Investing in health preparedness, response and resilience: a genomics costing tool focused on next generation sequencing

The world has seen unprecedented gains in the global genomic surveillance capacities for pathogens with pandemic and epidemic potential within the last 4 years. To strengthen and sustain the gains made, WHO is working with countries and partners to implement the Global Genomic Surveillance Strategy for Pathogens with Pandemic and Epidemic Potential 2022-2032. A key technical product developed through these multi-agency collaborative efforts is a genomics costing tool (GCT), as sought by many countries. This tool was developed by five institutions - Association of Public Health Laboratories, FIND, The Global Fund to Fight AIDS, Tuberculosis and Malaria, UK Health Security Agency, and the World Health Organization. These institutions developed the GCT to support financial planning and budgeting for SARS-CoV-2 next-generation sequencing activities, including bioinformatic analysis. The tool costs infrastructure, consumables and reagents, human resources, facility and quality management. It is being used by countries to (1) obtain costs of routine sequencing and bioinformatics activities, (2) optimize available resources, and (3) build an investment case for the scale-up or establishment of sequencing and bioinformatics activities. The tool has been validated and is available in English and Russian at https://www.who.int/publications/i/item/9789240090866. This paper aims to highlight the rationale for developing the tool, describe the process of the collaborative effort in developing the tool, and describe the utility of the tool to countries.

Methodology of emergency medical logistics for multiple epidemic areas in public health emergency

Coronavirus disease 2019(COVID-19) has brought great disasters to humanity, and its influence continues to intensify. In response to the public health emergencies, prompt relief supplies are key to reduce the damage. This paper presents a method of emergency medical logistics to quick response to emergency epidemics. The methodology includes two recursive mechanisms: (1) the time-varying forecasting of medical relief demand according to a modified susceptible-exposed-infected- Asymptomatic- recovered (SEIAR) epidemic diffusion model, (2) the relief supplies distribution based on a multi-objective dynamic stochastic programming model. Specially, the distribution model addresses a hypothetical network of emergency medical logistics with considering emergency medical reserve centers (EMRCs), epidemic areas and e-commerce warehousing centers as the rescue points. Numerical studies are conducted. The results show that with the cooperation of different epidemic areas and e-commerce warehousing centers, the total cost is 6% lower than without considering cooperation of different epidemic areas, and 9.7% lower than without considering cooperation of e-commerce warehousing centers. Particularly, the total cost is 20% lower than without considering any cooperation. This study demonstrates the importance of cooperation in epidemic prevention, and provides the government with a new idea of emergency relief supplies dispatching, that the rescue efficiency can be improved by mutual rescue between epidemic areas in public health emergency.

The burden, admission, and outcome of COVID-19 in Africa: protocol for a systematic review and meta-analysis

Background: According to the World Health Organization (WHO), the outbreak of coronavirus disease in 2019 (COVID-19) has been declared as pandemic and public health emergency that infected more than 5 million people worldwide at the time of writing this protocol. Strong evidence for the burden, admission, and outcome of COVID-19 has not been published in Africa. Therefore, this protocol will be served as a guideline to conduct a systematic review and meta-analysis of the burden, admission, and outcome of COVID-19 in Africa. Methods: Published and unpublished studies on the burden, admission, and outcome of COVID-19 in Africa and written in any language will be included. Databases (PubMed / MEDLINE, Google Scholar, Google, EMBASE, Web of Science, Microsoft Academic, WHO COVID-19 database, Cochran Library, Africa Wide Knowledge, and Africa Index Medicus) from December 2019 to May 2020 will be searched. Two independent reviewers will select, screen, extract data, and assess the risk of bias. The proportion will be measured using a random-effects model. Subgroup analysis will be conducted to manage hetrogeinity. The presence of publication bias will be assessed using Egger's test and visual inspection of the funnel plots. This systematic and meta-analysis review protocol will be reported per the PRISMA-P guidelines. Conclusion: This systematic review and meta-analysis protocol will be expected to quantify the burden, admission, and outcome of COVID-19 in Africa. Systematic review registration: This protocol was submitted for registration with the International Prospective Register of Systematic Reviews (PROSPERO) in March 2020 and accepted with the registration number: CRD42020179321(https://www.crd.york.ac.uk/PROSPERO).

