Search

Examination of imported commodities by trained inspectors searching for pest organisms is a common practice that phytosanitary regulatory agencies use to mitigate biosecurity risks along trade pathways. To investigate the effects of target size and color on the efficacy of these visual assessments, we affixed square decals to polystyrene models of mandarins. Sample units of 100 model fruit containing up to 10 marked models were examined by inspectors. Six sizes in six shades of brown were tested across two prevalence levels. The experiment consisted of five inspection rounds where 11 inspectors examined 77 sample units within an allocated time. The probability that decals were detected increased with mark size and color contrast. Smaller, low-contrast marks were mainly missed. The prevalence rate did not affect the detectability. Through the experiment, the false-positive rate dropped from 6% to 3%, whereas false-negative rates were constant throughout. Large, dark targets were readily found with a mean recall of >90%, whereas small, pale marks had a mean recall of 9%. Increased experience made inspectors more competent at recognizing decals, reducing the false positive rate. However, constant false-negative rates indicate that experience did not prevent inspectors from overlooking targets they could not perceive.

Abstract: Modern psychiatric practice requires the use of the Internet, and the current pandemic has accelerated the adoption of technology in clinics. Psychiatrists receive significant education on protecting patient privacy and medical information when using these tools. However, they receive little training regarding protecting their own personal privacy in the Internet era. Private information, often without one's knowledge, is frequently available online and accessible by patients. The work of physicians and psychiatrists creates additional unique vulnerabilities to privacy. Given the essential nature of the Internet in modern clinical practice, physicians should understand how to monitor and protect personal privacy and safety online. We provide advice to minimize vulnerability to a privacy breach, with a focus on areas unique to psychiatrists and psychiatric practice. We review the literature on physician safety online and offer guidance to get started., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Introduction: the Global-Partnership-Initiated-Biosecurity-Academia for Controlling Health Threats (GIBACHT) consortium conducts a biosafety and biosecurity training for fellows from Africa, the Middle East and Asia. To achieve a multiplier effect, fellows conduct trainings in their own organizations. It was during such trainings that training needs assessments were done assessing reasons for and barriers to biosafety and biosecurity training., Methods: this was a cross sectional assessment. Trainings were conducted from April to July 2018 and April to June 2019. In 2018, training needs were explored using a structured tool. Responses were coded using manifest content analysis and key issues identified. In 2019, respondents quantified the identified key issues using a Likert scale. Proportions of those who strongly agreed, agreed, neither agreed nor disagreed, disagreed or strongly disagreed were calculated and results presented in tables and charts., Results: in 2018 and 2019, there were 183 and 191 respondents respectively. About 96% of respondents in 2018 supported training in biosafety and biosecurity citing individual, community and global benefits. Barriers highlighted included governance, financial, human resource, information and infrastructure challenges. In 2019, majority of respondents indicated inadequate guidelines dissemination, lack of financial resources, inadequate personnel, lack of equipped laboratories and lack of instructional materials among major barriers., Conclusion: support for biosafety and biosecurity training was high though systemic barriers exist. Improving human resource capacity and provision of instructional materials can be achieved through training programs. However, systemic assessments need to be done before each training as different organizations have different barriers., Competing Interests: The authors declare no competing interests., (Copyright: Elizeus Rutebemberwa et al.)

Workplace violence is one of the most complex and dangerous occupational hazards facing hospital healthcare workers today. The United States Occupational Safety and Health Administration recommends that all hospitals have a violence prevention program. The purpose of this article is to describe the development and implementation of a preparedness program to address violent situations in healthcare as an essential component of workplace safety. The foundational program elements are leadership involvement, policy development, organization assessment, response personnel deployment, education, data repository and culture shift. A triad leadership from patient safety, security and nursing led the program. Key implementation lessons involved coordination of change within and across multiple sites., (Copyright © 2020 Longwoods Publishing.)

The prevalence of security guards in health care settings is growing worldwide. There is a need to explore and understand their role and actions to inform policy and training and support least restrictive practices in health care. The aim of this study was to conduct a retrospective chart audit of security guard logs to investigate security guard involvement in Code Blacks, called in emergency situations of personal threats including patient and/or visitor violence, in medical and surgical wards in a large metropolitan health network in South Australia. Security guards attended 1664 Code Blacks (0.63% of admissions) over the 2.5-year study period. Events were more frequently reported in medical than surgical wards. The most common reasons for security guard attendance were patients threatening/harming staff and patients threatening/harming themselves. The most frequent security guard actions were "Attend only/standby," "Physical restraint," and "Patient located and returned to the ward." The most frequent outcomes were physical restraint, chemical restraint, and de-escalation respectively. Results highlight the imperative that health services maintain and increase efforts to support least restrictive practice through policy directives and staff training., (© 2020 John Wiley & Sons Australia, Ltd.)

