essere reversibile in particolar modo in caso di diagnosi precoce e di altrettanto precoce trattamento. In questo caso, l'NGAL ci ha permesso di fare una diagnosi precoce di AKI preannunciando le alterazioni dei classici marker come la creatinina, inoltre abbiamo notato la correlazione diretta tra i valori di NGAL, l'evoluzione del danno renale e la prognosi per le due pazienti.

Mainstream healthcare has been facing numerous challenges, and it is expected to see that these challenges become more severe and frequent when healthcare is dealing with disasters. This points to the necessity of utilising technologies to support healthcare and disaster managers in making quality decisions during chaotic and rapidly changing conditions in disaster situations. Therefore, in this research, the objective is to identify the role of RFID technology in healthcare-related activities before, during, and after disasters in terms of application areas and phases of the disaster management cycle (DMC). A Delphi approach was used in this research. Two rounds of questionnaires were administered to a panel of experts to evaluate the actual and potential use of RFID applications for healthcare within DMC. The Delphi participants were the field experts in the areas of disaster management, disaster medicine, and information systems. Based on the Delphi results, RFID applications were seen to be most useful in the response and recovery phases of disasters. RFID was seen as being most helpful for health-related supply management and casualty information. There were concerns that privacy and security may be barriers to adoption and use. Other applications identified by this study include identifying and tracking medical resources (including clinicians and first responders) and their accurate coordination in the response missions, determining idle resources, and maximising their utilisation during response activities. In this research, 35 potential scenarios of RFID applications for healthcare purposes within DMC and Disaster e-Health (DEH) were evaluated with the Delphi participants. RFID technologies could play an important role in DMC and DEH to provide more reliable and timely information to support healthcare during disasters. Based on the research results, managing the supply chain emerged as a major RFID application for supporting disaster healthcare.

La tesi sostenuta in questo articolo è che i beni comuni del passato - quelli di sussistenza - possono diventare, se riletti ed aggiornati alla luce del presente, la spina dorsale di un ordine sociale alternativo a quello capitalistico, che domina sul mondo da circa tre secoli. Si ritiene che il "ritorno dei beni comuni", come viene chiamata la proposta presentata in questo elaborato, sia una necessità storica per riuscire a superare la crisi del capitalismo e i problemi da esso creati, specialmente nella sua ultima fase finanziaria: il saccheggio della natura, la privatizzazione dello spazio pubblico, la disoccupazione, le disuguaglianze sociali, i disastri ecologici. Per sostenere la proposta avanzata in questo articolo, prima di tutto vengono identificate le caratteristiche principali dei beni comuni come l'autogoverno da parte delle comunità locali., si ricorda brevemente come i beni comuni siano stati delegittimati dalla Rivoluzione industriale nel passaggio dal Medioevo alla modernità . Terzo: si mettono in evidenza le nuove "recinzioni" di acqua, aria, terra ed dell'energia, così come quella del cambiamento climatico. Quarto: il ritorno ai beni comuni richiede una fase intermedia, cioè la conversione ecologica delle economie che deve essere realizzata dalle comunità locali. Quinto: vengono considerati i motivi che non hanno ancora permesso al ritorno dei beni comuni di diventare il primo tema dell'agenda dei movimenti.

La questione dei beni comuni č in questo momento discussa in ogni angolo del mondo. E l'intensitŕ con cui il tema viene percepita č maggiore, piů acuta e anche culturalmente piů aggiornata in alcuni Paesi che un tempo si sarebbero detti del Sud del mondo. Basti pensare che alcune costituzioni dell'America Latina - per certi aspetti perfino mostruose nelle loro dimensioni (la Costituzione venezuelana ha 444 articoli!) - mettono i beni comuni al centro dell'attenzione e che uno di questi, il cibo, č affrontato con una novitŕ e una fantasia culturale in leggi, norme costituzionali, documenti del Brasile, del Kenya e dell'India. Dunque, se parliamo di beni comuni, dobbiamo guardarli non (solo) dall'angolo di casa nostra, anche perché in alcuni casi sarebbe impossibile. In questo momento uno dei beni comuni principali - la salvaguardia dell'ambiente planetario - č stato messo in grave pericolo dal terremoto di Fukushima e dalle sue conseguenze. Noi ci interroghiamo, ancora in questo momento, fino a che punto gli effetti di quanto č avvenuto rimarranno circoscritti all'area dove quel disastro si č verificato oppure se l'inquinamento atmosferico e del mare determineranno la contaminazione anche dei prodotti alimentari che importiamo dal Giappone. L'attenzione ai beni comuni ormai non puň, dunque, essere legata a un luogo e agli interessi di chi si trova in quel luogo.

È in atto un nuovo interesse nei confronti della smallness che non sia solo l'esito della lettura dei piccoli centri dal binocolo della grande scala. Oggi questi luoghi generano molteplici visioni, anche contrapposte: c'e` una grande attenzione al tema della fragilità e dell'abbandono così come a quello del ritorno ai luoghi. Il piccolo centro di Giampilieri Superiore (ME) rap-presenta una situazione particolare, essendo non abbastanza vicino al mare per rientrare tra gli insediamenti turistici costieri e non abbastanza lontano dal mare per poter rientrare nei progetti destinati alle aree interne (Snai); e se la frana del 2009 non lo avesse riportato alla ribalta nazionale per le 37 vittime sarebbe rimasto nel suo marginale anonimato. Invece, paradossalmente, proprio il disastro lo ha riportato al centro. Ma il totem della ricostruzione attraverso imponenti opere di ingegneria ha prevalso su una idea di sviluppo economico e sociale della comunità.

AbstractIntroductionThe March 11, 2011 disaster was unparalleled in the disaster history of Japan. There is still enormous effort required in order for Japan to recover from the damage, not only financially, but psychosocially. This paper is a review of the studies that have been undertaken since this disaster, from after the March 11th disaster in 2011 to the end of 2012, and will provide an overview of the disaster-health research literature published during this period.MethodsThe Japanese database Ichushi Ver. 5 was used to review the literature. This database is the most frequently used database in Japanese health-sciences research. The keywords used in the search were “Higashi Nihon Dai-shinsai” (The Great East Japan Earthquake).ResultsA total of 5,889 articles were found. Within this selection, 163 articles were categorized as original research (gencho ronbun). The articles were then sorted and the top four key categories were as follows: medicine (n = 98), mental health (n = 18), nursing (n = 13), and disaster management (n = 10). Additional categories were: nutrition (n = 4), public health (n = 3), radiology, preparedness, and pharmacology (n = 2 for each category). Nine articles appeared with only one category label and were grouped as “others.”ConclusionThis review provides the current status of disaster-health research following the Great East Japan Earthquake. The research focus over the selected period was greatly directed towards medical considerations, especially vascular conditions and renal dialysis. Considering the compounding factors of the cold temperatures at the time of the disaster, the geography, the extensive dislocation of the population, and the demographics of an aging community, it is noteworthy that the immediate and acute impact of the March 11th disaster was substantial compared with other events and their studies on the impact of disaster on chronic and long-term illness. The complexity of damage caused by the earthquake event and the associated nuclear power plant event, which possibly affected people more psychologically than physically, might also need to be investigated with respect to long term objectives for improving disaster preparedness and management.KakoM, ArbonP, MitaniS. Literature review on disaster health after the 2011 Great East Japan Earthquake. Prehosp Disaster Med. 2014;29(1):1-6.