Cost Analysis of 3 Concurrent Public Health Response Events: Financial Impact of Measles Outbreak, Super Bowl Surveillance, and Ebola Surveillance in Maricopa County

OBJECTIVE

To generate estimates of the direct costs of mounting simultaneous emergency preparedness and response activities to respond to 3 major public health events.

DESIGN

A cost analysis was performed from the perspective of the public health department using real-time activity diaries and retrospective time and activity self-reporting, wage and fringe benefit data, and financial records to track costs.

SETTING

Maricopa County Department of Public Health (MCDPH) in Arizona. The nation's third largest local public health jurisdiction, MCDPH is the only local health agency serving Maricopa's more than 4 000 000 residents. Responses analyzed included activities related to a measles outbreak with 2 confirmed cases, enhanced surveillance activities surrounding Super Bowl XLIX, and ongoing Ebola monitoring, all between January 22, 2015, and March 4, 2015.

PARTICIPANTS

Time data were sought from all MCDPH staff who participated in activities related to any of the 3 relevant responses. In addition, time data were sought from partners at the state health department and a community hospital involved in response activities. Time estimates were received from 128 individuals (response rate 88%).

MAIN OUTCOME MEASURE

Time and cost to MCDPH for each response and overall.

RESULTS

Total MCDPH costs for measles-, Super Bowl-, and Ebola-related activities from January 22, 2015, through March 4, 2015, were $224 484 (>5800 hours). The majority was for personnel ($203 743) and the costliest response was measles ($122 626 in personnel costs). In addition, partners reported working more than 700 hours for these 3 responses during this period.

CONCLUSIONS

Funding for public health departments remains limited, yet public health responses can be cost- and time-intensive. To effectively plan for future public health responses, it may be necessary to share experiences and financial lessons learned from similar public health responses. External partnerships represent a key contribution for responses such as those examined. It can be expensive for local public health departments to mount effective responses, especially when multiple responses occur simultaneously.

Ebola in the Netherlands, 2014-2015: costs of preparedness and response

The recent epidemic of Ebola virus disease (EVD) resulted in countries worldwide to prepare for the possibility of having an EVD patient. In this study, we estimate the costs of Ebola preparedness and response borne by the Dutch health system. An activity-based costing method was used, in which the cost of staff time spent in preparedness and response activities was calculated based on a time-recording system and interviews with key professionals at the healthcare organizations involved. In addition, the organizations provided cost information on patient days of hospitalization, laboratory tests, personal protective equipment (PPE), as well as the additional cleaning and disinfection required. The estimated total costs averaged €12.6 million, ranging from €6.7 to €22.5 million. The main cost drivers were PPE expenditures and preparedness activities of personnel, especially those associated with ambulance services and hospitals. There were 13 possible cases clinically evaluated and one confirmed case admitted to hospital. The estimated total cost of EVD preparedness and response in the Netherlands was substantial. Future costs might be reduced and efficiency increased by designating one ambulance service for transportation and fewer hospitals for the assessment of possible patients with a highly infectious disease of high consequences.

Integrating pharmacies into public health program planning for pandemic influenza vaccine response

BACKGROUND

During an influenza pandemic, to achieve early and rapid vaccination coverage and maximize the benefit of an immunization campaign, partnerships between public health agencies and vaccine providers are essential. Immunizing pharmacists represent an important group for expanding access to pandemic vaccination. However, little is known about nationwide coordination between public health programs and pharmacies for pandemic vaccine response planning.

