Dying within dyads: Stress, sense of security and support during palliative home care

Objectives

To examine similarities and dissimilarities in patient and family caregiver dyads in their experience of stress, support, and sense of security.

Methods

144 patients and their family caregivers participated. Patients were admitted to six Swedish specialist palliative home care units and diagnosed with a non-curable disease with an expected short survival. We analysed similarity patterns of answers within dyads (correlations) as well as dissimilarities, expressed as the difference between within-dyad responses. The latter were subjected to a model-building procedure using GLM, with 13 sociodemographic and clinical characteristics as independent variables.

Results

Within dyads, patients and family caregivers scored similar in their perception of support and sense of security with care. There was also dissimilarity within dyad responses in their perception of stress and support that could be attributed to sociodemographic or clinical characteristics. When patients scored higher levels of stress than family caregivers, the family caregiver was more likely to be male. Also family caregiver attachment style (attachment anxiety), patient age and the relationship of the family caregiver to the patient explained dissimilarities within the dyads.

Conclusions

Patients and family caregivers within the dyads often, but not always, had similar scores. We suggest that it is important that the healthcare staff identify situations in which perceptions within the dyads regarding stress and perception of support differ, such that they can recognise patients’ and family caregivers’ unique needs in different situations, to be able to provide adequate support and facilitate dyadic coping.

The 6 E Framework of Public Health Preparedness for Mass Gatherings-Lessons Learned From Super Bowl LIII, Fulton County, Georgia, 2019

CONTEXT

On February 3, 2019, Atlanta, Georgia, hosted Super Bowl LIII, which is classified as a National Special Security Event. The festivities comprising this major sporting event brought approximately half a million people to Atlanta, which posed significant challenges to the local public health community. As the lead local agency for public health planning, preparedness, and response efforts, Fulton County Board of Health (FCBOH) needed to address multiple specific tasks based on core functional areas outlined in the Emergency Support Function (ESF) 8 (eg, bioterrorism preparedness and epidemiological surveillance).

PROGRAM

To prepare for the Super Bowl, FCBOH developed a systematic approach to ensure community-wide public health preparedness for mass gatherings. This approach came to be known as the 6 E framework, which consists of (1) engaging stakeholders, (2) examining current capabilities and identifying gaps, (3) establishing roles and responsibilities, (4) executing plans to fill gaps, (5) exercising plans, and (6) evaluating impact.

IMPLEMENTATION

We define each step of the 6 E framework and present practical examples of how FCBOH implemented each step when preparing for the Super Bowl. Challenges that FCBOH faced and the lessons learned in the process are illustrated. The 6 E framework provides a systematic approach to community preparedness and allows local health departments to tailor the approach to serve local public health needs.

EVALUATION

The successful implementation of the 6 E framework allowed for stakeholders at the federal, state, and local levels (including law enforcement) to effectively coordinate an epidemiological investigation and response when 4 staff members reported gastrointestinal symptoms after eating at a feeding station.

DISCUSSION

Preparation for the Super Bowl required months of diligent cross-sectoral and cross-jurisdictional partnership building, and the 6 E framework can help other local public health jurisdictions prepare to host major mass gatherings.

Evaluation of Triage Methods for Criticality Accidents

Studies indicate that early identification of persons involved in and receiving high doses of radiation in accidents is key to providing life-saving medical treatment. Although the risk of criticality accidents is low, the potential impact to workers is significant. For facilities that employ large numbers of workers, a key element in the response to a radiological emergency is identifying personnel that received significant and potentially harmful doses. Also important is having the ability to screen large numbers of workers to identify persons who did not receive significant exposure so as to reduce the impact on emergency response efforts. At the Y-12 National Security Complex, the focus on criticality accident response is the rapid triage of personnel in order to identify persons exposed to large radiation doses and to prioritize those persons receiving the highest exposures. Once identified, personnel are transported to local medical facilities, including the Radiation Emergency Assistance Center/Training Site (REAC/TS), for medical evaluation and treatment. The Y-12 external dosimetry program uses a number of techniques to identify and prioritize workers, and these methods were evaluated at a criticality dosimetry intercomparison exercise. The methods used were shown to perform as intended, and other sites may consider incorporating these methods into their accident dosimetry response procedures.

