The CBMTS Industry V "Fourth World Congress on CBR&T" begins 14 April 2007 in Dubrovnik, Croatia. We would like to provide our readers with a selected group of Abstracts based on scheduled presentations at this CBMTS.
CBMTS Industry V: A Presentation Overview
An important area being considered in-depth for this 14th meeting in the CBMTS series is Dual Use and Biosecurity, Biosafety.
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"The Relationship of Microorganism Classification by US Government Guidelines to the Design of Laboratory Facilities"
by Dr. David Robinson, Chief Biologist, Battelle Memorial Institute.
When the first edition of the Biosafety in Microbiological and Biomedical Laboratories, (BMBL) series was published approximately 40 years ago its purpose was to provide a code of practice, guidelines and standards for the prevention of laboratory acquired infections to the laboratorian working in an infectious disease laboratory. The BMBL is based on the microorganism being worked on and is a set of recommendations which are advisory. While this is true, many agencies in the US government have incorporated all or parts of the BMBL in their regulations. This has led to the BMBL being accepted as as the de facto US standard for the design and operation of infectious disease laboratories.
The concept of biosecurity has evolved as a result of concerns related to access to microorganisms by terrorists following the anthrax letters of October 2001. While related to biosafety the specific requirements vary from those related to biosafety and are based on laws passed by the US Congress. The Select Agent Program of the US Centers for Disease Control has been given the responsibility for codifying and enforcing these regulations.
Both biosafety and biosecurity need to be considered in the design of a laboratory facility. The occasionally conflicting regulatory requirements can be best resolved by a Risk Assessment taking into account the microorganisms and the manipulations planned for the laboratory. This is an essential step for both laboratory design and subsequent laboratory operation.
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"OECD Policy Recommendations on Security for Biological Material's"
by Jack Radisch, O.E.C.D., Paris, France
Biomedical innovations derived from research on pathogenic micro-organisms promise astounding health and economic benefits. Some such biological resources employed in the R&D for diagnostic kits, vaccines and therapeutics, however, possess capacity for dual-use; they may be misused to develop biological weapons. Research facilities entrusted with possession of such dual-use materials have a responsibility to comply with biosecurity measures that are designed to prevent loss or theft and thereby reduce the probability of a bioterrorist attack. The OECD has provided a forum for its Member countries to engage in a dialogue of international co-operation with a view to produce policies that achieve a research environment fortified by biosecurity measures and capable of producing health innovations. In 2007, the OECD developed a risk assessment framework and risk management principles for Biological Resource Centres. Ongoing policy work at the OECD will look to design biosecurity guidelines appropriate to a broader range of facilities in possession of dual-use materials, such as university and industrial laboratories.
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"WMD Nonproliferation: Biosecurity in the Age of Terrorism"
by Professors Carleton J. Phillips, Ph.D. and Ronald K. Chesser, Ph.D., Texas Tech University
The international community has cooperated in arenas where diplomacy, treaties and conventions, and international bodies such as the IAEA and UN Security Council can have successful roles controlling WMD proliferation. This especially is the case for nuclear and chemical weapons. In our view, the potential use of biological agents and toxins presents a distinctive challenge not necessarily amenable to standard solutions and legal controls. Commercial biotechnology, basic biological research, and public and animal health are intertwined and of global significance.
Advancements in these civilian activities have legitimate value, but also can serve the needs of state-sponsored defensive and offensive biological weapons programs. More important, technical and scientific advances and development of public bioinformatics databases also simplifies an otherwise complex world for trans-national terrorists. In our paper we will draw upon our personal international experiences, including in the former Soviet Union and Iraq, to explain our concept of "shared risk" within the scientific community. Personal engagement, meaningful collaboration, adherence to uniform ethics and standards, and common scientific goals on an international scale are the best hedge against bio-terrorism. The global scientific community already is based upon shared principles that cross both cultural and political boundaries and thus are pre-adapted to play a major role in preventing the use of biology as a terrorist weapon.
