Do No Harm in Global Health Engagement

This manuscript examines the principle of "Do No Harm" in DoD Global Health Engagement (GHE) efforts. It highlights the potential positive and negative consequences of health investments and explores how unintentional harm is addressed in a global health context. The manuscript also discusses the involvement of the U.S. military in global health and the concept of dual loyalty faced by military GHE practitioners. The goal is to understand the challenges of doing no harm and identify methods to mitigate or avoid unintended negative consequences in DoD GHE activities.

Hydrogen-Bonded Complexes in Binary Mixture of Imidazolium-Based Ionic Liquids with Organic Solvents

Though local structures in ionic liquids are dominated by strong Coulomb forces, directional hydrogen bonds can also influence the physicochemical properties of imidazolium-based ionic liquids. In particular, the C-2 position of the imidazolium cation is acidic and can bind with suitable hydrogen bond acceptor sites of molecular solvents dissolved in imidazolium-based ionic liquids. In this report, we identify hydrogen-bonded microenvironments of the model ionic liquid, 1-ethyl-3-methylimidazolium tris(pentafluoroethyl) trifluorophosphate, and the changes that occur when molecular solvents are dissolved in it by using a C-D infrared reporter at the C-2 position of the cation. Our linear and nonlinear infrared experiments, along with computational studies, indicate that the molecular solvent dimethyl sulfoxide can form strong hydrogen-bonded dimers with the cation of the ionic liquid at the C-2 position. In contrast, acetone, which is also a hydrogen bond acceptor similar to dimethyl sulfoxide, does not show evidence of cation-solvent hydrogen-bonded conformers at the C-2 position. The outcome of our study on a broad scale strengthens the importance of cation-solute interactions in ionic liquids.

Assessment of Local and Regional Control in Atypical (WHO Grade 2) Meningiomas Receiving Fractioned Stereotactic Radiotherapy

PURPOSE/OBJECTIVE(S)

The optimal delivery of postoperative radiotherapy to WHO grade 2 or atypical meningiomas (AM) is controversial. The historical standard of care has been high dose fractionated radiation to the resection bed and a 2 cm CTV as in RTOG 0539. Single fraction radiosurgery offers a more conformal alternative with demonstrated local control for smaller AM in less sensitive areas. Though less studied, fractionated stereotactic radiosurgery (FSRT) promises safer treatment of larger AM in more sensitive locations while minimizing the treated volume. This single institution retrospective review examines the hypothesis that local and marginal failure patterns in AM treated with five fraction FSRT remain unacceptably high.

MATERIALS/METHODS

Thirty-nine patients received 27.5 - 30 Gy in 5 fractions to their AM from 2009 to 2022 with grading based on the WHO criteria active at the time of treatment. All treatments were frameless VMAT deliveries with no PTV margin. Histological diagnosis of AM, gross disease at time of FSRT, five fraction FSRT, and lack of prior local radiation were required for inclusion. Single fraction treatments were excluded. Local recurrence was defined similar to RECIST criteria as an increase of 20% in the greatest cross-sectional diameter on MRI (or CT if MRI contraindicated) with at least one voxel touching the prescription volume. To examine the role of CTV margin, marginal recurrence was defined as any new lesion outside of the prescription volume but within 2 cm of the resection cavity. High grade toxicity per CTCAE v5 was an irreversible grade 3 or any grade 4 toxicity. Resection for radionecrosis was considered a local failure if any viable tumor was seen on pathology.

RESULTS

Median follow up was 32.5 months (range 3.2-147.5 months). The number of AM treated post STR, post GTR recurrence, and definitively were 26, 16, and 5 respectively. 3-year local tumor control was estimated to be 84%. As expected, larger tumors were more likely to fail locally (p >.001). Two (5%) patients experienced high grade toxicity - both symptomatic radionecrosis requiring resection. Three-year marginal control was estimated to be 92.3%. Of the 5 tumors treated to the entire resection cavity, none experienced a marginal failure. Interestingly, recurrent tumors s/p GTR were more likely to recur marginally than tumors treated after STR (p = .009). Only 1 (4%) tumor treated after STR failed marginally while 4 (33%) tumors treated after GTR recurrence failed.

CONCLUSION

The rate of high-grade toxicity in AM receiving FSRT was low. Local control appeared comparable to historical rates which may suggest the need for dose escalation with longer term follow-up. Recurrent tumors appear more prone to marginal failures, however more work is needed to determine which patients may benefit from additional CTV margin and more prolonged fractionated dose schedules. Improved targeting with newer imaging studies (e.g., DOTATATE PET) should be examined to determine if more accurate targeting will improve outcomes.

