This is one of the most controversial books to appear in recent years, and one of the most difficult to appraise. In substance, Mrs. Lindbergh's thesis is that the great fact of history, the law of life, is eternal and inexorable change, that we are now in one of the great periods of rapid and profound change, and that it is therefore the better part of wisdom -- for Americans as well as for all other peoples -- to accept this process, whatever it may be, and not to fight against it. The "wave of the future," as it presents itself to Mrs. Lindbergh, is totalitarian, and in her eyes there is no use in our trying, Canute-like, to stem it. The net effect of Mrs. Lindbergh's book, perhaps unintentional, is even more destructive than the mechanistic approach to life expounded by her husband because it furnishes a sort of vade mecum for the defeatists. One of the most disturbing things about this sincere, and in some respects courageous, little volume is its evasion of some of the real issues, particularly the moral ones. It carries the subtitle "A Confession of Faith," but it is precisely faith that the author seems to lack.
Atit Jariwala, CEO of Bridgeton Holdings, is a hospitality and real estate enthusiast who operates, owns, and invests in a multitude of business types and asset classes, as well as in technology ventures that intersect with the physical world.
The Real Wave of the Future
While the concept of iontophoresis dates back to the early 1900s, only within the last few years have controlled clinical studies tested its efficacy.2 Iontophoresis is a noninvasive process that allows a greater bioavailability of a drug to reach the anterior and posterior segments than is normally possible with topical application.3 It is also safer than systemic dosing, which exposes patients to a higher risk of system-wide adverse effects, and intravitreal injection, which is invasive and increases the risk of infection.3
After more than a decade of R&D, some of these efforts are approaching commercialization. EyeGate completed the second Phase III study in mid-2018 looking at the application of the EGP-437 in anterior uveitis and is continuing to assess the next steps toward approval. Once clinicians have access to the EyeGate II system, the eye care community will be able to learn more about its real-world performance and, ultimately, where it fits in the overall treatment armamentarium.
The anticipation and competition are intense. Finding direct evidence of gravitational waves would launch a new era of astronomy. Spotting not just one gravitational-wave source, but eventually dozens and then thousands, astronomers say, will give them new ways to watch black holes collide, stars annihilate themselves and space-time shimmy. Gravitational waves would thus open an entirely new window onto a dynamic, ever-changing universe.
The upgrade will slowly increase the sensitivity of the detectors by a factor of ten, so that Advanced LIGO will be able to see neutron-star mergers not at 20 megaparsecs, but at 150 or even 200. That will multiply the volume of space that LIGO can search by 1,000, and will vastly improve the chance that the detector will spot one of the rare events that produce a gravitational wave.
This schedule, however, depends heavily on how quickly engineers can commission both interferometers. The team has decided to focus its energies on commissioning the detector at the relatively low frequencies where signals from binary neutron stars are thought to lurk. They will not worry so much about improving LIGO's performance at high frequencies, to snag other types of signals such as colliding black holes, unless they have their first gravitational waves in the bag.
Virgo hunts the same sources as LIGO, focusing mainly on colliding neutron stars. It began running in 2007 and has spotted no gravitational waves so far. But it, too, is in the middle of a major upgrade, currently scheduled to come online about a year after Advanced LIGO. Scientists from the two detectors share their data and collaborate closely; combining signals makes the analysis more robust, says Giovanni Losurdo, project leader for Advanced Virgo at the National Institute for Nuclear Physics in Florence, Italy. Crucially, having another interferometer on a different continent will help astronomers to accurately locate the source of any gravitational-wave signals.
Even as project leaders try to get Advanced LIGO up and running, they are also pushing to place a third detector in India, where it would allow astronomers to pinpoint the source of gravitational waves even more accurately. LIGO engineers have already built a set of components, and are storing them at Hanford. They are waiting for India's new government to select a site and approve funding, but depending on when that happens, LIGO India could be operational by 2022 for a total cost of roughly $350 million.
