Antibody Architecture: Responding to Bioterrorism

Bioterrorism, the use of biological and chemical agents for terrorist purposes, is one of the most potentially significant health and security threats currently facing the United States. Healthcare facilities as isolated entities are alone unable to provide sufficient, adaptable emergency response options during a bioterrorist attack--an unpredictable, low probability, high consequence event. Bioterrorism response must be systemic, distributed, flexible, and responsive for a wide range of event incidents, scenarios and contexts. A significant problem yet to be adequately addressed is the mitigation of the walking well--those who are not sick or injured but have the potential to inundate any designated response setting. Architectural interventions alone are limited in their ability to provide an appropriate response to an act of bioterrorism. An analogy to the human immune system and how it operates in the body to overcome pathogens will be used to articulate a systematic bioterrorism response and a series of architectural interventions for dealing with the walking well. Similar to our immune system, a response network (or system) should be created that operates throughout high risk urban contexts and takes advantage of existing architectural settings in order to deploy as needed and where needed in response to a bioterrorist attack. An antibody response to bioterrorism must be able to adapt to meeting the needs of various scenarios and contexts in which an incident might occur. Drawing on this biological metaphor, any proposed architectural interventions must include latent capabilities while having the ability to be activated in place and scalable in order to accommodate the multiple potential threats and the many variables inherent with bioterrorism. The proposal for an architectural response to bioterrorism is situated in Washington, D.C., identified as the highest potential target city in the United States for acts of bioterrorism. Appropriate latent resources capable of acting as a part of the response network throughout the D.C. urban context will be identified and their potential activation will be explored through two example scenarios, which will be used to illustrate the proposed model for systematic response. The most architecturally significant locations for (activated) small scale interjections will be designed to meet the first response needs of the general population who would be moving about in the city during the detection of an event. These sites and features will allow for differing degrees of self-diagnosis during and following an event as well as provide general day to day and event related public health information. The proposed architectural interjections will be designed to respond to the predicted fear and panic exhibited by the walking well during a bioterrorist attack, and minimize their potential for overwhelming hospitals and other healthcare settings in the target region

The nature of disasters and their challenges to healthcare ethics

Disasters are exceptional events that cause damages on a scale that result in widespread unmet human needs that are critical and urgent. The exceptional circumstances in disasters may render established ethical norms of healthcare practice inapplicable or inappropriate. Healthcare professionals who work in disasters are faced with choices that have direct impacts on the life, death, and suffering of both disaster victims, and themselves. Some choices faced may be dilemmatic choices between competing irreconcilable moral principles. Whilst some choices reflect uncertainty as to how to realise moral precepts. In these situations, there is an appeal for guidance that is fitted to the circumstances found within disasters. Appealing to codes of professional conduct and ethics is problematic as many codes are either silent on the difficulties encountered in disasters, or overly demanding through the use of imperative language. Considering the relative weakness of published codes, universal principles of first do no harm and do good are offered as guiding principles. However, in disasters opportunities exist for harming through nondoing, creating the possibility that as aid is rendered to some, harm is occasioned to others. When considering doing good in disasters, maximising aggregate benefit is the established ethical framework employed. However, this framework’s foundational assumptions of aggregation of benefits and harms, commensurability of different ends, and the privileging of the greater number are open to critique. Thus, the principles of first do no harm and do good are problematic in disaster settings. Virtue ethics is proposed as a novel response to the difficulties faced by healthcare professionals in disasters. Virtue ethics provides an account of the healthcare professional as one who must choose with wisdom, courage and integrity in exceptional circumstances. Further, virtue ethics provides an understanding of how it is possible to act well in the tragic circumstances found within disasters

An evaluation of post-Katrina emergency preparedness strategies in hospitals on the U.S. Gulf of Mexico coastline