Fentanyl Assay Derived from Intermolecular Interaction-Enabled Small Molecule Recognition (iMSR) with Differential Impedance Analysis for Point-of-Care Testing

Rapid and effective differentiation and quantification of a small molecule drug, such as fentanyl, in bodily fluids are major challenges for diagnosis and personal medication. However, the current toxicology methods used to measure drug concentration and metabolites require laboratory-based testing, which is not an efficient or cost-effective way to treat patients in a timely manner. Here, we show an assay for monitoring fentanyl levels by combining the intermolecular interaction-enabled small molecule recognition (iMSR) with differential impedance analysis of conjugated polymers. The differential interactions with the designed anchor interface were transduced through the perturbance of the electric status of the flexible conducting polymer. This assay showed excellent fentanyl selectivity against common interferences, as well as in variable body fluids through either testing strips or skin patches. Directly using the patient blood, the sensor provided 1%-5% of the average deviation compared to the "gold" standard method LC-MS results in the medically relevant fentanyl range of 20-90 nM. The superior sensing properties, in conjunction with mechanical flexibility and compatibility, enabled point-of-care detection and provided a promising avenue for applications beyond the scope of biomarker detection.

Worker Injuries in Southern California's Warehousing Industry: How to Better Protect Workers in This Burgeoning Industry?

Dangerous conditions and worker injuries in the rapidly growing warehousing industry have gained attention in recent years, with accounts typically drawing on worker reports and investigative journalism. We analyzed workers' compensation injury claims and California Division of Occupational Safety and Health (Cal/OSHA) citations in Southern California's large warehousing sector. Claims increased from 2014 to 2018, with a majority of injuries caused by repetitive motion, lifting and other ergonomic risk factors. Cal/OSHA cited employers for violating standards to protect workers from unsafe vehicle operations, dangerous machinery and equipment, and falls; and for failing to implement injury prevention programs. These citations address the causes of some worker injuries; however, no Cal/OSHA citations were issued for violating the state's Repetitive Motion Injuries prevention standard. Nor do enforcement activities address the underlying causes highlighted by workers-high production quotas and a relentless work pace-that characterize the industry. We discuss the value and limitations of our approach and the implications of our results.

Using workers' compensation claims to investigate occupational injuries among residential day laborers and domestic workers

BACKGROUND

While many states have legal provisions to extend workers' compensation eligibility to day laborers or domestic workers hired directly by homeowners or families, little is known about the nature or frequency of injury claims submitted on behalf of these "residential employees."

METHODS

We examined California workers' compensation claims records for injuries that appear to have occurred in residential settings between 2008 and 2018 and where the employer of record was an individual or family. We examined the demographic, occupational, and injury characteristics of our sample and analyzed factors that contribute to the likelihood of a claim resulting in some sort of payment.

RESULTS

We identified 5,463 workers' compensation claims that were likely submitted on behalf of residential employees. Claims most commonly reflected injuries to workers performing housekeeping tasks, followed by construction/maintenance and caregiving. Workers performing construction/maintenance or gardening/landscaping tasks were more likely to be injured on the same day of hire and were more likely to require hospitalization or emergency treatment for their injuries; however, these workers also had a smaller proportion of claims that resulted in payment. We found that employment tenure had the biggest impact on the likelihood of payment, with the odds increasing sharply after the first day of work.

CONCLUSIONS

Although the claims in our data set likely represent only a small fraction of all injuries to residential day laborers and domestic workers during this period, we suggest that workers' compensation claims can provide valuable clues for better understanding occupational injuries among workers in this largely informal sector.

C-D Vibration at C2 Position of Imidazolium Cation as a Probe of the Ionic Liquid Microenvironment

Unlike molecular solvents, imidazolium-based ionic liquids are entirely made of ions with spatial heterogeneity. There is a need for spectroscopic probes that can assess the microenvironment near the cations of these complex liquids. In this manuscript, we describe simple chemical procedures to label the C2 position of imidazolium cation with a C-D vibrational probe and show, through linear and nonlinear vibrational spectroscopies, that this C-D stretching mode can be a useful analytical tool to assess both the solvent microenvironment and solute-solvent interactions in imidazolium-based ionic liquids from the cation point of view. It is expected that this C-D vibration probe on the cation will lead to the development of innovative experimental strategies that can provide a better understanding of such ionic liquids.

