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The US is facing the most significant health challenge since the 1918-1919 flu pandemic. A response commensurate with this challenge requires engaged leadership and organization across private and public sectors that span federal agencies, public and private healthcare systems, professional organizations, and industry. In the trauma and emergency care communities, we have long discussed the tension between competition in healthcare and the need for regional cooperation to respond to large-scale disasters. The response to COVID-19 has required unprecedented coordination of private and public sector entities. Given the competitive nature of the US health system, these sectors do not regularly work together despite the requirement to do so during a national emergency. This crisis has exposed how structural aspects of the present healthcare system have limited our ability to rapidly transition to a whole-nation response during a national crisis. We propose a renewed focus on the intersection of the healthcare system and national security, with the express goal of creating a public-private partnership focused on leveraging our healthcare infrastructure to support the national security interests of the US., (Published by Elsevier Inc.)

Human achievements are often preceded by repeated attempts that fail, but little is known about the mechanisms that govern the dynamics of failure. Here, building on previous research relating to innovation 1-7 , human dynamics 8-11 and learning 12-17 , we develop a simple one-parameter model that mimics how successful future attempts build on past efforts. Solving this model analytically suggests that a phase transition separates the dynamics of failure into regions of progression or stagnation and predicts that, near the critical threshold, agents who share similar characteristics and learning strategies may experience fundamentally different outcomes following failures. Above the critical point, agents exploit incremental refinements to systematically advance towards success, whereas below it, they explore disjoint opportunities without a pattern of improvement. The model makes several empirically testable predictions, demonstrating that those who eventually succeed and those who do not may initially appear similar, but can be characterized by fundamentally distinct failure dynamics in terms of the efficiency and quality associated with each subsequent attempt. We collected large-scale data from three disparate domains and traced repeated attempts by investigators to obtain National Institutes of Health (NIH) grants to fund their research, innovators to successfully exit their startup ventures, and terrorist organizations to claim casualties in violent attacks. We find broadly consistent empirical support across all three domains, which systematically verifies each prediction of our model. Together, our findings unveil detectable yet previously unknown early signals that enable us to identify failure dynamics that will lead to ultimate success or failure. Given the ubiquitous nature of failure and the paucity of quantitative approaches to understand it, these results represent an initial step towards the deeper understanding of the complex dynamics underlying failure.

A strategic multilateral dialogue related to biosecurity risks in Southeast Asia, established in 2014, now includes participants from Singapore, Malaysia, Indonesia, Thailand, Philippines, and the United States. This dialogue is conducted at the nonministerial level, enabling participants to engage without the constraints of operating in their official capacities. Participants reflect on mechanisms to detect, mitigate, and respond to biosecurity risks and highlight biosecurity issues for national leadership. Participants have also identified factors to improve regional and global biosecurity, including improved engagement and collaboration across relevant ministries and agencies, sustainable funding for biosecurity programs, enhanced information sharing for communicable diseases, and increased engagement in international biosecurity forums.

Background: The study of morbidity and cost of drug prescriptions generated by the primary care physician, with specific populations directs Quality Improvement strategies of care., Aim: To identify acute pathologies in primary care medicine forces for internal security and to study the cost of drug prescription ., Methods: This is a cross-sectional survey during which, we analyzed the medical records (MR) and medical prescriptions (MP)for patients older than 5 years, presenting for acute pathologies, at the first online consultation polyclinic of the internal security forces(ISF) of Mahdia, during the year 2014. Data were collected using a standardized form. We opted for a two-stage sampling the first agreement by taking the second month of each season, the second systematic taking MR from one day to two., Results: We analyzed 701 MR. The average age of the consultants was 37 years with a sex ratio de1,34. Systems, respiratory, digestive, musculoskeletal, skin and cardiovascular, were accumulating 88.3% of acute morbidity diagnosed. The most prescribed therapeutic classes were antipyretics / analgesics (61.6%), antibiotics (42.7%), local treatments oto-rhino-laryngological and throat (28.6%), cough (13.6%), the non steroidal anti inflammatory (12.2%) and mucolytics (11.7%). The median cost of the prescription was 12.070 Tunisian Dinar (TD). The contribution of the patients served at the polyclinic of the FIS of Mahdia, in drug costs, was 35.1%., Conclusion: we were able to highlight the specificities of morbidity in the front line at the polyclinic of the FSI of Mahdia , the nature and cost of drug prescription that was equivalent to that of the general population but with better contribution third party payers.