Both the increase in traveler numbers and the heightened threat posed by terrorism in recent years represent significant challenges to airport security measures. To ensure that a high level of security is maintained, randomized security checks have been proposed as a promising alternative to traditional security approaches. The use of randomized checks means that only a specific number of people are selected for security screening. However, the likely effects of such a change in security procedures on travelers' security perceptions and on the deterrence of criminal activities remain unclear. Thus, the present study examines how varying the percentage of people screened during security checks influences people's security perceptions. In two online experiments, the participants were asked to imagine that they sought to smuggle an explosive dummy past an airport security check. The only information provided was the number of people screened during security checks, which was manipulated between-subjects in the first experiment and within-subjects in the second experiment. The participants then had to rate their security perception (i.e., the perceived likelihood of successfully smuggling the explosive dummy). The findings show that people perceive traditional security checks to be safer than randomized checks, irrespective of whether 90% or 30% of people are screened. Hence, if randomized security checks would indeed be implemented, it would automatically lead to a decreased perception of security. Furthermore, this decreased security perception might lead to an actual reduction in security, as the deterrence of criminal activities could also be reduced., (© 2020 Society for Risk Analysis.)

Using a simulated X-ray screening task, we tested 122 airport security screeners working with the support of explosives detection systems for cabin baggage screening (EDSCB) as low-level automation. EDSCB varied systematically on three automation reliability measures: accuracy, d', and positive predictive value (PPV). Results showed that when unaided performance was high, operator confidence was high, and automation provided only small benefits. When unaided performance was lower, operator confidence was lower, and automation with higher d' provided large benefits. Operator compliance depended on the PPV of automation: We found lower compliance for lower PPV. Automation with a high false alarm rate of 20% and a low PPV of .3 resulted in operators ignoring about one-half of the true automation alarms on difficult targets-a strong cry-wolf effect. Our results suggest that automation reliability described by d' and PPV is more valid than using accuracy alone. When the PPV is below .5, operators should receive clear instructions on how to respond to automation alarms., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

The existing tamper detection schemes for absolute moment block truncation coding (AMBTC) compressed images are able to detect the tampering. However, the marked image qualities of these schemes can be enhanced, and their authentication methods may fail to detect some special tampering. We propose a secure AMBTC tamper detection scheme that preserves high image fidelity with excellent detectability. In the proposed approach, a bit in bitmaps of AMBTC codes is sequentially toggled to generate a set of authentication codes. The one that causes the least distortion is embedded into the quantization levels with the guidance of a key-generated reference table (RT). Without the correct key, the same reference table cannot be constructed. Therefore, the proposed method is able to detect various kinds of malicious tampering, including those special tampering techniques designed for RT-based authentication schemes. The proposed method not only offers better image quality, but also provides an excellent and satisfactory detectability as compared with previous works., Competing Interests: The authors have declared that no competing interests exist.

Our objective was to quantify the impact on the use of zolpidem of the obligation implemented in France in 2017 to use secure prescription pads to prescribe it. We conducted a cohort study within the French SNDS healthcare database. Patients aged over 18 years of age were considered for inclusion. The number of prevalent users and incident episodes of zolpidem use were compared before the change in law (July 1, 2016 to January 1, 2017) and after (July 1, 2017 to January 1, 2018). A prevalent user was a patient who has been reimbursed for zolpidem at least once. An incident episode of zolpidem use was defined by a first administration of zolpidem without any prior administration within the previous six months. Regarding prevalence of zolpidem users, we observed a decrease from 2.79% (CI95%:2.75-2.83) to 1.48% (1.44-1.51), with a number of patients who stopped taking it after the change in law being approximately 4.3 times higher than the number of patients who started. We observed a negative association between the post-law change period (OR = 0.52 (0.51-0.53)) and the probability of receiving zolpidem, adjusting for sex, aging, low income and chronic disease. We observed a decrease from 183 treatment episodes per 100,000 insured months on average to 79 episodes per 100,000 insured months, with an incidence rate ratio (IRR) equal to 0.43 (0.38-0.49). The use of secure prescription pads seems to have reduced the exposure of the French population to zolpidem., Competing Interests: The authors have declared that no competing interests exist.

