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There is an upward trend in the use of military personnel and assets to provide domestic and international humanitarian assistance and disaster relief. International humanitarian law has constrained military involvement by imposing particular obligations when it comes to providing assistance. In nonconflict situations, however, these constraints are becoming increasingly unreasonable given that the priority is to fill the gap between global humanitarian capacity and actual community need. Militaries in the Indo-Asia-Pacific region have been proactively assessing their performance in humanitarian missions, and some have made significant progress in advancing civilian-military coordination. Future efforts must focus on improving the integration of military modes of operation and assets into emerging frameworks for disaster management and humanitarian efforts. Military policy makers need to assume a more active role in expanding their focus beyond response to all phases of disasters: prevention, preparedness, response, and recovery. [ABSTRACT FROM AUTHOR]

The World Health Organization defined climate change as the most important issue for the 21st century. In 2014, the State of Hawaii called climate change "a matter of security" that directly threatens "economic systems - food, water, energy, biodiversity and health" and has called for "actionable information for local decision making." According to the Intergovernmental Panel on Climate Change, the burden of human morbidity attributable to climate change is relatively small although not well quantified. Nevertheless, generic climate change impacts are often used to justify actions without adequate supporting local evidence. This paper analyzes Hawaii's health risks in relation to air pollution, heat extremes, ultraviolet radiation, and weather extremes and finds that Hawaii's natural geography, robust water, and sanitation infrastructure render the islands less vulnerable to many of the often-mentioned climate change threats. It concludes that the health security threat posed by climate change effects on Hawaii's physical environment over the next 35 years is slight in most areas and moderate with regard to ecosystem health. Because all global communities tend to be both discrete and unique in their vulnerability, it recommends the collection of grassroots, community-based resilience data to reveal local vulnerabilities that can inform strategic statewide planning. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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 [ABSTRACT FROM AUTHOR]

Public health and medical professionals are expected to be well-prepared for emergencies since they assume an integral role in any response. They need to be aware of planning issues, be able to identify their roles in emergency situations, and show functional competence. However, media perceptions and non-empirical publications often lack an evidence base when addressing this topic. This study attempted to assess the competencies of various health professionals by obtaining quantitative data on the state of bioterrorism preparedness and response competencies in Australia using an extensive set of competencies developed by Kristine Gebbie from the Columbia University School of Nursing Center for Health Policy with funding from the US Centres for Disease Control and Prevention. These competencies reflect the knowledge, capabilities and skills that are necessary for the here and now in public health. Sufficient data were collected to enable comparison between public health leaders, communicable disease specialists, clinicians (with and without medical degrees) and environmental health professionals. All health professionals performed well. However, the primary finding of this study was that clinicians consistently self-assessed themselves as lower in competence and clinicians with medical degrees self-assessed themselves as the lowest in bioterrorism competence. This has important implications for health professional training, national benchmarks, standards and competencies for the public health workforce. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Although head lice, Pediculus humanus capitis, are globally prevalent blood-sucking ectoparasites, the amount of blood imbibed by head lice has not been determined. This study investigated this parameter, as regular loss of a small quantity of blood may lead to an iron deficiency and anaemia. Adult female lice (66), adult males (46), and nymphs (152) were weighed before and after feeding in groups of 17–109 lice. The average amounts of blood imbibed at a single feed were: adult female louse (0.0001579 ml), adult male (0.0000657 ml) and nymph (0.0000387 ml). Assuming three feeds per day by an average infection of 30 lice (10 females, 10 males, and 10 nymphs), the average child with active pediculosis would loose 0.008 ml of blood per day. This amount of blood loss is of no clinical significance even in iron-deficient children. The most heavily infected child observed with 2657 lice could be expected to loose 0.7 ml/day or 20.8 ml/month, which may be of clinical importance in a child on an adequate diet, and would be significant in an iron-deficient child. However, if head lice feed more often than three times a day, a heavy infestation would have a greater potential to lead to iron deficiency. The frequency of feeding of head lice on the head of the human host needs to be determined. [ABSTRACT FROM AUTHOR]

Although the global increase in pediculosis is well known, little is known about the exact nature of head lice (Pediculus capitis ) transmission. Several mechanisms have been proposed such as head-to-head and fomite transmission, but some contention remains concerning the primary transmission route. This study investigated spatial and kinetic factors influencing the dynamics of hair-to-hair transfer to clarify further how head lice transmit from head to head. Forty-eight factorial experimental trials, with 10 replicates each, were conducted using 480 freshly caught P. capitis from primary school children. In the trials, each louse was placed on a stationary suspended hair or a mobile hair and was presented with mobile or stationary hairs for transmission. All hair passes involved contact between the uninhabited hair and the lice. Hairs without a louse were presented dorsally, laterally, and ventrally to the louse. They were also passed from head to tail or from tail to head and were moved at speeds of 8 m and 4 m per min. The proportion of P. capitis transmission was highly dependent on the specific setting. The tail-to-head direction, slow movement, and a parallel direction all proved favorable for transmission. The highest transfer proportion of P. capitis (85%) was observed in the setting where the presented hair was laterally slow moving in a parallel way from tail to head. No transmission at all was observed under an angle of 90 degrees. Hair-to-hair P. capitis transmission occurred more frequently when hairs were in particular physical and kinetic relationships. This suggests that head lice are less likely to take advantage of many proposed fomite transmission scenarios and are most likely to rely on head-to-head contact for transmission. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Abstract: Emergency medical services, or ‘ambulance services’, are a vehicle-intense component of the health sector that could contribute to that sector''s emissions reduction efforts. This analysis uses data from an inventory of ambulance service Scope 1 (arising from direct energy consumption) and Scope 2 (arising from purchased energy consumption) emissions, along with publicly available expenditure data and emissions multipliers derived from economy-wide input–output tables, to estimate the life cycle greenhouse gas emissions of Australian ambulance services. Total emissions are estimated at between 216,369 and 546,688 t CO2e annually, and represent between 1.8% and 4.4% of total Australian health sector emissions. Approximately 20% of ambulance service emissions arise from direct consumption of vehicle fuels (diesel and petrol) and aircraft fuels, with 22% arising from electricity consumption, and 58% arising from Scope 3 (e.g., supply chain; waste disposal) processes. Incorporating alternative fuels and higher efficiency vehicles into Australian ambulance services'' vehicle fleets could reduce their direct greenhouse emissions, but broader efforts targeting reduced electricity consumption, greener electricity generation, and environmentally friendly purchasing practices will be required to substantially reduce their total carbon footprint. [Copyright &y& Elsevier]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]