Improving Pandemic Response With Military Tools: Using Enhanced Intelligence, Surveillance, and Reconnaissance.

The coronavirus disease 2019 (COVID-19) pandemic rocked the world, spurring the collapse of national commerce, international trade, education, air travel, and tourism. The global economy has been brought to its knees by the rapid spread of infection, resulting in widespread illness and many deaths. The rise in nationalism and isolationism, ethnic strife, disingenuous governmental reporting, lockdowns, travel restrictions, and vaccination misinformation have caused further problems. This has brought into stark relief the need for improved disease surveillance and health protection measures. National and international agencies that should have provided earlier warning in fact failed to do so. A robust global health network that includes enhanced cooperation with Military Intelligence, Surveillance, and Reconnaissance (ISR) assets in conjunction with the existing international, governmental, and nongovernment medical intelligence networks and allies and partners would provide exceptional forward-looking and early-warning and is a proactive step toward making our future safe. This will be achieved both by surveilling populations for new biothreats, fusing and disseminating data, and then reaching out to target assistance to reduce disease spread in unprotected populations.

COVID-19 Community Stabilization and Sustainability Framework: An Integration of the Maslow Hierarchy of Needs and Social Determinants of Health.

All levels of government are authorized to apply coronavirus disease 2019 (COVID-19) protection measures; however, they must consider how and when to ease lockdown restrictions to limit long-term societal harm and societal instability. Leaders that use a well-considered framework with an incremental approach will be able to gradually restart society while simultaneously maintaining the public health benefits achieved through lockdown measures. Economically vulnerable populations cannot endure long-term lockdown, and most countries lack the ability to maintain a full nationwide relief operation. Decision-makers need to understand this risk and how the Maslow hierarchy of needs and the social determinants of health can guide whole of society policies. Aligning decisions with societal needs will help ensure all segments of society are catered to and met while managing the crisis. This must inform the process of incremental easing of lockdowns to facilitate the resumption of community foundations, such as commerce, education, and employment in a manner that protects those most vulnerable to COVID-19. This study proposes a framework for identifying a path forward. It reflects on baseline requirements, regulations and recommendations, triggers, and implementation. Those desiring a successful recovery from the COVID-19 pandemic need to adopt an evidence-based framework now to ensure community stabilization and sustainability.

Rationale for Military Involvement in Humanitarian Assistance and Disaster Relief.

Good relations and trust are the foundation of soft power diplomacy and are essential for the accomplishment of domestic interventions and any bilateral or multilateral endeavor. Military use for assistance and relief is not a novel concept, but it has increased since the early 1990s with many governments choosing to provide greater numbers of forces and assets to assist domestically and internationally. The increase is due to the growing lack of capacity in global humanitarian networks and increasingly inadequate resources available to undertake United Nations humanitarian assistance and disaster relief (HADR) missions. In response, the military has been more proactive in pursuing the improvement of military-to-military and military-to-civilian integration. This trend reflects a move towards more advanced and comprehensive approaches to security cooperation and requires increased support from the civilian humanitarian sector to help meet the needs of the most vulnerable. Military assistance is progressing beyond traditional methods to place a higher value on issues relating to civil cooperation, restoring public health infrastructure, protection, and human rights, all of which are ensuring a permanent diplomatic role for this soft power approach.

Association Between Energy Prices and US Hospital Patient Outcomes.

OBJECTIVE: To evaluate associations between changing energy prices and US hospital patient outcomes. METHODS: Generalized estimating equations were used to analyze relationships between changes in energy prices and subsequent changes in hospital patient outcomes measures for the years 2008 through 2014. Patient outcomes measures included 30-day acute myocardial infarction, heart failure, and pneumonia mortality rates, and 30-day acute myocardial infarction, heart failure, and pneumonia readmission rates. Energy price data included state average distillate fuel, electricity and natural gas prices, and the US average coal price. All of the price data were converted to 2014 dollars using Consumer Price Index multipliers. RESULTS: There was a significant positive association between changes in coal price and both short-term (P = 0.029) and long-term (P = 0.017) changes in the 30-day heart failure mortality rate. There was a similar significant positive association between changes in coal price and both short-term (P <0.001) and long-term (P = 0.002) changes in the 30-day pneumonia mortality rate. Changes in coal prices also were positively associated with long-term changes in the 30-day myocardial infarction readmission rate (P < 0.001). Changes in coal prices (P = 0.20), natural gas prices (P = 0.040), and electricity prices (P = 0.040) were positively associated with long-term changes in the 30-day heart failure readmission rate. CONCLUSIONS: Changing energy prices are associated with subsequent changes in hospital mortality and readmission measures. In light of these data, we encourage hospital, health system, and health policy leaders to pursue patient-support initiatives, energy conservation programs, and reimbursement policy strategies aimed at mitigating those effects.

