Clinical, Biomarker, and Research Tests Among US Government Personnel and Their Family Members Involved in Anomalous Health Incidents

Importance

Since 2015, US government and related personnel have reported dizziness, pain, visual problems, and cognitive dysfunction after experiencing intrusive sounds and head pressure. The US government has labeled these anomalous health incidents (AHIs).

Objective

To assess whether participants with AHIs differ significantly from US government control participants with respect to clinical, research, and biomarker assessments.

Design, Setting, and Participants

Exploratory study conducted between June 2018 and July 2022 at the National Institutes of Health Clinical Center, involving 86 US government staff and family members with AHIs from Cuba, Austria, China, and other locations as well as 30 US government control participants.

Exposures

AHIs.

Main Outcomes and Measures

Participants were assessed with extensive clinical, auditory, vestibular, balance, visual, neuropsychological, and blood biomarkers (glial fibrillary acidic protein and neurofilament light) testing. The patients were analyzed based on the risk characteristics of the AHI identifying concerning cases as well as geographic location.

Results

Eighty-six participants with AHIs (42 women and 44 men; mean [SD] age, 42.1 [9.1] years) and 30 vocationally matched government control participants (11 women and 19 men; mean [SD] age, 43.8 [10.1] years) were included in the analyses. Participants with AHIs were evaluated a median of 76 days (IQR, 30-537) from the most recent incident. In general, there were no significant differences between participants with AHIs and control participants in most tests of auditory, vestibular, cognitive, or visual function as well as levels of the blood biomarkers. Participants with AHIs had significantly increased fatigue, depression, posttraumatic stress, imbalance, and neurobehavioral symptoms compared with the control participants. There were no differences in these findings based on the risk characteristics of the incident or geographic location of the AHIs. Twenty-four patients (28%) with AHI presented with functional neurological disorders.

Conclusions and Relevance

In this exploratory study, there were no significant differences between individuals reporting AHIs and matched control participants with respect to most clinical, research, and biomarker measures, except for objective and self-reported measures of imbalance and symptoms of fatigue, posttraumatic stress, and depression. This study did not replicate the findings of previous studies, although differences in the populations included and the timing of assessments limit direct comparisons.

Neuroimaging Findings in US Government Personnel and Their Family Members Involved in Anomalous Health Incidents

Importance

US government personnel stationed internationally have reported anomalous health incidents (AHIs), with some individuals experiencing persistent debilitating symptoms.

Objective

To assess the potential presence of magnetic resonance imaging (MRI)-detectable brain lesions in participants with AHIs, with respect to a well-matched control group.

Design, Setting, and Participants

This exploratory study was conducted at the National Institutes of Health (NIH) Clinical Center and the NIH MRI Research Facility between June 2018 and November 2022. Eighty-one participants with AHIs and 48 age- and sex-matched control participants, 29 of whom had similar employment as the AHI group, were assessed with clinical, volumetric, and functional MRI. A high-quality diffusion MRI scan and a second volumetric scan were also acquired during a different session. The structural MRI acquisition protocol was optimized to achieve high reproducibility. Forty-nine participants with AHIs had at least 1 additional imaging session approximately 6 to 12 months from the first visit.

Exposure

AHIs.

Main Outcomes and Measures

Group-level quantitative metrics obtained from multiple modalities: (1) volumetric measurement, voxel-wise and region of interest (ROI)-wise; (2) diffusion MRI-derived metrics, voxel-wise and ROI-wise; and (3) ROI-wise within-network resting-state functional connectivity using functional MRI. Exploratory data analyses used both standard, nonparametric tests and bayesian multilevel modeling.

Results

Among the 81 participants with AHIs, the mean (SD) age was 42 (9) years and 49% were female; among the 48 control participants, the mean (SD) age was 43 (11) years and 42% were female. Imaging scans were performed as early as 14 days after experiencing AHIs with a median delay period of 80 (IQR, 36-544) days. After adjustment for multiple comparisons, no significant differences between participants with AHIs and control participants were found for any MRI modality. At an unadjusted threshold (P < .05), compared with control participants, participants with AHIs had lower intranetwork connectivity in the salience networks, a larger corpus callosum, and diffusion MRI differences in the corpus callosum, superior longitudinal fasciculus, cingulum, inferior cerebellar peduncle, and amygdala. The structural MRI measurements were highly reproducible (median coefficient of variation <1% across all global volumetric ROIs and <1.5% for all white matter ROIs for diffusion metrics). Even individuals with large differences from control participants exhibited stable longitudinal results (typically, <±1% across visits), suggesting the absence of evolving lesions. The relationships between the imaging and clinical variables were weak (median Spearman ρ = 0.10). The study did not replicate the results of a previously published investigation of AHIs.

