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The case of a 61-year-old New York woman who died from inhalational anthrax is presented. She was a hospital employee but no source of the anthrax was uncovered. She died about one week after her symptoms began., A 61-year-old woman who was a New York City hospital employee developed fatal inhalational anthrax, but with an unknown source of anthrax exposure. The patient presented with shortness of breath, malaise, and cough that had developed 3 days prior to admission. Within hours of presentation, she developed respiratory failure and septic shock and required mechanical ventilation and vasopressor therapy. Spiral contrast-enhanced computed tomography of the chest demonstrated large bilateral pleural effusions and hemorrhagic mediastinitis. Blood cultures, as well as DNA amplification by polymerase chain reaction of the blood, bronchial washings, and pleural fluid specimens, were positive for Bacillus anthracis. The clinical course was complicated by liver failure, renal failure, severe metabolic acidosis, disseminated intravascular coagulopathy, and cardiac tamponade, and the patient died on the fourth hospital day. The cause of death was inhalational anthrax. Despite epidemiologic investigation, including environme ntal, samples from the patient's residence and workplace, no mechanism foranthrax exposure has been identified.

In this article the authors describe a mathematical model, that can be used to protect an organization's network from unauthorized access, alteration of data, and unavailability. This model stresses flexibility and simplicity. Any company can cheaply tailor this model to its individual needs. It can easily be updated to accommodate new tools and policies that reduce an organization's risk. The model provides the optimal balance of security and risk, based on associated costs. By simply altering the relative importance of security to each network resource, our model can recalculate an optimal solution with three clicks of a button. The procedure and methodology described by the authors, can be used by other universities, businesses, and organizations trying to establish an optimal level of security in an information network. The model assumes a law of diminishing return with every additional defensive measures. The model reveals that the optimal suite of defensive measures costs $1.4 million and is expected to lower expected losses to $1.7 million, for a net savings of $5.9 million.

During major disasters, at what point in the decisional process do senior government officials transition from developing necessary situational awareness to perform decision making? This "transition to decision making" (TDM) concept was analyzed through a structured interview survey of 25 current and former US Federal Coordinating Officers (FCOs) and focused on their decision-making process during the initial response period in a Presidentially declared Stafford Act disaster. This analysis suggests that the TDM for these emergency leaders is influenced by the following five factors: 1) Analogue Factor: the decision maker's previous knowledge and experience from analogous disaster situations; 2) New Paradigm Factor: the degree to which the disaster situation is very atypical to the decision maker due to hazard type and or situation severity, 3) Data Capture Factor: the quality, amount, and speed of disaster situation data conveyed to the decision maker; 4) Data Integration Factor: the decision maker's ability to integrate situational data elements into a mental framework picture; and 5) Time Urgency Factor: the decision maker's perception as to time available before a decision has to be made. The article describes the factors and graphs that how these may influence the timing of the TDM in four types of emergency situations faced by FCOs: 1) an analogue disaster, 2) a disaster situation that presents a new paradigm, 3) an intuitive disaster situation, and 4) a disaster requiring an urgent response.