Forecasted Impact of Climate Change on Infectious Disease and Health Security in Hawaii by 2050.

OBJECTIVE: Climate change is expected to cause extensive shifts in the epidemiology of infectious and vector-borne diseases. Scenarios on the effects of climate change typically attribute altered distribution of communicable diseases to a rise in average temperature and altered incidence of infectious diseases to weather extremes. METHODS: Recent evaluations of the effects of climate change on Hawaii have not explored this link. It may be expected that Hawaii's natural geography and robust water, sanitation, and health care infrastructure renders residents less vulnerable to many threats that are the focus on smaller, lesser developed, and more vulnerable Pacific islands. In addition, Hawaii's communicable disease surveillance and response system can act rapidly to counter increases in any disease above baseline and to redirect resources to deal with changes, particularly outbreaks due to exotic pathogens. RESULTS: The evidence base examined in this article consistently revealed very low climate sensitivity with respect to infectious and mosquito-borne diseases. CONCLUSIONS: A community resilience model is recommended to increase adaptive capacity for all possible climate change impacts rather an approach that focuses specifically on communicable diseases. (Disaster Med Public Health Preparedness. 2016;10:797-804).

Managing Community Resilience to Climate Extremes, Rapid Unsustainable Urbanization, Emergencies of Scarcity, and Biodiversity Crises by Use of a Disaster Risk Reduction Bank.

Earth's climate is changing and national and international decision-makers are recognizing that global health security requires urgent attention and a significant investment to protect the future. In most locations, current data are inadequate to conduct a full assessment of the direct and indirect health impacts of climate change. All states require this information to evaluate community-level resilience to climate extremes and climate change. A model that is being used successfully in the United Kingdom, Australia, and New Zealand is recommended to generate rapid information to assist decision-makers in the event of a disaster. The model overcomes barriers to success inherent in the traditional ''top-down'' approach to managing crises and recognizes the capacity of capable citizens and community organizers to facilitate response and recovery if provided the opportunity and resources. Local information is a prerequisite for strategic and tactical statewide planning. Time and resources are required to analyze risks within each community and what is required to prevent (mitigate), prepare, respond, recover (rehabilitate), anticipate, and assess any threatening events. Specific requirements at all levels from state to community must emphasize community roles by focusing on how best to maintain, respond, and recover public health protections and the infrastructure necessary for health security.

Insights in public health: systems thinking: basic constructs, application challenges, misuse in health, and how public health leaders can pave the way forward.

The strengthening of health systems is fundamental to improving health outcomes, crisis preparedness, and our capacity to meet global challenges, such as accelerating progress towards the Millennium Development Goals, reducing maternal and child mortality, combating HIV, malaria and other diseases, limiting the effects of a new influenza pandemic, and responding appropriately to climate change. To meet these complex needs, the Association of Schools and Programs in Public Health, the World Health Organization, and the Institute of Medicine promote systems thinking as the only sensible means to respond to issues that greatly exceed the normal capacity of health and medical services. This paper agrees with the application of systems thinking but argues that health organizations have misunderstood and misapplied systems thinking to the extent that the term has become meaningless. This paper presents the basic constructs of systems thinking, explains why systems thinking has been misapplied, examines some misapplications of systems thinking in health, and suggests how the concept can be applied correctly to medicine and public health to achieve the reason it was adopted in the first place.

Higher energy prices are associated with diminished resources, performance and safety in Australian ambulance systems.

OBJECTIVE: To evaluate the impact of changing energy prices on Australian ambulance systems. METHODS: Generalised estimating equations were used to analyse contemporaneous and lagged relationships between changes in energy prices and ambulance system performance measures in all Australian State/Territory ambulance systems for the years 2000-2010. Measures included: expenditures per response; labour-to-total expenditure ratio; full-time equivalent employees (FTE) per 10,000 responses; average salary; median and 90th percentile response time; and injury compensation claims. Energy price data included State average diesel price, State average electricity price, and world crude oil price. RESULTS: Changes in diesel prices were inversely associated with changes in salaries, and positively associated with changes in ambulance response times; changes in oil prices were also inversely associated with changes in salaries, as well with staffing levels and expenditures per ambulance response. Changes in electricity prices were positively associated with changes in expenditures per response and changes in salaries; they were also positively associated with changes in injury compensation claims per 100 FTE. CONCLUSION: Changes in energy prices are associated with changes in Australian ambulance systems' resource, performance and safety characteristics in ways that could affect both patients and personnel. Further research is needed to explore the mechanisms of, and strategies for mitigating, these impacts. The impacts of energy prices on other aspects of the health system should also be investigated.