ABSTRAK Bencana kebakaran memberikan dampak yang mempengaruhi kehidupan dan harta benda. Besarnya dampak semakin parah di tempat-tempat dengan tingkat kesiapsiagaan bencana kebakaran yang rendah. Kesiapsiagaan bencana salah satu elemen penting dalam pengurangan risiko bencana dan meliputi kesadaran masyarakat, kesiapan memberikan tanggapan yang tepat dan pemulihan yang cepat. Masyarakat memiliki peran dalam mengurangi resiko kebencanaan kebakaran. Komunitas dan masyarakat perlu memperkuat dan meningkatkan kemampuan dalam kesiapsiagaan bencana pada daerah dan tingkat komunitasnya. Tujuan penelitian ini untuk mengetahui kesiapsiagaan masyarakat di Kelurahan Pekauman Banjarmasin dalam menghadapi bencana kebakaran. Penelitian ini menggunakan rancangan deskriptif kuantitatif. Penggumpulan data menggunakan kuesioner. Sampel sebanyak 74 kepala keluarga di Kelurahan Pekauman RT.09 RW.01 yang diambil dengan total sampling. Analisa data menggunakan distribusi frekuensi. Dari hasil penelitian diperoleh kesiapsiagaan masyarakat dalam menghadapi kebakaran mayoritas berada dalam kategori sangat siap sebanyak 44 (59,5%), dan paling sedikit berada di kategori hamper siap sebanyak 7 (9,5%). Pemberdayaan masyarakat dapat mencegah terjadinya bencana dan meningkatkan kesiapsiagaan jika terjadi kebakaran. Kata kunci: kebakaran, kesiapsiagaan, komunitas. DAFTAR PUSTAKA Arismawati, M.D & Wijaya, O. (2019). Analisis Kesiapsiagaan Masyarakat dalam Menghadapi Bencana Kebakaran Pada Kawasan Pemukiman Padat Penduduk (Studi Kasus Kelurahan Prawirodirjan Yogyakarta). Artikel Kesehatan Masyarakat, Universitas Ahmad Dahlan. Badan Nasional Penanggulangan Bencana. (2019). Daftar Bencana Informasi Indonesia (Dibi). Jakarta:BNPB Baker, L. R., & Cormier, L. A. (2012). Disaster Preparedness and Families of Children with Special Needs: A Geographic Comparison. Journal of Community Health, 38(1), 106–112. Chan, E. Y. Y., Kim, J. H., Lin, C., Cheung, E. Y. L., & Lee, P. P. Y. (2012). Is Previous Disaster Experience a Good Predictor for Disaster Preparedness in Extreme Poverty Households in Remote Muslim Minority Based Community in China?. Journal of Immigrant and Minority Health, 16(3), 466–472. Dantzler, D. (2013). Basic household disaster preparedness decisionalInfluences among male federal employees in the national Capital region. Dissertation Doctor of Philosophy Capella University. ProQuest LLC. UMI Number:3559889. Farisa, F.C. (2018). BNPB: Selama 2018, Ada 1.999 Kejadian Bencana Kebakaran. Kompas.com. Retrieved 5 November 2020 at 13:20 WITA From Https://Nasional.Kompas.Com/Read/2018/10/25/22572321/Bnpb-Selama-2018ada-1999-Kejadian-Bencana Gowing, J. R., Walker, K. N., Elmer, S. L., & Cummings, E. A. (2017). Disaster Preparedness among Health Professionals and Support Staff: What is Effective? An Integrative Literature Review. Prehospital and Disaster Medicine, 32(03), 321–328. Haswar, Andi. M. (2021). Ada 45 Kasus Kebakaran dalam 5 Bulan di Banjarmasin, 2 Orang Meninggal Dunia. Retrieved from https://regional.kompas.com/read/2021/05/20/215702278/ada-45-kasus-kebakaran-dalam-5-bulan-di-banjarmasin-2-orang-meninggal-dunia. Hermon, Dedi. (2015). Geografi Bencana Alam. Jakarta Jaslow, D., Ufberg, J., Yoon, R., McQueen, C., Zecher, D., & Jakubowski, G. (2005). Fire Safety Knowledge and Practices Among Residents of an Assisted Living Facility. Prehospital and Disaster Medicine, 20(02), 134–138. Kuntoro, C. (2017). Implementasi Manajemen Risiko Kebakaran Berdasarkan (Is) ISO 31000 PT Apac. Inti Corpora. HIGEIA, 1(4), pp. 109-119 Martanto, C., Aji, A., & Parman, S. (2017). Kajian Kesiapsiagaan Masyarakat dalam menghadapi Bencana Kebakaran di Kelurahan Kembangsari Kecamatan Semarang Tengah. Edu Geography,2LIPI-UNESCO/ISDR. (2006). Kajian Kesiapsiagaan Masyarakat dalam mengantisipasi Bencana Gempa Bumi dan Tsunami. Nakao, R., Kawasaki, R., & Ohnishi, M. (2019). Disaster preparedness of hillside residential area in Nagasaki city, Japan: evaluations regarding experiences related to a fire. Journal of Rural Medicine, 14(1), 95–102. National Fire Protection Association (NFPA). (2018). Standar for Portable Fire Extinguisherts. USA Nugroho. (2015). Preparedness Assessment Tools For Indonesia. Jakarta: Humanitarian Forum Indonesia & MDM. Pahriannoor, Fauzan, A., & Hadi, Z. (2020). Relationship Of Knowlage And Nurse Attitude With Fire Prevention And Management Of Fire Ar RSUD Ulin Banjarmasin In 2020. Artikel Kesehatan Masyarakat. pdf Thomas, Tracy N., Griffith, Michelle Leander ., Harp, Victoria., Joan P. Cioffi. (2015). Influences of Preparedness Knowledge and Beliefs on Household Disaster Preparedness. 64(35); 965-971 Yulia, F. C. (2020). Kesiapsiagaan Masyarakat Dalam Menghadapi Bencana Kebakaran di Kampung Pelangi Kota Semarang Tahun 2020. Retrived 7 Mei 2021, from http://lib.unnes.ac.id/41191/1/3201416048.