This article is the latest in an annual series analyzing federal funding for health security programs. We examine proposed funding in the President's Budget Request for FY2019, provide updated amounts for FY2018, and update actual funding amounts for FY2010 through FY2017. Building health security for the nation is the responsibility of multiple agencies in the US federal government, as well as that of state, tribal, territorial, and local governments and the private sector. This series of articles focuses on the federal government's role in health security by identifying health security-related programs in public health, health care, national security, and defense and reporting funding levels for that ongoing work.

There is seen to be a need for better biosecurity - the control of disease spread on and off farm - in the dairy sector. Veterinarians play a key role in communicating and implementing biosecurity measures on farm, and little research has been carried out on how veterinarians see their own and farmers' roles in improving biosecurity. In order to help address this gap, qualitative interviews were carried out with 28 veterinarians from Royal College of Veterinary Surgeon farm accredited practices in England. The results were analysed using a social ecology framework and frame analysis to explore not only what barriers vets identified, but also how vets saw the problem of inadequate biosecurity as being located. Veterinarians' frames of biosecurity were analysed at the individual, interpersonal and contextual scales, following the social ecology framework, which see the problem in different ways with different solutions. Farmers and veterinarians were both framed by veterinarians as individualised groups lacking consistency. This means that best practice is not spread and veterinarians are finding it difficult to work as a group to move towards a "predict and prevent" model of veterinary intervention. But diversity and individualism were also framed as positive and necessary among veterinarians to the extent that they can tailor advice to individual farmers. Veterinarians saw their role in educating the farmer as not only being about giving advice to farmers, but trying to convince the farmer of their perspective and values on disease problems. Vets felt they were meeting with limited success because vets and farmers may be emphasising different framings of biosecurity. Vets emphasise the individual and interpersonal frames that disease problems are a problem on farm that can and should be controlled by individual farmers working with vets. According to vets, farmers may emphasise the contextual frame that biosecurity is largely outside of their control on dairy farms because of logistical, economic and geographical factors, and so some level of disease on dairy farms is not entirely unexpected or controllable. There needs to be a step back within the vet-farmer relationship to realise that there may be different perspectives at play, and within the wider debate to explore the question of what a biosecure dairy sector would look like within a rapidly changing agricultural landscape., (Copyright © 2016 Elsevier B.V. All rights reserved.)

This latest article in the Federal Funding for Health Security series assesses FY2017 US government funding in 5 domains critical to strengthening health security: biosecurity, radiological and nuclear security, chemical security, pandemic influenza and emerging infectious disease, and multiple-hazard and general preparedness.

Is security an investment or a cost? Since the preventative value of security is difficult to prove, each professional security practitioner must do his or her best to take existing data and translate it into a language that the C-Suite will understand, the author says. In this article he describes ways that appropriate resourcesfor security in the healthcare environment can be validated.

This article presents a framework for economic consequence analysis of terrorism countermeasures. It specifies major categories of direct and indirect costs, benefits, spillover effects, and transfer payments that must be estimated in a comprehensive assessment. It develops a spreadsheet tool for data collection, storage, and refinement, as well as estimation of the various components of the necessary economic accounts. It also illustrates the usefulness of the framework in the first assessment of the tradeoffs between enhanced security and changes in commercial activity in an urban area, with explicit attention to the role of spillover effects. The article also contributes a practical user interface to the model for emergency managers., (© 2014 Society for Risk Analysis.)

The author, who has managed both in-house and contracted security services, states unequivocally that hospitals can save money by hiring a security company, but cautions that there may be other considerations involved. In this article he provides guidance on making valid and meaningful comparisons between the two options.

Hundreds of billions of dollars have been spent in homeland security since September 11, 2001. Many mathematical models have been developed to study strategic interactions between governments (defenders) and terrorists (attackers). However, few studies have considered the tradeoff between equity and efficiency in homeland security resource allocation. In this article, we fill this gap by developing a novel model in which a government allocates defensive resources among multiple potential targets, while reserving a portion of defensive resources (represented by the equity coefficient) for equal distribution (according to geographical areas, population, density, etc.). Such a way to model equity is one of many alternatives, but was directly inspired by homeland security resource allocation practice. The government is faced with a strategic terrorist (adaptive adversary) whose attack probabilities are endogenously determined in the model. We study the effect of the equity coefficient on the optimal defensive resource allocations and the corresponding expected loss. We find that the cost of equity (in terms of increased expected loss) increases convexly in the equity coefficient. Furthermore, such cost is lower when: (a) government uses per-valuation equity; (b) the cost-effectiveness coefficient of defense increases; and (c) the total defense budget increases. Our model, results, and insights could be used to assist policy making., (© 2012 Society for Risk Analysis.)

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.

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.

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.