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"Dual Use Threat Assessment Framework - An Attempt to Quantify the Risk"
by Eric R. Stephen and Jacques J. Lavigne, Defence R&D Canada and Brian Colton, Health Canada
Advances in the biosciences over the past decade have been rapid and transformative. While these advances offer significant benefit to society, they also provide very significant challenges in terms of security. Concerns over misuse and/or accidental use/release (dual use) although not new, are now being viewed through the security lens.
There is a wide-spread view that public or private sector scientists, supported through investments by pharmaceutical, environmental and agricultural interests working in the fields that comprise biotechnology, posses the ability to assess the implications of their own work and work within a regime of self-control that is for the most part self-governing (codes of practice). On the other end of the spectrum are those that would codify or legislate control. All this is being done in the absence of a mechanism for quantifying the threat.
This presentation will discuss the development of an assessment framework that addresses both actual and potential threats. The framework was developed based on available intelligence and other open source information along with interviews with those persons familiar with the concept of dual use and the multiple, sometimes competing agendas of a variety of interest groups. The framework will help to bring some clarity to the discussion and at the same time, help to inform those that are positioned to respond to the threat.
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The Biological/Terrorist Threat Sector provides for an exceptional information exchange. Going back to the first CBMTS in Switzerland, we find the CBMTS was at the forefront of this invaluable exchange and dialog.
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"The Pathology of Avian Influenza in Birds and Animals: An Analytical Review"
by Prof. Elena Ryabchikova and Dr. T.N. Getmanova, State Research Center of Virology and Biotechnology, Vector, Russia
Influenza virus remains enigmatic despite of long extensive studies. Avian influenza virus (H5N1) is able to infect a large spectrum of animal and bird species. Highly pathogenic avian influenza virus represents a serious problem both for a human and birds, particularly for chicks. Many studies have been performed in order to show differences between highly and low pathogenic avian influenza H5N1 viruses, and examine their biological properties. Many separate pathological and microscopic descriptions are interspersed in numerous published articles. The aim of our study was to analyze data published in international scientific journals, and to attempt a generalized view of avian influenza pathology in various animal and bird hosts. We summarized and systematized data describing pathological changes caused by both highly and low pathogenic types of avian influenza virus (H5N1) in animals and birds, and developed generalized descriptions with accent at the type of virus. We also tried to show up species specific features of pathological changes in birds and animals infected with avian influenza virus (H5N1).
The results of this analytical work may be useful for pathological studies of a new avian influenza virus isolates, and for understanding of avian influenza pathogenesis in birds and animals.
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"Adenovirus-vectored vaccine as a rapid-response tool against avian influenza pandemic"
by
Kent Van Kampen, and De-Chu Tang, Vaxin Inc., Birmingham, Alabama USA
Influenza viruses in nature undergo genetic mutation and reassortment. Three pandemics of avian influenza in man were recorded in the twentieth century. Highly pathogenic avian influenza (HPAI) viruses currently in circulation pose a threat for another world-wide pandemic, if they become transmissible from man to man. Manufacturing protective vaccines using current egg-based technology is often difficult due to the virulence of the virus and its adverse effects on the embryonating egg substrate. New technologies allow the creation of safe and protective pandemic influenza vaccines without the need for egg based substrates. These technologies allow new vaccines to be created in less than one month. Manufacturing is in tissue culture, not eggs. Vaccine can be administered to man non-invasively, without adjuvants, eliciting a rapid and protective immune response. Protective immunity against avian influenza (AI) virus was elicited in chickens by single-dose in ovo vaccination with a replication-competent adenovirus (RCA)-free human adenovirus serotype 5 (Ad5)-derived vector encoding an H5N9 avian influenza virus hemagglutinin. Vaccinated chickens were protected against both H5N1 and H5N2 HPAI virus challenges. Mass-administration of this bird flu vaccine can be streamlined with available robotic in ovo injectors. Vaccination using this vaccine could protect the the largest host reservoir (chickens) and greatly reduce the exposure of man to avian influenza. In addition, Ad5-vectored vaccines can be produced rapidly and the safety margin of a non-replicating vector is superior to that of a replicating counterpart. Furthermore, this mode of vaccination is compatible with epidemiological surveys of natural AI virus infections.