Recent tragedies are causing hospitals to more intensively review their strategies and broaden their approach to emergency preparation. The Gulf Coast storms of 2005 and 2008 and other catastrophic events nationwide have illustrated the central role hospitals can and should play in a community’s disaster recovery infrastructure. Given the unpredictability of the world today, with the possibility of a mass casualty crisis constantly threatening, there is an urgent need to seek and achieve higher levels of readiness. If a hospital organization is not investing in emergency preparedness on a continuous basis, that facility and its community are placed at higher risk. After bearing the brunt of several major, damaging storms for the past five years, hospitals along the coast in Louisiana, Mississippi and Texas have heightened their involvement in their own and their communities’ recoveries, rebuilding their respective facilities and human resources so they can offer quality healthcare services to their communities. This study sought to answer the following research question: What strategies are hospitals in coastal Louisiana, Mississippi and Texas using in their emergency preparedness plans five years since Hurricanes Katrina and Rita to facilitate their ability to respond more effectively under crisis conditions and to maintain critical patient care operations? The researcher took an in-depth look at the many lessons learned by nine Gulf Coast region hospitals during their experiences with Hurricanes Katrina, Rita, Gustav and Ike by interviewing hospital administrators and emergency preparedness personnel. These interactions revealed strategies that the hospitals have implemented and what has yet to be done. Study participants provided an evaluation of their emergency policies and plans, practices and implementation as well as improvements, evacuation versus shelter-in-place strategies, training and drills, supplies, reimbursement, communication and human resource issues. The study sought to identify trends and best practices being used by coastal healthcare facilities and to determine which of these have been put into practice. Finally, the study identified opportunities for future research in hospital emergency preparedness

Wildfire protection plan : Draft for public review, January 2008

164 pp. Includes maps and figures. Published January 2008. Captured January 6, 2008.This CWPP is intended to compliment and support other efforts and plans throughout the County. As a non-regulatory plan, the actions and strategies described herein are consistent with current regulations and existing planning guidelines described in the Curry County Comprehensive Plan, Curry Natural Hazards Mitigation Plan, and other relevant plans. [From the Plan]"With funds from a National Fire Plan grant, the CWPT expanded the effort evaluate structural vulnerability to wildfire through the entire county and they initiated the process to develop this Curry County Community Wildfire Protection Plan.

Covid-19, Law and Human Rights : Essex Dialogues. A Project of the School of Law and Human Rights Centre

Covid-19 presents one of the gravest, acute challenges our world has faced for many years. The pandemic impacts a vast array of areas of life across the globe. It also raises a multitude of very urgent questions for law and human rights. This volume provides a series of scholarly responses to many of the questions Covid-19 raises for the theory and practice of law and human rights. The assembled papers in this volume collectively seek to engage with academic and practitioner communities alike and the volume aims to positively contribute to our collective attempts to “build back better” once a globally available vaccine for Covid-19 has been produced and distributed. The volume emerged from a hastily convened Zoom meeting of over thirty colleagues based within the Human Rights Centre and the School of Law at the University of Essex. The purpose of the meeting was to gauge ongoing research related to Covid-19 and the breadth and array of responses led to this project. It quickly became apparent that many academic colleagues were extremely interested in contributing their expertise on a very broad range of multidisciplinary Covid-19 related topics and issues. The combination of contributors’ enthusiasm for the project and our editorial efforts has enabled us to produce this volume in a very timely manner. A mere three months has elapsed from the first meeting to the final publication! The contents of this volume span a very comprehensive range of topics, questions and expertise. The volume is purposefully multidisciplinary. It is also intended to be accessible to a relatively broad readership who, one imagines, is nevertheless united by an interest in the role which expertise has to play in confronting and overcoming the very many legal, social, philosophical and political challenges which Covid-19 entails

Primary health care service delivery by international actors in humanitarian emergencies

