Physician, Protect Thyself: Why Psychiatrists Should Be Aware of Their Internet Presence and How to Protect Themselves

ABSTRACT

Modern psychiatric practice requires the use of the Internet, and the current pandemic has accelerated the adoption of technology in clinics. Psychiatrists receive significant education on protecting patient privacy and medical information when using these tools. However, they receive little training regarding protecting their own personal privacy in the Internet era. Private information, often without one's knowledge, is frequently available online and accessible by patients. The work of physicians and psychiatrists creates additional unique vulnerabilities to privacy. Given the essential nature of the Internet in modern clinical practice, physicians should understand how to monitor and protect personal privacy and safety online. We provide advice to minimize vulnerability to a privacy breach, with a focus on areas unique to psychiatrists and psychiatric practice. We review the literature on physician safety online and offer guidance to get started.

Evaluating the Perceived Efficacy of Randomized Security Measures at Airports

Both the increase in traveler numbers and the heightened threat posed by terrorism in recent years represent significant challenges to airport security measures. To ensure that a high level of security is maintained, randomized security checks have been proposed as a promising alternative to traditional security approaches. The use of randomized checks means that only a specific number of people are selected for security screening. However, the likely effects of such a change in security procedures on travelers' security perceptions and on the deterrence of criminal activities remain unclear. Thus, the present study examines how varying the percentage of people screened during security checks influences people's security perceptions. In two online experiments, the participants were asked to imagine that they sought to smuggle an explosive dummy past an airport security check. The only information provided was the number of people screened during security checks, which was manipulated between-subjects in the first experiment and within-subjects in the second experiment. The participants then had to rate their security perception (i.e., the perceived likelihood of successfully smuggling the explosive dummy). The findings show that people perceive traditional security checks to be safer than randomized checks, irrespective of whether 90% or 30% of people are screened. Hence, if randomized security checks would indeed be implemented, it would automatically lead to a decreased perception of security. Furthermore, this decreased security perception might lead to an actual reduction in security, as the deterrence of criminal activities could also be reduced.

Automation reliability, human-machine system performance, and operator compliance: A study with airport security screeners supported by automated explosives detection systems for cabin baggage screening

Using a simulated X-ray screening task, we tested 122 airport security screeners working with the support of explosives detection systems for cabin baggage screening (EDSCB) as low-level automation. EDSCB varied systematically on three automation reliability measures: accuracy, d', and positive predictive value (PPV). Results showed that when unaided performance was high, operator confidence was high, and automation provided only small benefits. When unaided performance was lower, operator confidence was lower, and automation with higher d' provided large benefits. Operator compliance depended on the PPV of automation: We found lower compliance for lower PPV. Automation with a high false alarm rate of 20% and a low PPV of .3 resulted in operators ignoring about one-half of the true automation alarms on difficult targets-a strong cry-wolf effect. Our results suggest that automation reliability described by d' and PPV is more valid than using accuracy alone. When the PPV is below .5, operators should receive clear instructions on how to respond to automation alarms.

Prevalence of zolpidem use in France halved after secure prescription pads implementation in 2017: A SNDS database nested cohort study

Our objective was to quantify the impact on the use of zolpidem of the obligation implemented in France in 2017 to use secure prescription pads to prescribe it. We conducted a cohort study within the French SNDS healthcare database. Patients aged over 18 years of age were considered for inclusion. The number of prevalent users and incident episodes of zolpidem use were compared before the change in law (July 1, 2016 to January 1, 2017) and after (July 1, 2017 to January 1, 2018). A prevalent user was a patient who has been reimbursed for zolpidem at least once. An incident episode of zolpidem use was defined by a first administration of zolpidem without any prior administration within the previous six months. Regarding prevalence of zolpidem users, we observed a decrease from 2.79% (CI95%:2.75–2.83) to 1.48% (1.44–1.51), with a number of patients who stopped taking it after the change in law being approximately 4.3 times higher than the number of patients who started. We observed a negative association between the post-law change period (OR = 0.52 (0.51–0.53)) and the probability of receiving zolpidem, adjusting for sex, aging, low income and chronic disease. We observed a decrease from 183 treatment episodes per 100,000 insured months on average to 79 episodes per 100,000 insured months, with an incidence rate ratio (IRR) equal to 0.43 (0.38–0.49). The use of secure prescription pads seems to have reduced the exposure of the French population to zolpidem.