Head lice: the feelings people have.

BACKGROUND: Head lice are a source of amusement for outsiders and an embarrassing nuisance to those who have to deal with them. Our study collected the emotions experienced by people dealing with head lice. An area with extremely sparse literature, our purpose is to inform the development of more effective programs to control head lice. METHODS: We asked "what were your feelings upon discovery of head lice?" as part of a study exploring the experience of those treating head lice. A short questionnaire was available via the authors' head lice information internet site. A total of 294 eligible responses were collected over several months and analyzed, supported by QSR N6. RESULTS: The predominantly female (90 · 9%) respondents were residents of Australia (56 · 1%), USA (20 · 4%), Canada (7 · 2%), or UK (4 · 4%), and working full-time (43·0%) or part-time (34 · 2%). Reactions and feelings fell into three categories: strong (n = 320; 79% of all stated emotions), mediocre (n = 56; 20%), and neutral (n = 29; 9 · 8%). There were no positive emotions. COMMENT: The significant negative reaction was expected. The range of feeling expressed demonstrates the stigma held for these ectoparasites within western market economies. This contrasts with conceptions of head lice in traditional societies. The negative social effects of this perception create more problematic issues than the infection itself; these include quarantine, overtreatment, and a potentially negative psychological impact. Head lice control strategies and programs that address these negative emotional reactions may prove more effective than current biomedical focus.

The state of risk prevention in a sample of Australian hospitals, medical centres and allied health services.

This paper reports on an investigation into five risk prevention factors (technology, people, organisational structure, culture and top management psychology) to inform organisational preparedness planning and to update managers on the state of health care services. Data were collected by means of a 10-question, cross-sectional survey of key decision-making executives in eight different types of 75 health care organisations. Many organisations were found to have deficient risk prevention practices and allied health organisations were considerably worse than health organisations. Forty per cent of hospitals and chiropractic practices had out-dated or poor technology. Results on organisational culture and structure found that many executives associate these factors with risk prevention, but none of them appreciate the relationship between these factors and crisis causation. Gaps and areas for improvement are identified and a change in top management attitude is recommended to address resource allocation and implement appropriate risk prevention systems and mechanisms. Reactive managers need to increase their awareness of risks in order to become capable of preventing them. Proactive managers are those who invest in risk prevention.

The carbon footprint of Australian ambulance operations.

OBJECTIVE: To determine the greenhouse gas emissions associated with the energy consumption of Australian ambulance operations, and to identify the predominant energy sources that contribute to those emissions. METHODS: A two-phase study of operational and financial data from a convenience sample of Australian ambulance operations to inventory their energy consumption and greenhouse gas emissions for 1 year. State- and territory-based ambulance systems serving 58% of Australia's population and performing 59% of Australia's ambulance responses provided data for the study. RESULTS: Emissions for the participating systems totalled 67 390 metric tons of carbon dioxide equivalents. For ground ambulance operations, emissions averaged 22 kg of carbon dioxide equivalents per ambulance response, 30 kg of carbon dioxide equivalents per patient transport and 3 kg of carbon dioxide equivalents per capita. Vehicle fuels accounted for 58% of the emissions from ground ambulance operations, with the remainder primarily attributable to electricity consumption. Emissions from air ambulance transport were nearly 200 times those for ground ambulance transport. CONCLUSION: On a national level, emissions from Australian ambulance operations are estimated to be between 110 000 and 120 000 tons of carbon dioxide equivalents each year. Vehicle fuels are the primary source of emissions for ground ambulance operations. Emissions from air ambulance transport are substantially higher than those for ground ambulance transport.

The energy burden and environmental impact of health services.