Conclusions and Relevance

In this exploratory neuroimaging study, there were no significant differences in imaging measures of brain structure or function between individuals reporting AHIs and matched control participants after adjustment for multiple comparisons.

A Safety Approach for Improving Security - Effective Coordination Strategies at the Airport Security Screening Checkpoint

OBJECTIVE

This study aimed to analyze effective teamwork at security checkpoints by investigating how security crews communicate in different (routine and threat) situations.

BACKGROUND

Working at an airport security screening checkpoint is challenging. Although tasks and processes are highly regulated and standardized due to legal requirements, security screeners must be trained to deal with unforeseen threat situations involving high levels of uncertainty. Therefore, security crews need to engage in flexible and adaptive coordination according to the situation and circumstances.

METHOD

We conducted a field study with 20 airport security screening crews comprising 100 security screeners. Teamwork in terms of interaction between crew members was measured, differentiating between proactive "push" communication and information on request representing "pull" communication. Furthermore, non-task related communication was assessed.

RESULTS

While crews showed non-task related communication more in routine situations, both task-related "push" and "pull" communication occurred more in threat situations. In terms of team performance, we could show significant positive effects of proactive "push" communication and non-task related interaction in threat situations.

CONCLUSION

Our results underscore the specific setting of airport security screening and the challenges that arise for teamwork. This study investigates professional screeners and passengers in the field. In contrast to other high-risk areas, security crews are confronted with a third party that complicates coordination strategies considered effective in previous studies.

APPLICATION

Our findings recommend situation-specific communication strategies for practical training for airport security screening crews.

Sex and Racial/Ethnic Differences in School Security Measures, Bullying Victimization, and Perceived School Safety: Implications for Pediatric Health Care

INTRODUCTION

Using the 2017 National Crime Victimization Survey dataset, this study examined the association between the types of school security measures and students' bullying victimization and perceived school safety.

METHOD

Using logistic regression and ordinary least square regression analyses, the study addressed whether these associations vary by sex and race/ethnicity, as most research has treated sex and race/ethnicity as covariates.

RESULTS

The study found that none of the security measures were associated with bullying victimization among the total sample. However, there were sex and racial differences in the association between security measures and bullying victimization. There were also sex and racial/ethnic variations in the association between security measures and perceived school safety.

DISCUSSION

Scholars, health care practitioners, and policymakers must reflect and reconsider whether increasing school security and control would contribute to the safety and well-being of racial/ethnic minority students in school.

Threats to conservation from national security interests

There is a growing trend of nation states invoking national security and emergency declarations to build state-sponsored infrastructure projects for border defense, energy production, and transportation. Established laws, regulations, and agreements for the protection of nature and cultural heritage within and between countries are becoming secondary to national security, compromising the function of protected areas, such as national parks, wilderness areas, and biosphere reserves that safeguard biodiversity, climate, and human health. We considered cases where decades-long multinational cross-border endangered species recovery programs have been jeopardized by waivers of environmental protection laws to facilitate rapid construction of border barriers that impede the movement and migration of animals, such as at the US-Mexico and Poland-Belarus borders. Renewable energy megaprojects, such as the Pinacate solar plant in Mexico, coupled with power transmission lines and road networks likewise cast a large footprint on the land and are being carried out with minimal to no environmental compliance under the guise of national security. National sovereignty likewise has been used as justification for bypassing laws to proceed with similar projects, such as Mexico's Dos Bocas refinery and Poland's Vistula Spit canal. Emphasis on security is also apparent in increasing military expenditure by the world's largest economies, which has created a mismatch with improvement in environmental policy stringency. Decisions to prioritize security can undermine democratic principles and environmental review protocols, trivialize humanity's dependence on functioning ecosystems, and contradict the United Nation's resolution on the human right to a healthy environment. Framing infrastructure projects as matters of national security also foments civil and political unrest by the labeling and casting of dissenters, including conservation scientists and environmental defenders, as antinational. World leaders must refrain from misusing extraordinary powers, adhere to laws and international agreements, and consult experts and local people before taking unilateral action on projects that affect ecological and human communities.