A systematic review protocol for crime trends facilitated by synthetic biology

BACKGROUND

When new technologies are developed, it is common for their crime and security implications to be overlooked or given inadequate attention, which can lead to a 'crime harvest'. Potential methods for the criminal exploitation of biotechnology need to be understood to assess their impact, evaluate current policies and interventions and inform the allocation of limited resources efficiently. Recent studies have illustrated some of the security implications of biotechnology, with outcomes of misuse ranging from compromised computers using malware stored in synthesised DNA, infringement of intellectual property on biological matter, synthesis of new threatening viruses, 'genetic genocide,' and the exploitation of food markets with genetically modified crops. However, there exists no synthesis of this information, and no formal quality assessment of the current evidence. This review therefore aims to establish what current and/or predicted crimes have been reported as a result of biotechnology.

METHODS

A systematic review will be conducted to identify relevant literature. ProQuest, Web of Science, MEDLINE and USENIX will be searched utilizing a predefined search string, and Backward and Forward searches. Grey literature will be identified by searching the official UK Government website (www.gov.uk) and the Global database of Dissertations and Theses. The review will be conducted by screening title/abstracts followed by full texts, utilising pre-defined inclusion and exclusion criteria. Papers will be managed using Eppi-center Reviewer 4 software, and data will be organised using a data extraction table using a descriptive coding tool. A predefined rating system (speculative, experimental or currently occurring) will be used to sort studies, and a thematic synthesis of the results will be presented.

DISCUSSION

Despite the concerns raised about the misuse of biotechnology, no previous work has been conducted from a Crime Science perspective to collate and assess the literature. This systematic review aims to identify the types of offending activity facilitated by biotechnology, including synthetic biology and genetic engineering. The objective of the review is to examine whether this offending activity can be prevented by assessing the conditions necessary for the crime events to occur. It is anticipated that evidence generated from this review will guide future research in this area and aid relevant stakeholders to prioritise and allocate limited resources to biotechnology crime prevention.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42019131685.

User abnormal behavior recommendation via multilayer network

With the growing popularity of online services such as online banking and online shopping, one of the essential research topics is how to build a privacy-preserving user abnormal behavior recommendation system. However, a machine-learning based system may present a dilemma. On one aspect, such system requires large volume of features to pre-train the model, but on another aspect, it is challenging to design usable features without looking to plaintext private data. In this paper, we propose an unorthodox approach involving graph analysis to resolve this dilemma and build a novel private-preserving recommendation system under a multilayer network framework. In experiments, we use a large, state-of-the-art dataset (containing more than 40,000 nodes and 43 million encrypted features) to evaluate the recommendation ability of our system on abnormal user behavior, yielding an overall precision rate of around 0.9, a recall rate of 1.0, and an F1-score of around 0.94. Also, we have also reported a linear time complexity for our system. Last, we deploy our system on the "Wenjuanxing" crowd-sourced system and "Amazon Mechanical Turk" for other users to evaluate in all aspects. The result shows that almost all feedbacks have achieved up to 85% satisfaction.

Findings from Healthcare in Danger Project: Pakistan security assessment of a public and private tertiary care hospital in Karachi: Gaps and way forward

OBJECTIVE

To identify and compare security gaps in a public and private tertiary care hospital.

METHODS

The study was conducted in January 2016 using a tool adopted from Ingersoll Rand Security Technologies, Occupational Safety and Health Association and findings of baseline research carried out by Health Care in Danger Project at a public and private sector hospital in Karachi. The names of hospitals were kept confidential. Areas assessed included adequacy of workforce, existing institutional mechanisms and campus security. The tool was completed by interviewing administration, security department, and healthcare workers in wards and the emergency departments as well as patients, attendants and through observation visits.

RESULTS

The burden of doctors at the private-sector hospital was higher compared to the publicsector hospital (40 versus 22 patients per doctor per day) in the outpatient department. Privatesector hospital scored better than public-sector hospital with regards to compliance to security management standards (68% versus 50%), security perception of staff (90% versus 50%), security staffing (60% versus 50%), and visitor management (80% versus 40%). Campus security was better at private-sector hospital (56% versus 31%). Scores for employee orientation and training were low (30% and 20%), while scores for organisational partnerships were high in both hospitals (80% each). .