Background: When new technologies are developed, it is common for their crime and security implications to be overlooked or given inadequate attention, which can lead to a 'crime harvest'. Potential methods for the criminal exploitation of biotechnology need to be understood to assess their impact, evaluate current policies and interventions and inform the allocation of limited resources efficiently. Recent studies have illustrated some of the security implications of biotechnology, with outcomes of misuse ranging from compromised computers using malware stored in synthesised DNA, infringement of intellectual property on biological matter, synthesis of new threatening viruses, 'genetic genocide,' and the exploitation of food markets with genetically modified crops. However, there exists no synthesis of this information, and no formal quality assessment of the current evidence. This review therefore aims to establish what current and/or predicted crimes have been reported as a result of biotechnology., Methods: A systematic review will be conducted to identify relevant literature. ProQuest, Web of Science, MEDLINE and USENIX will be searched utilizing a predefined search string, and Backward and Forward searches. Grey literature will be identified by searching the official UK Government website (www.gov.uk) and the Global database of Dissertations and Theses. The review will be conducted by screening title/abstracts followed by full texts, utilising pre-defined inclusion and exclusion criteria. Papers will be managed using Eppi-center Reviewer 4 software, and data will be organised using a data extraction table using a descriptive coding tool. A predefined rating system (speculative, experimental or currently occurring) will be used to sort studies, and a thematic synthesis of the results will be presented., Discussion: Despite the concerns raised about the misuse of biotechnology, no previous work has been conducted from a Crime Science perspective to collate and assess the literature. This systematic review aims to identify the types of offending activity facilitated by biotechnology, including synthetic biology and genetic engineering. The objective of the review is to examine whether this offending activity can be prevented by assessing the conditions necessary for the crime events to occur. It is anticipated that evidence generated from this review will guide future research in this area and aid relevant stakeholders to prioritise and allocate limited resources to biotechnology crime prevention., Systematic Review Registration: PROSPERO CRD42019131685.

With the growing popularity of online services such as online banking and online shopping, one of the essential research topics is how to build a privacy-preserving user abnormal behavior recommendation system. However, a machine-learning based system may present a dilemma. On one aspect, such system requires large volume of features to pre-train the model, but on another aspect, it is challenging to design usable features without looking to plaintext private data. In this paper, we propose an unorthodox approach involving graph analysis to resolve this dilemma and build a novel private-preserving recommendation system under a multilayer network framework. In experiments, we use a large, state-of-the-art dataset (containing more than 40,000 nodes and 43 million encrypted features) to evaluate the recommendation ability of our system on abnormal user behavior, yielding an overall precision rate of around 0.9, a recall rate of 1.0, and an F1-score of around 0.94. Also, we have also reported a linear time complexity for our system. Last, we deploy our system on the "Wenjuanxing" crowd-sourced system and "Amazon Mechanical Turk" for other users to evaluate in all aspects. The result shows that almost all feedbacks have achieved up to 85% satisfaction., Competing Interests: The corresponding author (Weiyi Liu) is an employee in JD Urban computing business unit. The company only provided support in the form of salaries for Weiyi Liu but did not have any additional role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

The 2014 to 2016 Ebola outbreak response resulted in many lessons learned about biocontainment patient care, leading to enhanced domestic capabilities for highly infectious and hazardous communicable diseases. However, additional opportunities for improvement remain. The article identifies and describes key considerations and challenges for laboratory analysis, clinical management, transportation, and personnel management during the care of patients infected with Ebola or other special pathogens. Dedication to maintaining preparedness enables biocontainment patient care teams to perform at the highest levels of safety and confidence., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Introduction: In recent years, several high-profile attacks on hospitals providing medical aid in conflict settings have raised international concern. The International Humanitarian Law prohibits the deliberate targeting of health care settings. Violation of this law is considered a war crime and impacts both those delivering and receiving medical aid., Problem: While it has been demonstrated that both aid workers and health care settings are increasingly being targeted, little is known about the trends and characteristics of security incidents involving aid workers in health care compared to non-health care settings., Methods: Data from the publicly available Aid Worker Security Database (AWSD) containing security incidents involving humanitarian aid workers world-wide were used in this study. The security incidents occurring from January 1, 1997 through December 31, 2016 were classified by two independent reviewers as having occurred in health care and non-health care settings, and those in health care settings were further classified into five categories (hospital, health clinic, mobile clinic, ambulance, and vaccination visit) for the analysis. A stratified descriptive analysis, χ2 Goodness of Fit test, and Cochran-Armitage test for trend were used to examine and compare security incidents occurring in health care and non-health care settings., Results: Among the 2,139 security incidents involving 4,112 aid workers listed in the AWSD during the study period, 74 and 2,065 incidents were in health care settings and non-health care settings, respectively. There was a nine-fold increase from five to 45 incidents in health care settings (χ2 = 56.27; P < .001), and a five-fold increase from 159 to 852 incidents in non-health care settings (χ2 = 591.55; P < .001), from Period 1 (1997-2001) to Period 4 (2012-2016). Of the 74 incidents in health care settings, 23 (31.1%) occurred in ambulances, 15 (20.3%) in hospitals, 13 (17.6%) in health clinics, 13 (17.6%) during vaccination visits, and six (8.1%) in mobile clinics. Bombings were the most common means of attack in hospitals (N = 9; 60.0%), followed by gun attacks (N = 3; 20.0%). In health care settings, 184 (95.3%) were national staff and nine (4.7%) were international staff., Conclusion: Security threats are a growing occupational health hazard for aid workers, especially those working in health care settings. There is a need for high-quality data from the field to better monitor the rapidly changing security situation and improve counter-strategies so aid workers can serve those in need without having to sacrifice their lives.