Detection of safety helmet and mask wearing using improved YOLOv5s

With the advancement of society, ensuring the safety of personnel involved in municipal construction projects, particularly in the context of pandemic control measures, has become a matter of utmost importance. This paper introduces a security measure for municipal engineering, combining deep learning with object detection technology. It proposes a lightweight artificial intelligence (AI) detection method capable of simultaneously identifying individuals wearing masks and safety helmets. The method primarily incorporates the ShuffleNetv2 feature extraction mechanism within the framework of the YOLOv5s network to reduce computational overhead. Additionally, it employs the ECA attention mechanism and optimized loss functions to generate feature maps with more comprehensive information, thereby enhancing the precision of target detection. Experimental results indicate that this algorithm improves the mean average precision (mAP) value by 4.3%. Furthermore, it reduces parameter and computational loads by 54.8% and 53.8%, respectively, effectively striking a balance between lightweight operation and precision. This study serves as a valuable reference for research pertaining to lightweight target detection in the realm of municipal construction safety measures.

Locked external doors on inpatient mental health units: A scoping review

The principles of least restrictive care and recovery-focused practice are promoted as contemporary practice in the care of individuals with mental ill health, underpinning legislation concerning mental health and illness in many jurisdictions worldwide. Inpatient mental health units with locked doors are incompatible with this style of care and throwback to a time where care for mental illness was primarily custodial. The aim of this scoping review is to determine whether evidence exists for locking mental health unit doors, whether this practice is compatible with recovery-focused care and to determine whether door locking has changed since a review conducted by Van Der Merwe et al. (Journal of Psychiatric and Mental Health Nursing, 16, 2009, 293) found that door locking was not the preferred practice in the management of acute mental health units. We used Arksey and O'Malley's (International Journal of Social Research Methodology: Theory and Practice, 8, 2005, 19) framework for scoping reviews, with our initial search locating 1377 studies, with screening narrowing final papers for inclusion to 20. Methodologies for papers included 12 using quantitative methodology, 5 qualitative and 3 that used mixed methods designs. Poor evidence was found for door locking to mitigate risks such as absconding, aggression or illicit substance importation. Furthermore, locked doors had a detrimental impact on the therapeutic relationship, nurse job satisfaction and intention to leave the profession. This scoping review indicates that research is urgently needed to address a mental healthcare culture where door locking is an entrenched practice. Studies of alternative approaches to risk management are required to ensure inpatient mental health units are truly least-restrictive, therapeutic environments.

When the security measure meets bordered penality: Release procedures for persons who are not criminally responsible without residence rights in Belgium

Offenders considered to be persons not criminally responsible (hereafter Persons NCR) in Belgium, are subjected to a security measure. This is executed by means of a forensic care trajectory, often beginning in high-security prison units or forensic psychiatric facilities, and moving through medium and lower security psychiatric facilities, with the intention to ultimately integrate them back into society. Within this group there are 145 persons without residence rights. This article is attentive to how the forensic care trajectories for people without residence rights are currently navigated. Six qualitative interviews were conducted with key decision-makers in the forensic care trajectories of Persons NCR. Moreover, we analyse the legislative framework regarding the security measure and illustrate how features of 'bordered penality' are clearly present. Our results indicate that when working towards a return to the country of origin fails, Persons NCR without residence rights become neglected, either in high-security prison units or forensic facilities. We explore avenues to improve this precarious situation, and consider possibilities to guarantee mental healthcare according to a persons' security needs rather than their residence rights.