By definition, hospitals should be among the places with the highest safety index (1). But often, on these premises, we have occasional accidents which may be dangerous and which illustrate the way hospitals are exposed to various and often undervalued risks.The incidences of unforeseen, dangerous situations involving sudden accidents, of uncontrollable emergency conditions and also of larger catastrophes are awful. Recent accidents proved inadequate safety inside hospitals. In Parma (2) escaping gas was followed by an explosion that destroyed a division of the hospital and resulted in wounded and dead. In Mondovi, an explosion in the central heating system of the hospital caused the death of an employee. A fire that broke out in an old people's home in Southern Italy brought about the death of three persons. The first shocks of the earthquake in 1980 caused the death of many patients and staff (including six physicians) in the so called “safe” hospital of San Angelo Dei Lombardi. In the earthquake in 1976 many patients and some personnel of the hospital staff in Gemona, Friuli lost their lives (3)Apparently these facts are not closely linked together. Some were caused by human error, others by inadequacy of buildings, age of structures, even where the disaster was due to natural causes. However all these events show the presence of the common denominator of “high risk,” typical of hospital structures (4,5). The principle dangerous situations are: (a) risks coming from the structures of the premises (no earthquake-proof principles of modular structure); and (b) risks connected with the working activities (6,7).

ABSTRACT: This article describes an algorithm for an adaptive distance protection in a sub-transmission system considering operating conditions with changes in the topology due to an abnormal condition, electrical failure or a natural disaster, includes the effect of adjacent generation in the distance relay protection zones, with the incorporation of renewable energies in mixed participation. Two scenarios are proposed, in the first case occurred a contingency, and the transmission systems changes the initial topology. Protections are automatically reparametrized. The second case includes the income of renewable energy generation in a specific point of power electrical Systems. Protections are automatically recalculated. The objective of an automatic coordination permit to operator to restore the sensitivity, selectivity and reliability the electrical protection system in the lowest time. Keywords: Adaptive distance relay, renewable energy, distance protection, infeed effect..)

Horticulture commodities, especially potatoes have a relatively high risk and economic value. Potato farming risks include production risk due to climate anomalies that cause pest and disease attacks, natural disasters, price risk, and other market risks. Knowledge of risk will direct farmers’ behavior on production activities and their farming performance. The objectives of this study were: (1) identify the risks from each potato farmer’s perceptions, (2) evaluate the priority risk for each potato farmer, (3) analyze the production performance of each potato farmer, and (4) compile a risk mitigation strategy potato farmer in Batu City. Research location choosen by multistage cluster sampling from subdistricts to villages that is a potato production’s center. The data were collected by structured interviews. The FAHP was used to analyze the risk faced by potato farmers. Measurement of potato production performance is carried out by analyzing technical efficiency using the DEA BCC model. The risk mitigation strategy is formulated considering risk priorities and the performance achieved by potato farmers. According to results, it is shows that collectively the highest risk comes from operational aspect by the score of 0,35. These operational risks can be mitigated by using desease-resistant varieties. The results of the potato production’s performance shows that 58,33% of the farmers are technically efficient. According to scale efficiency, 65% of farmers are operating on the IRS

West Sumatra Province is one of the provinces in Indonesia that is vulnerable to natural disasters, especially earthquakes and tsunamis. Padang city, as the capital city of West Sumatra, is an area that is included in an area with a high level of vulnerability (High Risk Zone) to tsunamis. Therefore, the construction of public buildings such as hospitals, government offices, and school buildings must have certain technical engineering that is able to anticipate the damage and collapse of buildings due to the earthquake and tsunami. One of the public buildings as an educational facility in Padang city is the Elementary School building of the 23/24 (SD 23/24 Padang), located close to the beach. Based on the evaluation results of the Detail Engineering Design (DED) documents, it is found that this building was designed without taking into account the tsunami loads. Therefore, a building assessment should be carried out to check the capacity of the building to resist the working loads, including the tsunami loads, and to investigate the effect of the tsunami loads on the SD 23/24 Padang building. In this study, the building was analyzed using ETABS v.18 software based on the new Indonesian Seismic Code, SNI 1726-2019 for seismic load and FEMA P646-2019 for calculating tsunami loads. The results show that the SD 23/24 Padang building is strong against earthquake loads, but it doesn’t have enough capacity when tsunami loads are applied, in which there are several structural elements (columns/beams) that do not have sufficient capacity to withstand the combined earthquake and tsunami loads. The effect of tsunami loads on the building structure is also discussed in this paper.