Implications of Social and Legal Status on Immigrants' Health in Disaster Zones

This commentary highlights how immigrants who are linguistically isolated, have limited social networks, and lack legal immigration status experience unique health risks in disaster zones. Research on immigrants and disasters tends to focus on immigrants with these characteristics who are residents of disaster-affected areas, disaster recovery workers, or both. We review the sparse research literature and provide examples of innovative but underresourced programs that reduce immigrants' exposure to disaster-related health hazards and economic exploitation in the recovery. We conclude with recommendations for advancing these initiatives while, simultaneously, addressing the anti-immigrant policies that contribute to these disaster-related inequities.

Ortho-Methylarylamines as Time-Dependent Inhibitors of Cytochrome P450 1A1 Enzyme

BACKGROUND

Members of the cytochrome P450 1A family metabolize many procarcinogens such as polycyclicaromatic hydrocarbons and heterocyclic amines. Inactivation of these enzymes is a prerequisite for cancer prevention and treatment in certain cases. Mechanism-based inhibition (time and co-factor dependent) is an effective method for the inactivation of these enzymes. Our recent study on emodin analogs revealed an anthraquinone with ortho-methylarylamine moiety that exhibited timedependent inhibition of P450 enzymes 1A1 and 1A2.

METHODS

To determine whether the amino group or the methyl group or both were responsible for the time-dependent inhibition of these enzymes, a set of eleven compounds containing the orthomethylarylamine moiety were identified through a database search, and studied for the inhibition of the P450 enzymes 1A1, 1A2, 2A6 and 2B1. Our earlier studies on carbazole derivatives provided us with highly selective P450 1A2 inhibitors. Glycine scanning studies were performed on the docked proteinligand complexes of compounds 1-20 in order to understand the contribution of different protein residues towards the ligand binding.

RESULTS

Four compounds were found to cause selective time-dependent inhibition of P450 1A1 with KI values ranging from 0.24 to 8.25 mM. These compounds exhibited only direct inhibition of P450 1A2. Molecular modeling studies of these molecules indicated that the shapes of the molecules, their binding modes, and the methyl substituent in close proximity (4.5-5.7 Å) to the heme-Fe all contributed to their selective time-dependent inhibition activity on P450 1A1. Glycine scanning studies for P450 1A1 indicated that ligand interaction with Phe123 was the strongest binding contributor and similar studies for P450 1A2 indicated that ligand interactions with the phenylalanine residues 226 and 260 were the largest binding contributors.

CONCLUSION

Four compounds have been identified that exhibit selective time-dependent inhibition of P450 1A1. Modeling studies have indicated that the proximity of the aromatic methyl group to the heme-Fe could be the main contributor for time-dependent inhibition. Future studies will focus on the confirmation of the involvement of the aromatic methyl group in enzyme inactivation.

Point-of-Care Determination of Acetaminophen Levels with Multi-Hydrogen Bond Manipulated Single-Molecule Recognition (eMuHSiR)

This work aims to face the challenge of monitoring small molecule drugs accurately and rapidly for point-of-care (POC) diagnosis in current clinical settings. Overdose of acetaminophen (AP), a commonly used over the counter (OTC) analgesic drug, has been determined to be a major cause of acute liver failure in the US and the UK. However, there is no rapid and accurate detection method available for this drug in the emergency room. The present study examined an AP sensing strategy that relies on a previously unexplored strong interaction between AP and the arginine (Arg) molecule. It was found that as many as 4 hydrogen bonds can be formed between one Arg molecule and one AP molecule. By taking advantages of this structural selectivity and high tenability of hydrogen bonds, Arg, immobilized on a graphene surface via electrostatic interactions, was utilized to structurally capture AP. Interestingly, bonded AP still remained the perfect electrochemical activities. The extent of Arg-AP bonds was quantified using a newly designed electrochemical (EC) sensor. To verify the feasibility of this novel assay, based on multihydrogen bond manipulated single-molecule recognition (eMuHSiR), both pharmaceutical and serum sample were examined. In commercial tablet measurement, no significant difference was seen between the results of eMuHSiR and other standard methods. For measuring AP concentration in the mice blood, the substances in serum, such as sugars and fats, would not bring any interference to the eMuHSiR in a wide concentration range. This eMuHSiR method opens the way for future development of small molecule detection for the POC testing.