The Boundary of the Market for Biosecurity Risk

Imported goods create value in destination countries but also create biosecurity risk. Although widely used in other domains of the economy, risk markets have not been created to manage losses that occur when exotic pests and diseases are introduced with traded goods. In this article we show that not all biosecurity risks are insurable. Losses arising from effort needed to detect and respond to exotic pests and diseases that breach national borders appear to be insurable because entry of these threats and consequent response costs, can be regarded as random events. As pests and diseases establish and spread, however, loss of access to export markets and productivity losses display systematic risk and appear to be uninsurable. Other insurability criteria support this definition of the boundary of biosecurity risk markets. We use the Australian biosecurity system as an example, although the framework described in this study will be applicable to biosecurity systems worldwide. We argue that biosecurity risk insurance could be incorporated into the current biosecurity system but would require legislation mandating importers to purchase insurance. Advantages of actuarial pricing of biosecurity risk are: (i) an increase in economic efficiency to the extent that importers respond to the price of biosecurity risk; (ii) financial sustainability would improve because actuarial pricing creates a structural link between funds available for biosecurity activities and risk exposure; and (iii) equity issues evident in the current biosecurity system could be addressed because risk creators (importers) would fund response activities through the purchase of insurance.

Human security as biosecurity Reconceptualizing national security threats in the time of COVID-19

Research within security studies has struggled to determine whether infectious disease (ID) represents an existential threat to national and international security. With the emergence of SARS-CoV-2 (COVID-19), it is imperative to reexamine the relationship between ID and global security. This article addresses the specific threat to security from COVID-19, asking, "Is COVID-19 a threat to national and international security?" To investigate this question, this article uses two theoretical approaches: human security and biosecurity. It argues that COVID-19 is a threat to global security by the ontological crisis posed to individuals through human security theory and through high politics, as evidenced by biosecurity. By viewing security threats through the lens of the individual and the state, it becomes clear that ID should be considered an international security threat. This article examines the relevant literature and applies the theoretical framework to a case study analysis focused on the United States.

Science, technology, security: Towards critical collaboration

Science and technology play a central role in the contemporary governance of security, both as tools for the production of security and as objects of security concern. Scholars are increasingly seeking to not only critically reflect on the interplays between science, technology and security, but also engage with the practices of security communities that shape and are shaped by science and technology. To further help this growth of interest in security topics within science and technology studies (STS), we explore possible modes of socio-technical collaboration with security communities of practice. Bringing together literatures from STS and critical security studies, we identify several key challenges to critical social engagement of STS scholars in security-related issues. We then demonstrate how these challenges played out over the course of three case studies from our own experience in engaging security communities of practice. We use these vignettes to show that there is a rich vein of developments in both theory and practice that STS scholars can pursue by attending to the interplay of science, technology and security.

K-12 School Shootings: Implications for Policy, Prevention, and Child Well-Being

Schools should be considered safe spaces for children; children need to feel secure in order to grow and learn. This article argues that when a school shooting occurs, the harm goes beyond those who are injured or killed, because the presumption of security is shattered, and the mental and emotional health of the students is threatened. There are many interventions for preventing these attacks at the school, state, and federal levels. This article explores evidence behind some of these interventions and describes the delicate balance in implementing interventions without introducing undue stress and anxiety into a child's everyday life.

Validity of the National Health Security Preparedness Index as a Predictor of Excess COVID-19 Mortality

OBJECTIVE

This study compared 2019 values for the National Health Security Preparedness Index (NHSPI) with 2020 rates of coronavirus disease 2019 (COVID-19)-related mortality as reported by the 50 US states and Puerto Rico during the first six months of the US pandemic (March 1 - August 31, 2020).

METHODS

Data regarding provisional death counts and estimates of excess deaths for COVID-19 according to state and territory were downloaded from the Centers for Disease Control and Prevention (CDC) National Center for Health Statistics website. Reporting included the six-month-long period of March 1 - August 31, 2020. Excess mortality rates were calculated as the number of excess deaths per 100,000 persons in each state population using 2019 US Census Bureau data. Mean values for state and territorial NHSPI domain indices were compared to state and territorial rates of COVID-19-related excess mortality using multiple linear regression, including analysis of variance. Correlations between the 51 state and territorial NHSPI values and corresponding COVID-19 excess mortality rates were calculated using Pearson's correlation coefficient.