For now, the field's future rests in the hands of de Rosa and his colleagues. He frowns, perplexed, at a glowing screen in the Livingston control room. Something is still not quite right with how the light is bouncing off one particular mirror in the machine. But it is dinner time. He rounds up the others in the room, and they head for a Mexican restaurant for a short break.
Prospects for the rest of the year and beyond hinge on the questions of whether and when future variants will emerge. As long as Omicron remains the dominant variant, there is reason for relative optimism. Our scenario analysis suggests that Omicron-related hospitalizations are likely to continue to decline in the United States and remain at relatively low levels through the spring and summer (Exhibit 2). We might then expect to see a seasonality-driven wave of disease next fall and winter, but hospitalizations would likely peak well below the level of the wave we just experienced.
Omicron is already among the most infectious human viruses known to science. 40 40. See Exhibit 1. While even greater infectiousness (such as the sub-variant BA.2 has exhibited) is possible, to become dominant a new variant would likely need to also partially or fully evade prior immunity, including that provided by Omicron infection. If such a variant emerged, its average clinical severity would then be critical. Exhibit 3 lays out three example scenarios for the potential characteristics and trajectory of the pandemic under a new dominant variant. This is not a complete list of possible future variants but some potential options. (Note: these scenarios are not related to the Omicron-hospitalization scenario shown in Exhibit 2.)
In any scenario for the future of the COVID-19 pandemic, much depends on the ways in which societies respond. Three levers are likely to be especially important, starting with the extent to which countries can effectively scale and make available new oral therapeutics with the potential to reduce the chance of progression to severe disease, and which are unlikely to be blunted by Omicron. Second, evidence is accumulating that booster doses are especially important for protecting against the Omicron variant; accelerating their rollout will help protect populations. And third, given public fatigue and the lessons of the past two years, finding the right combination of public-health measures will be critical.
Each of these observed trends may change as sample sizes increase, confounding factors are considered, and the clinical course of disease plays out over time. The answers, when they arrive, will have important consequences for the months ahead. Given the uncertainty, we have built a set of scenarios describing potential outcomes measured by hospitalization rate. They are indexed on the recent Delta wave and show whether various potential combinations of infectiousness, immune evasion, and clinical severity are likely to lead to a higher or lower rate of COVID-19-related hospitalization.
The analysis is quite sensitive to public-health interventions and behaviors. Exhibit 1 assumes a US public-health response similar to that seen during the Delta wave. Exhibit 2 shows potential outcomes if more stringent public-health measures were to be employed in the United States; this could lead to a disease burden that is similar to or only moderately worse than seen in the past six months, depending on the characteristics of the virus. The exhibit also shows how much more stringent those measures would need to be to potentially prevent the disease burden from exceeding the burden of Delta. Our analysis accounts for waning immunity and suggests that even if Omicron were to have no impact, the next six months of Delta-driven disease in the United States could be about as severe as the past six months were.
As countries transition over time to managing COVID-19 as an endemic disease, the world may reach a long-term state of disease prevention similar to that seen with the flu, with annual or twice yearly booster doses. In the short term, an accelerated rollout of booster doses of COVID-19 vaccines is likely to be one of the best protections against an Omicron-fueled wave of the disease.
We have written previously about two endpoints for the COVID-19 pandemic: a transition toward normalcy, and herd immunity. The transition would gradually normalize aspects of social and economic life, with some public-health measures remaining in effect as people gradually resume prepandemic activities. Many high-income countries did begin such a transition toward normalcy during the second quarter of this year, only to be hit with a new wave of cases caused by the Delta variant and exacerbated by vaccine hesitancy.
Given that sufficient vaccine doses are available to vaccinate the highest-risk populations in the coming months, we expect to see the EU transition to normalcy during the second quarter of the year, although the start of this transition may be delayed until late in the quarter by a new wave of cases in some countries. A key difference for the European Union, as compared with the United Kingdom and the United States: herd immunity is more likely in the fourth quarter than the third quarter, given the likely timeline of vaccine delivery (Exhibit 3). 2ff7e9595c
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