September 11 and the subsequent anthrax attacks marked the beginning of significant investment by the federal government to develop a national public health emergency response capability. Recognizing the importance of the public health sector's contribution to the burgeoning homeland security enterprise, this investment was intended to convey a "dual benefit" by strengthening the overall public health infrastructure while building preparedness capabilities. In many instances, federal funds were used successfully for preparedness activities. For example, electronic health information networks, a Strategic National Stockpile, and increased interagency cooperation have all contributed to creating a more robust and prepared enterprise. Additionally, the knowledge of rarely seen or forgotten pathogens has been regenerated through newly established public health learning consortia, which, too, have strengthened relationships between the practice and academic communities. Balancing traditional public health roles with new preparedness responsibilities heightened public health's visibility, but it also presented significant complexities, including expanded lines of reporting and unremitting inflows of new guidance documents. Currently, a rapidly diminishing public health infrastructure at the state and local levels as a result of federal budget cuts and a poor economy serve as significant barriers to sustaining these nascent federal public health preparedness efforts. Sustaining these improvements will require enhanced coordination, collaboration, and planning across the homeland security enterprise; an infusion of innovation and leadership; and sustained transformative investment for governmental public health.

The Seventh Review Conference of the Biological Weapons Convention (BWC), the first international treaty to outlaw an entire class of weapons, was held in Geneva in December 2011. On 7 December, Secretary of State Hillary Clinton became the highest-ranking US government official to address a BWC meeting. Secretary Clinton told the assembled delegation that ‘we view the risk of bioweapons attack as both a serious national security challenge and a foreign policy priority’. At the same time, she warned that a large-scale disease outbreak ‘could cripple an already fragile global economy’. Secretary Clinton's speech reflected a new understanding that the range of biological threats to international security has expanded from state-sponsored biological warfare programmes to include biological terrorism, dual-use research and naturally occurring infectious diseases such as pandemics. Recognizing these changes, President Barack Obama released a new national strategy for countering biological threats in 2009. This strategy represents a shift in thinking away from the George W. Bush administration's focus on biodefence, which emphasized preparing for and responding to biological weapon attacks, to the concept of biosecurity, which includes measures to prevent, prepare for and respond to naturally occurring and man-made biological threats. The Obama administration's biosecurity strategy seeks to reduce the global risk of naturally occurring and deliberate disease outbreaks through prevention, international cooperation, and maximizing synergies between health and security. The biosecurity strategy is closely aligned with the Obama administration's broader approach to foreign policy, which emphasizes the pragmatic use of smart power, multilateralism and engagement to further the national interest. This article describes the Obama administration's biosecurity strategy; highlights elements of continuity and change from the policies of the Bush administration; discusses how it fits into Obama's broader foreign policy agenda; and analyses critical issues that will have to be addressed in order to implement the strategy successfully.

National security organizations in the United States, including the armed services and the intelligence community, have developed a close relationship with the scientific establishment. The latest technology often fuels warfighting and counter-intelligence capacities, providing the tactical advantages thought necessary to maintain geopolitical dominance and national security. Neuroscience has emerged as a prominent focus within this milieu, annually receiving hundreds of millions of Department of Defense dollars. Its role in national security operations raises ethical issues that need to be addressed to ensure the pragmatic synthesis of ethical accountability and national security., Competing Interests: The authors have declared that no competing interests exist.

In the wake of the report of the World Health Organisation's Commission on the Social Determinants of Health, Closing the gap in a generation (Marmot 2008), this invited commentary considers the scope for geographical research on global health. We reflect on current work and note future possibilities, particularly those that take a critical perspective on the interplay of globalisation, security and health.

This article considers the role of play in the context of technological emergence and expansion, particularly as it relates to recently emerging surveillance technologies. As a case study, I consider the trajectory of automated face recognition—a biometric technology of numerous applications, from its more controversial manifestations under the rubric of national security to a clearly emerging orientation toward play. This shift toward “playful” biometrics—or from a technology traditionally coded as “hard” to one now increasingly coded as “soft”—is critical insofar as it renders problematic the traditional modes of critique that have, up until this point, challenged the expansion of biometric systems into increasingly ubiquitous realms of everyday life. In response to this dynamic, I propose theorizing the expansion of face recognition specifically in relation to “play,” a step that allows us to broaden the critical space around newly emerging playful biometrics, as well as playful surveillance more generally. In addition, play may also have relevance for theorizing other forms of controversial technology, particularly given its potential role in processes of obfuscation, normalization, and marginalization.