Mortality and Morbidity during Extreme Heat Events and Prevalence of Outdoor Work: An Analysis of Community-Level Data from Los Angeles County, California

Heat is a well-recognized hazard for workers in many outdoor settings, yet few investigations have compared the prevalence of outdoor work at the community level and rates of heat-related mortality and morbidity. This analysis examines whether heat-related health outcomes occur more frequently in communities with higher proportions of residents working in construction, agriculture, and other outdoor industries. Using 2005–2010 data from Los Angeles County, California, we analyze associations between community-level rates of deaths, emergency department (ED) visits, and hospitalizations during summer heat events and the prevalence of outdoor work. We find generally higher rates of heat-related ED visits and hospitalizations during summer heat events in communities with more residents working outdoors. Specifically, each percentage increase in residents working in construction resulted in an 8.1 percent increase in heat-related ED visits and a 7.9 percent increase in heat-related hospitalizations, while each percentage increase in residents working in agriculture and related sectors resulted in a 10.9 percent increase in heat-related ED visits. The findings suggest that outdoor work may significantly influence the overall burden of heat-related morbidity at the community level. Public health professionals and healthcare providers should recognize work and employment as significant heat risk factors when preparing for and responding to extreme heat events.

Adaptive behaviour, executive function and employment in adults with Down syndrome

BACKGROUND

Individuals with Down syndrome (DS) demonstrate difficulties with aspects of executive function (EF) and adaptive behaviour across the lifespan. There is a current lack of information regarding how these difficulties relate to employment outcomes in adulthood. This study evaluated the adaptive behaviour and EF profiles of individuals with DS during early adulthood and the association between these areas of functioning and employment status.

METHODS

Parents or caregivers of primarily young adults with DS (n = 31; mean chronological age = 25.9 years; SD = 5.92) completed the Vineland Adaptive Behavior Scales - Second Edition the Behavior Rating Inventory of Executive Function - Adult version and a demographic questionnaire that requested information regarding adult employment status.

RESULTS

Findings indicated a distinct pattern of relative strengths and challenges in adaptive behaviour and EF. In addition, the EF sub-domain of working memory was a significant predictor of employment status.

CONCLUSIONS

Specific aspects of the DS cognitive profile may have an important influence on employment status in primarily young adults with DS. Implications for interventions are discussed.

24-hour care: Work and sleep conditions of migrant Filipino live-in caregivers in Los Angeles

INTRODUCTION

Live-in formal caregivers spend consecutive days in patients' homes, raising questions about their ability to secure adequate sleep while on duty. Few studies have examined sleeping conditions and outcomes for this growing workforce.

METHODS

We collected weeklong sleep logs and interview data from 32 Filipino caregivers in Los Angeles who provide live-in services at least 3 consecutive days per week.

RESULTS

Respondents recorded a total average of 6.4 sleep hours during workdays divided over 2.4 sleep periods. Caregivers rated sleep quality as lower while at work; over 40% indicated excessive daytime sleepiness. Female caregivers reported worse sleep outcomes than their male counterparts. Some variations in sleep outcomes were found by employment arrangements.

CONCLUSION

Live-in caregivers experience frequent sleep interruptions at all hours of the day and night to attend to patients' needs. The resulting impacts on sleep quality pose risks for both work-related injury and errors in patient care. Am. J. Ind. Med. 59:1120-1129, 2016. © 2016 Wiley Periodicals, Inc.

Managers' perceptions of the value and impact of HAZWOPER worker health and safety training

BACKGROUND

Worker training is a core component of the OSHA Hazardous Waste Operations and Emergency Response (HAZWOPER) standard, but few studies have considered what motivates managers to provide HAZWOPER training to employees or what they value in that training.

METHODS

In 2012, four university-based programs conducted an exploratory survey of managers who sent employees to HAZWOPER courses. Results from 109 respondents were analyzed.

RESULTS

Forty-two percent of respondents cited regulations as the most important reason to provide HAZWOPER training; many indicated they would provide less training if there were no standard in place. Three-quarters (74%) reported training had improved workplace conditions. Fewer than half said they were likely to involve trained employees in aspects of the organization's H&S program.

DISCUSSION

Compliance with regulatory requirements is an important factor shaping managers' training delivery decisions. Managers recognize positive impacts of training. These impacts could be enhanced by further leveraging employee H&S knowledge and skills.