METHODS

To assess relationships and planning activities between public health programs and pharmacies, we analyzed data from Centers for Disease Control and Prevention assessments of jurisdictions that received immunization and emergency preparedness funding from 2012 to 2015.

RESULTS

Forty-seven (88.7%) of 53 jurisdictions reported including pharmacies in pandemic vaccine distribution plans, 24 (45.3%) had processes to recruit pharmacists to vaccinate, and 16 (30.8%) of 52 established formal relationships with pharmacies. Most jurisdictions plan to allocate less than 10% of pandemic vaccine supply to pharmacies.

DISCUSSION

While most jurisdictions plan to include pharmacies as pandemic vaccine providers, work is needed to establish formalized agreements between public health departments and pharmacies to improve pandemic preparedness coordination and ensure that vaccinating pharmacists are fully utilized during a pandemic.

Federal Funding for Health Security in FY2017

This latest article in the Federal Funding for Health Security series assesses FY2017 US government funding in 5 domains critical to strengthening health security: biosecurity, radiological and nuclear security, chemical security, pandemic influenza and emerging infectious disease, and multiple-hazard and general preparedness.

Preparedness for epidemic disease or bioterrorism: minimum cost planning for the location and staffing of urban point-of-dispensing centers

Urban health authorities in the United States have been charged with developing plans for providing the infrastructure necessary to dispense prophylactic medications to their populations in the case of epidemic disease outbreak or bioterrorist attack. However, no specific method for such plans has been prescribed. This article formulates and demonstrates the use of an integer programming technique for helping to solve a part of the dispensing problem faced by cities, namely that of providing the federally required infrastructure at minimum cost, using their limited time and resources. Specifically, the technique minimizes the number of point-of-dispensing (POD) centers while covering every resident in all the census tracts within the city's jurisdiction. It also determines the optimal staffing requirement in terms of the number of nurses at each POD. This article includes a demonstration of the model using real data from Cleveland, OH, a mid-sized US city. Examples are provided of data and computational results for a variety of input parameter values such as population throughput rate, POD capacities, and distance limitations. The technique can be readily adapted to a wide range of urban areas.

Federal funding for health security in FY2015

Previous articles in this series have provided funding information for federal civilian biodefense programs and programs focused on radiological and nuclear preparedness and consequence management. This year the authors have expanded the focus of the analysis to US federal funding for health security. This article provides proposed funding amounts for FY2015, estimated amounts for FY2014, and actual amounts for FY2010 through FY2013 in 5 domains critical to health security: biodefense programs, radiological and nuclear programs, chemical programs, pandemic influenza and emerging infectious disease programs, and multiple-hazard and preparedness programs.

Shelf-life extension program (SLEP) as a significant contributor to Strategic National Stockpile Maintenance: the Israeli experience with ciprofloxacin

In the past decade, the 2001 anthrax incident in the U.S. and the 2003 SARS epidemic have highlighted the biological threat to civilian populations. The risk posed by the natural or manmade spread of biological agents among the population dictates a need for better national preparedness. One key component of this preparation is the establishment of a Strategic National Stockpile (SNS) of pharmaceuticals that would provide appropriate medical countermeasures in case of an outbreak. However, to reduce the expense of such a stockpile and to make it worthwhile, there is also a need for a shelf-life extension program (SLEP) through which pharmaceuticals could be extended beyond manufacturer-ascribed shelf life, as long as they meet regulation standards. In this article, we review the Israeli experience with the national ciprofloxacin stockpile procurement and shelf-life extension program.