Background: Nurses are disproportionately prone to experience incidents of violent victimization. Despite the vast literature on violence in healthcare settings, few studies have identified effective violence prevention interventions., Aim: The aim of the study was to explore the experiences of nurses regarding the implementation of technology-based violence prevention interventions., Methods: Qualitative data were collected through semi-structured focus groups and interviews with 11 nurses at Humber River Hospital. Interviews were audiotaped, transcribed and subjected to a content analysis to identify core themes from the data., Results: Three themes were identified: reassurance of safety, an increase in proactive measures and limitations of technology. Nurses held positive perceptions of the impact of technology-based interventions on violent incidents. The interventions were regarded as effective for the detection of potentially violent patients as well as for providing assistance from security staff when a violent incident occurs or appears imminent. However, nurses also acknowledged that patient-related violence was "unavoidable" and that technology cannot fully prevent violence from occurring., Conclusion: The findings from this study support the replication of these interventions in other healthcare facilities. Engaging staff, patients and families in this unique digital and technology-enriched environment has been critical for the successful implementation of the violence prevention electronic flagging system. Patient and family education and communication were essential for addressing concerns related to "labelling.", (Copyright © 2019 Longwoods Publishing.)

Dual-use research poses a significant challenge for scientists in the biomedical field and for global health security in general. As the scientific knowledge and materials required for the development of biological agents become progressively more accessible and inexpensive, there is an increased need to understand and improve the governance of scientific research. Prevention of the misuse of facilities, equipment, agents, and scientific knowledge requires high levels of awareness of the concept of dual-use research, starting with early-career scientists and graduate students. In this study, the attitudes and level of awareness of postgraduate students in Pakistan toward the issues surrounding dual-use research were assessed through a survey containing both quantitative and qualitative questions in 32 universities in 4 provinces, federal area, and Azad Jammu and Kashmir regions of Pakistan; 933 students responded. Most (58.2%) had never heard of dual-use research of concern (DURC), while 18.5% had heard the term but were unsure of its meaning. Irrespective of prior knowledge, a higher percentage of students (68.6%) felt an obligation to report research misuse. Considering the need for DURC training, 94.1% of the respondents agreed that the principal investigator should take the responsibility to train students on DURC at the start of a research project. When experimental results having dual-use potential, 69.1% indicated they would publish with limited protocol, with 43.5% indicating they would publish the limited protocol only if there was a way for scientists to access their data. The survey results revealed limited DURC awareness among researchers across Pakistan. However, the respondents, although not formally educated about DURC, were quite aware of its impact. The information gained in this survey will be valuable in addressing country-specific awareness and training needs.

Objectives: Despite a policy of zero tolerance towards workplace violence (WPV) in Australian public hospital EDs, the incidence of WPV continues to increase. The aim of this study was to characterise security responses to WPV within an adult level 4 ED., Methods: A retrospective single-centre review of episodes of WPV perpetrated by adults occurring within the ED was conducted between 1 January 2013 and 31 December 2015. Cases were identified using a prospectively recorded security register that records all events of security personnel attendance. The presence of police officers on initial presentation was the primary exposure variable., Results: There were 1853 violent episodes committed by 1224 patients requiring security intervention during the study period, with half the episodes (n = 916; 49%) involving perpetrators who had committed at least two or more violent acts during the study period. Most cases (n = 1057, 57%; 95% CI: 55-59) occurred in the absence of police presence. Only 144 (7.8%) cases were managed by the presence of security personnel without physical security interventions., Conclusions: EDs should not rely on police response to prevent or handle violence. The finding of a high proportion of events being perpetrated by repeat offenders indicate that data sharing between EDs for identification of perpetrators of WPV can be useful for prevention of future episodes. ACEM policy for WPV in EDs should encompass further details on security credentialing and preventive strategies towards minimisation of WPV in the Australian EDs., (© 2018 Australasian College for Emergency Medicine.)

Objective: To identify and compare security gaps in a public and private tertiary care hospital., Methods: The study was conducted in January 2016 using a tool adopted from Ingersoll Rand Security Technologies, Occupational Safety and Health Association and findings of baseline research carried out by Health Care in Danger Project at a public and private sector hospital in Karachi. The names of hospitals were kept confidential. Areas assessed included adequacy of workforce, existing institutional mechanisms and campus security. The tool was completed by interviewing administration, security department, and healthcare workers in wards and the emergency departments as well as patients, attendants and through observation visits., Results: The burden of doctors at the private-sector hospital was higher compared to the publicsector hospital (40 versus 22 patients per doctor per day) in the outpatient department. Privatesector hospital scored better than public-sector hospital with regards to compliance to security management standards (68% versus 50%), security perception of staff (90% versus 50%), security staffing (60% versus 50%), and visitor management (80% versus 40%). Campus security was better at private-sector hospital (56% versus 31%). Scores for employee orientation and training were low (30% and 20%), while scores for organisational partnerships were high in both hospitals (80% each). ., Conclusions: Four-pronged strategic framework is recommended that shall comprise restricting access of attendants/visitors/vendors, improving interaction between patients/healthcare workers/guards, mechanisms of reporting and responding to violent events, and maintaining sufficient resources for enhancing and improving security in hospitals.

