Pediatr Crit Care Med

IntroductionImproved health outcomes are associated with neonatal and pediatric critical care in well-organized, cohesive, regionalized systems that are prepared to support and rehabilitate critically ill victims of a mass casualty event. However, present systems lack adequate surge capacity for neonatal and pediatric mass critical care. In this document, we outline the present reality and suggest alternative approaches.MethodsIn May 2008, the Task Force for Mass Critical Care published guidance on provision of mass critical care to adults. Acknowledging that the critical care needs of children during disasters were unaddressed by this effort, a 17-member Steering Committee, assembled by the Oak Ridge Institute for Science and Education with guidance from members of the American Academy of Pediatrics, convened in April 2009 to determine priority topic areas for pediatric emergency mass critical care recommendations.Task Force RecommendationsStates and regions (facilitated by federal partners) should review current emergency operations and devise appropriate plans to address the population-based needs of infants and children in large-scale disasters. Action at the state, regional, and federal levels should address legal, operational, and information systems to provide effective pediatric mass critical care through: 1) predisaster/mass casualty planning, management, and assessment with input from child health professionals; 2) close cooperation, agreements, public-private partnerships, and unique delivery systems; and 3) use of existing public health data to assess pediatric populations at risk and to model graded response plans based on increasing patient volume and acuity.CC999999/Intramural CDC HHS/United States2015-09-06T00:00:00Z22067921PMC45611757388vault:1277

A Prognostics Framework Development for Swarm Satellite Formations

Prognostics is the science of predicting the failure(s) of a component or a system and understanding how the performance will change in the event of a failure or degradation mechanism. With accurate predictions of possible failures, autonomous mitigative actions can be taken to correct/repair any issues or alert human operators of a failure threshold exceedance requiring condition-based maintenance. Although there is extensive research on failure predictions for a component or a system, there are significantly more opportunities to foray into failure predictions and prognostics for a system of systems such as an airspace consisting of multiple aircraft, a fleet of unmanned aerial vehicles, and a swarm of intelligent satellite systems. Failure prediction and mitigation are particularly important in autonomous systems such as satellite swarm systems that need effective resource management and minimal human interactions. Based on NASA's decadal survey, there is a clear need to prioritize the development of satellite swarm technology for studies of space physics and Earth science. The science community will propose future missions that return in-situ measurements from a 3-D (three-dimensional) volume of space, with relative spacecraft motion and inter-satellite baselines controlled according to the mission objectives. For such multi-spacecraft missions, it is required that ground operations resources do not scale with the number of satellites, thus compromising the swarm or leading to inefficiencies in resource allocation. Swarms of tens or hundreds of small satellites will require autonomy in attitude control, navigation and failure. Although significant research has been conducted in the areas of autonomous formation flying algorithms, less attention has been given to the development of resilient systems robust to failures.The focus of this research paper is the integration of model-based prognostics into the swarm dynamics control and decision-making algorithms. We simulate swarm management strategies for a subsystem failure to demonstrate the importance of failure predictions by comparing two cases: (i) no health information is provided to the system and utilized in the decision-making process and (2) system health information is obtained using prognostics and employed by the control system. One example scenario presented is for the GPS (Global Positioning System) system of an individual satellite to perform off-nominally due to increasing estimated error. In this scenario, the keep-out zone for that satellite would become more conservative, thereby decreasing the risk of collision. This is achieved via tuning the individual artificial repulsive functions assigned to each satellite.This paper is structured as follows. First we provide an overview of current swarm technology development, where we specifically use the term swarm to define multiple satellites flying in formation in similar orbits, with cross-link communication and station-keeping capabilities. Second, we give an introduction to the Swarm Orbital Dynamics Advisor (SODA), a tool that accepts high-level configuration commands and provides the orbital maneuvers required to achieve the prescribed formation configuration. Third, we provide the details of the model-based prognostics algorithm implementation in SODA. Finally, we present different case studies for potential component/subsystem failures and the swarm responses based with and without failure prediction information