In 1942 over 110,000 Japanese Americans were evacuated from the West Coast to ten inland, barbed wire-enclosed relocation centers in the name of national security. Agriculture was a key component of the eight arid to semi-arid centers located in the western United States. Each center's agricultural program included produce for human consumption, feed crops, and livestock. Some centers also grew seed, ornamental, and war crops. Evacuees raised and consumed five types of livestock and sixty-one produce varieties, including many traditional foods. Seasonal surpluses were preserved, shipped to other centers, or sold on the open market. Short growing seasons, poor soils, initially undeveloped lands, pests, equipment shortages, and labor issues hampered operations. However, imprisoned evacuee farmers proved that diverse agricultural programs could succeed in the harsh settings primarily because of labor-intensive farming methods, ingenuity, and the large markets provided by the centers. These agricultural programs played major roles in feeding, providing meaningful employment, and preparing evacuees for life outside the centers, and readied lands for post-war "homesteaders."

The frequent and swift emergence of new and devastating infectious diseases has brought renewed attention to health as an issue of international importance. Some states and regional organizations, including in Asia, have begun to regard infectious disease as a national and international security issue. This article seeks to examine the Vietnamese government's response to the epidemics of avian influenza and Human immunodeficiency virus. Both diseases have been recognized at different times as threats to international security and both are serious infectious disease problems in Vietnam. Yet, the character of the central government's response to these two epidemics has been starkly different. How and why this disparity in policy approaches occurs depends largely on the epidemiological, economic and political context in which they occur. Although epidemiological factors are frequently explored when discussing disease as a security issue, seldom are the political, social and economic characteristics of the state invoked. These dimensions, and their interaction with the epidemiology of the disease, are central to understanding which diseases are ultimately treated by states as security issues. In particular, the role of economic security as a powerful motivator for resistance to control measures and the role that local implementation of policies can have in disrupting the effect of central government policy are explored. In exploring both the outcomes of securitization, and its facilitating conditions, I suggest some preliminary observations on the potential costs and benefits of securitizing infectious disease and its utility as a mechanism for protecting health in Asia.

This essay examines inmate "crucifixion protests" in Ecuador's largest prison during 2003-04. It shows how the preventively incarcerated-of whom there are thousands-managed to effectively denounce their extralegal confinement by embodying the violence of the Christian crucifixion story. This form of protest, I argue, simultaneously clarified and obscured the multiple layers of sovereign power that pressed down on urban crime suspects, who found themselves persecuted and forsaken both outside and within the space of the prison. Police enacting zero-tolerance policies in urban neighborhoods are thus a key part of the penal state, as are the politically threatened family members of the indicted, the sensationalized local media, distrustful neighbors, prison guards, and incarcerated mafia. The essay shows how the politico-theological performance of self-crucifixion responded to these internested forms of sovereign violence, and were briefly effective. The inmates' cross intervention hence provides a window into the way sovereignty works in the Ecuadorean penal state, drawing out how incarceration trends and new urban security measures interlink, and produce an array of victims.

Introduction: Little has been published on the management of psychiatric crises in rural areas, and little is known of the security needs or use of "secure rooms" in rural hospitals., Method: We conducted a 3-year retrospective chart audit on the use of our secure room/security guard system at a rural hospital in a town of 3500, located 220 km from our psychiatric referral centre., Results: Use of our secure room/security guard system occurred at the rate of 1.1 uses/1000 emergency department visits, with the most common indication being physician perception of risk of patient suicide or self-harm. Concern for staff safety was a factor in 10% of uses. Eighty percent of patients were treated locally, with most being released from the secure room after 2 days or less. Fourteen percent of patients required ultimate transfer to our psychiatric referral centre and 6% to a detoxification centre. The average annual cost of security was $16 259.61., Discussion: A secure room can provide the opportunity for close observation of a potentially self-harming patient, additional security for staff and early warning if a patient flees the hospital. Most admissions were handled locally, obviating the need for transfer to distant psychiatric referral centres. Most patients who were admitted were already known as having a psychiatric illness and 80% of the patients required the use of the secure room/security guard system for less than a 2-night stay, suggesting that most rural mental health crises pass quickly., Conclusion: Most patients admitted to a rural hospital with a mental health crisis can be managed locally if an adequate secure room/security guard system is available.

Concerns about biosecurity in the food system raise a variety of issues about how the system is presently organized, why it might be vulnerable, what we could reasonably do to better secure it, and the costs of doing so. Emphasizing the role of incentives in efficient resource allocation, this article considers economic dimensions of three aspects of the general problem. One is the global problem, or the way biosecurity measures can affect how countries relate to each other and the global consequences that result. Another is how to best manage the immediate aftermath of a realized threat in order to minimize damage. The third is how to seek to prevent realization of the threat. Some policy alternatives are presented.