Two-factor authentication has been available to technology consumers for a long time, and a few years ago businesses and institutions began implementing optional two-factor authentication to improve digital security. Now more universities and hospitals are moving from optional to mandatory two-factor authentication, and employees used to two-factor authentication for their personal digital life must adjust to using two-factor authentication in their work flow. This column will review some of the ongoing and emergent aspects of two-factor authentication to enhance security in an ever-changing digital landscape.

To investigate the current management and biosecurity practices and identify possible differences between different types of breeders, a cross-sectional study was carried out in 102 Belgian dog breeding facilities ranging from small (less than 10 dams on site) to large-scale (more than 50 dams on site or at least 500 puppies sold yearly) breeders. Veterinary prophylactic protocols (ie, vaccination, endoparasite control, ectoparasitic treatments) were highly implemented (91.5 per cent, 92.6 per cent, 42.7 per cent, respectively) across all breeder categories. 13.8 per cent of all visited breeders reported to administer antimicrobials to each female post partum and 10.3 per cent reported to treat all puppies, or at least of one breed, systematically with antimicrobials. Large-scale breeders reported to employ staff more frequently (p<0.01), and appeared to be more familiar with the principles of biosecurity. They reported to apply disinfection (p<0.01) and hygienic measures (p=0.03) across all parts of the facility, and to quarantine newly acquired dogs (p<0.01) more often compared with small-scale breeders. Nonetheless, a moderate knowledge of and use of disinfection was recorded, as was the presence of pet dogs, breaking the compartmentalisation. Results of this study indicate that there is substantial room for improvement in hygiene and disease management across all categories of breeders. The characterisation of different types of dog breeders with respect to biosecurity and management practices is a first step towards improvement of dog husbandry and biosecurity measures. Tailored guidelines should permit breeders to further improve the health of breeding animals and puppies while reducing the risk of infectious disease outbreaks and associated expenses., Competing Interests: Competing interests: None declared., (© British Veterinary Association (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Background: Emerging pathogens such as Zika, chikungunya, Ebola, and dengue viruses are serious threats to national and global health security. Accurate forecasts of emerging epidemics and their severity are critical to minimizing subsequent mortality, morbidity, and economic loss. The recent introduction of chikungunya and Zika virus to the Americas underscores the need for better methods for disease surveillance and forecasting., Methods: To explore the suitability of current approaches to forecasting emerging diseases, the Defense Advanced Research Projects Agency (DARPA) launched the 2014-2015 DARPA Chikungunya Challenge to forecast the number of cases and spread of chikungunya disease in the Americas. Challenge participants (n=38 during final evaluation) provided predictions of chikungunya epidemics across the Americas for a six-month period, from September 1, 2014 to February 16, 2015, to be evaluated by comparison with incidence data reported to the Pan American Health Organization (PAHO). This manuscript presents an overview of the challenge and a summary of the approaches used by the winners., Results: Participant submissions were evaluated by a team of non-competing government subject matter experts based on numerical accuracy and methodology. Although this manuscript does not include in-depth analyses of the results, cursory analyses suggest that simpler models appear to outperform more complex approaches that included, for example, demographic information and transportation dynamics, due to the reporting biases, which can be implicitly captured in statistical models. Mosquito-dynamics, population specific information, and dengue-specific information correlated best with prediction accuracy., Conclusion: We conclude that with careful consideration and understanding of the relative advantages and disadvantages of particular methods, implementation of an effective prediction system is feasible. However, there is a need to improve the quality of the data in order to more accurately predict the course of epidemics.

Health information technology (IT) offers exciting opportunities for providing novel services to patients, and for improving the quality and safety of care.  However, the introduction of IT can lead to unintended consequences, and create opportunities for failure, which can have significant effects on patient safety.  In this paper I argue that many health IT patient safety risks are probably quite predictable, but are often not considered at the time.  This puts patients at risk, and it threatens the successful adoption of health IT.  I recommend that healthcare providers focus on strengthening their processes for organisational learning, promote proactive risk management strategies, and make risk management decisions transparent and explicit.

While many organizations maintain multiple layers of security control methodologies to prevent outsiders from gaining unauthorized access, persons such as employees or contractors who have been granted legitimate access can represent an "insider threat" risk. Interestingly, some of the most notable radiological events involving the purposeful contamination or exposure of individuals appear to have been perpetrated by insiders. In the academic and medical settings, radiation safety professionals focus their security efforts on (1) ensuring controls are in place to prevent unauthorized access or removal of sources, and (2) increasing security controls for the unescorted accessing of large sources of radioactivity (known as "quantities of concern"). But these controls may not completely address the threat insiders represent when radioactive materials below these quantities are present. The goal of this research project was to characterize the methodologies currently employed to counteract the insider security threat for the misuse or purposeful divergence of radioactive materials used in the academic and medical settings. A web-based survey was used to assess how practicing radiation safety professionals in academic and medical settings anticipate, evaluate, and control insider threat security risks within their institutions. While all respondents indicated that radioactive sources are being used in amounts below quantities of concern, only 6 % consider insider threat security issues as part of the protocol review for the use of general radioactive materials. The results of this survey identify several opportunities for improvement for institutions to address security gaps.