In addition to mass immunization of poultry, both animals and humans have been effectively immunized by intranasal administration of Ad5-vectored influenza vaccines without any appreciable side effects, even in mice and human volunteers with preexisting immunity to Ad5. RCA-free Ad5-vectored AI vaccines may provide a critical tool for mitigating an AI pandemic in a simple, rapid, and safe manner.
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"Military & Military Medical Support in Highly Pathogenic Avian Influenza (HPAI/H5N1) Pandemic Scenario"
by Vaso Taleski M.D., PhD, Institute of Preventive Medicine, Military Hospital, Skopje, Macedonia
Avian influenza (Bird flu) is a highly contagious viral disease affecting mainly chickens, turkeys, ducks, other birds and mammals. Reservoirs for HPAI /H5N1 virus are shore birds and waterfowl (asymptomatic, excrete virus in feces for a long periods of time), live bird markets and commercial swine facilities. Virus tends to cycle between pigs and birds. HPAI (H5N1) virus is on every Ôtop tenÕ list available for potential agricultural bio-weapon agents.
The threat of a HPAI /H5N1 pandemic is a definitively global phenomenon and the response must be global. A number of National plans led to various measures of preventing and dealing with epidemics/pandemics.
Lessons learned form the pandemic history indicated essential role of military & military medical support to civil authorities in a crisis situation. Based on International Military Medical Avian Influenza Pandemic workshop (Vienna 2006), an expected scenario would involve 30-50% outpatients, 20-30% hospital admission, 2-3% deaths, 10-20% complicated cases. Activities of civil hospital may be reduced by 50%.
Benefits of military support could be in: Transportation of patients (primarily by air); Mass vaccination and provision of all other preventive measures (masks, Tamiflu); Restriction of movements; Infection control of health care facilities; Field hospitals for triage and quarantine, military barracks to treat milder cases and military hospitals for severe cases; Deal with corpses; Stockpiling (vaccines, antiviral, antibiotics, protective equipment, supplies); Training; Laboratories; Ensure public safety, etc.
With the aim of minimizing the risk of a pandemic spread by means of rapid and uncomplicated cooperation, an early warning system has to be established to improve surveillance, improve international contacts (WHO, ECDC, CDC), establish Platform for sharing information, close contacts of national and international military and civilian surveillance networks and databases, cooperation between military and civilian labs (external quality control).
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"Epidemiology of Multiresistant Acinetobacter Infections in Bulgaria"
by Dr. Encho Savov M.D., Military Medical Academy, Department of Microbiology, Sofia, Bulgaria
Evolution of bacteria towards resistance to antimicrobial drugs, including these with multidrug resistance, is very important issue for hospital epidemiology in all over the world. There are many papers about an increasing number of Acinetobacter baumannii blood stream and other type of infections in patients at military medical facilities in the Iraq / Kuwait region and in Afganistan during Operation Enduring Freedom /OEF /. It has now become also a one of the major cause of hospital acquired infections in
Bulgaria which due to its remarkable propensity to rapidly acquire resistance determinants to a wide range of antimicrobial drugs. According to the data obtained in Bulgaria, it can be concluded that the majority of the A.baumannii isolates was strikingly resistant, including the 3rd generation of cephalosporines, quinolones and also carbapenems, in the last years. Different methods / phenotypical and molecular methods, including PCR/ for a multidrug A.baumannii investigation and its clonality determination are needed, especially when the strains are not epidemiologicaly related.
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The Chemical and Radiological Sector provide a wealth of information for professionals representing all Sectors:
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"The Importance of Particle Size in Estimating Downwind Contamination From an RDD"
by Timothy Bauer, NSWC, Dahlgren Division, Virginia US
There is general agreement that realistic quantities of radiological material released from a radiological dispersal device (RDD) will not travel more than a couple hundred meters at toxic levels. Of greater concern in the case of such an incident is the size of the area contaminated with radiological particles. Remediation of contaminated areas will require either removal of the deposited particles or disposal of the contaminated materials.