From biodefence to biosecurity: the Obama administration's strategy for countering biological threats

The Seventh Review Conference of the Biological Weapons Convention (BWC), the first international treaty to outlaw an entire class of weapons, was held in Geneva in December 2011. On 7 December, Secretary of State Hillary Clinton became the highest-ranking US government official to address a BWC meeting. Secretary Clinton told the assembled delegation that ‘we view the risk of bioweapons attack as both a serious national security challenge and a foreign policy priority’. At the same time, she warned that a large-scale disease outbreak ‘could cripple an already fragile global economy’. Secretary Clinton's speech reflected a new understanding that the range of biological threats to international security has expanded from state-sponsored biological warfare programmes to include biological terrorism, dual-use research and naturally occurring infectious diseases such as pandemics. Recognizing these changes, President Barack Obama released a new national strategy for countering biological threats in 2009. This strategy represents a shift in thinking away from the George W. Bush administration's focus on biodefence, which emphasized preparing for and responding to biological weapon attacks, to the concept of biosecurity, which includes measures to prevent, prepare for and respond to naturally occurring and man-made biological threats. The Obama administration's biosecurity strategy seeks to reduce the global risk of naturally occurring and deliberate disease outbreaks through prevention, international cooperation, and maximizing synergies between health and security. The biosecurity strategy is closely aligned with the Obama administration's broader approach to foreign policy, which emphasizes the pragmatic use of smart power, multilateralism and engagement to further the national interest. This article describes the Obama administration's biosecurity strategy; highlights elements of continuity and change from the policies of the Bush administration; discusses how it fits into Obama's broader foreign policy agenda; and analyses critical issues that will have to be addressed in order to implement the strategy successfully.

Historical review of sports policy in rural China (1949-2008)

The rural population in China remains in the majority, and has traditionally played a key role in the development of China. This paper outlines the rhetoric of, and the material changes in the development of rural sports policy in the period since 1949. In effect this represents the largest single programmatic attempt to develop a rural sports policy, and it is one which reflects and contributes to the changing ideology of the state in China. The article explores the historical context of the unfolding of rural sports policy, the rationales provided by state and party leaders and representatives, and the rhetoric employed in supporting such policy direction. The development of policy is described as falling into three periods. From 1949 to 1977 the emphasis was on developing policies to promote labour production and national defence. This was succeeded by a period from 1978 to 2001 in which the major focus was on promoting a culturally positive environment (the construction of a 'spiritual civilization'), while in the period 2002 -08 the concern was with promoting equity and reducing the gap between urban and rural life quality. These developing rationales have sought in a variety of ways to address the major imbalances that exist in Chinese society between urban and rural, Eastern and Western China, and sports policy has thus became a significant tool in China's modernization agenda in the rural context.

The illicit consumption of military uniforms in Britain, 1914–1918

Focusing on the British home front during the First World War, this article explores civilians’ motives for acquiring and wearing military garments and accoutrements to which they were not entitled. It suggests that uniforms could be donned either to avoid the attentions of recruiting sergeants, or to perpetrate criminal deceptions. That said, individuals did not always wear illicit uniforms in order to ‘disguise’ their civilian identity. Rather, many men claimed a sense of entitlement to such items, either on the basis of previous war service, or, more often, on the basis of their contributions to the war effort on the home front. The acquisition of military items could also reflect men's roles as consumers: for many civilians, acquiring and wearing the newly glamorous uniforms was a consumer choice that could also open the door to further leisure and consumer opportunities. Overall, illicitly wearing military items undermined the uniform's link with service and sacrifice on the battle fronts: it allowed individuals to assume the appearance of combatants or to assert their patriotic identities without actually exposing themselves to military duties or dangers. It also reflected (some) men's continued perception of themselves as consumers, keen, even in wartime, to adopt what they saw as the most desirable sartorial option.