Introduction: The Brøset Violence Checklist (BVC) is a six item checklist that rates patients according to their risk of violence in the subsequent 24h - a score of ?3 indicates a "high risk" of violence. This study is the first to evaluate the statistical utility of the BVC when administered by a security officer in a hospital emergency department (ED)., Method: A healthcare security officer conducted BVC assessments on patients who presented to the ED of a public hospital in metropolitan South East Queensland, Australia, over a two month period. Violent/aggressive acts requiring security intervention were registered in a database., Results: 2064 ED patients were assessed on the BVC and 35 patients committed a violent/aggressive act (1.7%). BVC sensitivity was 45.7% and specificity 99.4%. At a cut-off score of BVC3, the positive predictive value was 55.2%. Violent patients were around 71 times more likely to score BVC?3 than non-violent patients., Conclusions: The BVC has good sensitivity, specificity, and predictive value in this setting. Using the BVC may help to implement measures that mitigate the impact of violent patients in the ED, or ideally, implement procedures that prevent violence towards ED workers in the first place., (Copyright © 2017. Published by Elsevier Ltd.)

Objective: To study the application of classified protection of information security in the information system of air pollution and health impact monitoring, so as to solve the possible safety risk of the information system., Methods: According to the relevant national standards and requirements for the information system security classified protection, and the professional characteristics of the information system, to design and implement the security architecture of information system, also to determine the protection level of information system., Results: Basic security measures for the information system were developed in the technical safety and management safety aspects according to the protection levels, which effectively prevented the security risk of the information system., Conclusion: The information system established relatively complete information security protection measures, to enhanced the security of professional information and system service, and to ensure the safety of air pollution and health impact monitoring project carried out smoothly.

To ensure the safety of staff, patients, and visitors to psychiatric inpatient units, a standardized safe search protocol was developed and implemented across a psychiatric facility. This article provides an overview of the methods used in the planning, implementation, and spread of this quality improvement initiative, focusing on the concepts of change management, leadership, and team involvement. The professional development of point-of-care staff is enhanced by active engagement in quality improvement initiatives.

Background: Joint replacement surgery is having an increasing demand as national healthcare systems confront an ever ageing population. Surgical complications associated with lower limb arthroplasty are well known but less investigation has been performed examining its effect on air travel, more specifically, unwanted and significant inconvenience caused to travelers going through airport security., Methods: In lower limb arthroplasty clinics, 50 patients who met our selection criteria were given questionnaires. Ten airport security officers from 4 international airports (London Stansted, London Gatwick, London Heathrow, and Amsterdam Schiphol International Airport) were also given a separate questionnaire. The opinion of the Civil Aviation Authority was also sought., Results: All 50 patients (mean age, 70.4 years; range, 55 to 84 years) who were presenting in lower limb arthroplasty clinics and who met our selection criteria volunteered to enter the study. Twenty-eight of these patients were female (mean age, 69.1 years; range, 55 to 84 years) and 22 were male (mean age, 71.2 years; range, 58 to 81 years). Of the patients, 14% stated that their joint replacements did not set off the airport security alarm. Responses were received from 10 airport security officers as well. Six airport security officers were male and 4 were female. All of the airport officers were aware of some form of implant identification card with 90% stating that these were useful to them at airport security. Eight-four percent of the patients stated that an implant identification card outlining what joint replacement they possessed and when this had been done would be very useful. Sixteen percent of the patients did not think a card would be beneficial since all of them had set off the airport alarm system only once or less in their lifetime., Conclusions: It is the opinion of airport security officers and patients that joint replacement implant identification cards streamline airport security checks and decrease the need for more invasive searches at airport security., Competing Interests: CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported.

The use of pellet guns during the recent unrest in Kashmir as a method of crowd control has been questioned because of several deaths and numerous injuries. Across the world, these rubber pellets have been shown to inflict serious injuries, permanent disability, and death. The volatility of mob violence, inaccuracies in aim of the pellets, over-use of the pellet guns, and the perception of their harmlessness enhances the destructive potential of these so-called non-lethal weapons. There is also the larger ethical question whether any form of pain, however minimal, could be inflicted to control violent crowds.

The aim of the comment "Use of pellet guns for crowd control in Kashmir: How lethal is 'non-lethal'?" was neither to disparage the armed forces, nor recommend counterinsurgency strategies, nor support any particular community or group. It sought to raise discussions around the question pointed out by the responder himself, namely, "the ethical point of view" on the use of pellet guns in controlling violent mobs. The author also feels that the question is not so much about "favouring" the protestors or the security forces, but whether an instrument that causes significant fatalities and morbidities among bystanders should continue to be used as a method of crowd control.