Contours of expected contaminated areas have been presented which extend more than 10 miles downwind of the release location. It would be impossible to remediate such a large area, so the likely response will be to permanently seal most of it off from further use. Not only are these radiation contours below levels of concern, the particle size assumed is unreasonably low, especially when the density of radioactive materials is considered. Using an appropriate RDD characterization and range of particle sizes, this presentation will show that expected contamination areas should be small enough to make remediation feasible.
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"Radiological Dispersal, Polonium-210, and Lessons for Public Health"
by Robert C. Whitcomb, Jr. and C.W. Miller, Centers for Disease Control and Prevention, Atlanta Georgia.
On November 23, 2006, Alexander Litvinenko died in London as a result of being poisoned with Polonium-210. Public health authorities in the United Kingdom (UK) subsequently found Polonium-210 contamination at a number of locations in and around London. UK authorities have determined that citizens of 48 countries other than the UK, including the United States, may have been exposed to this contamination. UK authorities asked the CDC to contact approximately 160 individuals who may have been exposed to Po-210. These citizens have been advised that their risk of adverse health effects is likely to be low, but, if they are concerned, they should contact their primary health care provider. In turn, physicians are referred to state and local public health departments or CDC for further information on Po-210, including where they can seek testing of 24 hour urine samples for Po-210, if desired. CDC posted guidance for members of the public and physicians on its website, and it responded to numerous inquiries from national media. Working with our UK colleagues, CDC developed guidelines for judging when a measurement of Po-210 in urine was or was not a level of concern. Because the death of Mr. Litvinenko is an ongoing criminal investigation, one of the major challenges of this response to what is a radiological dispersal device event has been the inability to obtain all of the technical detail desired to perform assessments. This has complicated the ability to communicate effectively with citizens and members of the public health community. These and other lessons learned from this response will help prepare the public health community to respond more effectively to future contamination events involving radioactive dispersal in the environment.
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"Border Control of Nuclear and Other Radioactive Materials"
by Sasa Medakovic, Ankica Cizmek, Matjaz Prah, State Office for Nuclear Safety, Zagreb, Croatia
In the second half of year 2006, stationary detection systems for nuclear and other radioactive materials were installed on Border Crossing Bregana, Croatia. Yantar 2U, which is the commercial name of the system, is integrated automatic system capable of detection of nuclear and other radioactive materials prepared for fixed-site customs applications (Russian origin). Installed system contains portal monitors, camera, communication lines and communication boxes and server. Two fully functional separate systems has been installed on BC Bregana, one on truck entrance and another one on car entrance. In this article the operational experience of installed system is presented. This includes statistical analysis of recorded alarms, evaluation of procedures for operational stuff and maintenance and typical malfunction experience, as well as some of the recommendation for future use of detection systems.
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"Toxic Effects of Peracetic Acid Used as a Chemical Weapon During Workers Riots"
by Jasmina Jovic-Stosic, Veljko Todorovic, and Zoran Segr, National Poison Control Centre, Belgrade, Serbia
Peracetic acid (PAA) is a mixture of acetic acid and hydrogen peroxide, often used as antimicrobial agent on food processing equipment. It may explosively decompose on shock, friction or concussion. PAA is a strong oxidant, corrosive to the eyes, skin, respiratory and digestive tract.
Depending on concentration, contact may cause severe burns of the skin or the eyes, and inhalation may cause lung edema. We report toxic effects of PAA used as a chemical weapon in workers riots.