RESULTS

These calculations revealed a high degree of variance (adjusted r square = 0.02 and 0.25) and poor correlation (P = .16 and .08) among values for the overall NHSPI as compared to low and high estimates of excess COVID-19 mortality rates for 50 US states and Puerto Rico.There was also a high degree of variance (adjusted r square = 0.001 and 0.03) and poor correlation (P values ranging from .09 to .94) for values for the six individual domains of the NHSPI as compared to low and high estimates of excess COVID-19 mortality rates for 50 US states and Puerto Rico.

CONCLUSION

The NHSPI does not appear to be a valid predictor of excess COVID-19 mortality rates for 50 US states and Puerto Rico during the first six months of the pandemic.

The political and security dimensions of the humanitarian health response to violent conflict

The nature of armed conflict throughout the world is intensely dynamic. Consequently, the protection of non-combatants and the provision of humanitarian services must continually adapt to this changing conflict environment. Complex political affiliations, the systematic use of explosive weapons and sexual violence, and the use of new communication technology, including social media, have created new challenges for humanitarian actors in negotiating access to affected populations and security for their own personnel. The nature of combatants has also evolved as armed, non-state actors might have varying motivations, use different forms of violence, and engage in a variety of criminal activities to generate requisite funds. New health threats, such as the COVID-19 pandemic, and new capabilities, such as modern trauma care, have also created new challenges and opportunities for humanitarian health provision. In response, humanitarian policies and practices must develop negotiation and safety capabilities, informed by political and security realities on the ground, and guidance from affected communities. More fundamentally, humanitarian policies will need to confront a changing geopolitical environment, in which traditional humanitarian norms and protections might encounter wavering support in the years to come.

Increasing the Rate of Documentation of Security Interventions in the Emergency Department: Big Orange Security Sticker (BOSS) Project

BACKGROUND

Security interventions in aggressive and violent patients in the emergency department (ED) are not always documented in the clinical record, which can compromise the effectiveness of communication, and increase clinical risks.

LOCAL PROBLEM

Fewer than half of all security interventions are documented in the clinical record.

METHODS

The study had a pre- and posttest design including a retrospective audit of patient medical records and a staff survey.

INTERVENTION

A dedicated sticker, to be completed by nursing and security staff, was placed into the clinical notes as a record of the security intervention.

RESULTS

From 1 month before to 1 month after implementation, the rate of documentation of security interventions in clinical notes increased from 43.3% to 68.8% (P = .01), and was maintained for 3 months after implementation.

CONCLUSIONS

The rate of documentation of ED security interventions in clinical notes can be increased by encouraging clinicians and security staff to collaborate and share documentation responsibilities.

Medical image encryption based on biometric keys and lower-upper decomposition with partial pivoting

The security of medical image transmission in telemedicine is very important to patients' privacy and health. A new asymmetric medical image encryption scheme is proposed. The medical image is encrypted by two spiral phase masks (SPM) and the lower-upper decomposition with partial pivoting, where the SPM is generated from the iris, chaotic random phase mask, and amplitude truncated spiral phase transformation. The proposed scheme has the following advantages: First, the iris is used for medical image encryption, which improves the security of the encryption scheme. Second, the combination of asymmetric optical encryption and three-dimensional Lorenz chaos improves the key space and solves the linear problem based on double-random phase encoding. Third, compared with other encryption schemes, the proposed scheme has advantages in occlusion attacks, key space, correlation, and information entropy. Numerical simulation and optical results verify the feasibility and robustness of the encryption scheme.

School Security?

"Schools rethink security training" was the headline on page 1 of the 30 December 2019 issue of The Baltimore Sun daily newspaper. The accompanying article went on to explain that Maryland school students felt unsafe at school. Students on average rated their physical safety at 3.5 and emotional safety at 5.4, each on a scale of 1 to 10, with 10 being the best score. Many students gave their physical safety scores at 1 out of 10. And this is despite active shooter drills that are meant to teach them what to do if there is a violent confrontation, and in which they have all had to participate.

Global Health Security Risk Assessment in the Biological Threat Reduction Program

In 2014, the Biological Threat Reduction Program (BTRP) developed a country assessment tool to assess the risk to a country's biosurveillance, biosafety, and biosecurity systems and their vulnerability to naturally occurring, accidental, or nefarious release of weaponizable pathogens. The country assessment tool is a unique method of assessing public health and veterinary systems at the national and subnational levels. The assessment process is led by a multisectoral, multidisciplinary team composed of 8 subject matter experts who conduct a combination of document reviews, individual and focus group interviews, and in-person assessments. The intent of the tool was to standardize the BTRP program planning process and support quantitative metrics to measure partner country capacities and capabilities throughout BTRP engagement. Used in more than 25 countries to establish a baseline of the health security risk landscape, the tool provides a foundation for identifying and prioritizing system-wide risk mitigation and management activities as well as periodic evaluations of the impacts of these activities.