Visualizing diurnal population change in urban areas for emergency management

There is an increasing need for a quick, simple method to represent diurnal population change in metropolitan areas for effective emergency management and risk analysis. Many geographic studies rely on decennial U.S. Census data that assume that urban populations are static in space and time. This has obvious limitations in the context of dynamic geographic problems. The U.S. Department of Transportation publishes population data at the transportation analysis zone level in fifteen-minute increments. This level of spatial and temporal detail allows for improved dynamic population modeling. This article presents a methodology for visualizing and analyzing diurnal population change for metropolitan areas based on this readily available data. Areal interpolation within a geographic information system is used to create twenty-four (one per hour) population surfaces for the larger metropolitan area of Salt Lake County, Utah. The resulting surfaces represent diurnal population change for an average workday and are easily combined to produce an animation that illustrates population dynamics throughout the day. A case study of using the method to visualize population distributions in an emergency management context is provided using two scenarios: a chemical release and a dirty bomb in Salt Lake County. This methodology can be used to address a wide variety of problems in emergency management.

Horror and hope: (re)presenting militarised children in global North-South relations

This article examines the (re)presentations of militarised children in contemporary global politics. In particular, it looks at the iconic image of the 21st century's child soldier, the subject of which is constructed as a menacing yet pitiable product of the so-called new wars of the global South. Yet this familiar image is a small, one-dimensional and selective (re)presentation of the issues facing children who are associated with conflict and militarism. In this sense it is a problematic focal point for analysing the insecurity and human rights of children in and around conflict. Instead, this article argues that the image of the child soldier asserts an important influence in its effect upon global North-South relations. It demonstrates how the image of the child soldier can assist in constructing knowledge about the global South, and the global North's obligations to it, either through programmes of humanitarianism, or through war.

Reintegrating young combatants: do child-centred approaches leave children—and adults—behind?

This article uses recent experience in Angola to demonstrate that young fighters were not adequately or effectively assisted after war ended in 2002. The government's framework excluded children from accessing formal disarmament, demobilisation and reintegration (DDR) programmes, and its subsequent attempts to target children have largely failed. More critically the case of Angola calls into question the broader effectiveness and appropriateness of child-centred DDR. First, such targeting is inappropriate to distinct post-conflict contexts and constructs a 'template child' asserted to be more vulnerable and deserving than adult ex-combatants, which does little to further the reintegration of either group, or the rights of the child in a conflict context. Second, child-centred reintegration efforts tend to deny children agency as actors in their own reintegration. Third, such efforts contribute to the normalisation of a much larger ideational and structural flaw of post-conflict peace building, wherein 'success' is construed as the reintegration of large numbers of beneficiaries back into the poverty and marginalisation that contributed to conflict in the first place.

The social, political, ethical, and economic aspects of biodefense vaccines

Besides natural disasters and naturally occurring novel infectious diseases, nothing potentially threatens the health and stability of nations and health systems as much as the devastating threat and unfathomability of bioterrorism. Other than attempts at political solutions and interdictive attempts, only antimicrobials and vaccines offer possible means for protection. Of these, vaccines offer the most immediate and definitive of preventive solutions. Limiting the development and use of vaccines however are social, political, ethical, and economic considerations, and this article will provide a brief exploration of each of these issues and the intersection with the need for such vaccines. In this article we define bioterrorism as the deliberate use of naturally occurring or bioengineered microorganisms in order to cause harm to people, animals, or plants.

An academic medical center under prolonged rocket attack--organizational, medical, and financial considerations

The Rambam Medical Center, the major academic health center in northern Israel, serving a population of two million and providing specialized tertiary care, was exposed to an unprecedented experience during the Second Lebanon War in the summer of 2006. For more than one month, it was subjected to continuous rocket attacks, but it continued to provide emergency and routine medical services to the civilian population and also served the military personnel who were evacuated from the battlefront. To accomplish the goals of serving the population while itself being under fire, the Rambam Medical Center had to undertake major organizational decisions, which included maximizing safety within the hospital by shifting patients and departments, ensuring that the hospital was properly fortified, managing the health professional teams' work schedules, and providing needed services for the families of employees. The Rambam Medical Center's Level I trauma center expertise included multidisciplinary teams and extensive collaborations; modern imaging modalities usually reserved for peacetime medical practice were frequently used. The function of the hospital teams during the war was efficient and smooth, based on the long-term actions taken to prepare for disasters and wartime conditions. Routine hospital services continued, although at 60% of normal occupancy. Financial losses incurred were primarily due to the decrease in revenue-generating activity. The two most important components of managing the hospital under these conditions are (1) the ability to arrive at prompt and meaningful decisions with respect to the organizational and medical hospital operations and (2) the leadership and management of the professional staff and teams.