A group of workers attacked the security guards in beverage plant, throwing out beer bottles filled with PAA. Bottles exploded, producing irritant mists and fumes, and splashing some of the guards with acid. After about 20 minutes of exposure in the closed space, 30 persons were transported to the emergency room; 22 of them were transferred to the hospital. After the initial treatment, 10 patients were admitted for further treatment. The symptoms of exposure included burning sensation and pain of the eyes, throat and skin, cough and shortness of breath. Effects on the eyes included redness and corneal erosions. Pulmonary disturbances were prolonged expirium and wheezing by auscultation, and hypoxemia. Skin burns were ranged as grade I-III. Treatment included rinse of eyes and skin, systemic therapy with corticosteroids, beta adrenergic drugs and theophylline. Surgical treatment was necessary in grade III skin burns.
A variety of common industrial chemicals may be misused as a chemical weapon. We point out the hazards of serious toxic effects of PAA if used in riots or terrorists attacks.
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"Carcinogenicity of Mustard Gas: Report of the Cancer Registry Project Among Mustard Gas Exposed Iranian Veterans"
by M. Reza Soroush, M .Reza Zafarghandi, M. Holakui, Janbazan Medical & Engineering Research Center JMERC, Tehran, Iran
Since 2003 The Janbazan Medical & Engineering Research Center in collaboration with Tehran University has conducted a nationwide cancer registry project among all Iranian Veterans with history of exposure to mustard gas during 1980-1988 Iran Iraq war.
This mixed cohort study has a retrospective phase from the exposure time to 2003 and a prospective phase from 2003 to 2013. The main goal is to find any possible relationship between exposure to mustard gas and developing cancer as a long term health effect. A total number of 7500 individual (both military and civilians) with confirmed medical records of exposure to mustard gas have been included in the study to be compared with the same number of control population as well as the statistics of the national cancer registry system. The follow up of all cases is being done as a part of the national health monitoring program of the Janbazan (veterans) organization. In this report the latest findings of this project will be presented.
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The Consequence Management and Medicine Sector provides both an in-depth and a broad look at this complex spectrum.
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"Smoke Inhalation and Cyanide Poisoning: 20+ Years Of The Paris Experience"
by Frédéric J. Baud, Medical and Toxicological Critical Care Department, Hôpital Lariboisiére, Univérsite de Paris, Paris, France
Hydroxocobalamin has been used as a cyanide poisoning antidote for many years in France. It has recently been approved by the US FDA. In Paris, hydroxocobalamin is carried by the Brigade de Sapeurs Pompiers (Paris Fire Brigade) in mobile intensive care vehicles and has been administered empirically to victims of enclosed-space fire smoke inhalation who meet the criteria of having soot in the nose, mouth, or throat, any alteration in mental status or disturbance in consciousness, and especially if any degree of hypotension is present (BP </= 100 mmHg systolic). The administration of hydroxocobalamin at the scene was shown to be safe.
Hydroxocobalamin has also been efficacious and safe in "pure" cyanide poisoning, as long as brain death has not already occurred. A "toxidrome" of cyanide poisoning has been developed in our institution in Paris, and its application can assist in making the diagnosis of this life-threatening poisoning which cannot be emergently diagnosed by currently-available laboratory methods.
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"Strategic Planning for Emergencies: Lessons Learned from Katrina"
by Murray G. Hamilton, Uni. of Denver and All Hazards Management (AHM) and Hassan Mashhadi and Duane Habeck, AHM, Denver, Colorado USA
The tragedy that was unleashed when hurricane Katrina hit the United States southern coast and most particularly New Orleans is still being examined. Regardless of the allocation of blame for the response, or lack thereof, several very important components of what needs to be included in effective strategic, management, and response plans were revealed in the aftermath. The first tenet is to be sure not to make the problem worse. In other words, the goal is to prevent emergencies from becoming a disaster that subsequently grows to a catastrophe. Essential components that need to be addressed start with protection and rescue of affected people. Several characteristics of an effective strategic plan that will address saving lives include leadership, continuity of government and business, effective communications, adequate evacuation plans and security of electronic infrastructure. Katrina analysis confirms that the process to integrate all the components istoo complex to be accomplished ad hoc. This presentation will outline objective methodology to successfully integrate the various facets that comprise an effective strategic plan, management plan, and tactical plans.