Assessing the Risks Posed by the Convergence of Artificial Intelligence and Biotechnology

Rapid developments are currently taking place in the fields of artificial intelligence (AI) and biotechnology, and applications arising from the convergence of these 2 fields are likely to offer immense opportunities that could greatly benefit human health and biosecurity. The combination of AI and biotechnology could potentially lead to breakthroughs in precision medicine, improved biosurveillance, and discovery of novel medical countermeasures as well as facilitate a more effective public health emergency response. However, as is the case with many preceding transformative technologies, new opportunities often present new risks in parallel. Understanding the current and emerging risks at the intersection of AI and biotechnology is crucial for health security specialists and unlikely to be achieved by examining either field in isolation. Uncertainties multiply as technologies merge, showcasing the need to identify robust assessment frameworks that could adequately analyze the risk landscape emerging at the convergence of these 2 domains.This paper explores the criteria needed to assess risks associated with Artificial intelligence and biotechnology and evaluates 3 previously published risk assessment frameworks. After highlighting their strengths and limitations and applying to relevant Artificial intelligence and biotechnology examples, the authors suggest a hybrid framework with recommendations for future approaches to risk assessment for convergent technologies.

The biosecurity benefits of genetic engineering attribution

Biology can be misused, and the risk of this causing widespread harm increases in step with the rapid march of technological progress. A key security challenge involves attribution: determining, in the wake of a human-caused biological event, who was responsible. Recent scientific developments have demonstrated a capability for detecting whether an organism involved in such an event has been genetically modified and, if modified, to infer from its genetic sequence its likely lab of origin. We believe this technique could be developed into powerful forensic tools to aid the attribution of outbreaks caused by genetically engineered pathogens, and thus protect against the potential misuse of synthetic biology.

Airport Security Screener Problem-Solving Knowledge and Implications

OBJECTIVE

This research investigates security screeners' knowledge and the effect that differences in knowledge have on the performance of problem-solving activities. We argue that the development of problem-solving knowledge enables security screeners to perform effective problem-solving activity, which assists search and decision-making processes.

BACKGROUND

Airport security screening research has investigated the many variables that affect security screeners' search and decision making during simulated threat-detection tasks. Although search and decision making are essential aspects of security screening, few studies have investigated the problem-solving knowledge and activities that support security screening task performance.

METHOD

Sixteen more-experienced and 24 less-experienced security screeners were observed as they performed x-ray screening in the field at an Australian international airport's departure security checkpoint. Participants wore eye-tracking glasses and delivered concurrent verbal protocol.

RESULTS

When interacting with other security screeners, more-experienced screeners demonstrated situational knowledge more than less-experienced screeners, whereas less-experienced screeners experienced more insufficient knowledge. Lag-sequential analysis using combined data from both screener groups showed that situational knowledge facilitated effective problem-solving activity to support search and decision making. Insufficient knowledge led screeners to seek assistance and defer decision making.

CONCLUSION

This study expands current understandings of airport security screening. It demonstrates that security screeners develop knowledge that is specific to problem solving. This knowledge assists effective problem-solving activity to support search and decision making, and to mitigate uncertainty during the x-ray screening task.

APPLICATION

Findings can inform future security screening processes, screener training, and technology support tools. Furthermore, findings are potentially transferable to other domains.

Neuromodulatory hacking: a review of the technology and security risks of spinal cord stimulation

BACKGROUND

Spinal cord stimulation (SCS) is a neuromodulatory technique used to relieve chronic pain. Previous instances of malicious remote control of implantable medical devices, including insulin delivery pumps and implantable cardiac defibrillators, have been documented. Though no cases of neuromodulatory hacking have been recorded outside of the academic setting, an understanding of SCS technology and the possible consequences of manipulation is important in promoting safety.

METHODS

We review the components and implantation protocol of a SCS system, the functionality and technological specifications for SCS systems in the global market based on their device manuals, and patient- and clinician-specific adjustable factors. Furthermore, we assess documented instances of implantable medical device hacking and speculate on the potential harms of targeting SCS systems.

