Regulatory, safety, and privacy concerns of home monitoring technologies during COVID-19

There has been increasing interest in the use of home monitoring technologies during the COVID-19 pandemic to decrease interpersonal contacts and the resultant risks of exposure for people to the coronavirus SARS-CoV-2. This Perspective explores how the accelerated development of these technologies also raises major concerns pertaining to safety and privacy. We make recommendations for needed interventions to ensure safety and review best practices and US regulatory requirements for privacy and security. We discuss, among other topics, Emergency Use Authorizations for medical devices and privacy laws of the USA and Europe.

The 2019 Global Health Security Index (GHSI) and its implications for New Zealand and Pacific regional health security

It is important for all countries to secure themselves against infectious disease threats, including potential global catastrophic biological risks. The Global Health Security Index (GHSI), first published in 2019, is a comprehensive, objective assessment of health security capabilities across 195 States Parties to the International Health Regulations. The GHSI is a broader assessment than the World Health Organization Joint External Evaluation and emphasises public documentation of preparedness as well as sustainable capabilities. New Zealand scored 54/100 on the GHSI (35th in the world). But also worryingly, the range of scores for New Zealand's Pacific neighbours was 19.2-27.8, highlighting potential regional vulnerabilities. Clearly, the New Zealand Government needs to do more to ensure its own optimal preparedness for global biological threats, and document these preparations to assure the international community. But it should also provide additional overseas development assistance (bringing this assistance up to 0.7% of GNI as per UN recommendations) and work with Pacific Nations to enhance health security in the region.

Developing Vaccines for SARS-CoV-2 and Future Epidemics and Pandemics: Applying Lessons from Past Outbreaks

The COVID-19 pandemic is a stark reminder of the heavy toll that emerging infectious diseases (EIDs) with epidemic and pandemic potential can inflict. Vaccine development, scale-up, and commercialization is a long, expensive, and risky enterprise that requires substantial upfront planning and offers no guarantee of success. EIDs are a particularly challenging target for global health preparedness, including for vaccine development. Insufficient attention has been given to challenges, lessons learned, and potential solutions to support and sustain vaccine industry engagement in vaccine development for EIDs. Drawing from lessons from the most recent Ebola epidemic in the Democratic Republic of the Congo, as well as the 2009 H1N1 influenza, 2014-2016 Ebola, and 2015-16 Zika outbreaks preceding it, we offer our perspective on challenges facing EID vaccine development and recommend additional solutions to prioritize in the near term. The 6 recommendations focus on reducing vaccine development timelines and increasing business certainty to reduce risks for companies. The global health security community has an opportunity to build on the current momentum to design a sustainable model for EID vaccines.

Health security capacities in the context of COVID-19 outbreak: an analysis of International Health Regulations annual report data from 182 countries

BACKGROUND

Public health measures to prevent, detect, and respond to events are essential to control public health risks, including infectious disease outbreaks, as highlighted in the International Health Regulations (IHR). In light of the outbreak of 2019 novel coronavirus disease (COVID-19), we aimed to review existing health security capacities against public health risks and events.

METHODS

We used 18 indicators from the IHR State Party Annual Reporting (SPAR) tool and associated data from national SPAR reports to develop five indices: (1) prevent, (2) detect, (3) respond, (4) enabling function, and (5) operational readiness. We used SPAR 2018 data for all of the indicators and categorised countries into five levels across the indices, in which level 1 indicated the lowest level of national capacity and level 5 the highest. We also analysed data at the regional level (using the six geographical WHO regions).

FINDINGS

Of 182 countries, 52 (28%) had prevent capacities at levels 1 or 2, and 60 (33%) had response capacities at levels 1 or 2. 81 (45%) countries had prevent capacities and 78 (43%) had response capacities at levels 4 or 5, indicating that these countries were operationally ready. 138 (76%) countries scored more highly in the detect index than in the other indices. 44 (24%) countries did not have an effective enabling function for public health risks and events, including infectious disease outbreaks (7 [4%] at level 1 and 37 [20%] at level 2). 102 (56%) countries had level 4 or level 5 enabling function capacities in place. 32 (18%) countries had low readiness (2 [1%] at level 1 and 30 [17%] at level 2), and 104 (57%) countries were operationally ready to prevent, detect, and control an outbreak of a novel infectious disease (66 [36%] at level 4 and 38 [21%] at level 5).