An Advanced Conceptual Diagnostic Healthcare Framework for Diabetes and Cardiovascular Disorders

The data mining along with emerging computing techniques have astonishingly influenced the healthcare industry. Researchers have used different Data Mining and Internet of Things (IoT) for enrooting a programmed solution for diabetes and heart patients. However, still, more advanced and united solution is needed that can offer a therapeutic opinion to individual diabetic and cardio patients. Therefore, here, a smart data mining and IoT (SMDIoT) based advanced healthcare system for proficient diabetes and cardiovascular diseases have been proposed. The hybridization of data mining and IoT with other emerging computing techniques is supposed to give an effective and economical solution to diabetes and cardio patients. SMDIoT hybridized the ideas of data mining, Internet of Things, chatbots, contextual entity search (CES), bio-sensors, semantic analysis and granular computing (GC). The bio-sensors of the proposed system assist in getting the current and precise status of the concerned patients so that in case of an emergency, the needful medical assistance can be provided. The novelty lies in the hybrid framework and the adequate support of chatbots, granular computing, context entity search and semantic analysis. The practical implementation of this system is very challenging and costly. However, it appears to be more operative and economical solution for diabetes and cardio patients.Comment: 11 PAGE

A One Health Evaluation of the Southern African Centre for Infectious Disease Surveillance

Rooted in the recognition that emerging infectious diseases occur at the interface of human, animal, and ecosystem health, the Southern African Centre for Infectious Disease Surveillance (SACIDS) initiative aims to promote a trans-sectoral approach to address better infectious disease risk management in five countries of the Southern African Development Community. Nine years after SACIDS’ inception, this study aimed to evaluate the program by applying a One Health (OH) evaluation framework developed by the Network for Evaluation of One Health (NEOH). The evaluation included a description of the context and the initiative, illustration of the theory of change, identification of outputs and outcomes, and assessment of the One Healthness. The latter is the sum of characteristics that defines an integrated approach and includes OH thinking, OH planning, OH working, sharing infrastructure, learning infrastructure, and systemic organization. The protocols made available by NEOH were used to develop data collection protocols and identify the study design. The framework relies on a mixed methods approach by combining a descriptive and qualitative assessment with a semi-quantitative evaluation (scoring). Data for the analysis were gathered during a document review, in group and individual interviews and in an online survey. Operational aspects (i.e., OH thinking, planning, and working) were found to be balanced overall with the highest score in the planning dimension, whereas the infrastructure (learning infrastructure, systemic organization, and sharing infrastructure) was high for the first two dimensions, but low for sharing. The OH index calculated was 0.359, and the OH ratio calculated was 1.495. The program was praised for its great innovative energy in a difficult landscape dominated by poor infrastructure and its ability to create awareness for OH and enthuse people for the concept; training of people and networking. Shortcomings were identified regarding the balance of contributions, funds and activities across member countries in the South, lack of data sharing, unequal allocation of resources, top-down management structures, and limited horizontal collaboration. Despite these challenges, SACIDS is perceived to be an effective agent in tackling infectious diseases in an integrated manner

An Approach for Actions to Prevent Suicides on Commuter and Metro Rail Systems in the United States, MTI Report 12-33

The primary goals of this report are to discuss measures to prevent suicides on commuter and metro rail systems, and to outline an approach for suicide prevention on rail systems. Based on existing literature and analysis of data obtained from the Metrolink system in Southern California, it was found that most suicides occur near station platforms and near access points to the track. Suicides occurred most frequently when relatively more trains were in operation and in areas of high population density. There do not appear to be suicide “hot spots” (e.g., linked to mental hospitals in the proximity, etc.), based on data analyzed for U.S. systems. The suicide prevention measures range from relatively inexpensive signs posting call-for-help suicide hotline information to costly platform barriers that physically prevent people from jumping onto tracks in front of trains. Other prevention measures fall within this range, such as hotlines available at high frequency suicide locations, or surveillance systems that can report possible suicide attempts and provide the opportunity for intervention tactics. Because of the relatively low number of suicides on rail systems, as compared to the overall number of suicides in general, a cost-effective strategy for preventing suicides on rail systems should be approached in a very focused manner. The prevention measures executed by the rail authorities should be focused on the suicides occurring on the rail systems themselves, while the broader problem of suicides should be left to community-based prevention efforts. Moreover, prevention measures, such as surveillance and response, could “piggyback” on surveillance and response systems used for other purposes on the rail systems to make such projects economically feasible