RESULTS

SCS systems from Abbott Laboratories, Boston Scientific, Medtronic, and Nevro have unique functionality and technological specifications. Six parameters in device control can potentially be targeted and elicit various harms, including loss of therapeutic effect, accelerated battery drainage, paresthesia in unintended locations, muscle weakness or dysfunction, tissue burn, and electrical shock.

CONCLUSIONS

Based on the history of implantable medical device hacking, SCS systems may also be susceptible to manipulation. As the prevalence of SCS use increases and SCS systems continuously evolve in the direction of wireless control and compatibility with mobile devices, appropriate measures should be taken by manufacturers and governmental agencies to ensure safety.

Benign or disordered development? Assessment and simulation of security of highly aggregated tourist crowds in China

Arising with increasing security issues in highly aggregated tourist crowds (HATCs), widespread attention has been dedicated to security status. Assessing and forecasting the security status of HATCs in various situations related to tourist destinations is an important strategy of security management. Thus, this study constructed a system dynamic flow diagram for the security evaluation of HATCs. The relevant data were collected on perceptions of crowded tourists through questionnaires at Tianyou Peak during China's National Day (Golden Week Holiday). Additionally, efforts were made to conduct online surveys at Shanghai Disney Park and Shilin Night Market in Taipei, since crowding always occurs in these two areas. Empirical results based on Vensim software suggest that HATC status is the result of the coupling of various influencing factors and the result of the benign coupling of the three subsystems: multi-source pressure, state variation, and management response. HATC security presents a changing trend of “increase-decrease-recovery”. Differences exist in the changes of HATC security status in different spaces and at different time nodes. The findings also indicated that HATCs that appear in the daytime are more stable than HATCs that appear at special time nodes. This study highlighted that the security management of HATCs should focus on systematization, differentiation, and precision management.

Evolving population distribution in China's border regions: Spatial differences, driving forces and policy implications

The security and socioeconomic development of China’s border areas are of great significance to the nation and the wider world. Using census, statistical, digital elevation model (DEM) and network data, this paper employs visual analysis to capture population distribution patterns in China’s 131 border counties from 1982 to 2010. Multiple stepwise regression is carried out to identify the influencing factors of population dynamics in border regions. The main findings include: China’s most heavily populated border areas are primarily in the northeast, northwest, and the Guangxi-Yunnan region, while rapid growth of population is found in western Inner Mongolia, southwest Xinjiang, northwest Tibet, and southern Yunnan. Given the increasingly market-oriented migration mechanism, the national reclamation policy has been no longer effective in population attraction in the new century. Education has significantly lowered and will continuously lower the fertility rate in remote border areas. The factors influencing population growth show a remarkable regional heterogeneity along China’s long border.

Analyzing medical device connectivity and its effect on cyber security in german hospitals

BACKGROUND

Modern healthcare devices can be connected to computer networks and many western healthcare institutions run those devices in networks. At the same time, cyber attacks are on the rise and there is evidence that cybercriminals do not spare critical infrastructure such as major hospitals, even if they endanger patients. Intuitively, the more and closer connected healthcare devices are to public networks, the higher the risk of getting attacked.

METHODS

To asses the current connectivity status of healthcare devices, we surveyed the field of German hospitals and especially University Medical Center UMCs.

RESULTS

The results show a strong correlation between the networking degree and the number of medical devices. The average number of medical devices is 25.150, with a median of networked medical devices of 3.600. Actual key users of networked medical devices are the departments Radiology, Intensive Care, Radio-Oncology RO, Nuclear Medicine NUC, and Anaesthesiology in the group of UMCs. In the next five years, the usage of networked medical devices will increase significantly in the departments of Surgery, Intensive Care, and Radiology. We detected a strong correlation between the degree of connectivity and the likelihood of being attacked.The survey answers regarding the cyber security status reveal a lack of security basics in some of the inquired hospitals. We did discover successful attacks in hospitals with separated or subsidiary departments. A fusion of competencies on an organizational level facilitates the right behavior here. Most hospitals rated themselves predominantly positively in the self-assessment but also stated the usefulness of IT security insurance.

CONCLUSIONS

Concluding our results, hospitals are already facing the consequences of omitted measures within their growing pool of medical devices. Continuously relying on historically grown structures without adaption and trusting manufactures to solve vectors is a critical behavior that could seriously endanger patients.