One minute after the detonation of the atomic bomb: the erased effects of residual radiation

The U.S. Government's official narrative denies the effects of residual radiation which appeared one minute after the atomic bomb detonations in Hiroshima and Nagasaki. This paper explores declassified documents from the U.S. Atomic Energy Commission, the Atomic Bomb Casualties Commission, and others and shows that these documents actually suggested the existence of serious effects from residual radiation.

Through hell and high water: New Orleans, August 29 - September 15, 2005

In October of 2005 the Historic New Orleans Collection initiated an oral history project entitled "Through Hell and High Water: New Orleans, August 29 - September 15, 2005." The intent of the project was to capture the stories of first responders who worked in the New Orleans metropolitan area during the storm and the weeks that followed. The interview process has been linked with the after-action studies done by some of the local first-responding agencies and has provided a much-needed outlet for first responders. To date over three hundred subjects have been interviewed, and our work thus far has shown us that top-down methods of documentation do not work with an event like Katrina. The almost total loss of communications made it impossible for high-ranking members of the different agencies to control or even know what lower-ranking members were doing. As a result it will be necessary to cast a wide net in our documentation effort.

Pharmaceuticals and the strategic national stockpile program

This article discusses current stockpile practices after exploring a history of the use of biologic agents as weapons, the preventive measures that the federal government has used in the past, and the establishment of a Strategic National Stockpile Program in 2003. The article also describes the additional medical supplies from the managed inventory and the federal medical stations. The issues (financial burden, personnel, and materiel selection) for local asset development are also discussed. Critical is the cost to local communities of the development and maintenance of a therapeutic agent stockpile and the need for personnel to staff clinics and medical stations. Finally, the important role of the dental profession for dispensing medication and providing mass immunization in the event of a disaster is described.

Turning biodefense dollars into products

Five years after the US anthrax attacks, and more than two years after BioShield legislation was ratified, a survey reveals that biodefense funding has thus far produced only a handful of products for clinical development.

The American biodefense industry: from emergency to nonemergence

Since 1998, and especially since the "Amerithrax" emergency of 2001, the United States has ambitiously funded biodefense projects, intending not only to enhance detection and management of any biological-weapons attack but also to establish a robust domestic biodefense industry. I asked if the United States had fulfilled this latter intention. Using the RAND Corporation's RaDiUS database, I examined federal biodefense grants and contracts awarded from 1995 through most of 2005, noting recipient type, awarding unit, funding level, and the disease focus of research-and-development support. Patterns in these data as well as other sources suggest that the biodefense industry as late as 2005 remained in a nascent stage, with most firms small, precariously financed, and more responsive to funders' announcements and solicitations than to opportunities for self-directed innovation. A biodefense industry with investor-capital funding and retained earnings, with its own leading companies, with its own stock analysts, and with its own legitimacy in commercial and financial markets did not emerge over the period studied, nor does its emergence appear imminent.

E3LSI research: an essential element of biodefense

The threat of bioterrorism has prompted the U.S. to undertake a vast biodefense initiative, including funding biodefense-related scientific research at unprecedented levels. Unfortunately, the many ethical, economic, environmental, legal, and social implications (E(3)LSI) of biodefense research and activities are not yet receiving the attention they warrant. Previously, in laudable demonstrations of foresight and responsibility, the federal government has funded research into the E(3)LSI of other recent scientific endeavors--namely, the Human Genome Project and the nanotechnology research program--through directed appropriations from their respective research budgets. This article advocates and proposes a model for a portion of biodefense funding to be similarly set aside for an E(3)LSI research program to complement biodefense research, to ensure that bioterror preparedness does not give rise to harmful or otherwise undesirable unintended consequences.