CONCLUSIONS

Four-pronged strategic framework is recommended that shall comprise restricting access of attendants/visitors/vendors, improving interaction between patients/healthcare workers/guards, mechanisms of reporting and responding to violent events, and maintaining sufficient resources for enhancing and improving security in hospitals.

A Pilot Examination of the Methods Used to Counteract Insider Threat Security Risks Associated with the Use of Radioactive Materials in the Research and Clinical Setting

While many organizations maintain multiple layers of security control methodologies to prevent outsiders from gaining unauthorized access, persons such as employees or contractors who have been granted legitimate access can represent an "insider threat" risk. Interestingly, some of the most notable radiological events involving the purposeful contamination or exposure of individuals appear to have been perpetrated by insiders. In the academic and medical settings, radiation safety professionals focus their security efforts on (1) ensuring controls are in place to prevent unauthorized access or removal of sources, and (2) increasing security controls for the unescorted accessing of large sources of radioactivity (known as "quantities of concern"). But these controls may not completely address the threat insiders represent when radioactive materials below these quantities are present. The goal of this research project was to characterize the methodologies currently employed to counteract the insider security threat for the misuse or purposeful divergence of radioactive materials used in the academic and medical settings. A web-based survey was used to assess how practicing radiation safety professionals in academic and medical settings anticipate, evaluate, and control insider threat security risks within their institutions. While all respondents indicated that radioactive sources are being used in amounts below quantities of concern, only 6 % consider insider threat security issues as part of the protocol review for the use of general radioactive materials. The results of this survey identify several opportunities for improvement for institutions to address security gaps.

[Application of classified protection of information security in the information system of air pollution and health impact monitoring]

OBJECTIVE

To study the application of classified protection of information security in the information system of air pollution and health impact monitoring, so as to solve the possible safety risk of the information system.

METHODS

According to the relevant national standards and requirements for the information system security classified protection, and the professional characteristics of the information system, to design and implement the security architecture of information system, also to determine the protection level of information system.

RESULTS

Basic security measures for the information system were developed in the technical safety and management safety aspects according to the protection levels, which effectively prevented the security risk of the information system.

CONCLUSION

The information system established relatively complete information security protection measures, to enhanced the security of professional information and system service, and to ensure the safety of air pollution and health impact monitoring project carried out smoothly.

Should a medical ethics journal discuss the actions of the security forces?

This refers to the comment "Use of pellet guns for crowd control in Kashmir: How lethal is 'non-lethal'?" by Siddarth David in the Indian Journal of Medical Ethics. My objection is not to the ethics of the use of pellet guns, but to the ethics of publishing such an article in a journal devoted to medical ethics.

A question of ethics, not nationalism: author's response

The aim of the comment "Use of pellet guns for crowd control in Kashmir: How lethal is 'non-lethal'?" was neither to disparage the armed forces, nor recommend counterinsurgency strategies, nor support any particular community or group. It sought to raise discussions around the question pointed out by the responder himself, namely, "the ethical point of view" on the use of pellet guns in controlling violent mobs. The author also feels that the question is not so much about "favouring" the protestors or the security forces, but whether an instrument that causes significant fatalities and morbidities among bystanders should continue to be used as a method of crowd control.

[Planning a Health Residence for Prison Security Measures, Tuscany (Italy)]

Health Residences for Prison Security Measures are facilities hosting psychotic persons who have committed crimes and providing them with personalized rehabilitation and treatment plans to promote their reinstatement in society. The aim of this study was to describe the criteria for planning and designing a prison health residence in the Tuscany region (Italy), to be managed by the regional healthcare service, in line with current regulations, with dedicated staff for providing specific treatment plans and programmes.

When and Why Threats Go Undetected: Impacts of Event Rate and Shift Length on Threat Detection Accuracy During Airport Baggage Screening

OBJECTIVE

We aimed to assess the impact of task demands and individual characteristics on threat detection in baggage screeners.

BACKGROUND

Airport security staff work under time constraints to ensure optimal threat detection. Understanding the impact of individual characteristics and task demands on performance is vital to ensure accurate threat detection.

METHOD

We examined threat detection in baggage screeners as a function of event rate (i.e., number of bags per minute) and time on task across 4 months. We measured performance in terms of the accuracy of detection of Fictitious Threat Items (FTIs) randomly superimposed on X-ray images of real passenger bags.