The pandemic of COVID-19 has afflicted every individual and has initiated a cascade of directly or indirectly involved events in precipitating mental health issues. The human species is a wanderer and hunter-gatherer by nature, and physical social distancing and nationwide lockdown have confined an individual to physical isolation. The present review article was conceived to address psychosocial and other issues and their aetiology related to the current pandemic of COVID-19. The elderly age group has most suffered the wrath of SARS-CoV-2, and social isolation as a preventive measure may further induce mental health issues. Animal model studies have demonstrated an inappropriate interacting endogenous neurotransmitter milieu of dopamine, serotonin, glutamate, and opioids, induced by social isolation that could probably lead to observable phenomena of deviant psychosocial behavior. Conflicting and manipulated information related to COVID-19 on social media has also been recognized as a global threat. Psychological stress during the current pandemic in frontline health care workers, migrant workers, children, and adolescents is also a serious concern. Mental health issues in the current situation could also be induced by being quarantined, uncertainty in business, jobs, economy, hampered academic activities, increased screen time on social media, and domestic violence incidences. The gravity of mental health issues associated with the pandemic of COVID-19 should be identified at the earliest. Mental health organization dedicated to current and future pandemics should be established along with Government policies addressing psychological issues to prevent and treat mental health issues need to be developed. References World Health Organization (WHO) Coronavirus Disease (COVID-19) Dashboard. 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During physical distancing, children do not meet their peers to play or talk together. Peer relationships have a crucial influence on all child development, especially for social skills or behaviour during early childhood. This study aims to determine changes in children's social behaviour during physical distancing during the Covid-19 pandemic. This research method is a descriptive quantitative study designed with the percentage value was used as a score for measuring the results of parental observations of children concerning the child's social behaviour instrument. Quota sampling (150 parents) was used to reach participants from various cities in Indonesia to see cultural differences. Data on children's social behaviour was obtained using the Preschool and Kindergarten Behaviour Scale (PKBS) tests. The data were then analysed using descriptive statistics. The results show that there are changes in children's social behaviour during physical distancing. Children who are less independent (58.9%) are the biggest decline in social behaviour reported by parents, while the one who changes the least is cleaning up the mess that has been made (38.7%). The implication of the results of this study is that parents should continue to pay attention to their children's social behaviour by providing opportunities for children to interact with peers in the house while still paying attention to health protocols. Keywords: Early Childhood, Social Behaviour, Physical Distancing References: Aksoy, P., & Baran, G. (2010). Review of studies aimed at bringing social skills for children in preschool period. Procedia - Social and Behavioural Sciences, 9, 663–669. https://doi.org/10.1016/j.sbspro.2010.12.214 Al-Tammemi, A. B. (2020). The Battle Against COVID-19 in Jordan: An Early Overview of the Jordanian Experience. Frontiers in Public Health, 8(May), 1–6. https://doi.org/10.3389/fpubh.2020.00188 Arkorful, V., & Abaidoo, N. (2015). 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The Lancet, 395(10227), 912–920. https://doi.org/10.1016/S0140-6736(20)30460-8 Cachón-Zagalaz, J., Zagalaz-Sánchez, M. L., Arufe-Giráldez, V., Sanmiguel-Rodríguez, A., & González-Valero, G. (2021). Physical activity and daily routine among children aged 0-12 during the COVID-19 pandemic in Spain. International Journal of Environmental Research and Public Health, 18(2), 1–13. https://doi.org/10.3390/ijerph18020703 Ceylan, S. S., Erdoğan, Ç., & Turan, T. (2021). Investigation of the effects of restrictions applied on children during Covid-19 pandemic. Journal of Pediatric Nursing, 61, 340–345. https://doi.org/10.1016/j.pedn.2021.09.013 Chaelin, K. R. et al. (2018). Association of Digital Media Use with Subsequent Symptoms of Attention Defi-cit/Hyperactivity Disorder Among Adolescents. J. Am. Med. Assoc. Corredor, G. A., Justicia-Arráez, A., Romero-López, M., & Benavides-Nieto, A. (2017). Longitudinal Study of the Effects of Social Competence on Behavioral Problems. 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The ecology of social support in relation to academic and behavioral self-perceptions among African American boys and girls. Journal of Human Behaviour in The Social Environment, 28(6), 798–816. Gülay, H., & Önder, A. (2013). A study of social-emotional adjustment levels of preschool children in relation to peer relationships. Education 3-13, 41(5), 514–522. https://doi.org/10.1080/03004279.2011.609827 Hu, B. Y., Johnson, G. K., Teo, T., & Wu, Z. (2020). Relationship Between Screen Time and Chinese Children’s Cognitive and Social Development. Journal of Research in Childhood Education, 34(2), 183–207. https://doi.org/10.1080/02568543.2019.1702600 Idoiaga Mondragon, N., Berasategi Sancho, N., Dosil Santamaria, M., & Eiguren Munitis, A. (2021). Struggling to breathe: A qualitative study of children’s wellbeing during lockdown in Spain. Psychology and Health, 36(2), 179–194. https://doi.org/10.1080/08870446.2020.1804570 Izza, H. (2020). 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Early Education and Development, 00(00), 1–18. https://doi.org/10.1080/10409289.2020.1843925 Leeuw, R. A. De, Logger, D. N., Westerman, M., Bretschneider, J., Plomp, M., & Scheele, F. (2019). Influencing factors in the implementation of postgraduate medical e-learning: A thematic analysis. 1–10. Liu, Y., Yue, S., Hu, X., Zhu, J., Wu, Z., Wang, J., & Wu, Y. (2021). Associations between feelings/behaviors during COVID-19 pandemic lockdown and depression/anxiety after lockdown in a sample of Chinese children and adolescents. Journal of Affective Disorders, 284(November 2020), 98–103. https://doi.org/10.1016/j.jad.2021.02.001 Mantovani, S., Bove, C., Ferri, P., Manzoni, P., Cesa Bianchi, A., & Picca, M. (2021). Children ‘under lockdown’: Voices, experiences, and resources during and after the COVID-19 emergency. Insights from a survey with children and families in the Lombardy region of Italy. 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Journal of Family Communication, 21(3), 186–204. https://doi.org/10.1080/15267431.2021.1931228 Mochida, S., Sanada, M., Shao, Q., Lee, J., Takaoka, J., Ando, S., & Sakakihara, Y. (2021). Factors modifying children’s stress during the COVID-19 pandemic in Japan. European Early Childhood Education Research Journal. https://doi.org/10.1080/1350293X.2021.1872669 Mohamed, A. H. H. (2017). Gender as a moderator of the association between teacher – child relationship and social skills in preschool. Early Child Development and Care, 0(0), 1–15. https://doi.org/10.1080/03004430.2016.1278371 Morelli, M., Cattelino, E., Baiocco, R., Trumello, C., Babore, A., Candelori, C., & Chirumbolo, A. (2020). Parents and Children During the COVID-19 Lockdown: The Influence of Parenting Distress and Parenting Self-Efficacy on Children’s Emotional Well-Being. Frontiers in Psychology, 11(October), 1–10. https://doi.org/10.3389/fpsyg.2020.584645 Morgül, E., Kallitsoglou, A., & Essau, C. (2020). Psychological effects of the COVID-19 lockdown on children and families in the UK. Revista de Psicología Clínica Con Niños y Adolescentes, 7(3), 42–48. https://doi.org/10.21134/rpcna.2020.mon.2049 Munasinghe, S., Sperandei, S., Freebairn, L., Conroy, E., Jani, H., Marjanovic, S., & Page, A. (2020). The Impact of Physical Distancing Policies During the COVID-19 Pandemic on Health and Well-Being Among Australian Adolescents. Journal of Adolescent Health, 67(5), 653–661. https://doi.org/10.1016/j.jadohealth.2020.08.008 Munastiwi, E., & Puryono, S. (2021). Unprepared management decreases education performance in kindergartens during Covid-19 pandemic. Heliyon, 7(5), e07138. https://doi.org/10.1016/j.heliyon.2021.e07138 Naser, A. Y., Al-Hadithi, H. T., Dahmash, E. Z., Alwafi, H., Alwan, S. S., & Abdullah, Z. A. (2020). The effect of the 2019 coronavirus disease outbreak on social relationships: A cross-sectional study in Jordan. 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This paper describes the origins and progress of an international project to advance disaster eHealth (DEH) – the application of eHealth technologies to enhance the delivery of healthcare in disasters. The study to date has focused on two major themes; the role of DEH in facilitating inter-agency communication in disaster situations, and the fundamental need to promote awareness of DEH in the education of disaster managers and health professionals. The paper deals mainly with on-going research on the second of these themes, surveying the current provision of disaster medicine education, the design considerations for a DEH programme for health professionals, the key curriculum topics, and the optimal delivery mode.

