Fit for purpose quality management system for military forensic exploitation.

In a previous publication we described a systems approach to forensic science applied in the military domain. The forensic science 'system of systems' describes forensic science as a sub-system in the larger criminal justice, law enforcement, intelligence, and military systems, with quality management being an important supporting system. Quality management systems help to ensure that organisations achieve their objective and continually improve their capability. Components of forensic science quality management systems can include standardisation of processes, accreditation of facilities to national/international standards, and certification of personnel. A fit for purpose quality management system should be balanced to allow organisations to meet objectives, provide continuous improvement; mitigate risk; and impart a positive quality culture. Considerable attention over the last decades has been given to the need for forensic science quality management systems to meet criminal justice and law enforcement objectives. More recently, the need for the forensic quality management systems to meet forensic intelligence objectives has been considered. This paper, for the first time, discusses the need for a fit for purpose quality management system for military forensic exploitation.

The Impact of Adherence to Treatment for ADHD on the Quality of Military Service - The Israeli Military Experience.

INTRODUCTION: Attention deficit hyperactive disorder (ADHD) is prevalent in 5.9-7.1% of children and adolescents, and 5% of adults. It results in poor academic, occupational, and social functioning. Pharmacotherapy improves core symptoms; however, average adherence levels are low and decrease at 16-17 years of age, just before the recruitment age to Israel Defense Forces (IDF). This study evaluated the effect of adherence to ADHD pharmacotherapy on occupational performance among soldiers. MATERIALS AND METHODS: Retrospective data were collected for the study cohort, which included all soldiers serving in the IDF from 2008 through 2012 (n > 500,000). Each soldier in the cohort was categorized based on adherence to treatment, as measured by prescriptions filled monthly: (1) no treatment, (2) low adherence (<2/year), (3) medium adherence (2-6/year), and (4) high adherence (>6/year). Occupational performance was evaluated by 3 indicative parameters: (1) number of sick days, (2) number of exemptions from daily activities, and (3) military profession disqualification, including sub-analysis to military profession groups. RESULTS: ADHD pharmacotherapy adherence correlated inversely with occupational performance, as exhibited by more sick days and exemptions from daily activities. All soldiers pharmacologically treated for ADHD had higher professional disqualification rates compared with soldiers who did not require ADHD treatment. In contrast to the general trend, in the military drivers group, higher rates of ADHD adherence correlated with lower professional disqualification rates. CONCLUSIONS: Our hypothesis that greater adherence would correlate positively with better occupational performance was refuted. We speculate that increased adherence levels are indicative of more severe ADHD and thus, accompanied by lower occupational performance. The correlation between increased adherence and improved driving ability could be attributed to the nature of driving professions, which require a high level of concentration. Due to the importance of driving in both military and civilian settings, interventions designed to enhance adherence to treatment for ADHD among drivers could have a broad effect on driving consequences, and should be considered by policymakers.

Lessons learned from non-medical industries: the tragedy of the USS Greeneville.

In February 200l the nuclear powered submarine USS Greeneville collided with the Japanese fishing trawler Ehime Maru, killing nine passengers. A series of small failures and hurried actions escalated into tragedy. This incident provides lessons learned that can be used by healthcare organizations to improve patient safety. Expertise, training, equipment, and procedures appeared to be adequate protection, yet the presence of multiple defences obscured their faulty functioning, just as they often do in medical settings. A number of other problems occurred aboard Greeneville which we also see in health care. The problem was the total breakdown of communication. The Greeneville team also failed to move from a rigid hierarchical structure to a more flexible adaptive structure. Communication often breaks down in healthcare settings, which are organized to maximize status and hierarchical differences, thus often impeding information flow needed to make decisions. Redundancy failed aboard Greeneville as it often does in medicine. Finally, the Captain of the Greeneville established an artificially hurried situation. Time constrained situations happen all the time in health care. We recommend strategies to mitigate the development of these kinds of processes.

Air Force approach to risk assessment for halon replacements.