INTERPRETATION

Countries vary widely in terms of their capacity to prevent, detect, and respond to outbreaks. Half of all countries analysed have strong operational readiness capacities in place, which suggests that an effective response to potential health emergencies could be enabled, including to COVID-19. Findings from local risk assessments are needed to fully understand national readiness capacities in relation to COVID-19. Capacity building and collaboration between countries are needed to strengthen global readiness for outbreak control.

FUNDING

None.

Real-time Concealed Object Detection from Passive Millimeter Wave Images Based on the YOLOv3 Algorithm

The detection of objects concealed under people's clothing is a very challenging task, which has crucial applications for security. When testing the human body for metal contraband, the concealed targets are usually small in size and are required to be detected within a few seconds. Focusing on weapon detection, this paper proposes using a real-time detection method for detecting concealed metallic weapons on the human body applied to passive millimeter wave (PMMW) imagery based on the You Only Look Once (YOLO) algorithm, YOLOv3, and a small sample dataset. The experimental results from YOLOv3-13, YOLOv3-53, and Single Shot MultiBox Detector (SSD) algorithm, SSD-VGG16, are compared ultimately, using the same PMMW dataset. For the perspective of detection accuracy, detection speed, and computation resource, it shows that the YOLOv3-53 model had a detection speed of 36 frames per second (FPS) and a mean average precision (mAP) of 95% on a GPU-1080Ti computer, more effective and feasible for the real-time detection of weapon contraband on human body for PMMW images, even with small sample data.

Development of Invisible Sensors and a Machine-Learning-Based Recognition System Used for Early Prediction of Discontinuous Bed-Leaving Behavior Patterns

This paper presents a novel bed-leaving sensor system for real-time recognition of bed-leaving behavior patterns. The proposed system comprises five pad sensors installed on a bed, a rail sensor inserted in a safety rail, and a behavior pattern recognizer based on machine learning. The linear characteristic between loads and output was obtained from a load test to evaluate sensor output characteristics. Moreover, the output values change linearly concomitantly with speed to attain the sensor with the equivalent load. We obtained benchmark datasets of continuous and discontinuous behavior patterns from ten subjects. Recognition targets using our sensor prototype and their monitoring system comprise five behavior patterns: sleeping, longitudinal sitting, lateral sitting, terminal sitting, and leaving the bed. We compared machine learning algorithms of five types to recognize five behavior patterns. The experimentally obtained results revealed that the proposed sensor system improved recognition accuracy for both datasets. Moreover, we achieved improved recognition accuracy after integration of learning datasets as a general discriminator.

Justice and rule of law failure in Haiti: A view from the Shanties

Since 1995, significant investments have been made in justice reform initiatives in Haiti. The results, however, have been meager. Drawing upon data from a longitudinal study conducted in Cité Soleil between 2008 and 2011, this article illuminates the short-sightedness of top-down reforms that fail to meet the demands of the population, leaving them to fend for themselves. In the absence of a viable justice system Cité Soleil residents have resorted to alternative, and at times pathological, measures to exact some level of "justice". In this article, we contend that an empirically grounded base of knowledge of the demand side of justice and the promotion of trust-building strategies that engage the active participation of citizens in the country are necessary to enact and sustain justice and rule of law reform. Such an approach will create a venue to channel civil society's demands, build political will and facilitate coordination between stakeholders and Haitian society for self-sustained rule of law institutions and long-term peace building in Haiti.

A comparison of long-term medium secure patients within NHS and private and charitable sector units in England

BACKGROUND

In England, forensic psychiatric hospital services are provided at three security levels: high, medium and low. All are publicly funded and similarly regulated, but medium and low secure services are provided in the private and charitable (PCS) sector as well as the National Health Service (NHS). Originally, medium secure hospital services were conceived as for up to 2 years' inpatient stay, but numbers of longer stay patients have been rising. Little is known about their characteristics or whether they differ between NHS and PCS settings.