RESULTS

Analyses of the percentage of correct FTI identifications (hits) show that longer shifts with high baggage throughput result in worse threat detection. Importantly, these significant performance decrements emerge within the first 10 min of these busy screening shifts only.

CONCLUSION

Longer shift lengths, especially when combined with high baggage throughput, increase the likelihood that threats go undetected.

APPLICATION

Shorter shift rotations, although perhaps difficult to implement during busy screening periods, would ensure more consistently high vigilance in baggage screeners and, therefore, optimal threat detection and passenger safety.

Regulation of X-Ray Security Scanners in Michigan

In January of 2013 the Transportation Security Administration (TSA) ordered the removal of x-ray security scanners from airports by June of 2013. Since that time several of these scanners have been purchased at a reduced cost by various state and county governments for use in screening individuals entering or leaving their facilities. To address this issue the Radiation Safety Section of the State of Michigan drafted a set of registration conditions for facilities to follow when using these security scanners. Inspection procedures and measurement protocols were developed to estimate the dose to screened individuals. Inspections were performed on nine of the 16 registered backscatter scanners in the state and the one transmission scanner. The average estimated effective dose to screened individuals was ∼11 nSv for a two view scan from a backscatter system. The effective dose was 0.446 μSv, 0.330 μSv, and 0.150 μSv for a transmission system operated in the high, medium, and low dose modes, respectively. The limit suggested in the new registration condition is 0.25 μSv for a general use system and 10 μSv for a limited use system.

Review of Restricted Experiment Requests, Division of Select Agents and Toxins, Centers for Disease Control and Prevention, 2006-2013

The Centers for Disease Control and Prevention (CDC) Division of Select Agents and Toxins (DSAT) regulates laboratories that possess, use, or transfer select agents and toxins in the United States. DSAT also mitigates biosafety risks through the review of "restricted experiments," which under the select agent regulations are experiments that pose heightened biosafety risks. From January 2006 through December 2013, DSAT received 618 requests from 109 entities to perform potentially restricted experiments. Of these requests, 85% were determined not to meet the regulatory definition of a restricted experiment, while 15% of the requests met the definition of a restricted experiment. Of the 91 restricted experiments proposed, DSAT approved 31 (34%) requests because the biosafety conditions proposed were commensurate with the experiments' biosafety risk. All 31 approved restricted experiments were for work with select toxins. DSAT did not approve 60 restricted experiment requests due to potentially serious biosafety risks to public health and safety. All 60 denied restricted experiments proposed inserting drug resistance traits into select agents that could compromise the control of disease. The select agents and toxins associated most frequently with requests that met the regulatory definition of a restricted experiment are Shiga toxin (n = 16), Burkholderia mallei (n = 15), Botulinum neurotoxin (n = 14), and Brucella abortus (n = 14). In general, all restricted experiment decisions are determined on a case-by-case basis. This article describes the trends and characteristics of the data associated with restricted experiment requests among select agents that have an impact on public health and safety (HHS only agents) or both public health and safety and animal health or products (overlap agents). The information presented here, coupled with the information published in the restricted experiment guidance document ( www.selectagents.gov ), is intended to promote awareness among the research community of the type of experiments that meet the regulatory definition of a restricted experiment as well as to provide a greater understanding of the restricted experiment review process.

BSL-3 laboratory practices in the United States: comparison of select agent and non-select agent facilities

New construction of biosafety level 3 (BSL-3) laboratories in the United States has increased in the past decade to facilitate research on potential bioterrorism agents. The Centers for Disease Control and Prevention inspect BSL-3 facilities and review commissioning documentation, but no single agency has oversight over all BSL-3 facilities. This article explores the extent to which standard operating procedures in US BSL-3 facilities vary between laboratories with select agent or non-select agent status. Comparisons are made for the following variables: personnel training, decontamination, personal protective equipment (PPE), medical surveillance, security access, laboratory structure and maintenance, funding, and pest management. Facilities working with select agents had more complex training programs and decontamination procedures than non-select agent facilities. Personnel working in select agent laboratories were likely to use powered air purifying respirators, while non-select agent laboratories primarily used N95 respirators. More rigorous medical surveillance was carried out in select agent workers (although not required by the select agent program) and a higher level of restrictive access to laboratories was found. Most select agent and non-select agent laboratories reported adequate structural integrity in facilities; however, differences were observed in personnel perception of funding for repairs. Pest management was carried out by select agent personnel more frequently than non-select agent personnel. Our findings support the need to promote high quality biosafety training and standard operating procedures in both select agent and non-select agent laboratories to improve occupational health and safety.