Finding safe, environmentally acceptable, and effective replacements for Halon fire-extinguishing agents and other chemicals banned by the Montreal Protocol is a formidable task for Air Force research and development organizations. One factor that makes this task a challenge is the uncertainty in relating toxicology studies in laboratory animals to the human situation. This uncertainty from toxicology studies affects the risk assessment process by calling for very conservative decisions. Because of this uncertainty, public pressure and politics also impact the regulatory process. The Air Force approach to assessing health hazards for Halon replacements is to provide scientific information that directly applies to the parts of the extrapolation process that are responsible for the most uncertainty. Most regulatory agencies readily incorporate scientific information, when it is available, which can reduce uncertainty. These Air Force studies will be used to provide realistic exposure levels for replacement chemicals which will allow mission accomplishment and provide safety for the worker and the populace.

Overview--Air Force policy on halons.

Halons have been used for decades by the Air Force for a variety of fire protection applications. Their unique combination of effectiveness, low toxicity, ease of use, cleanliness, and low manufacturing cost appear to make them ideal for many situations. Unfortunately, they also deplete the earth's protective ozone layer and, consequently, their production is being phased out globally under the Montreal Protocol. United States legislation implementing the terms of the Protocol required an end to production of ozone depleting chemicals (ODCs) by the year 2000. In November 1991, the Air Force issued a policy requiring an end to ODC purchases by the end of 1997. In February 1992, President Bush announced an even more accelerated phaseout to 1995. The Montreal Protocol is expected to be amended to reflect the more aggressive US phaseout date. This accelerated date increases the urgency of the Air Force's search for ODC alternatives, especially for mission critical uses for which no alternatives have yet been identified. The search is complicated by the fact that the requirements an alternative must meet are unique to their specific application. This paper will provide an overview of the most important Air Force halon uses and review Air Force strategies for ensuring mission continuity until alternatives can be developed.

International law and law enforcement firearms.

Several international agreements set constraints on the legitimate use of firearms as representing lethal force. Their meaning in terms of weapons technology must take into account their operational frame of reference, and legitimate warfare can be regarded as a law enforcement operation with similar principles on the use of force. Changes in weapons technology, such as new types of ammunition, transforming firearms into weapons with less-lethal and even humanitarian options, require new interpretations of the legislation. A division into lethal and non-lethal weapons is an oversimplification and the separation of international humanitarian law into military and law enforcement provisions can be questioned from the technical aspect. The type of technology acceptable for law enforcement use of firearms should be defined. An assessment for weapon injury should not be based on lethality, but rather on the potential for tissue damage and its reversibility.

[Improvement in the combat and special training of the medical service]. / O sovershenstvovanii boevoi i spetsial'noi podgotovki meditsinskoi sluzhby.

The analysis of the existing system of training shows that it has accumulated a certain number of organizational, practicoscientifical, methodical and program-informational problems that need to be solved. Alterations must be made first of all in the whole organizational and program-methodical plan, that will considerably change the elements of structure and the proper contents of combat and special training in medical service. The basic elements of these changes are the following: to assure the continuity between the training and practical work of medical officers in peaceful time and war period; to regard the basic (fundamental) training on clinical and other subjects as a key task of training in the higher military medical establishments; to provide the officers' skill training on the basis of complex qualification tasks; to create methodical cabinets (and more later simulator centers) in each unit or establishment; to form the training centers of medical staff on the basis of internship; to create a basic laboratory of new methods of training and medical education on the basis of Military Medical Division in the Russian Medical Academy of Post-Graduate Education.

El desafío de la privacidad en Sanidad / The challenge of privacy in Healthcare

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Comparative review of marine mammal guidance implemented during naval exercises.

This article reviews the types and effectiveness of marine mammal mitigation measures used during some naval activities worldwide. The three main standard methods used to mitigate the potential impacts of naval sonar sound on marine mammals are (1) time/area planning (of exercises/active sonar use) to avoid marine mammals; (2) implementation of operational procedures (e.g. 'soft start' - where sound levels are gradually increased over time); and (3) monitoring of animals for the purpose of maintaining an 'exclusion zone' around the sound source. Suggestions towards a minimum worldwide mitigation standard are made.