Primary health care (PHC) is usually the first point of contact people have with a country's health system. The aim of PHC is to provide comprehensive, accessible, community-based care that meets the health needs of individuals throughout their lifetime. Humanitarian emergencies (HEs) are characterised by an inability of affected populations to cope with an event using their own resources. In HEs, international actors often provide humanitarian assistance to affected populations. The majority of health services are delivered at the PHC level. In fact, approximately 90% of the activity of the largest humanitarian medical actor, Medecins sans Frontieres (MSF), is conducted at the PHC level each year. Despite the significance of PHC activity in HEs, there are currently no established guidelines for the humanitarian community on service implementation, particularly related to the context, national health system capacity and the expectations of affected communities. The overarching aim of this thesis is to provide empirical evidence to describe the PHC system of a HE from the perspective of international actors. To achieve this aim, I addressed three key research questions: 1. What is currently known about how PHC services are delivered in HEs by international actors? 2. How do key concepts of PHC apply in a HE? and 3. What does a health systems approach look like with respect to PHC delivery in a HE? To answer the first question, I undertook a scoping narrative literature review of peer-reviewed literature from 1978 to 2016 and grey literature from 2013 to 2018. I included primary reports of PHC interventions delivered in the acute phase of a HE by international actors, and analysed these interventions against an existing PHC framework. I found that the PHC system collapses during a HE, that international actors delivered PHC services according to their own capacity, setting their own aims and objectives, and that little consideration was given to community empowerment in service delivery. I used field visits to MSF projects in northern Nigeria and Lebanon as case studies to answer the second research question. In northern Nigeria, a visit and realist analysis of a MSF maternal health care project highlighted the importance of understanding the 'context' of an intervention, particularly the role of PHC in comprehensively addressing maternal and neonatal mortality and morbidity. In the Bekaa valley region of Lebanon, I used routinely collected patient data on non-communicable diseases (NCDs) from four MSF PHC clinics to investigate the concepts of geographic accessibility, availability of facilities, adjustment to population health needs and continuity of care for patients seeking NCD care. I found that access to care was dependent on context, that there was a relationship between continuity of care and access to a clinic, and that humanitarian access plays a key role in these settings. The final research question was answered using principles of complex adaptive systems theory and the findings from the case studies. I developed a conceptual framework to explain the dynamic relationship between the national health system of a country, the system created by international actors and that of individuals and communities affected by a HE. The findings presented in this thesis have important implications for practice and further research. International health actors working in HEs need to better understand the context in which PHC services are delivered to provide effective and relevant health care. The principles of PHC are relevant in HEs, however they need to be adapted. If we are to achieve the goals of the Declaration of Astana to 'leave no one behind', we must place greater emphasis on understanding the inter-dependent relationships between the national health system, international actors and communities themselves

Beyond Disability Rights: A Way Forward After the 2020 Election

Throughout Donald Trump’s presidency, people with disabilities and other historically marginalized communities experienced incessant attacks on their rights. From continuous attempts to repeal the Affordable Care Act, to decreased enforcement of federal disability rights laws, to reductions to social safety net programs, to the intentional disregard of the COVID-19 pandemic, Trump’s presidency threatened nearly every facet of disabled people’s lives. However, even before the Trump administration, people with disabilities experienced a range of pervasive and persistent social, economic, and health inequities. Moreover, many of these injustices endure today—nearly two years since President Trump left office. The disability rights movement originated in the 1970s with the aim of securing civil rights protections for disabled people. Unfortunately, notwithstanding the disability rights movement’s many achievements, people with disabilities—especially those who live at the intersection of disability and other historically marginalized identities—continue to experience widespread and assiduous injustices. Consequently, elucidating the root causes of these pervasive and persevering inequities is essential to finally confronting them. Importantly, the Trump presidency’s further marginalization of people with disabilities illustrates the fragility of disability rights in the United States and underscores the urgent need to reimagine a more equitable approach to disability rights. This Article critically examines the panoply of injustices experienced by people with disabilities and demonstrates why the prevailing approach to disability rights is insufficient for challenging the long-lasting and deeply entrenched subjugation of people with disabilities. Then, drawing from the tenets of disability justice, this Article proposes a vision to help activists, legal professionals, scholars, and policymakers conceive of and articulate the basic contours of a paradigm shift that supports reimagining the fight for justice for disabled people in a way that finally disrupts the widespread oppression experienced by disabled people. In particular, the Article suggests normative and transformative legal and policy solutions necessary for achieving and delivering justice for all people with disabilities. In light of the 2020 election and President Joe Biden’s professed commitment to people with disabilities, this Article offers essential and timely insights for reimagining the fight for justice for all people with disabilities by moving beyond the prevailing approach to disability rights and instead adopting disability justice