Harmonization of European laboratory response networks by implementing CWA 15793: use of a gap analysis and an "insider" exercise as tools

Laboratory response networks (LRNs) have been established for security reasons in several countries including the Netherlands, France, and Sweden. LRNs function in these countries as a preparedness measure for a coordinated diagnostic response capability in case of a bioterrorism incident or other biocrimes. Generally, these LRNs are organized on a national level. The EU project AniBioThreat has identified the need for an integrated European LRN to strengthen preparedness against animal bioterrorism. One task of the AniBioThreat project is to suggest a plan to implement laboratory biorisk management CWA 15793:2011 (CWA 15793), a management system built on the principle of continual improvement through the Plan-Do-Check-Act (PDCA) cycle. The implementation of CWA 15793 can facilitate trust and credibility in a future European LRN and is an assurance that the work done at the laboratories is performed in a structured way with continuous improvements. As a first step, a gap analysis was performed to establish the current compliance status of biosafety and laboratory biosecurity management with CWA 15793 in 5 AniBioThreat partner institutes in France (ANSES), the Netherlands (CVI and RIVM), and Sweden (SMI and SVA). All 5 partners are national and/or international laboratory reference institutes in the field of public or animal health and possess high-containment laboratories and animal facilities. The gap analysis showed that the participating institutes already have robust biorisk management programs in place, but several gaps were identified that need to be addressed. Despite differences between the participating institutes in their compliance status, these variations are not significant. Biorisk management exercises also have been identified as a useful tool to control compliance status and thereby implementation of CWA 15793. An exercise concerning an insider threat and loss of a biological agent was performed at SVA in the AniBioThreat project to evaluate implementation of the contingency plans and as an activity in the implementation process of CWA 15793. The outcome of the exercise was perceived as very useful, and improvements to enhance biorisk preparedness were identified. Gap analyses and exercises are important, useful activities to facilitate implementation of CWA 15793. The PDCA cycle will enforce a structured way to work, with continual improvements concerning biorisk management activities. Based on the activities in the AniBioThreat project, the following requirements are suggested to promote implementation: support from the top management of the organizations, knowledge about CWA 15793, a compliance audit checklist and gap analysis, training and exercises, networking in LRNs and other networks, and interinstitutional audits. Implementation of CWA 15793 at each institute would strengthen the European animal bioterrorism response capabilities by establishing a well-prepared LRN.

ICRP Publication 125: Radiological Protection in Security Screening

The use of technologies to provide security screening for individuals and objects has been increasing rapidly, in keeping with the significant increase in security concerns worldwide. Within the spectrum of technologies, the use of ionizing radiation to provide backscatter and transmission screening capabilities has also increased. The Commission has previously made a number of statements related to the general topic of deliberate exposures of individuals in non-medical settings. This report provides advice on how the radiological protection principles recommended by the Commission should be applied within the context of security screening. More specifically, the principles of justification, optimisation of protection, and dose limitation for planned exposure situations are directly applicable to the use of ionising radiation in security screening. In addition, several specific topics are considered in this report, including the situation in which individuals may be exposed because they are concealed (‘stowaways’) in a cargo container or conveyance that may be subject to screening. The Commission continues to recommend that careful justification of screening should be considered before decisions are made to employ the technology. If a decision is made that its use is justified, the framework for protection as a planned exposure situation should be employed, including optimization of protection with the use of dose constraints and the appropriate provisions for authorisation and inspection.

Tools for an effective annual review of the Security Management Plan

A hospital's Security Management Plan, required by the Joint Commission, can also be used by security management professionals, the author points out, to ensure that they are continually monitoring and improving the program in a changing healthcare environment.