AIMS

To describe and compare characteristics of long-stay patients in NHS and in PCS medium security hospital units.

METHODS

Data were extracted from clinical records in 14 NHS and 9 PCS hospital units for all patients fulfilling criteria for long stay: having been in high security for more than 10 years or medium security for more than 5 years or in a mix of both for more than 15 years in total.

RESULTS

178 NHS and 107 PCS patients were eligible for inclusion, respectively, 16 and 22% of the total patient populations in these settings. The mean length of stay in a medium or high secure setting was similar: 163 and 164 months. Characteristics of the patients, however, differed between unit type. NHS services admitted more patients from prison and PCS services more from other hospitals. NHS services included a lower proportion of patients with personality disorder or intellectual disability. 'Challenging behaviour' was more prevalent in PCS; a history of absconding was found more often among NHS patients.

CONCLUSIONS

The two systems of service appear to be used differently. More research is needed to explain why patients apparently without behavioural disturbances remain in specialist secure facilities for such a long time and whether their needs are truly being met in the least restrictive environment possible.

Nurses' Perspectives of Factors That Influence Therapeutic Relationships in Secure Inpatient Forensic Hospitals

BACKGROUND

The therapeutic relationship is synonymous with mental health nursing and fundamental to the provision of nursing care, regardless of the setting in which care is provided. This literature review examines, from a nursing perspective, factors influencing the formation and maintenance of therapeutic relationships in forensic mental health settings.

METHODS

A systematic search of the literature, using a range of electronic databases, focusing on nurse-patient therapeutic relationships in forensic settings was conducted. Articles were Critical Appraisal Skills Programme quality appraised, followed by a meta-aggregative thematic approach to data analysis and synthesis to identify themes and, finally, a production of an "action" policy statement.

FINDINGS AND IMPLICATION FOR PRACTICE

Eight articles met the criteria for review inclusion. Nine themes were identified; seven were categorized as internal/interpersonal factors, and two were categorized as external/environmental factors (with some themes interconnected). Synthesis of findings resulted in the production of a policy statement encouraging forensic mental health nurses to be aware of intrapersonal influences on therapeutic relationships and the need to provide a safe and supportive clinical environment for these relationships to form.

Taking Privacy to a New Level: Texas Lowers Reporting Threshold for Security Breaches

Federal requirements have not changed, but starting Jan. 1, breach notification requirements will become even more stringent for Texas physicians or medical entities. The Texas Legislature dropped the threshold for breach reporting from 500 patients to 250. House Bill 4390 also requires medical entities to report breaches to the Texas attorney general's office within 60 days of the breach.

A review of airport dual energy X-ray baggage inspection techniques: Image enhancement and noise reduction

In this paper, we present a review of the research literature regarding applying X-ray imaging of baggage scrutiny at airport. It discusses multiple X-ray imaging inspection systems used in airports for detecting dangerous objects inside the baggage. Moreover, it also explains the dual energy X-ray image fusion and image enhancement factors. Different types of noises in digital images and noise models are explained in length. Diagrammatical representations for different noise models are presented and illustrated to clearly show the effect of Poisson and Impulse noise on intensity values. Overall, this review discusses in detail of Poisson and Impulse noise, as well as its causes and effect on the X-ray images, which create un-certainty for the X-ray inspection imaging system while discriminating objects and for the screeners as well. The review then focuses on image processing techniques used by different research studies for X-ray image enhancement, de-noising, and their limitations. Furthermore, the most related approaches for noise reduction and its drawbacks are presented. The methods that may be useful to overcome the drawbacks are also discussed in subsequent sections of this paper. In summary, this review paper highlights the key theories and technical methods used for X-ray image enhancement and de-noising effect on X-ray images generated by the airport baggage inspection system.

An approach for adaptive automatic threat recognition within 3D computed tomography images for baggage security screening

BACKGROUND

The screening of baggage using X-ray scanners is now routine in aviation security with automatic threat detection approaches, based on 3D X-ray computed tomography (CT) images, known as Automatic Threat Recognition (ATR) within the aviation security industry. These current strategies use pre-defined threat material signatures in contrast to adaptability towards new and emerging threat signatures. To address this issue, the concept of adaptive automatic threat recognition (AATR) was proposed in previous work.

