Planning for grey rhino risks : How to prepare for the 'unforeseeable'.

Grey rhino risks are high-impact but seemingly low-probability risks that get shuttled to the sidelines, often due to a misguided hope that the risk will not materialise in the near term, so mitigation planning can be delayed or dismissed. As the author has argued previously in this journal, it is time to change the way we look at risks in order to reassess and re-prioritise our grey rhino risks. We must stop shrugging our shoulders and treating grey rhinos as 'unforeseeable' and therefore absolving ourselves from doing anything about them. The author's previous paper, ''Rhinos and risk assessments: Adjusting risk assessment methodologies to account for "unforeseeable' events"'1 provided a methodology for pulling grey rhinos into the spotlight, so that we can see them more easily and recognise that their high-impact status requires both acknowledging and planning for. The present paper takes the methodology a step further - demonstrating how to plan for grey rhino risks that have been identified. Rather than continuing to tag grey rhinos as 'unforeseeable', we can and must prepare our organisations for them.

Plasma p217+tau versus NAV4694 amyloid and MK6240 tau PET across the Alzheimer's continuum.

Introduction: We evaluated a new Simoa plasma assay for phosphorylated tau (P-tau) at aa217 enhanced by additional p-tau sites (p217+tau). Methods: Plasma p217+tau levels were compared to 18F-NAV4694 amyloid beta (Aß) positron emission tomography (PET) and 18F-MK6240 tau PET in 174 cognitively impaired (CI) and 223 cognitively unimpaired (CU) participants. Results: Compared to Aß- CU, the plasma levels of p217+tau increased 2-fold in Aß+ CU and 3.5-fold in Aß+ CI. In Aß- the p217+tau levels did not differ significantly between CU and CI. P217+tau correlated with Aß centiloids P = .67 (CI, P = .64; CU, P = .45) and tau SUVRMT P = .63 (CI, P = .69; CU, P = .34). Area under curve (AUC) for Alzheimer's disease (AD) dementia versus Aß- CU was 0.94, for AD dementia versus other dementia was 0.93, for Aß+ versus Aß- PET was 0.89, and for tau+ versus tau- PET was 0.89. Discussion: Plasma p217+tau levels elevate early in the AD continuum and correlate well with Aß and tau PET.

Rhinos and risk assessments: Adjusting risk assessment methodologies to account for 'unforeseeable' events.

It is wrong to describe the COVID-19 pandemic as a 'black swan' (ie a catastrophic event that no one saw coming). Far more apt would be to call it a 'grey rhino' - something that has long been predicted but overlooked by leadership the world over. This paper argues that it is time to stop relying on outdated risk formulas and adjust risk assessment methodologies to account for these grey rhinos. Simply put, it is time to accept that the potential impact of an event is more important than its likelihood.

Leprosy's Untainted Child.

In the face of an obdurate disease, the Mission to Lepers made a virtue out of "saving" children from leprosy and from paganism by separating them from their parents so that they became a source of publicity, sponsorship, and fund-raising. This policy transformed a benevolent work of mercy into a professional one, for it soon became clear that children separated from their parents did not develop leprosy. Consequently, the asylum became a site where scientific conclusions were made about the transmission of the disease, and the authority of the mission was enhanced at international medical conferences. This nascent professionalism became sufficient for the Philippines to also be persuaded to remove children from their leprosy-infected parents. In turn, Culion-based research on the observations of children ensured the authority of the American and Philippine doctors in informing decisions made by the League of Nations and later the World Health Organization.

The leprosy asylum in India: 1886-1947.

Writing against a historical practice that situates the leprosy asylum exclusively within prison-like institutions, this article seeks to show the variation in leprosy asylums, the contingencies of their evolution, and the complexity of their designs, by devoting attention to the characteristics of the leprosy asylum in India from 1886 to 1947, in particular to the model agricultural colony. Drawing upon the travel narratives of Wellesley Bailey, the founder of the Mission to Lepers in India, for three separate periods in 1886, 1890-91, and 1895-96, it argues that leprosy asylums were formed in response to a complex conjunction of impulses: missionary, medical, and political. At the center of these endeavors was the provision of shelter for persons with leprosy that accorded with principles of good stewardship and took the form of judicious use of donations provided by benefactors. As the Mission to Lepers began to bring about improvements and restructuring to asylums, pleasant surroundings, shady trees, sound accommodation, and good ventilation became desirable conditions that would confer physical and psychological benefits on those living there. At the same time, the architecture of the asylum responded to economic imperatives, in addition to religious and medical aspirations, and asylums moved towards the regeneration of a labor force. Leprosy-affected people were increasingly employed in occupations that contributed to their sustenance and self-sufficiency, symbolically reincorporating the body damaged by leprosy into the economic world of productive relations.

Leprosy and the elusive M. leprae: colonial and Imperial medical exchanges in the nineteenth century.

In the 1800s, humoral understandings of leprosy successively give way to disease models based on morbid anatomy, physiopathology, and bacteriology. Linkages between these disease models were reinforced by the ubiquitous seed/soil metaphor deployed both before and after the identification of M.leprae. While this metaphor provided a continuous link between medical descriptions, Henry Vandyke Carter's On leprosy (1874) marks a convergence of different models of disease. Simultaneously, this metaphor can be traced in popular medical debates in the late nineteenth century, accompanying fears of a resurgence of leprosy in Europe. Later the mapping of the genome ushers in a new model of disease but, ironically, while leprosy research draws its logic from a view of the world in which a seed and soil metaphor expresses many different aspects of the activity of the disease, the bacillus itself continues to be unreceptive to cultivation.

The papers of Stanley Browne: leprologist and medical missionary (1907-1986).

This article elaborates a significant archival acquisition that supplement the collection documents related to the life and work of Stanley George Browne held at the Wellcome Library for the History and Understanding of Medicine in London, specifically his work in the Belgian Congo (from 1936 to 1959), at Uzuakoli in Nigeria (1959 to 1966), in London with the Leprosy Study Centre (1966-1980), and also in his international capacity as leprosy consultant. It also briefly refers to an endangered collection of documents, photographs, files and correspondence held in a small museum in Culion Sanatorium, The Philippines. This research is part of the International Leprosy Association Global Project on the History of Leprosy. Its results can be accessed at the site http://www.leprosyhistory.org

Leprosy and the elusive M. Leprae: colonial and imperial medical exchanges in the nineteenth century

No século XIX, abordagens humorais da lepra deram origem a sucessivos modelos da doenças baseados na anatomia patológica, na fisiopatologia e na bacteriologia. As relaçöes entre esses modelos da doença foram reforçadas pela onipresente metáfora 'da semente e do solo', difundida tanto antes quanto depois da identificaçäo do M.Leprae. A época em que a metáfora fornecia um elo de ligaçäo contínuo entre as várias descriçöes médicas da doença, Henry Vandyke Carter publicava On leprosy (1874), estabelendo uma convergência de seus diferentes modelos. Simultaneamente, a metáfora se fazia presente nos debates médicos e populares de fins do século XIX, juntamente com o medo do surgimento da lepra na Europa. Mais recentemente, o mapeamento do genoma humano determinou a formulaçäo de um novo modelo para a doença. Mas, ironicamente, enquanto as pesquisas concernentes a ela se apóiam numa visäo de mundo em que a metáfora da semente e do solo ainda expressa diferentes aspectos da açäo da doença, o próprio bacilo permanece refratário a todos os esforços visando seu cultivo