Questo articolo si propone di analizzare il disastro globale causato dall'epidemia di COVID-19 che ha turbato l'esistenza di quasi tutta l'umanità. Esaminare le significative limitazioni alle libertà individuali e collettive per proteggere la salute pubblica e, in secondo luogo, mitigare il più possibile l'impatto della pandemia sulle attività economiche. L'attenzione dell'articolo si concentrerà esclusivamente sulle norme che impattano sulla disciplina generale delle obbligazioni e dei contratti, tralasciando le importantissime disposizioni in materia di rapporti di lavoro, contratti di mutuo, contratti bancari e assicurativi, ecc. Verificherà fino a che punto la situazione sociale, sanitaria, economica e istituzionale determinata dalla pandemia rappresenti uno stato di emergenza, non dissimile dal dopoguerra, ma che non deve e non può essere considerato uno stato di eccezione.

To predict weather conditions as an anticipation act towards natural disasters, a weather radar is needed. In weather radar technology, antennas play an important role in supporting the performance of the weather radar. Vivaldi antenna is the right choice because it has an unlimited bandwidth so it is able to operate at the desired work frequency, including the working frequency of weather radar (9.4 GHz). This research discusses the modification of tapered slots, circular stub, radial stub, length and width of the reference vivaldi antenna [1] using CST Studio software. After modifications and measurements, a return loss value of -23.25336989 dB, bandwidth of 500 MHz, VSWR 1.188463357, gain of 3.99 dBi, and unidirectional radiation patterns. All the resulting antenna parameter values are in good condition and qualify the weather radar antenna for a working frequency of 9.4 GHz.

Mount Semeru had erupted three times in 2021. The last eruption caused many victims. The fact that there were many death toll and citizens affected by the eruption, many people started to blame the PVMBG, as the responsible government agency to the disaster since their duties are to monitor the volcano activities and to give prior warning to the citizens who lived near the volcano. A news article was written a few days after the mount erupted. This article contains many explanations and clarifications from the PVMBG. Therefore, this current study aims to review a news article entitled “Mount Semeru eruption warning issued on Dec 1, PVMBG claims”. There are two problems addressed in this study; 1) “What social wrong does Tempo’s text reveal in the Mount Semeru eruption warning article?”; and 2) “What ideology does Tempo’s text reflect in the Mount Semeru eruption warning article?”. In answering these problems, the writer employed critical discourse analysis. The method used in this study is Critical Discourse Analysis. Furthermore, Fairclough's four stages and three dimensions approach of CDA were used. The sentences which show the social wrong are chosen and analyzed by using the transitivity. The findings show that the social wrong is the PVMBG insists that they are not responsible for the numbers of victims caused by the eruption. The PVMBG needs the social wrong since they try to keep their good image and professionalism. The solutions to the problem are related to the involvement of the citizens in the group message and the improvement of the geological mitigation programs.

Catastrophic expenditure occurs when a household allocates more than 40% of its effective, or non-subsistence, income for health expenditures.1,2 In general, low-income households, those with older persons or persons with disabilities, and families with members requiring healthcare for chronic illnesses are more likely to experience this phenomenon. 3 In the Philippine setting, it has also been suggested that disasters create catastrophic spending situations.4 As household incomes are generally fixed, incurring unexpected, large, and/or long-term expenditures typically means either reducing allocation for other expense items (e.g., diminution of the budget for food or shelter) or sourcing funding elsewhere (e.g., incurring substantial debt to bridge the shortfall), and may lead to the impoverishment of the family, particularly for those who are living remarkably close the knife’s edge of poverty. Hence, protecting individuals and families from such financial catastrophe has become an important policy objective at the global and domestic levels.5–7 Using the 40% non-subsistence income threshold, it has been estimated that the 0.78% (95% uncertainty interval: 0.71 – 0.85) of households in the Philippines experienced catastrophic health expenditure.1 Meanwhile, using a 25% total household budget as a cut-off point – as measured for the Sustainable Development Goals – would increase the proportion to 1.41% of households.8 These figures, however, seem to underestimate the actual situation, as shown by related data from the 2018 Family Income and Expenditure Survey and the Philippine National Health Accounts 2014-2019.9,10 First, households typically spend around 75% of their income, which translates to an average annual savings of about 75,000 pesos. Second, roughly two-thirds (63%) of expenses were allocated for food, shelter, and utilities. In comparison, only 2.7% went to health expenses (or about 6,500 pesos per year for the entire household, using as reference the 239,000 pesos total annual household expenses). Third, the per capita health expenditure in 2019 was estimated at Php 6,662.20 – the bulk of which went to curative care in hospitals – nearly half (47.9%) contributed directly from out-of-pocket. In short, regularly, households allocate only a small amount for health-related expenses but are forced to spend more when presented with conditions requiring more expensive treatment. A separate analysis showed that catastrophic health expenditures were, on average, more than 60,000 pesos annually; medicines and in-patient services accounted for two-thirds of this amount.11 Given that the net household savings are not substantial, the question arises as to where the difference in funding requirement comes from. Lasco et al.’s paper in this issue provides an answer in this respect and extends our insight into how individuals and families deal with health expenditures.12 Drawing on data