This refers to the comment "Use of pellet guns for crowd control in Kashmir: How lethal is 'non-lethal'?" by Siddarth David in the Indian Journal of Medical Ethics. My objection is not to the ethics of the use of pellet guns, but to the ethics of publishing such an article in a journal devoted to medical ethics.

Purpose/objective: A mental health organization in Ontario, Canada, noted an increase in unsafe items entering locked inpatient units. The purpose of this project was to develop and implement a search protocol to improve patient, staff, and visitor safety by preventing unsafe items from entering a locked inpatient unit., Description of the Project: Under the guidance of a clinical nurse specialist, an interprofessional team used the Failure Mode and Effects Analysis framework to identify what items were considered unsafe, how these unsafe items were entering the unit, and what strategies could be used to prevent these items from entering the unit. A standardized search protocol was identified as a strategy to prevent items from entering the unit., Outcome: The standardized search protocol was developed and piloted on 1 unit. To support the search protocol, an interprofessional team created a poster using a mnemonic aid to educate patients, staff, and visitors about which items could not be brought onto the unit. Educational sessions on the search protocol were provided for staff. The difference between the number of incidents before and after the implementation of the search protocol was statistically significant., Conclusions: Safety on an inpatient unit was increased as incidents of unsafe items entering the unit decreased.

We propose a standard model for a novel data access tier - registered access - to facilitate access to data that cannot be published in open access archives owing to ethical and legal risk. Based on an analysis of applicable research ethics and other legal and administrative frameworks, we discuss the general characteristics of this Registered Access Model, which would comprise a three-stage approval process: Authentication, Attestation and Authorization. We are piloting registered access with the Demonstration Projects of the Global Alliance for Genomics and Health for which it may provide a suitable mechanism for access to certain data types and to different types of data users., Competing Interests: As part of its International Policy interoperability and data Access Clearinghouse (IPAC), the Public Population Project in Genomics and Society (P3G) offers DACO services to the research community.

Since the launch of the Global Polio Eradication Initiative (GPEI) in 1988 the global incidence of poliomyelitis has fallen by nearly 99 %. From a situation where wild type poliovirus was endemic in 125 countries across five continents, transmission is now limited to regions of just three countries - Pakistan, Afghanistan and Nigeria. A sharp increase in Pakistan's poliomyelitis cases in 2014 prompted the International Health Regulations Emergency Committee to declare the situation a 'public health emergency of international concern'. Global polio eradication hinges on Pakistan's ability to address the religious, political and socioeconomic barriers to immunisation; including discrepancies in vaccine coverage, a poor health infrastructure, and conflict in polio-endemic regions of the country. This analysis provides an overview of the GPEI, focusing on the historical and contemporary challenges facing Pakistan's polio eradication programme and the impact of conflict and insecurity, and sheds light on strategies to combat vaccine hesitancy, engage local communities and build on recent progress towards polio eradication in Pakistan.

The concept of state failure has only recently emerged in the political science and legal literature. Although state failure has been used to predict violent conflicts, and all citizens are affected by violence in failed/fragile states, women are especially at risk. Using data from the WomanStats project, this study's findings reveal that the physical security of women is lower in failed/fragile states compared with more sustainable nations. The characteristics of failed states that increase the likelihood of various forms of violence against women are identified, including high levels of militarization, countries with neighboring states at war, and massive movement of refugees., (© The Author(s) 2016.)

Purpose - It is a simple fact that prisons cannot exist - practically, legally, ethically or morally - without the support of physicians and other health professionals. Access to adequate healthcare is one of the fundamental measures of the legitimacy of a jail or prison. At the same time, there is a fundamental tension in the missions of the prison and doctor. The primary mission of the prison is security and often punishment. Reform and rehabilitation have intermittently been stated goals of prisons in the last century, but in practice those humane goals have rarely governed prison administrative culture. The primary mission of the physician is to promote the health and welfare of his or her patient. The paper aims to discuss these issues. Design/methodology/approach - At times, what is required to serve the patient's best interest is at odds with the interests of security. Much of the work of the prison physician does not conflict with the operation of security. Indeed, much of the work of the prison physician is allowed to proceed without much interference from the security regime. But given the fundamental discord in the legitimate missions of security vs medicine, conflict between the doctor and the warden is inevitable. Findings - In this paper, the authors consider the example of patient confidentiality to illustrate this conflict, using case examples inspired by real cases from the experience of the authors. Originality/value - The authors provide an ethical and practical framework for health professionals to employ when confronting these inevitable conflicts in correctional settings.

Health Residences for Prison Security Measures are facilities hosting psychotic persons who have committed crimes and providing them with personalized rehabilitation and treatment plans to promote their reinstatement in society. The aim of this study was to describe the criteria for planning and designing a prison health residence in the Tuscany region (Italy), to be managed by the regional healthcare service, in line with current regulations, with dedicated staff for providing specific treatment plans and programmes.