How COVID-19 is reshaping U.S. national security policy

In the wake of the COVID-19 pandemic, the United States is actively reshaping parts of its national security enterprise. This article explores the underlying politics, with a specific interest in the context of biosecurity, biodefense, and bioterrorism strategy, programs, and response, as the United States responds to the most significant outbreak of an emerging infectious disease in over a century. How the implicit or tacit failure to recognize the political will and political decision-making connected to warfare and conflict for biological weapons programs in these trends is explored. Securitization of public health has been a focus of the literature over the past half century. This recent trend may represent something of an inverse: an attempt to treat national security interests as public health problems. A hypothesis is that the most significant underrecognized problem associated with COVID-19 is disinformation and the weakening of confidence in institutions, including governments, and how adversaries may exploit that blind spot.

Climate change and groundwater overdraft impacts on agricultural drought in India: Vulnerability assessment, food security measures and policy recommendation

The problem of drought in India is a major issue in terms of various adverse impacts on livelihood of society. Drought Early Warning System (DEWS), a real-time drought-monitoring tool, has reported that over a fifth of India's geographical area (21.06 %) is suffering drought-like situations. This is 62 % larger than the drought-affected area during the same period last year, which was 7.86 %. Drought affects 21.06 %, with conditions ranging from unusually dry to extremely dry. While 1.63 % and 1.73 % of the area are experiencing 'extreme' or 'exceptional' dry conditions, 2.17 % is experiencing 'severe' dry conditions. Under 'moderate' dry circumstances, up to 8.15 % is possible. In this perspective groundwater vulnerability assessment in the overall country is needed for implementing the sustainable and long-term strategies for escaping from this type of hazardous situation. The main objective of this study is to estimate the drought vulnerability in changing climate which eventually influences the food security of India. The groundwater overdraft is one of the crucial elements in agricultural drought vulnerability. Various related parameters have been selected for estimating the drought vulnerability and its impact to food security in India. Here, MaxEnt (maximum entropy) and ANN (analytical neural network) has been considered in this perspective. The AUC values for the training datasets in the ANN and MaxEnt model are 0.891 and 0.921, respectively. The AUC values in ANN and MaxEnt model for the validation datasets are 0.876 and 0.904, respectively. Here MaxEnt model is most optimal than ANN considering predictive accuracy. From this study analysis it is established that western, south and middle portion of country is very much prone to drought vulnerability. So, special emphases in terms of the regional planning have to be taken into consideration for sustainable planning.

MFA-net: Object detection for complex X-ray cargo and baggage security imagery

Deep convolutional networks have been developed to detect prohibited items for automated inspection of X-ray screening systems in the transport security system. To our knowledge, the existing frameworks were developed to recognize threats using only baggage security X-ray scans. Therefore, the detection accuracy in other domains of security X-ray scans, such as cargo X-ray scans, cannot be ensured. We propose an object detection method for efficiently detecting contraband items in both cargo and baggage for X-ray security scans. The proposed network, MFA-net, consists of three plug-and-play modules, including the multiscale dilated convolutional module, fusion feature pyramid network, and auxiliary point detection head. First, the multiscale dilated convolutional module converts the standard convolution of the detector backbone to a conditional convolution by aggregating the features from multiple dilated convolutions using dynamic feature selection to overcome the object-scale variant issue. Second, the fusion feature pyramid network combines the proposed attention and fusion modules to enhance multiscale object recognition and alleviate the object and occlusion problem. Third, the auxiliary point detection head adopts an auxiliary head to predict the new keypoints of the bounding box to emphasize the localizability without requiring further ground-truth information. We tested the performance of the MFA-net on two large-scale X-ray security image datasets from different domains: a Security Inspection X-ray (SIXray) dataset in the baggage domain and our dataset, named CargoX, in the cargo domain. Moreover, MFA-net outperformed state-of-the-art object detectors in both domains. Thus, adopting the proposed modules can further increase the detection capability of the current object detectors on X-ray security images.

Nigeria in the COVID era: Health system strengthening for national security and prosperity

The coronavirus disease-19 pandemic has spread to all parts of the world. As of 20 May 2022, over 500 million confirmed cases have occurred with over 6 million deaths. In Nigeria, over 255,000 cases have occurred with more than 3000 deaths. The pandemic has adversely affected virtually all aspects of human endeavour, with a severe impact on the health system. The Nigerian health system was ill prepared for the pandemic, and this further weakened it. The impacts of the pandemic on the health system include disruption of health services, low motivation of the health workforce, unresponsive leadership and poor funding. The national response, though initially weak, was ramped up to expand capacity building, testing, public enlightenment, creation of isolation and treatment centres and research. The funding for the national response was from the government, private sector and multilateral donors. Nigeria must comprehensively strengthen its health system through motivating and building the capacity of its human resources for health, improved service delivery and provision of adequate funding, to be better prepared against future pandemics.