OBJECTIVES: We reviewed the English-language literature on the energy burden and environmental impact of health services. METHODS: We searched all years of the PubMed, CINAHL, and ScienceDirect databases for publications reporting energy consumption, greenhouse gas emissions, or the environmental impact of health-related activities. We extracted and tabulated data to enable cross-comparisons among different activities and services; where possible, we calculated per patient or per event emissions. RESULTS: We identified 38 relevant publications. Per patient or per event, health-related energy consumption and greenhouse gas emissions are quite modest; in the aggregate, however, they are considerable. In England and the United States, health-related emissions account for 3% and 8% of total national emissions, respectively. CONCLUSIONS: Although reducing health-related energy consumption and emissions alone will not resolve all of the problems of energy scarcity and climate change, it could make a meaningful contribution.

Crisis management teams in health organisations.

Crisis management teams (CMT) are necessary to ensure adequate and appropriate crisis management planning and response to unforeseen, adverse events. This study investigated the existence of CMTs, the membership of CMTs, and the degree of training received by CMTs in Australian health and allied health organisations. This cross-sectional study draws on data provided by executive decision makers in a broad selection of health and allied health organisations. Crisis management teams were found in 44.2 per cent of the health-related organisations surveyed, which is ten per cent lower than the figure for business organisations. Membership of these CMTs was not ideal and did not conform to standard CMT membership profiles. Similarly, the extent of crisis management training in health-related organisations is 20 per cent lower than the figure for business organisations. If organisations do not become pro-active in their crisis management practices, the onus is on government to improve the situation through regulation and the provision of more physical, monetary and skill resources to ensure that the health services of Australia are sufficiently prepared to respond to adverse events.

The state of systemic threat surveillance in some Australian health organisations.

Crises are preceded by the emission of a series of early warning signals. If detected, these act like triggers for organisational action in anticipation of a known or unknown threat. It is vitally important to detect these signals to enable proactive, preventative actions that limit the impact of ensuing damage. The extent of threat surveillance (signal detection) in health organisations is an unknown, so a cross-sectional survey was conducted to assess the degree to which signal detection mechanisms are used. The focus of signal detection mechanisms and their degree of organisational integration was also assessed, as were organisational attitudes to whistle-blowers. Participants were executives in hospitals, medical centres, aged care homes, pharmacies, dental clinics and physiotherapy, chiropractic and podiatry practices. The results show that health organisations have inadequate signal detection mechanisms focusing on a limited selection of threats. Organisations often fail to integrate and disperse their mechanisms and focus almost entirely on internal signals. A majority of the surveyed organisations failed to reward bearers of bad news. In conclusion, the health organisations surveyed lacked systematic and systemic threat surveillance processes and mechanisms that are essential if they are to become better prepared for crises.

Deficient crisis-probing practices and taken-for-granted assumptions in health organisations.

The practice of crisis-probing in proactive organisations involves meticulous and sustained investigation into operational processes and management structures for potential weaknesses and flaws before they become difficult to resolve. In health organisations, crisis probing is a necessary part of preparing to manage emerging health threats. This study examined the degree of pre-emptive probing in health organisations and the type of crisis training provided to determine whether or not they are prepared in this area. This evidence-based study draws on cross-sectional responses provided by executives from chiropractic, physiotherapy, and podiatry practices; dental and medical clinics; pharmacies; aged care facilities; and hospitals. The data show a marked lack of mandatory probing and a generalised failure to reward crisis reporting. Crisis prevention training is poor in all organisations except hospitals and aged care facilities where it occurs at an adequate frequency. However this training focuses primarily on natural disasters, fails to address most other crisis types, is mostly reactive and not designed to probe for and uncover key taken-for-granted assumptions. Crisis-probing in health organisations is inadequate, and improvements in this area may well translate into measurable improvements in preparedness and response outcomes.

Aquatic insect predators and mosquito control.

Mosquitoes are serious biting pests and obligate vectors of many vertebrate pathogens. Their immature larval and pupal life stages are a common feature in most tropical and many temperate water bodies and often form a significant proportion of the biomass. Control strategies rely primarily on the use of larvicides and environmental modification to reduce recruitment and adulticides during periods of disease transmission. Larvicides are usually chemical but can involve biological toxins, agents or organisms. The use of insect predators in mosquito control has been exploited in a limited fashion and there is much room for further investigation and implementation. Insects that are recognized as having predatorial capacity with regard to mosquito prey have been identified in the Orders Odonata, Coleoptera, Diptera (primarily aquatic predators), and Hemiptera (primarily surface predators). Although their capacity is affected by certain biological and physical factors, they could play a major role in mosquito control. Furthermore, better understanding for the mosquitoes-predators relationship(s) could probably lead to satisfactory reduction of mosquito-borne diseases by utilizing either these predators in control programs, for instance biological and/or integrated control, or their kairomones as mosquitoes' ovipoisting repellents. This review covers the predation of different insect species on mosquito larvae, predator-prey-habitat relationships, co-habitation developmental issues, survival and abundance, oviposition avoidance, predatorial capacity and integrated vector control.