Semi-automated CCTV surveillance: the effects of system confidence, system accuracy and task complexity on operator vigilance, reliance and workload

Recent advances in computer vision technology have lead to the development of various automatic surveillance systems, however their effectiveness is adversely affected by many factors and they are not completely reliable. This study investigated the potential of a semi-automated surveillance system to reduce CCTV operator workload in both detection and tracking activities. A further focus of interest was the degree of user reliance on the automated system. A simulated prototype was developed which mimicked an automated system that provided different levels of system confidence information. Dependent variable measures were taken for secondary task performance, reliance and subjective workload. When the automatic component of a semi-automatic CCTV surveillance system provided reliable system confidence information to operators, workload significantly decreased and spare mental capacity significantly increased. Providing feedback about system confidence and accuracy appears to be one important way of making the status of the automated component of the surveillance system more 'visible' to users and hence more effective to use.

Biodefence and the production of knowledge: rethinking the problem

Biodefence, broadly understood as efforts to prevent or mitigate the damage of a bioterrorist attack, raises a number of ethical issues, from the allocation of scarce biomedical research and public health funds, to the use of coercion in quarantine and other containment measures in the event of an outbreak. In response to the US bioterrorist attacks following September 11, significant US policy decisions were made to spur scientific enquiry in the name of biodefence. These decisions led to a number of critical institutional changes within the US federal government agencies governing scientific research. Subsequent science policy discussions have focused largely on 'the dual use problem': how to preserve the openness of scientific research while preventing research undertaken for the prevention or mitigation of biological threats from third parties. We join others in shifting the ethical debate over biodefence away from a simple framing of the problem as one of dual use, by demonstrating how a dual use framing distorts the debate about bioterrorism and truncates discussion of the moral issues. We offer an alternative framing rooted in social epistemology and institutional design theory, arguing that the ethical and policy debates regarding 'dual use' biomedical research ought to be reframed as a larger optimisation problem across a plurality of values including, among others: (1) the production of scientific knowledge; (2) the protection of human and animal subjects; (3) the promotion and protection of public health (national and global); (4) freedom of scientific enquiry; and (5) the constraint of government power.

Commentary on 'Biodefence and the production of knowledge: rethinking the problem'

Buchanan and Kelley provide a sophisticated and thoughtful critique of contemporary discussions of biosecurity. They provide sound critiques of American biodefence institutions, and the general sense of imminent threat underlying the rush to fund biodefence. However, the essay consistently misrepresents the breadth and depth of scholarly research on the ethics and politics of biodefence.

Hospital security: "protecting the business"

Implementing management science into security isn't hard and is more necessary than ever according to the author who presents and illustrates a five point plan that he says will get the security job done easier and with more commitment from the Board.

Healthcare security staffing for smaller facilities: where science meets art

Obtaining effective security resourcing and staffing for smaller healthcare facilities presents many difficulties, according to the author In this article, he provides guidance to security practitioners on taking existing data and translating it into a language that administration will understand and appreciate.

Implementing healthcare information security: standards can help

Using widely spread common approaches to systems security in health dedicated controlled environments, a level of awareness, confidence and acceptance of relevant standardisation is evaluated. Patients' information is sensitive, so putting appropriate organisational techniques as well as modern technology in place to secure health information is of paramount importance. Mobile devices are becoming the top priorities in advanced information security planning with healthcare environments being no exception. There are less and less application areas in healthcare without having a need for a mobile functionality which represents an even greater information security challenge. This is also true in emergency treatments, rehabilitation and homecare just to mention a few areas outside hospital controlled environments. Unfortunately quite often traditional unsecured communications principles are still in routine use for communicating sensitive health related information. The security awareness level with users, patients and care professionals is not high enough so potential threats and risks may not be addressed and the respective information security management is therefore weak. Standards like ISO/IEC 27000 ISMS family, the ISO/IEC 27799 information security guidelines in health are often not well known, but together with legislation principles such as HIPAA, they can help.

The changing face of hospital security: re-tooling for the future

Natural disasters, new diseases, increased violence, combined with cuts in Medicare and Medicaid funding will be among a host of developments that will challenge healthcare security professionals in the next three decades, according to the authors, and require changes in crime control methods, greater reliance on metrics, and development of innovative practices to survive and flourish.

National standards to prevent, detect, and respond to prison rape. Final rule; request for comment on specific issue

The Department of Justice (Department) is issuing a final rule adopting national standards to prevent, detect, and respond to prison rape, as required by the Prison Rape Elimination Act of 2003 (PREA). In addition, the Department is requesting comment on one issue relating to staffing in juvenile facilities. Further discussion of the final rule is found in the Executive Summary.