Worker Engagement in the Health and Safety Regulatory Arena under Changing Models of Worker Representation

This paper examines the efforts of a labor-community-university partnership in Southern California to confront violations of workplace health and safety standards by employers of nonunion workers in low-wage jobs. A worker engagement model has opened avenues for workers and worker advocates to participate in the regulatory arena absent union representation. This approach has achieved notable successes to date, including groundbreaking Cal/OSHA citations and nascent collaboration with agency officials to target enforcement of health and safety standards. We argue this model constitutes the foundation needed to support a potentially viable form of tripartism that allows nonunion workers a voice, albeit limited, in the health and safety regulatory process.

Mortality among veterans with type 2 diabetes initiating metformin, sulfonylurea or rosiglitazone monotherapy

AIMS/HYPOTHESES

Despite oral hypoglycaemic medications being the most commonly used pharmacological treatments for type 2 diabetes, research is limited on their comparative safety, particularly their effects on overall mortality. We compared mortality risk with monotherapy initiation of four oral hypoglycaemic medications in a nationwide cohort of US veterans with type 2 diabetes.

METHODS

We identified new users of oral hypoglycaemic medication monotherapy between 2004 and 2009 who received care for at least 1 year from the Veterans Health Administration.Patients were followed until initial monotherapy discontinuation,addition of another diabetes pharmacotherapy, death or end of follow-up. Mortality HRs were estimated using Cox regression adjusted for potential confounding factors.

RESULTS

Among new users of metformin, sulfonylureas and rosiglitazone (185,360 men, 7,812 women), 4,256 (2.2%) died during follow-up. Average duration of medication use ranged from 1.4 to 1.7 years. Significantly higher mortality risk was seen for glibenclamide (known as glyburide in the USA and Canada) (HR 1.38, 95% CI 1.27, 1.50) or glipizide (HR 1.55,95% CI 1.43, 1.67) compared with metformin monotherapy,and for glipizide compared with rosiglitazone (HR 1.27, 95%CI 1.01, 1.59) or glibenclamide monotherapy (HR 1.12, 95%CI 1.02, 1.23). A significant sex–rosiglitazone interaction was seen (p=0.034) compared with metformin monotherapy, with women having a higher HR (HR 4.36, 95% CI 1.34, 14.20)than men (HR 1.19, 95% CI 0.95, 1.49).

CONCLUSIONS/INTERPRETATIONS

Significantly higher mortality was associated with glibenclamide, glipizide and rosiglitazone use compared with metformin, and with glipizide use compared with rosiglitazone or glibenclamide. The potential for residual confounding by indication should be considered in interpreting these results.

Shaping the future: ten years of the occupational health internship program

The Occupational Health Internship Program (OHIP) was initiated in 2003 to recruit a new, diverse generation of occupational safety and health (OSH) professionals and to advance OSH within union and community-based initiatives. It retains the principles of the original OCAW/Montefiore internship program while adapting to the changed landscape of the 21st-century workplace. Case studies of OHIP projects illustrate how students have contributed to key OSH policies-to regulate silica exposure among construction workers, apply principles of green chemistry with Vietnamese nail salon workers, and integrate OSH into "green" jobs in the recycling industry. They have supported innovative campaigns with immigrant workers in contingent jobs-from taxi drivers to warehouse workers. The students, in turn, have been inspired to enter the OSH arena as professionals and worker advocates with the potential to contribute new energy to an OSH movement.

SU-E-T-158: Neutron Damage of Power Electronics Used during Image Guidance in Proton Therapy

PURPOSE

A series of measurements were performed in a clinical proton therapy beam to assess the sensitivity of silicon-based electronics in commercial x-ray generators to single event burnout from the secondary neutron background in proton therapy treatments.

METHODS

Failure rates were nondestructively measured in various metal oxide semiconductor field-effect transistors (MOSFETs) as a function of applied voltage using a dedicated test circuit board. Neutrons were produced by 230 MeV protons stopping in a brass beam target and high beam current was used to accelerate testing. Neutron fluences were measured by activation analysis of carbon and aluminum in both the test setup and in situ at the generator. Failure rates were determined by scaling results based on beam monitor output to the relevant neutron fluence rate.

RESULTS

Current pulses from the test board clearly indicated the onset of single event burnout without destroying the MOSFET. The neutron fluence measured on the test board was 4.3 ± 0.8×106 n cm-2 MU-1 and this is consistent with previous measurements. The MOSFET failure rate decreased rapidly with a reduction in the applied voltage and is 20-30 times lower in higher-rated components at the same voltage. Under nominal operating conditions the estimated failure rate is tens of failures per year for a generator 6m from the treatment position.