Billions for Biodefense: Federal Agency Biodefense Budgeting, FY2005–FY2006

Since 2001, the United States government has spent substantial resources on preparing the nation against a bioterrorist attack. An earlier article analyzed the civilian biodefense funding by the federal government from fiscal years 2001 through 2005. This article updates those figures with budgeted amounts for fiscal year 2006, specifically analyzing the budgets and allocations for biodefense at the Department of Health and Human Services, the Department of Homeland Security, the Department of Agriculture, the Environmental Protection Agency, the National Science Foundation, and the Department of State.

Public health and national security: the critical role of increased federal support

Protecting the public's health historically has been a state and local responsibility. However, the growing threat of bioterrorism has highlighted the importance of a strong public health infrastructure to the nation's homeland security and has focused increased attention on the preparedness of the public health system. As a result, federal public health funding has increased exponentially since the anthrax attacks of late 2001, and Congress has passed sweeping new federal legislation intended to strengthen the nation's public health system. This heightened level of federal interest and support should yield important public health benefits. Most recognize that after years of neglect the public health infrastructure cannot be rebuilt overnight. As we implement a comprehensive strategy to increase the capabilities and capacity of our nation's public health system, it is essential to address a series of important policy questions, including the appropriate level of ongoing public health investments from local, state, and federal sources.

Is the Turkish health care system ready to be a part of the European Union?

Lately, Turkey is struggling to recover from the economic effects of the economic crisis so that the government officials are trying to impose budget cuts in health and education sectors. After the United States, the country's national defense expenditures are the highest among the NATO countries. Therefore, Turkey allocates only 3-4% of the gross domestic product for health care expenses. Overall, the health status in Turkey is the lowest among the European Union countries; infant mortality rate is about 45 per 1000 live births, which is the highest on the European continent, and per capita health care expenditure is $120. Although 75% of the people are covered by some type of public insurance, 25% of the Turkish people do not have any insurance coverage. The national system is funded by taxes (43%), out of pocket payments (32%), and social and private insurance premiums (25%). This study examines whether Turkey is ready to be a part of the European Union in terms of the health sector of its economy and health status of its people.

Willingness to pay for defense against weapons of mass destruction

A survey assessed the willingness to pay for defense against weapons of mass destruction. The results were evaluated according to the benefit to society. The results indicated preferences for increased spending on intelligence gathering, training, and equipment. We concluded that the United States is spending less for weapons of mass destruction defense than the sample population was willing to pay.

Popular gymnastics and the military spirit in Germany, 1848-1871

Over the course of the nineteenth century, a popular nationalist movement developed in the German states that had gained considerable strength by 1871, the year of unification. The German gymnastics association movement was one of the main forms in which popular nationalism was organized. It was started by Friedrich Ludwig Jahn early in the nineteenth century as a means to train young Germans to fight the French occupation. Gradually, it developed into a movement that sought to unify Germany, a project that was not, at first, supported by the German states. The movement was also guided by liberal and, especially before the revolution of 1848, democratic principles, and in this sense, too, was at odds with the reigning political system in Central Europe.

From camp follower to lady in uniform: women, class and military institutions before 1920

In the crisis of the First World War, the vast expansion of military control over civil society included women's work. Women contributed not only directly to war production but also to maintaining the entire socioeconomic structure in jobs such as trolley conductor or farm worker. Hundreds and thousands of women volunteered for war work in social and relief organisations. If their work under wartime conditions did not differ radically from the centuries-old tradition of nursing and other forms of care-giving, the considerable human force they now brought to military support work raised to a new level the debate over the proper role of women in modern democratic society. And whether members of the armed forces, employees or civilian volunteers, they all wore uniforms.