OBJECTIVE

In this paper, we present a solution to AATR based on such X-ray CT baggage scan imagery. This aims to address the issues of rapidly evolving threat signatures within the screening requirements. Ideally, the detection algorithms deployed within the security scanners should be readily adaptable to different situations with varying requirements of threat characteristics (e.g., threat material, physical properties of objects).

METHODS

We tackle this issue using a novel adaptive machine learning methodology with our solution consisting of a multi-scale 3D CT image segmentation algorithm, a multi-class support vector machine (SVM) classifier for object material recognition and a strategy to enable the adaptability of our approach. Experiments are conducted on both open and sequestered 3D CT baggage image datasets specifically collected for the AATR study.

RESULTS

Our proposed approach performs well on both recognition and adaptation. Overall our approach can achieve the probability of detection around 90% with a probability of false alarm below 20%.

CONCLUSIONS

Our AATR shows the capabilities of adapting to varying types of materials, even the unknown materials which are not available in the training data, adapting to varying required probability of detection and adapting to varying scales of the threat object.

Some cues are more equal than others: Cue plausibility for false alarms in baggage screening

This study investigated the effects of cue plausibility in a baggage screening task. 120 participants had to indicate whether a prohibited item was present in a series of grey-scaled X-ray images of baggage. They were assisted by a support system, which pointed at the location of a suspicious object. A 2 × 2 × 2 between-subjects design was used. Cue plausibility for false alarms (i.e. how the cued object was similar to a prohibited item) and support system reliability were manipulated at two levels (high/low). Furthermore, half of participants were provided with a rationale about automation failures (RAF) to reduce their negative impact on trust and performance. The results showed lower performance and more compliance with automation suggestions when cues were implausible than plausible. The RAF increased the response time and did not improve detection performance. Overall, this suggests that effective (computer-based) training is needed to reduce the negative effect of plausible cues.

Human health as a philosophic phenomenon and an important component of national security and state sovereignty potential

OBJECTIVE

The aim: Examination of the human health problem as a philosophical phenomenon and an important component of national security and potential of the state sovereignty.

PATIENTS AND METHODS

Materials and methods: The authors have analyzed scientific data (7 references) using methods of systemic approach and systemic analysis.

CONCLUSION

Conclusions: The population health was always and is currently a state priority in civilized countries. Ukrainian researchers have no doubt the problem "Population health and state security and defense" needs the participation of not only medical specialists, but also of sociologists, economists, ecologists, politicians; this problem is a poly-disciplinary one. Reforms in the health care field of Ukraine are to solve an especially important and urgent task - strengthening of Ukrainian people health. The essence of concepts «national security» та «sovereignty of the state» being conditioned to a significant degree by the health state of our citizens leads to affirmation the steadfast state sovereignty to be a factor ensuring the stability and high level of national security. It is currently of the greatest importance to take into consideration all the possible configurations of future having determined strategic priorities and preparing favorable conditions for steadfast development. Currently, such development is dependent on the level of community health and quality of state government.

A reference architecture for plausible Threat Image Projection (TIP) within 3D X-ray computed tomography volumes

BACKGROUND

Threat Image Projection (TIP) is a technique used in X-ray security baggage screening systems that superimposes a threat object signature onto a benign X-ray baggage image in a plausible and realistic manner. It has been shown to be highly effective in evaluating the ongoing performance of human operators, improving their vigilance and performance on threat detection.

OBJECTIVE

With the increasing use of 3D Computed Tomography (CT) in aviation security for both hold and cabin baggage screening a significant challenge arises in extending TIP to 3D CT volumes due to the difficulty in 3D CT volume segmentation and the proper insertion location determination. In this paper, we present an approach for 3D TIP in CT volumes targeting realistic and plausible threat object insertion within 3D CT baggage images.

METHOD

The proposed approach consists of dual threat (source) and baggage (target) volume segmentation, particle swarm optimisation based insertion determination and metal artefact generation. In our experiments, real baggage data collected from airports are used to generate TIP volumes for evaluation. We also propose a TIP quality score metric to automatically estimate the quality of generated TIP volumes.