gathered from 30 focus group discussions participated in by 250 individuals representing different socio-demographic and stakeholder groups, their results offer a human dimension to the processes that families go through as they initially forego help-seeking, owe money, and finally request institutional assistance to finance their health need. The low incidence of catastrophic health expenditure in the country currently documented by official sources may be attributed to either of two scenarios. The optimistic scenario is that institutional assistance and subsidized healthcare in government facilities can bridge the shortfall in health financing, averting financial catastrophe for the family. Our prior research, however, has shown that such institutional assistance is almost always not sufficient to cover the deficit unless a family is resourceful enough that they can tap multiple providers or donors.13,14 The alternative is that individuals or families do not go beyond the first stage of pagtitiis, so much so that no further treatment can be offered when the individual interfaces with a healthcare provider. An additional point must be thought-out when considering catastrophic health expenditure. Health needs are fraught with uncertainty, which biases an individual’s capacity to adequately prepare, financially or otherwise, for such occurrence. Uncertainty in this sense means that there is a dimension of indeterminacy of a future health state, such as when healthcare professionals discuss the risk of a person suffering complications from a chronic illness.15 Prior research has shown that accurate risk perceptions are vital in healthcare. 16 Yet, we are well aware that the concept of risk, or chance, is a rather abstract notion that distorts our decision-making processes, especially about things that are unknown, unobserved, or not yet experienced.17 The burden, therefore, of preparing for unexpected healthcare expenditure should be shifted from the individual or household through the strengthening of existing social safety nets and reducing the out-of-pocket share in total health expenditure. This will entail additional investments by the government and the social health insurance program and will be among the challenges that the new dispensation will have to consider as we collectively rise from the ravages of the pandemic. Carl Abelardo T. Antonio, MD, MPH Department of Health Policy and Administration College of Public Health University of the Philippines Manila, Manila, Philippines REFERENCES World Health Organization. Designing Health Financing Systems to Reduce Catastrophic Health Expenditure [Internet]. Geneva: World Health Organization; 2005 [cited 2022 Jun 06]. Available from https://apps.who.int/iris/handle/10665/70005. Xu K, Evans DB, Kawabata K, Zeramdini R, Klavus J, Murray CJ. Household Catastrophic Health Expenditure: A Multicountry Analysis. Lancet. 2003 Jul 12;362(9378):111-7. doi: 10.1016/S0140-6736(03)13861-5. Azzani M, Roslani AC, Su TT. Determinants of Household Catastrophic Health Expenditure: A Systematic Review. Malays J Med Sci. 2019 Jan;26(1):15-43. doi: 10.21315/mjms2019.26.1.3. Espallardo N, Geroy LS, Villanueva R, Gavino R, Nievera LA, Hall JL. A Snapshot of Catastrophic Post-disaster Health Expenses after Typhoon Haiyan. Western Pac Surveill Response J. 2015 Nov 6;6 Suppl 1(Suppl 1):76-81. doi: 10.5365/WPSAR.2015.6.2.HYN_017. World Health Organization. The World Health Report. Health Systems Financing: The Path to Universal Coverage [Internet]. Geneva: World Health Organization; 2010 [cited 2022 June 6]. Available from https://apps.who.int/iris/handle/10665/44371 United Nations. Transforming Our World: The 2030 Agenda for Sustainable Development [Internet]. [New York]: United Nations; 2015 [cited 2022 June 6]. Available from https://sdgs.un.org/publications/transforming-our-world-2030-agenda-sustainable-development-17981 Congress of the Philippines. Republic Act No. 11223, Universal Health Care Act [Internet]. 2019 [cited 2022 June 6]. Available from https://www.officialgazette.gov.ph/2019/02/20/republic-act-no-11223/ World Health Organization. Global Health Observatory [Internet].n.d. [cited 2022 June 6]. Available from https://www.who.int/data/gho/data/indicators/indicator-details/GHO/population-with-household-expenditures-on-health-greater-than-25-of-total-household-expenditure-or-income-(-sdg-indicator-3-8-2)-(-) Philippine Statistics Authority. 2018 Family Income and Expenditure Survey. Volume 1. National and regional estimates [Internet]. Quezon City: Philippine Statistics Authority; 2020 [cited 2022 June 6]. Available from https://psa.gov.ph/sites/default/files/FIES%202018%20Final%20Report.pdf Philippine Statistics Authority. Philippine National Health Accounts 2014-2019 [Internet]. Quezon City: Philippine Statistics Authority; 2020 [cited 2022 June 6]. Available from https://psa.gov.ph/sites/default/files/Publication%20PNHA%202019%20signed_0.pdf Bredenkamp C, Buisman LR. Financial Protection from Health Spending in the Philippines: Policies and Progress. Health Policy Plan. 2016 Sep;31(7):919-27. doi: 10.1093/heapol/czw011. Lasco G, Yu VG, David CC. The Lived Realities of Health Financing: A Qualitative Exploration of Catastrophic Health Expenditure in the Philippines. Acta Med Philipp. 2022; 56(11):11-21. doi.org/10.47895/amp.vi0.2389. Antonio CT, Bermudez AC, Cochon KL, Garcia FB, Gueverra JP, Manalo JA, Quizon RR, Salvino RP, Benedicto EG. Stakeholder Perceptions on the Challenges of Financing Debilitating Illnesses: The Case of Colorectal Cancer and Schizophrenia in the Philippines. Phil J Health Res Dev. 2017;21(2):17-19. Guevarra JP, Antonio CT, Cochon KL, Bermudez AC, Garcia FB, Manalo JA, Pagtiilan GT, Guevarra EM, Salvino RP, Benedicto EG. Financial Assistance for Treatment of Schizophrenia in the Philippines. Acta Med Philipp. 2022;56(5):75-81. doi: 10.47895/amp.vi0.3376. Han PK, Klein WM, Arora NK. Varieties of Uncertainty in Health Care: A Conceptual Taxonomy. Med Decis Making. 2011 Nov-Dec;31(6):828-38. doi: 10.1177/0272989x11393976. Ferrer R, Klein WM. Risk Perceptions and Health Behavior. Curr Opin Psychol. 2015 Oct 1;5:85-89. doi: 10.1016/j.copsyc.2015.03.012. Enke B. What You See is All There Is. Q J Econ. 2020; 135(3): 1363-98. doi: 10.1093/qje/qjaa012.