Objective: We aimed to assess the impact of task demands and individual characteristics on threat detection in baggage screeners., Background: Airport security staff work under time constraints to ensure optimal threat detection. Understanding the impact of individual characteristics and task demands on performance is vital to ensure accurate threat detection., Method: We examined threat detection in baggage screeners as a function of event rate (i.e., number of bags per minute) and time on task across 4 months. We measured performance in terms of the accuracy of detection of Fictitious Threat Items (FTIs) randomly superimposed on X-ray images of real passenger bags., Results: Analyses of the percentage of correct FTI identifications (hits) show that longer shifts with high baggage throughput result in worse threat detection. Importantly, these significant performance decrements emerge within the first 10 min of these busy screening shifts only., Conclusion: Longer shift lengths, especially when combined with high baggage throughput, increase the likelihood that threats go undetected., Application: Shorter shift rotations, although perhaps difficult to implement during busy screening periods, would ensure more consistently high vigilance in baggage screeners and, therefore, optimal threat detection and passenger safety., (© 2015, Human Factors and Ergonomics Society.)

In January of 2013 the Transportation Security Administration (TSA) ordered the removal of x-ray security scanners from airports by June of 2013. Since that time several of these scanners have been purchased at a reduced cost by various state and county governments for use in screening individuals entering or leaving their facilities. To address this issue the Radiation Safety Section of the State of Michigan drafted a set of registration conditions for facilities to follow when using these security scanners. Inspection procedures and measurement protocols were developed to estimate the dose to screened individuals. Inspections were performed on nine of the 16 registered backscatter scanners in the state and the one transmission scanner. The average estimated effective dose to screened individuals was ∼11 nSv for a two view scan from a backscatter system. The effective dose was 0.446 μSv, 0.330 μSv, and 0.150 μSv for a transmission system operated in the high, medium, and low dose modes, respectively. The limit suggested in the new registration condition is 0.25 μSv for a general use system and 10 μSv for a limited use system.

The article investigates the characteristics and forms of cooperation between criminal investigation officers* and forensic laboratory specialists in pre-trial proceedings, as well as practical problems in such cooperation. Recently there have been a number of particularly heated debates about the relationship between determining a person possessing special knowledge and his/her status in pre-trial proceedings. Other discussed aspects include cooperation between entities involved in pre-trial proceedings in international contexts. A less intensive (albeit equally important) discussion relates to the form and characteristics of cooperation between criminal investigation officers on the one hand and specialists and experts on the other in investigating criminal acts. Bearing in mind the high practical importance and the existing differences in scholarly approaches to these issues, the current study concentrates on the forms and content of cooperation between law enforcement officers and specialists (experts) from forensic laboratories, as well as on problems resulting from such cooperation and directions for improvement. The first part of the article presents selected views on the definition of a person possessing special knowledge currently used in Lithuania** and in a number of other states. In the authors' opinion, unification (harmonization) of various notions (definitions), terms and statuses of an expert, a specialist and special knowledge should be one of the objectives in implementing the vision of the joint European forensic science area 2020. Achieving this objective requires a comprehensive analysis of standards in law and management in using special knowledge of each state***. The second part, supported by empirical study results, discusses practical problems of cooperation between a law enforcement officer and a specialist (expert), analyzes three basic forms of their cooperation and presents the content of those forms: activities at the crime scene, cooperation of the two entities in commissioning tests, preparing test materials and actual performance of such tests, and finally participation of a specialist in other pre-trial activities. This part of the paper also proposes methods of improving the efficiency of such cooperation. The third part is based on an evaluation of the study results and presents the authors' observations regarding the tendency of improving the efficiency of cooperation between law enforcement officers and specialists (experts).

Background: National safety alert systems publish relevant information to improve patient safety in hospitals. However, the information has to be transformed into local action to have an effect on patient safety. We studied three research questions: How do Swiss healthcare quality and risk managers (qm/rm(1)) see their own role in learning from safety alerts issued by the Swiss national voluntary reporting and analysis system? What are their attitudes towards and evaluations of the alerts, and which types of improvement actions were fostered by the safety alerts?, Methods: A survey was developed and applied to Swiss healthcare risk and quality managers, with a response rate of 39 % (n=116). Descriptive statistics are presented., Results: The qm/rm disseminate and communicate with a broad variety of professional groups about the alerts. While most respondents felt that they should know the alerts and their contents, only a part of them felt responsible for driving organizational change based on the recommendations. However, most respondents used safety alerts to back up their own patient safety goals. The alerts were evaluated positively on various dimensions such as usefulness and were considered as standards of good practice by the majority of the respondents. A range of organizational responses was applied, with disseminating information being the most common. An active role is related to using safety alerts for backing up own patient safety goals., Conclusions: To support an active role of qm/rm in their hospital's learning from safety alerts, appropriate organizational structures should be developed. Furthermore, they could be given special information or training to act as an information hub on the issues discussed in the alerts., (Copyright © 2016. Published by Elsevier GmbH.)