Bioterrorism

Terrorism preparedness is a highly specific component of general emergency preparedness. In addition to the unique pediatric issues involved in general emergency preparedness, terrorism preparedness must consider several additional issues, including the unique vulnerabilities of children to various agents as well as the limited availability of age- and weight-appropriate antidotes and treatments. Although children may respond more rapidly to therapeutic intervention, they are at the same time more susceptible to various agents and conditions and more likely to deteriorate if not carefully monitored. It is well known that children may exhibit different effects of biologic agents. Here are some examples: • Smallpox: Lack of immunity in children, whereas some adults who were vaccinated as children may still possess some degree of immunity. • Trichothecenes: The data show that children maybe more susceptible. • Melioidosis : Children manifest unique parotitis. • Anthrax: Recent and older data support the concept that children are less susceptible to the effects of anthrax

National Preparedness Planning: The Historical Context and Current State of the U.S. Public's Readiness, 1940-2005

In the United States, national public preparedness efforts meant to ready individuals and families for disasters have been driven primarily by international threats, actual or anticipated. These include terrorism, war and the potential for global instability such as the millennium Y2K computer error. The national dialogue on public preparedness following Hurricanes Katrina and Rita in the fall of 2005 is a notable departure from the more typical focus of public preparedness, which is oriented toward terrorism and international threats. However, the response to the hurricanes was largely viewed as an unanticipated test of the public’s readiness for a disaster and the penetration of the public preparedness messages that have been actively promulgated since 11 September 2001. As such, we argue that the poor state of public readiness that was found in the U.S. Gulf Coast region after the hurricanes actually reflects a national state of unpreparedness for emergency events despite the post-September 11th calls from all levels of government for the U.S. public to be prepared

Pediatric Preparedness for Disasters and Terrorism: A National Consensus Conference: Executive Summary

In a time of crisis, it is essential to ensure the needs of children are being met in planning and preparing for disasters and terrorist events. The current adult models and guidelines cannot be applied to the care of children. We convened experts from the multiple areas of expertise and disciplines involved in the planning for and care of children during times of disaster and terrorist events. The goals of this unprecedented meeting were to: 1) Build collaboration among individuals with expertise in pediatrics, pediatric emergency medicine, pediatric critical care, pediatric surgery, and emergency management, including disaster planning, management, and response; 2) Review and summarize the existing data on the needs of children in disasters, including planning, preparation, and response; 3) Develop consensus on the needs of children in disasters; 4) Create a research agenda to address knowledge gaps based on the limited data that exist on the needs of children in disasters

Individual differences in pain sensitivity are associated with cognitive network functional connectivity following one night of experimental sleep disruption.

Previous work suggests that sleep disruption can contribute to poor pain modulation. Here, we used experimental sleep disruption to examine the relationship between sleep disruption-induced pain sensitivity and functional connectivity (FC) of cognitive networks contributing to pain modulation. Nineteen healthy individuals underwent two counterbalanced experimental sleep conditions for one night each: uninterrupted sleep versus sleep disruption. Following each condition, participants completed functional MRI including a simple motor task and a noxious thermal stimulation task. Pain ratings and stimulus temperatures from the latter task were combined to calculate a pain sensitivity change score following sleep disruption. This change score was used as a predictor of simple motor task FC changes using bilateral executive control networks (RECN, LECN) and the default mode network (DMN) masks as seed regions of interest (ROIs). Increased pain sensitivity after sleep disruption was positively associated with increased RECN FC to ROIs within the DMN and LECN (F(4,14) = 25.28, pFDR = 0.05). However, this pain sensitivity change score did not predict FC changes using LECN and DMN masks as seeds (pFDR > 0.05). Given that only RECN FC was associated with sleep loss-induced hyperalgesia, findings suggest that cognitive networks only partially contribute to the sleep-pain dyad

Recovery Research, Katrina's Fifth Anniversary, and Lessons Relearned

What may be called “disaster science” is a broad field that begins with understanding hazards, risks, and population vulnerabilities and moves on to establishing best-practice models of response, mitigation, and recovery. Gaps abound in our collective knowledge in all of these areas, and it is fair to suggest that we have only begun to scratch the surface in terms of what we need to know. The goal continues to be to learn how to prevent disasters whenever possible and, when prevention is not possible, to at least optimize survival, preserve vital infrastructure, and return rapidly to a state of normalcy