A comparison of botanical and synthetic substances commonly used to prevent head lice (Pediculus humanus var. capitis) infestation.

BACKGROUND: Pediculosis, caused by head lice (Pediculidae: Pediculus humanus var. capitis), is experiencing a global resurgence, with the prevalence in primary schools averaging as high as 40% in some areas regardless of socioeconomic factors. Control efforts using chemical treatments are becoming increasingly ineffective, with insecticide resistance recorded in several countries. Prevention using repellents and oils would be useful if they limited transmission. Many commercially available substances reputedly have effective repellent qualities, but remain untested. METHODS: This study tested the preventative efficacy of N,N-diethyl-3-methylbenzamide (DEET) against several commercially available botanicals to clarify their value as transmission inhibitors, irritants, repellents, and antifeedants. RESULTS: The transfer of head lice to treated hairs was limited by the slippery nature of the oils rather than their repellent qualities. Irritancy was not important because lice proceeded despite being highly irritated, except in the case of coconut. Tea tree and peppermint caused the most repellence, and tea tree and lavender prevented some blood feeding on treated skin. Comparatively, tea tree oil was most efficacious, with DEET ranking equal second overall with coconut, peppermint, and a botanical mixture. CONCLUSIONS: Neither DEET nor any of the botanicals tested showed sufficient preventative efficacy to be endorsed.

Comparative efficacy of two nit combs in removing head lice (Pediculus humanus var. capitis) and their eggs.

BACKGROUND: Fine tooth lice combs fall into two classes based on the material from which their teeth are made: plastic or metal. Metal combs are further divided into those that are made from a flat sheet of metal, and hence have rectangular teeth, and those that have cylindrical teeth embedded in a plastic base. METHODS: The efficacy of two fine tooth combs [Lice Meister comb (metal) and Lady Jayne comb (plastic)] in removing head lice (Pediculus humanus var. capitis) and their eggs from the hair of children was evaluated after treatment with a viscous head lice product (Lice Blaster; Emerald Forest Pharmaceuticals Pty Ltd, Currumbin, Qld, Australia). The hair of 27 children was divided into two sections sagitally, and each comb was randomly assigned to one half of the hair, and the lice and eggs removed by the combs were counted. RESULTS: In 96% of subjects, the Lice Meister comb removed more eggs than the Lady Jayne comb, with an average of three to four times more hatched, dead, and live eggs removed. The Lice Meister comb removed more lice than the Lady Jayne comb in 10 subjects, the same in eight subjects, and less in nine subjects. CONCLUSION: Overall, the Lice Meister comb is recommended as a more effective comb for use in controlling head lice infestations, whether employed with conditioner or with insecticide treatment. This appears to be the first study investigating the efficacy of nit combs in vivo. Further research is needed to determine which characteristics of fine tooth combs are the most important in removing head lice eggs.

Efficacy of eight larvicidal botanical extracts from Khaya senegalensis and Daucus carota against Culex annulirostris.

The failure to discover a significant new class of insecticides has led many researchers back to biodiscovery studies in the search for new and economically viable alternatives. After a preliminary screening of botanical extracts using descending series of concentrations (1,000, 500, 100, 50, and 5 mg/liter), 8 extracts from 2 potential botanical agents, Khaya senegalensis (Desrousseaux) and Daucus carota L., were tested against 4th instars of Culex annulirostris (Skuse) following the standard World Health Organization insecticide susceptibility methodology. The median lethal concentration (LC50) values for K. senegalensis against Cx. annulirostris using acetone, ethanol, hexane, and methanol extracts were 20.12, 5.1, 5.08, and 7.62 mg/liter, respectively. The LC50 values for D. carota against Cx. annulirostris using acetone, ethanol, hexane, and methanol extracts were 236.00, 36.59, 77.19, and 241.8 mg/liter, respectively. Extracts from K. senegalensis were more potent than those from D. carota against Cx. annulirostris and hexane and ethanol were the best solvents to extract essential oils from both plant species, respectively. In potency, K. senegalensis was similar to azadirachtin, but fractionation and compound isolation of the hexane extract in particular may reveal a potent phytochemical that could be compared to synthetic mosquitocides.