Securing Schools? Examining the Longitudinal Relationships Between Student Behavior and Engagement With Security Measures in Urban School Systems

The use of school security measures has increased over the last two decades. Yet prior research suggests school security measures have a deterrent effect on student misbehavior. Existing studies often focus on school-level comparisons in security as opposed to examining how students within a given school differ in their interaction with security measures (i.e., within-school differences). To address this gap in the literature, the current study estimates the association between individual students' engagement with security and multiple forms of maladaptive student behavior in school. In particular, this study is guided by two research questions: 1) What is the relationship between students' engagement with school security measures and their engagement in problem behaviors; and, 2) To what extent do the relationships between engagement with security and student behavior problems differ by student race and ethnicity? Longitudinal data were collected from students at two separate time points in one academic year (N=359) across eight schools in one urban school district. Using a series of models to examine how students' engagement with school security measures is related to their perpetration of student behavior, findings highlight negative associations between engagement with school security and non-serious violent and weapons-related crime. While the school security change score and students' engagement in problem behaviors was no different for Black students than it was for students who were non-Black or non-Hispanic, the negative association between engagement with security and behavior indicated a stronger deterrent effect for Hispanic students. Findings suggest that engagement with school security should be examined at the within-school level and with consideration that racial and ethnic differences might vary from student to student within any given school. Moreover, long-term programming goals should be established when developing process for securing schools with emphasis on how security measures might influence individual students differently within the school setting.

How Realistic Is Threat Image Projection for X-ray Baggage Screening?

At airports, security officers (screeners) inspect X-ray images of passenger baggage in order to prevent threat items (bombs, guns, knives, etc.) from being brought onto an aircraft. Because threat items rarely occur, many airports use a threat-image-projection (TIP) system, which projects pre-recorded X-ray images of threat items onto some of the X-ray baggage images in order to improve the threat detection of screeners. TIP is regulatorily mandated in many countries and is also used to identify officers with insufficient threat-detection performance. However, TIP images sometimes look unrealistic because of artifacts and unrealistic scenarios, which could reduce the efficacy of TIP. Screeners rated a representative sample of TIP images regarding artifacts identified in a pre-study. We also evaluated whether specific image characteristics affect the occurrence rate of artifacts. 24% of the TIP images were rated to display artifacts and 26% to depict unrealistic scenarios, with 34% showing at least one of the two. With two-thirds of the TIP images having been perceived as realistic, we argue that TIP still serves its purpose, but artifacts and unrealistic scenarios should be reduced. Recommendations on how to improve the efficacy of TIP by considering image characteristics are provided.

Active shooter mitigation techniques

This paper looks at current active shooter mitigation techniques employed by schools throughout the country in an attempt to mitigate casualties during an active shooter event. The researchers modified an existing Columbine High School agent-based model created by Jae Lee, MS, to examine if the introduction of a school resource officer (SRO), concealed carry weapon (CCW) holder, or both would change the outcome of the previous research. RUN.HIDE.FIGHT® scenarios were modeled with the same parameters of the previous work, but now included armed first responders during the incident to assess whether their presence decreased casualties through a reduction in response time. The researchers determined that the addition of either an SRO, CCW holder, or both significantly reduced casualty rates during an active shooter scenario.

Airport security as translation through division and movement

Based on an ethnographic research at Václav Havel Airport Prague, this article explores how contemporary airport security might by studied using an ANT-inspired approach. Security provision can be understood as a set of chains of translation that produces security and threat. Incoming actors, whose statuses are initially indeterminate, are translated into secure or threatening ones. This framing enables the uncovering of division and movement as the logics guide the system performance. The use of this perspective enables us to explicate the system's functioning in practice, including its inherent challenges and social consequences.

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.

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.