RESULT

In our experiments with real baggage CT volumes and varying threat items, 90.25% of the generated TIP volumes are graded as good by human evaluation, 7% of them are of medium quality with minor flaws and 2.75% of them are bad.

CONCLUSION

Qualitative evaluations on real 3D CT baggage imagery show that our approach is able to generate realistic and plausible TIP which are indiscernible from real CT volumes and the TIP quality scores are consistent with human evaluations.

Challenging Europe: Technology, Environment, and the Quest for Resource Security

Since the nineteenth century, access to and the development of natural resources became an important element of national and international politics. Resource security emerged as an issue vital to national security; and resource competition and crises gave rise to international tensions as well as to technological innovation and new modes of transnational cooperation.

Ecological Security Assessment Based on Ecological Footprint Approach in Hulunbeir Grassland, China

Hulunbeir grassland, as a crucial ecological barrier and energy supply base in northwest China, suffers from a fragile ecological environment. Therefore, it is crucially important for Hulunbeir grassland to achieve the sustainable development of its social economies and ecological environments through the evaluation of its ecological security. This paper introduces the indexes of the ecological pressure index (EPI), ecological footprint diversity index (EFDI), and ecological coordination coefficient (ECC) based on the ecological footprint model. Furthermore, the Stochastic Impacts by Regression on Population, Affluence, and Technology (STIRPAT) model was applied to analyze the main driving factors of the change of the ecological footprint. The results showed that: The ecological footprint (EF) per capita of Hulunbeir grassland has nearly doubled in 11 years to 11.04 ha/cap in 2016, while the ecological capacity (EC) per capita was rather low and increased slowly, leading to a continuous increase of per capita ecological deficit (ED) (from 5.7113 ha/cap to 11.0937 ha/cap). Within this, the footprint of fossil energy land and grassland contributed the most to the total EF, and forestland and cropland played the major role in EC. The EPI increased from 0.82 in 2006 to 1.25 in 2016, leading the level of ecological security to increase from level 3 (moderately safe) to level 4 (moderately risky). The indexes of the EFDI and ECC both reached a minimum in 2014 and then began to rise, indicating that Hulunbeir steppe’s ecological environment, as well as its coordination with economy, was considered to be worse in 2014 but then gradually ameliorated. The STIRPAT model indicated that the main factors driving the EF increase were per capita GDP and the proportion of secondary industry, while the decrease of unit GDP energy consumption played an effective role in curbing the continuous growth of the EF. These findings not only have realistic significance in promoting the coordinated development between economy and natural resource utilization under the constraint of fragile environment, but also provide a scientific reference for similar energy-rich ecologically fragile regions.

Plutonium Desorption from Nuclear Melt Glass-Derived Colloids and Implications for Migration at the Nevada National Security Site, USA

The migration of low levels of plutonium has been observed at the Nevada National Security Site (NNSS) and attributed to colloids. To better understand the mechanism(s) of colloid-facilitated transport at this site, we performed flow cell desorption experiments with mineral colloid suspensions produced by hydrothermal alteration of NNSS nuclear melt glass, residual material left behind from nuclear testing. Three different colloid suspensions were used: (1) colloidal material from hydrothermal alteration of nuclear melt glass at 140 °C; (2) at 200 °C; and (3) plutonium sorbed to SWy-1 montmorillonite at room temperature. The 140 °C sample contained only montmorillonite, while zeolite and other phases were present in the 200 °C sample. Overall, more plutonium was desorbed from the 140 °C colloids (ca. 9-16%) than from the 200 °C colloids (ca. 4-8%). Furthermore, at the end of the 4.5 day flow cell experiments, the desorption rates for the 140 °C colloids and the Pu-montmorillonite colloids were similar while the desorption rates from the 200 °C colloids were up to an order of magnitude lower. We posit that the formation of zeolites and clays hydrothermally altered at 200 °C may lead to a more stable association of plutonium with colloids, resulting in lower desorption rates. This may give rise to more extensive colloid-facilitated transport and help explain why trace levels of plutonium are found downgradient from their original source decades after a nuclear detonation. Interestingly, in the case of cesium (a co-contaminant of plutonium), no difference was observed between the 140 and 200 °C colloids. This reflects intrinsic differences between cesium and plutonium sorption/desorption behavior (charge, cation size) and suggests that the Cs sorption mechanism (cation exchange) is not similarly affected by colloid formation temperature.