Contact structure and potential risk factors for avian influenza transmission among open-sided chicken farms in Kamalia, an important poultry rearing area of Pakistan

Since 1994, the domestic poultry in Pakistan has experienced several outbreaks due to avian influenza viruses of subtypes H7N3, H5N1, and H9N2. This paper reveals horizontal contacts and potential risk factors for the spread of avian influenza infection between open-sided chicken farms in Kamalia, a sub-district of Punjab province. Between April and June 2009, an interview-based questionnaire was administered to a sample of 78 growers. The survey identified the following potential biosecurity risks for outbreak propagation: i) short buffer distances between farms, ii) disposal of carcasses and other organic wastes into the environment, iii) entry of feral birds into poultry sheds, iv) visits of poultry farmers to possible cross-contamination sites, v) absence of boundary walls, vi) incomplete biosecurity on high-risk visitors (i. e. those going inside the poultry houses), essential vehicles and equipment used by vaccination crews vii) visits of intermediaries and service providers and, viii) sharing of egg trays between farms at production. For most of the variables, there was no significant difference between the broiler and layer type of farms (p < or = 0.05). The risk of an extensive outbreak in Kamalia was concluded to be due to its high poultry density, ubiquitous small-scale, market-oriented poultry production with medium to low biosecurity, and the affiliation of the farmers to multiple service providers. To reduce the risk of having an outbreak, farm-specific biosecurity gaps should be identified and appropriate action taken to close these gaps. Improvement in biosecurity and targeted surveillance are therefore considered critical to limit the spread of infection should an outbreak occur.

How to prevent workplace violence incidents and improve security using baseline security assessments

To meet state and OSHA requirements for dealing with and reporting workplace violence, a growing number of hospitals, the author reports, are turning to baseline workplace violence assessments which survey employees in different roles, combined with a threat analysis and an analysis of existing controls and historical incidents that can be reviewed and tracked over time to show improvement or decline.

Online applied dual-use biosecurity education: a case study from the University of Bradford

Reflecting a consensus that emerged at the 2008 Meeting of States Parties of the Biological Weapons Convention on the importance of ensuring that those working in the biological sciences are aware of their obligations under the Convention and relevant national legislation and guidelines; and in regard to the consensus on the importance of awareness raising and education and training programmes, and of the role that these can play in assisting in the implementation of the Convention, this paper highlights how novel online e-learning approaches can efficiently and effectively be deployed in building a sustainable worldwide capability in this much neglected area of education and training. It provides examples of the development and evolution of education and training resources, notes the importance of standing agenda items for the intersessional process of the BWC between the Seventh and Eight Review Conferences and the range of opportunities that therefore arise for States Party and civil society collaboration in building capacity and achieving sustainability in this area.

Linking hospital security to customer service: making the case for 'world class' security

The reluctance of many hospitals today to invest money and resources into security and safety while at the same time promoting customer good will is a fallacy that has to be corrected, according to the author. He demonstrates how high customer satisfaction scores, as well as regulatory compliance, can only be achieved if a hospital takes the steps necessary to provide adequate safety and security to patients, visitors, physicians and to all who come to the hospital.

It will never happen here, right?

No health care facility--whether acute or long term care; urban or rural; small or large--is immune from violence today, the author reports. Money saved by not providing adequate security, she adds, exposes the facility to much greater monetary and other risks. In this article, she provides healthcare security professionals with risk management strategies they can use to identify and address security vulnerabilities.

Best practices of hospital security planning for patient surge--a comparative analysis of three national systems

This paper examines three international healthcare security systems as they relate to patient surge in Canada, Israel, and the United States. Its purpose is to compare the systems, to highlight unique characteristics that define those systems, and to initiate the development of best practices that transcend national boundaries. Several significant national characteristics of demographics, healthcare systems, and political climate, among others, present challenges to translating best practices among these three countries. However, we have found that best practice strategies exist in areas of communications, coordination, building design, space adaptability, and patient routing (both from the community to the hospital, as well as within the hospital) that can be shared and incorporated into the healthcare preparedness efforts in all three countries.

Effective strategies for hospital parking garage security

Security at hospital parking facilities is of critical importance, and can be integrated in many ways, from the traditional active and passive measures, to more creative features such as mixed-use and even blast walls and anti-climb walls, according to the authors. In this article, they describe both traditional and post 9/11 security features as employed in four new hospital parking structures.