A systems approach to evaluate One Health initiatives

Challenges calling for integrated approaches to health, such as the One Health (OH) approach, typically arise from the intertwined spheres of humans, animals, and ecosystems constituting their environment. Initiatives addressing such wicked problems commonly consist of complex structures and dynamics. As a result of the EU COST Action (TD 1404) “Network for Evaluation of One Health” (NEOH), we propose an evaluation framework anchored in systems theory to address the intrinsic complexity of OH initiatives and regard them as subsystems of the context within which they operate. Typically, they intend to influence a system with a view to improve human, animal, and environmental health. The NEOH evaluation framework consists of four overarching elements, namely: (1) the definition of the initiative and its context, (2) the description of the theory of change with an assessment of expected and unexpected outcomes, (3) the process evaluation of operational and supporting infrastructures (the “OH-ness”), and (4) an assessment of the association(s) between the process evaluation and the outcomes produced. It relies on a mixed methods approach by combining a descriptive and qualitative assessment with a semi-quantitative scoring for the evaluation of the degree and structural balance of “OH-ness” (summarised in an OH-index and OH-ratio, respectively) and conventional metrics for different outcomes in a multi-criteria-decision-analysis. Here, we focus on the methodology for Elements (1) and (3) including ready-to-use Microsoft Excel spreadsheets for the assessment of the “OH-ness”. We also provide an overview of Element (2), and refer to the NEOH handbook for further details, also regarding Element (4) (http://neoh.onehealthglobal.net). The presented approach helps researchers, practitioners, and evaluators to conceptualise and conduct evaluations of integrated approaches to health and facilitates comparison and learning across different OH activities thereby facilitating decisions on resource allocation. The application of the framework has been described in eight case studies in the same Frontiers research topic and provides first data on OH-index and OH-ratio, which is an important step towards their validation and the creation of a dataset for future benchmarking, and to demonstrate under which circumstances OH initiatives provide added value compared to disciplinary or conventional health initiatives

Accredited qualifications for capacity development in disaster risk reduction and climate change adaptation

Increasingly practitioners and policy makers working across the globe are recognising the importance of bringing together disaster risk reduction and climate change adaptation. From studies across 15 Pacific island nations, a key barrier to improving national resilience to disaster risks and climate change impacts has been identified as a lack of capacity and expertise resulting from the absence of sustainable accredited and quality assured formal training programmes in the disaster risk reduction and climate change adaptation sectors. In the 2016 UNISDR Science and Technology Conference on the Implementation of the Sendai Framework for Disaster Risk Reduction 2015–2030, it was raised that most of the training material available are not reviewed either through a peer-to-peer mechanism or by the scientific community and are, thus, not following quality assurance standards. In response to these identified barriers, this paper focuses on a call for accredited formal qualifications for capacity development identified in the 2015 United Nations landmark agreements in DRR and CCA and uses the Pacific Islands Region of where this is now being implemented with the launch of the Pacific Regional Federation of Resilience Professionals, for DRR and CCA. A key issue is providing an accreditation and quality assurance mechanism that is shared across boundaries. This paper argues that by using the United Nations landmark agreements of 2015, support for a regionally accredited capacity development that ensures all countries can produce, access and effectively use scientific information for disaster risk reduction and climate change adaptation. The newly launched Pacific Regional Federation of Resilience Professionals who work in disaster risk reduction and climate change adaptation may offer a model that can be used more widely