Migration of noble gas tracers at the site of an underground nuclear explosion at the Nevada National Security Site

As part of an underground gas migration study, two radioactive noble gases (³⁷Ar and ¹²⁷Xe) and two stable tracer gases (SF₆ and PFDMCH) were injected into a historic nuclear explosion test chimney and allowed to migrate naturally. The purpose of this experiment was to provide a bounding case (natural transport) for the flow of radioactive noble gases following an underground nuclear explosion. To accomplish this, soil gas samples were collected from a series of boreholes and a range of depths from the shallow subsurface (3 m) to deeper levels (~160 m) over a period of eleven months. These samples have provided insights into the development and evolution of the subsurface plume and constrained the relative migration rates of the radioactive and stable gas species in the case when the driving pressure from the cavity is low. Analysis of the samples concluded that the stable tracer SF₆ was consistently enriched in the subsurface samples relative to the radiotracer ¹²⁷Xe, but the ratios of SF₆ and ³⁷Ar remained similar throughout the samples.

Healthcare under siege: a qualitative study of health-worker responses to targeting and besiegement in Syria

OBJECTIVES

To explore health-worker perspectives on security, improving safety, managing constrained resources and handling mass casualties during besiegement in Syria.

DESIGN

A qualitative study using semi-structured key informant interviews, conducted remotely over WhatsApp and Skype, and analysed thematically using inductive coding.

SETTING

Secondary and tertiary health facilities affected by besiegement in Aleppo (from July to December 2016) and Rural Damascus (from August 2013 to February 2018).

PARTICIPANTS

Twenty-one male Syrian health-workers and service-users who had experienced besiegement and targeting of their health facilities.

RESULTS

Participants described four related challenges of: (i) conflict-related responses, particularly responding to mass casualties; (ii) targeted attack responses, particularly preventing/surviving facility bombings; (iii) besiegement responses, particularly mitigating severe resource constraints; and (iv) chronic risk responses, particularly maintaining emotional resilience. Mass casualty response involved triage and training to prioritise mortality reduction and available resources, for example those with greatest need and likelihood of survival. Targeting response was largely physical, including fortification, working underground, reducing visibility and services dispersal. Besiegement response required resource conservation, for example, controlling consumption, reusing consumables, low-technology equipment, finding alternative supply routes, stockpiling and strengthening available human resources through online trainings and establishing a medical school in Ghouta. Risk responses included managing safety worries, finding value in work and maintaining hope.

CONCLUSION

Besieged health-workers were most affected by severe resource constraints and safety concerns while responding to overwhelming mass casualty events. Lessons for targeting/besiegement planning include training staff and preparing for: (i) mass casualties, through local/online health-worker training in triage, emergency response and resource conservation; allowing task-shifting; and providing access to low-technology equipment; (ii) attacks, through strengthened facility security, for example, protection and deterrence through fortification, working underground and reducing visibility; and (iii) besiegement, through ensuring access to internet, electricity and low-technology/reusable equipment; securely stockpiling fuel, medicines and supplies; and establishing alternative supply routes.

Risk Factors Associated With Inpatient Violence During Medium Security Treatment

Violence is a common phenomenon both in regular and forensic psychiatric settings, and has a profound impact on staff and other patients. Insight into the individual risk factors associated with violence in forensic psychiatric settings is rare and is therefore the subject of this research. A retrospective file study in three medium security units in Flanders was conducted to compare non-violent inpatients with inpatients who engaged in (verbal and physical) violent behavior. Binary logistic regression analyses were used to examine which variables contributed independently to the risk of violence. The results showed that absconding during treatment was independently associated with physical violence. A personality disorder diagnosis and general non-compliance with treatment were associated with verbal violence. Both types of violence predicted early termination of treatment. Contrary to previous research, the results from the risk assessment tools were not associated with inpatient violence. Clinical implications are discussed and include, among others, that clinicians should remain vigilant for early warning signs of non-compliance during treatment.