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"Intraosseous Administration of Antidotes in the Chemical Weapons Victim - An Alternative to the Intravenous Route?"
by Stephen Borron, Juan Arias, University of Texas Health Science Center, San Antonio Texas USA
Hazardous materials paradigms call for definitive treatment of chemical victims to begin in the "warm zone" during decontamination. This delay may result in lethal outcomes, particularly in the case of multiple victims, where rescue may be delayed due to insufficient numbers of rescue teams.
It is virtually impossible for rescuers in full protective gear to establish intravenous lines. In recent years, significant advances have been made in intraosseous (IO) infusion devices. An IO device developed in our institution, the EZ-IO is very easily placed by rescuers in typical work uniforms. IO placement takes longer while in protective gear, but is feasible.
The IO is equivalent to an intravenous line, allowing more rapid administration of antidotes in the event of chemical mass casualties. Antidotes not amenable to intramuscular administration and even those often given IM may be more effective given IO.
IO administration has the following possible advantages over intravenous or intramuscular antidote administration:
- Drugs administered IO reach the vascular system virtually instantaneously.
- IO administration may be performed in protective clothing and could theoretically be employed while awaiting rescue.
- IO administration may be preferred over intravenous administration in the warm zone.
In summary, IO administration of antidotes should be further evaluated for use in chemical disasters. The ease and speed of placement, ready access to the vascular tree, and potential for earlier intervention make it a potentially ideal means of vascular access and antidotal administration in the mass casualty situation.
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Detection, Identification Decontamination - another combined area with full coverage
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"The CBRN Threat Needs New Dedicated Analysers"
by Stef Stienstra, Active Technology Transfer Europe, Beek-Ubbergen, The Netherlands
After the 9-11 attack by terrorists several governments realized their vulnerability towards creative asymmetric attacks. Due to increasing complexity of our society we create more vulnerability towards terror attacks. More chemical substances than we realize can be misused to destabilize our modern society. Recently aircraft passengers were confronted with new regulations, which limit the amount of fluid, which a passenger can bring on board with hand luggage. How far should we go limiting the allowance to bring liquids and substances on board? It indicates that we need new analytic instruments for screening the safety of luggage in all types of transport.
An inventory was made of the present demand for safe transport and its vulnerability to terror attacks. Also the safety and safety awareness in public buildings, offices and industrial complexes was assessed.
Knowing the demand for a certain safety level, an inventory was made to identify analytical equipment, which can be used to check passengers and luggage on possible threats. The same can be used for protecting public areas, offices and industrial complexes.
It is amazing how some governments, financially driven, underestimate the consequences of CBRNE incidences and disasters. Both threats due to release of dangerous substances just by accident and deliberate abuse of chemicals and/or biologicals by terror organizations is underestimated.
Financial rationales are often the cause that the preparedness is less that technically could be possible.
Still some commercial companies realize the importance of safety and preparedness towards terror attacks and take their precautions. Several detection systems are now under development and a new market of safety devices comes into existence.
Key question is how far we would like to go with defending us with technical devices against potential terror attacks. Also the design of buildings, transport vehicles and industrial complexes can limit the risk on CBRNE incidences.
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"The Environics Mobile CBRN Detection System"
by Timo Jaakkola and Krister Liljegren, Environics Oy, Mikkeli Finland
Environics Oy has developed a novel monitoring system for detection of Chemical, Biological, Radiological and Nuclear compounds. The system is portable and rapidly installed into a monitoring location. It will allow real time monitoring and alarming of Chemical Warfare agents (Nerve, Blister, Blood), Toxic industrial chemicals (General toxic-alarm), Biological warfare agents (Bacteria, viruses, toxins), Radiological agents such as alpha and gamma radiation. Monitoring Station makes continuously measurements. Sensor data is processed and stored to local database by the Master Module (MM) that is located within the station. The MM sends the data to the Control Centers by using communication network. The Control Center receives and logs the data and shows it in real time on a map interface. The status of each sensor and detector can be seen in real time.
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