CONCLUSION

The sensitivity of x-ray generator power electronics to neutron-induced single-event burnout is significant and can affect the implementation of image-guided techniques for proton therapy. Strategies and system designs to mitigate this phenomenon are being investigated to help enable x-ray generators withstand the proton therapy environment. This research was supported by the NIH/NCI under grant number 6-PO1 CA 21239.

From agricultural fields to urban asphalt: the role of worker education to promote California's heat illness prevention standard

This article describes an innovative approach to reach and educate workers and worker advocates about California's outdoor heat illness prevention standard. In 2010, Cal/OSHA initiated a statewide education campaign to reduce heat-related illnesses and fatalities and increase awareness of the standard's requirements. In Southern California, the UCLA Labor Occupational Safety and Health Program (LOSH) focused on three principal strategies of community-based outreach, popular education, and organizational capacity building. Central to the LOSH approach was the integration of health promotores into core program planning and training activities and the expansion of campaign activities to a wide variety of rural and urban workers. We describe each of these strategies and analyze the possibilities and constraints of worker education to support implementation of this standard, particularly given the vulnerabilities of the impacted workforce, the often precarious nature of employment arrangements for these workers, and the resource limitations of Cal/OSHA.

The supply of pharmaceuticals in humanitarian assistance missions: implications for military operations

In this article, we provide an overview of key international guidelines governing the supply of pharmaceuticals during disasters and complex emergencies. We review the World Health Organization's guidelines on pharmaceutical supply chain management and highlight their relevance for military humanitarian assistance missions. Given the important role of pharmaceuticals in addressing population health needs during humanitarian emergencies, a good understanding of how pharmaceuticals are supplied at the local level in different countries can help military health personnel identify the most appropriate supply options. Familiarity with international guidelines involved in cross-border movement of pharmaceuticals can improve the ability of military personnel to communicate more effectively with other actors involved in humanitarian and development spheres. Enhancing the knowledge base available to military personnel in terms of existing supply models and funding procedures can improve the effectiveness of humanitarian military operations and invite policy changes necessary to establish more flexible acquisition and funding regulations.

IRT-Sofia BNCT beam tube optimization study

An optimization study of IRT-Sofia BNCT beam tube is presented. In the study we used the MIT/FCB experience. The enlarging of filter/moderator cross section dimensions and the decreasing of collimator length within the limits of the IRT-Sofia reactor design were analyzed. The influence of beam and reactor core axes non-coincidence on the beam properties was also evaluated. The irradiation resistance of polytetrafluoroethylene (Teflon(®)) was also evaluated. The results provide information for making decisions on the IRT-Sofia BNCT beam construction.

The supply of pharmaceuticals in humanitarian assistance missions: implications for military operations

In this article, we provide an overview of key international guidelines governing the supply of pharmaceuticals during disasters and complex emergencies. We review the World Health Organization?s guidelines on pharmaceutical supply chain management and highlight their relevance for military humanitarian assistance missions. Given the important role of pharmaceuticals in addressing population health needs during humanitarian emergencies, a good understanding of how pharmaceuticals are supplied at the local level in different countries can help military health personnel identify the most appropriate supply options. Familiarity with international guidelines involved in cross-border movement of pharmaceuticals can improve the ability of military personnel to communicate more effectively with other actors involved in humanitarian and development spheres. Enhancing the knowledge base available to military personnel in terms of existing supply models and funding procedures can improve the effectiveness of humanitarian military operations and invite policy changes necessary to establish more flexible acquisition and funding regulations.

Effective monitoring and evaluation of military humanitarian medical operations

Non-military government agencies and non-governmental organizations (NGOs) have made great strides in the evaluation of humanitarian medical work, and have learned valuable lessons regarding monitoring and evaluation (M&E) that may be equally as valuable to military medical personnel. We reviewed the recent literature by the worldwide humanitarian community regarding the art and science of M&E, with focus toward military applications. The successes and failures of past humanitarian efforts have resulted in prolific analyses. Alliances of NGOs set the standard for humanitarian quality and M&E standards. Military medical personnel can apply some of these standards to military humanitarian M&E in complex and stability operations. The authors believe that the NGO community?s M&E standards should be applied to improve evaluation of U.S. military medical humanitarian operations.