Photo by Sangharsh Lohakare on Unsplash ABSTRACT The public should debate the ethical and social challenges arising from heritable human genome editing (HHGE). The notorious case involving He Jiankui may have led to the disfavor of gene editing and a precautionary approach. While the de facto global moratorium on HHGE is clearly justified considering our current inability to implement it safely and effectively, the difficult ethical considerations should be addressed prior to the ability to initiate widespread HHGE. This piece argues that prospective patients and other members of society beyond the scientific community must be included in the conversation. It emphasizes the potential role of those not directly participating in HHGE science, calling the broader academic community not simply to wait for scientists’ results and only afterward react. Pointing to key historical examples, I contend that scientific progress is intrinsically linked with the surrounding societal discussion and that it is not only scientists who can influence where the HHGE story ends. INTRODUCTION l. Rogue Scientists Chinese biophysicist He Jiankui announced the world’s first genetically modified babies in 2018. Naturally, the treatment aroused the attention of the world’s media, which focused on He’s reckless actions. Indeed, in setting up and carrying out the procedure in question, he flouted norms of good scientific practice on a range of levels—errors paid with time in prison. Since the He controversy, few scientists have aggressively approached heritable human genome editing (HHGE) and challenged the current research norms. The most outspoken exception is the Russian molecular biologist Denis Rebrikov of the Pirogov Russian National Research Medical University. He publicly declared his intention to apply clustered regularly interspaced short palindromic repeats (CRISPR) to embryos to help couples avoid passing serious medical conditions to their children. However, Rebrikov met fierce opposition both inside and beyond Russia and, with leading CRISPR scientists and bioethicists abroad describing him as a “cowboy” who had “weak data” and was trying to “grab some attention.”[1] So far, Rebrikov’s plans have failed to come to fruition. Although there are 126 entries listed in a registry of HHGE research recently created by the World Health Organization (WHO),[2],[3] it seems that clinical HHGE has been paused for the time being. ll. Steering the Conversation A section of the scientific community has been trying to steer the ethical debate on HHGE away from the actions of rogue scientists and back to an issue that is central to the matter—the interests of patients. The majority would agree that the most compelling potential application of germline genome editing is for the prevention of devastating genetic conditions, for example, when both parents carry Huntington’s disease, for which “genome editing offers the only prospect of bearing a healthy, genetically related child.”[4] Despite such justification for scientists to continue pursuing research in the area, there has been a notable reticence in the wider academic community regarding making the ethical case for HHGE and clarifying in which medical situations such a technique might be reasonably applied. Even among those who recognize that the HHGE cases' controversies should not be a reason for panic over designer babies, some believe that starting the ethical debate is premature. A key part of the argument is that the current technological and scientific knowledge available is far from ready to deliver on treatments. A similar stance preventing debate in the wider society is that “difficult questions” about cost, accessibility, and social justice remain.[5] Whether intended or not, the implication is that the position of wider society in the HHGE story should be a reactive one, namely waiting to see what the scientists throw at them and then dealing with it. I argue that there is not only an immediate need for broader academic and societal input on the ethical and social aspects of the HHGE debate but that there is a deep symbiosis between scientific progress and its surroundings, whereby science both shapes and is shaped by the societal environment in which it takes place. The WHO published a position paper, recommendations, and a framework for governance. The framework for governance describes global standards for the governance and oversight of HHGE.[6] The position paper emphasized the importance of global and inclusive dialogue,[7] and many other boards have also called for broad public engagement.[8] It is imperative that WHO’s governance framework meets everyone’s needs. After all, as with any medical treatment, it is not the scientist who developed the treatment or the doctor who delivers it that is most important– that honor falls to the patient. In the case of HHGE, the beneficiaries include those members of society who hope to reproduce. Yet HHGE has the potential to impact society. We all should have an opportunity to be a part of world-changing decisions that lead to the creation are made and feel a responsibility to participate. lll. Shutting Down the Academic Debate At the 30th Annual Conference of the Japanese Association for Bioethics, which took place in late 2018 after He’s experiment, the discussion about HHGE was shut down quickly. Notwithstanding the understandable issues raised with He’s case, one participant after another stood up to voice support for an outright and complete ban on the use of CRISPR.[9] The ban was based on the grounds that editing the human genome would result in a cascade of unforeseen and irreversible consequences for future generations. One participant forcefully argued that “the deoxyribose nucleic acid (DNA) rubicon should never be crossed for above all, it was deeply immoral to do so when there was no way of obtaining the consent of those who would actually stand affected—our descendants.”[10] Another saw it as putting humanity on a slippery slope toward enhancements, and some feared the catastrophic mistakes that might result from their use.[11] While the above event provides just one snapshot of the debate that was taking place around the world at the time, it captures the strong reservations in the scientific community. It is a common view, not only in Japan, that the human genome is something sacred, a relic handed down from generations, that we ought to treasure and preserve. In support of such a view, religious and other more pragmatic reasons are offered. For example, some may fear the disasters that might befall us if we choose to intervene in the process through which we pass our genetic code from one generation to another. Such arguments are certainly still at the heart of the ethical debate, but the foundations upon which they are built are by no means universally accepted. Stanford University bioethicist Henry Greely writes, “the human germline genome” does not exist; instead, each of us has a unique genome.[12] Greely argues that HHGE is no different from the changes our genomes have undergone through numerous medical interventions. For example, synthetic insulin has increased the number of people with DNA variations that lead to diabetes. Those with this condition would have died as a child in the past. However, now they live long enough to be able to reproduce. Similarly, the transition from hunting to farming centuries ago resulted in a greater number of copies in our gene pool of starch-digesting genes. Yet Greely suggested that, practically, HHGE is “not very useful in the near- to midterm” (by which he means “the next several decades”)[13] “mainly because other technologies can attain almost all the important hoped-for benefits of [HHGE], often with lower risk,” citing embryo selection and somatic gene editing as two alternative options. Greely argued that applying HHGE for enhancement beyond disease prevention and is currently not a realistic option because we lack the necessary knowledge. In Greely’s opinion, “how worried should we be [about HHGE]…? A bit, but not very and not about much.”[14] Greely’s assertions that other scientific debates should take precedence and that the concerns are not ripe for debate yet are concerning. lV. Why Shutting Down the Debate Might Not be a Good Idea First, the timeframe described by Greely seems somewhat out of line with that described by leading scientists. As far back as 2018, at the same Summit where He made his revelations, George Q. Daley stressed that HHGE is scientifically feasible here and that the ethical considerations can no longer be put off: “…a number of groups have applied gene editing now to human embryos in the context of in vitro fertilization and attempting to determine variations of a protocol that would enhance the fidelity and reduce mosaicism. I think there has been an emerging consensus that the off-target problem is manageable, and in some cases even infinitesimal. There are some interesting proofs of principles, like diseases such as beta-thalassemia that could potentially be approached with this strategy.”[15] It would also be possible to challenge Greely on various other aspects. One of which would be the number of cases to which HHGE would be relevant and the kinds of moral allowances that might be made, and each case concludes that more urgency is required in the ethical debate. Greely suggests that most people can use preimplantation genetic testing (PGD), which is the embryo selection process, and that perhaps HHGE could apply to couples where both have the same autosomal recessive gene.[16] Greely rules out considering HHGE in cases where PGD is applicable. Greely concedes PGD does not already represent the answer on this topic, as it often fails to provide couples with enough healthy embryos to transfer. As a resolution to this issue, he points to the creation of eggs using induced pluripotent stem cell (iPSC) techniques, whereby eggs can potentially be created from other cells.