Hurricane Sandy: Lessons Learned, Again

Hurricane Sandy was a sobering reminder to those of us who call New York home that it is a port city and subject to the whims of wind and water. The storm itself was massive: climatologically, a thousand miles wide at its peak; economically, an estimated excess of $50 billion in damages. In the New York metropolitan area, 97 people died in the storm, thousands were displaced from their homes, and 2 major hospitals required perilous evacuations even as the hurricane force winds engulfed the metropolitan region. For those of us in the fields of disaster medicine and public health preparedness, the question is, were we ready? During the past decade considerable public investment has been made in standardizing command and communication, assuring appropriate and rapid supply chains, and training the medical and public health workforces to respond appropriately. And yet, in the week after the storm, persistent reports of widespread gaps in the provision of coordinated relief were received from the Rockaways to Coney Island to Staten Island and New Jersey. The question was not one of capacity and capability as much as it was of communication and coordination. Resources did not always make it the last mile to reach those most in need

Lessons from Katrina – What Went Wrong, What Was Learned, Who’s Most Vulnerable

If humans did not occupy the planet, disasters would never occur. Massive climatic events, earthquakes, volcanic eruptions, and tsunamis would be regular occurrences, of course, and the earth would look like a dynamic cauldron of natural activity, changing the look and the balance of nature and natural events continuously and randomly. What morphs these natural phenomenon into catastrophic events we call “disasters” is simply the presence of human beings who by choice, chance, or necessity find themselves in harm’s way. The “human factors” may be straightforward and benign. For instance, people making their livelihood from the sea are at risk from coastal storms and tsunamis. Similarly, people are found living in areas at considerable risk for mudslides and volcanoes. It could even be said that living in New Orleans, a coastal city actually below sea level, is a gamble, as was so dramatically emphasized by the storms and subsequent flooding of August and September 2005

The Willingness of U.S. Emergency Medical Technicians to Respond to Terrorist Incidents

A nationally representative sample of basic and paramedic emergency medical service providers in the United States was surveyed to assess their willingness to respond to terrorist incidents. EMTs were appreciably (9-13%) less willing than able to respond to such potential terrorist-related incidents as smallpox outbreaks, chemical attacks, or radioactive dirty bombs (p < 0.0001). EMTs who had received terrorism-related continuing medical education within the previous 2 years were twice as likely (OR = 1.9, 95% CI 1.9, 2.0) to be willing to respond to a potential smallpox dissemination incident as those who indicated that they had not received such training. Timely and appropriate training, attention to interpersonal concerns, and instilling a sense of duty may increase first medical provider response rates

Transit Detection in the MEarth Survey of Nearby M Dwarfs: Bridging the Clean-First, Search-Later Divide

In the effort to characterize the masses, radii, and atmospheres of potentially habitable exoplanets, there is an urgent need to find examples of such planets transiting nearby M dwarfs. The MEarth Project is an ongoing effort to do so, as a ground-based photometric survey designed to detect exoplanets as small as 2 Earth radii transiting mid-to-late M dwarfs within 33 pc of the Sun. Unfortunately, identifying transits of such planets in photometric monitoring is complicated both by the intrinsic stellar variability that is common among these stars and by the nocturnal cadence, atmospheric variations, and instrumental systematics that often plague Earth-bound observatories. Here we summarize the properties of MEarth data gathered so far, and we present a new framework to detect shallow exoplanet transits in wiggly and irregularly-spaced light curves. In contrast to previous methods that clean trends from light curves before searching for transits, this framework assesses the significance of individual transits simultaneously while modeling variability, systematics, and the photometric quality of individual nights. Our Method for Including Starspots and Systematics in the Marginalized Probability of a Lone Eclipse (MISS MarPLE) uses a computationally efficient semi-Bayesian approach to explore the vast probability space spanned by the many parameters of this model, naturally incorporating the uncertainties in these parameters into its evaluation of candidate events. We show how to combine individual transits processed by MISS MarPLE into periodic transiting planet candidates and compare our results to the popular Box-fitting Least Squares (BLS) method with simulations. By applying MISS MarPLE to observations from the MEarth Project, we demonstrate the utility of this framework for robustly assessing the false alarm probability of transit signals in real data. [slightly abridged]Comment: accepted to the Astronomical Journal, 21 pages, 12 figure