[17] However, given the extremely limited success of iPSCs in the clinical arena to date, in vitro gametogenesis is a highly speculative solution. Certainly, the progress of iPSC research is not such a safe bet that placing all our hopes on it at the expense of HHGE techniques is currently justified. (Also, it should be noted that making eggs using the iPSC technique is hardly an ethical problem-free area itself.) In summary, the cases of couples looking to conceive that Greely rules out by pointing to PGD should be kept on the HHGE table, as various other scholars have suggested.[18] Many of us debating HHGE are not scientists, so the best we can do is draw from the information we glean from those more technically capable. As a society, we are not just passive observers of science; we should have influence over decisions that impact society. Indeed, even if the available science is not yet at a place where we should be worried about large-scale ethical and social concerns, the story will continue to unfold in the future. While Greely is happy to see the human race “muddle through” the ethical challenges of scientific breakthroughs, such a position fails to recognize that society at large is far from powerless. V. Society Influencing Scientific Progress There are some notable examples of society’s impact on scientific progress. For example, political policies led to the development of nuclear technology for war and strategic deterrence, despite societal objections seen through demonstrations of people protesting using the slogan “no nukes.” Furthermore, the Bush administration drastically limited the use of embryonic stem cells in the 2000s due to a strong religious and cultural influence on policy.[19] Societal debate potentially serves as a powerful factor in guiding science. Where societal acceptance is ambiguous, science tends to operate on its own. But where science would impact life’s fundamental issues like war, how embryos should be valued, or the end of life, society should weigh in and influence the role of science. Societal views on the current global moratorium on HHGE could lead to a ban, as has been advocated.[20] On the other hand, societal views that value HHGE as a way to expand reproductive autonomy may justify permitting its use. Opening an ethics debate about it would enable scientists to pursue technologies that society deems justifiable as well as set limits for where they should stop. Making this process more difficult, the He affair has clearly colored public discourse on HHGE in a way that inhibits debate. In Japan, a sequence of questionnaires in 2016, 2018, and 2019 showed that the widely publicized HHGE scandal led to a significant decline in the acceptance of genome editing technology in general, particularly for human reproduction. Specifically, the surveys revealed a stark rise in disapproval of the technology’s use on fertilized human eggs—from 12 percent in 2018 to 29 percent in 2019.[21] The three scientists that conducted these surveys suggested that “the news of the twin babies in China had a substantial influence on the Japanese public,” damaging the reputation of HHGE.[22] It seems likely that the public distaste for HHGE was prompted by He’s research rather than considerations about the scientific potential of HHGE The change in public opinion may also make politicians and scientists more hesitant when it comes to taking the lead in the HHGE debate. Ultimately, this can restrict the public discussion of the central ethical challenges of the technology and hinder efforts to determine whether there is a responsible path forward other than an outright ban. Stressing the importance of the issue again to potential patients and failing to engage further with the HHGE debate is surely not something society should allow. While there are many important ongoing debates about genetics, like biohacking and DIY hobbyists, HHGE deserves attention as well. In fact, attention to the ethics of HHGE should help — more awareness of how these tools can be applied and what germline genome editing is will make people more alert to the existing danger and better understand how to mitigate it. Perhaps more importantly, a clear message from society to researchers about what objectives are reasonable to pursue regarding the HHGE technologies will facilitate good science. Having a publicly determined criterion would allow scientists to not live in fear that they might be blacklisted for seeking progress in grey areas and instead confidently chase progress where it is allowed. Vl. What Now? HHGE is here (or will be soon) and brings many ethical and social challenges. However, the challenges should not be left to individual scientists and couples in desperate situations to manage alone. Moving toward how these challenges can be met practically, it is helpful to draw a parallel with the issue of implementing human rights. In the early 21st century, political philosopher Michael Freeman of the University of Essex lamented that implementing human rights had been left to lawyers. Although legal experts were clearly essential in putting together the global human rights framework, Freeman’s concern was that they were not best placed to understand implementing human rights in various contexts. Setting out a broader, interdisciplinary approach, he called for social scientists to tackle these difficult questions, ultimately moving human rights forward around the world. Similarly, in medical technology like HHGE, scientists are crucial to the story, but at the same time, they are not trained to deal with all the accompanying challenges. Bioethicists are also important, clarifying the arguments that society needs to resolve. There is a need for even wider input from across the scholarly community. For instance, as with human rights, international and domestic regulation is required, and clearly, the legal community has a role here. Moreover, as described by Freeman, since all law is political in its creation and has impacts across society, political scientists and sociologists can provide impactful input. CONCLUSION We are in it together, and we have roles to play in the discussion of HHGE. Societal discourse does not always trail the scientific reality, but rather, it can condition the path that science will follow. Given the importance of what is at stake, not only for the potential patients, but for humanity, we should not leave the HHGE debate only to scientists, and we should not leave it until later. - [1] Cohen J. “Embattled Russian scientist sharpens plans to create gene-edited babies,” Science, 21 Oct. 2019. doi:10.1126/science.aaz9337. [2] World Health Organization. “WHO issues new recommendations on human genome editing for the advancement of public health,” News release, 12 July 2021, www.who.int/news/item/12-07-2021-who-issues-new-recommendations-on-human-genome-editing-for-the-advancement-of-public-health. [3] World Health Organization. “Human Genome Editing Registry,” https://www.who.int/groups/expert-advisory-committee-on-developing-global-standards-for-governance-and-oversight-of-human-genome-editing/registry. [4] Daley GQ, Lovell-Badge R, and Steffann J. “After the Storm–A Responsible Path for Genome Editing,” New England Journal of Medicine 380, no. 10 (2019): 897-9. doi:10.1056/NEJMp1900504. [5] Daley GQ, Lovell-Badge R, and Steffann J. “After the Storm–A Responsible Path for Genome Editing,” New England Journal of Medicine 380, no. 10 (2019): 897-9. doi:10.1056/NEJMp1900504 [6] World Health Organization. “WHO issues new recommendations on human genome editing for the advancement of public health,” News Release, July 12, 2021, www.who.int/news/item/12-07-2021-who-issues-new-recommendations-on-human-genome-editing-for-the-advancement-of-public-health. [7] WHO 2021. Human Genome Editing: Position Paper, WHO Expert Advisory Committee on Developing Global Standards for Governance and Oversight of Human Genome Editing. [8] Daley GQ, Lovell-Badge R, and Steffann J. “After the Storm–A Responsible Path for Genome Editing,” New England Journal of Medicine 380, no. 10 (2019): 897-9. doi:10.1056/NEJMp1900504. [9] 30th Annual Conference of the Japanese Association for Bioethics, 8-9 Dec. 2018, Kyoto Prefectural University, Kyoto. [10] 30th Annual Conference of the Japanese Association for Bioethics, 8-9 Dec. 2018, Kyoto Prefectural University, Kyoto. [11] 30th Annual Conference of the Japanese Association for Bioethics, 8-9 Dec. 2018, Kyoto Prefectural University, Kyoto. [12] Greely HT. “Why the Panic Over ‘Designer Babies’ Is the Wrong Worry,” LeapsMag, 30 Oct. 2017, leapsmag.com/much-ado-about-nothing-much-crispr-for-human-embryo-editing; Greely HT. “CRISPR’d babies: human germline genome editing in the ‘He Jiankui Affair’,” Journal of Law and the Biosciences 2019; 6(1): 111–83. doi: 10.1093/jlb/lsz010; Greely HT. CRISPR People: The Science and Ethics of Editing Humans (Massachusetts: Massachusetts Institute of Technology Press, 2021). [13] Greely HT. “Why the Panic Over ‘Designer Babies’ Is the Wrong Worry,” LeapsMag, 30 Oct. 2017, leapsmag.com/much-ado-about-nothing-much-crispr-for-human-embryo-editing. [14] Greely HT. “Why the Panic Over ‘Designer Babies’ Is the Wrong Worry,” LeapsMag, 30 Oct. 2017, leapsmag.com/much-ado-about-nothing-much-crispr-for-human-embryo-editing. [15] Daley, G. (n.d.). Genome-editing-pathways to Translation. Transcript of the Human-Genome Editing Summit 2018 Hong Kong. Retrieved March 17, 2022, from https://diyhpl.us/wiki/transcripts/human-genome-editing-summit/2018-hong-kong/george-daley-genome-editing-pathways-to-translation/ [16] Greely HT. “CRISPR’d babies: human germline genome editing in the ‘He Jiankui affair’,” Journal of Law and the Biosciences 2019: 6(1): 111–83. doi:10.1093/jlb/lsz010. [17] Greely HT. 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