Orientation Virtual Meeting National Advisory Committee for the National Health Security Preparedness Index

Refining the measures and methodologies used within the National Health Security Preparedness Index will allow users to make more meaningful comparisons of preparedness levels across U.S. geographic areas and to assess changes in preparedness over time

The National Health Security Preparedness Index: National Advisory Committee Meeting

This meeting of the National Advisory Committee for the National Health Security Preparedness Index program discussed strategies for improving the theoretical framework, measures, and analytic methodologies used in assessing and comparing preparedness levels across U.S. states and the nation as a whole

Summary of Results from the 2016 National Health Security Preparedness Index

The National Health Security Preparedness Index tracks the nation’s progress in preparing for, responding to, and recovering from disasters and other large-scale emergencies that pose risks to health and well-being in the United States. Because health security is a responsibility shared by many different stakeholders in government and society, the Index combines measures from multiple sources and perspectives to offer a broad view of the health protections in place for nation as a whole and for each U.S. state. The Index identifies strengths as well as gaps in the protections needed to keep people safe and healthy in the face of disasters, and it tracks how these protections vary across the U.S. and change over time. Results from the 2016 release of the Index, containing data from 2013 through 2015, reveal that preparedness is improving overall, but protections remain uneven across the U.S., and they are losing strength in some critical areas

Nonquiescent Relaxation in Entangled Polymer Liquids After Step Shear

Large step shear experiments revealed through particle tracking velocimetry that entangled polymeric liquids display either internal macroscopic movements upon shear cessation or rupturelike behavior during shear. Visible inhomogeneous motions were detected in five samples with the number of entanglements per chain ranging from 20 to 130 at amplitudes of step strain as low as 135%

Summary of Proposed Updates to the National Health Security Preparedness Index for 2015-2016

This report describes proposed updates in methodology and measures for the 2015-16 release of the National Health Security Preparedness Inde

Reducing Cancer Disparities through Community Engagement in Policy Development: The Role of Cancer Councils

Cancer is the second leading cause of death in the U.S and a source of large racial and ethnic disparities in population health. Policy development is a powerful but sometimes overlooked public health tool for reducing cancer burden and disparities. Along with other partners in the public health system, community-based organizations such as local cancer councils can play valuable roles in developing policies that are responsive to community needs and in mobilizing resources to support policy adoption and implementation. This paper examines the current and potential roles played by local cancer councils to reduce cancer burden and disparities. Responsive public health systems require vehicles for communities to engage in policy development. Cancer councils provide promising models of engagement. Untapped opportunities exist for enhancing policy development through cancer councils, such as expanding targets of engagement to include private-sector stakeholders and expanding methods of engagement utilizing the Affordable Care Act’s Prevention and Public Health Fund

Diversity Strategies for Nuclear Power Plant Instrumentation and Control Systems

This report presents the technical basis for establishing acceptable mitigating strategies that resolve diversity and defense-in-depth (D3) assessment findings and conform to U.S. Nuclear Regulatory Commission (NRC) requirements. The research approach employed to establish appropriate diversity strategies involves investigation of available documentation on D3 methods and experience from nuclear power and nonnuclear industries, capture of expert knowledge and lessons learned, determination of best practices, and assessment of the nature of common-cause failures (CCFs) and compensating diversity attributes. The research described in this report does not provide guidance on how to determine the need for diversity in a safety system to mitigate the consequences of potential CCFs. Rather, the scope of this report provides guidance to the staff and nuclear industry after a licensee or applicant has performed a D3 assessment per NUREG/CR-6303 and determined that diversity in a safety system is needed for mitigating the consequences of potential CCFs identified in the evaluation of the safety system design features. Succinctly, the purpose of the research described in this report was to answer the question, 'If diversity is required in a safety system to mitigate the consequences of potential CCFs, how much diversity is enough?' The principal results of this research effort have identified and developed diversity strategies, which consist of combinations of diversity attributes and their associated criteria. Technology, which corresponds to design diversity, is chosen as the principal system characteristic by which diversity criteria are grouped to form strategies. The rationale for this classification framework involves consideration of the profound impact that technology-focused design diversity provides. Consequently, the diversity usage classification scheme involves three families of strategies: (1) different technologies, (2) different approaches within the same technology, and (3) different architectures within the same technology. Using this convention, the first diversity usage family, designated Strategy A, is characterized by fundamentally diverse technologies. Strategy A at the system or platform level is illustrated by the example of analog and digital implementations. The second diversity usage family, designated Strategy B, is achieved through the use of distinctly different technologies. Strategy B can be described in terms of different digital technologies, such as the distinct approaches represented by general-purpose microprocessors and field-programmable gate arrays. The third diversity usage family, designated Strategy C, involves the use of variations within a technology. An example of Strategy C involves different digital architectures within the same technology, such as that provided by different microprocessors (e.g., Pentium and Power PC). The grouping of diversity criteria combinations according to Strategies A, B, and C establishes baseline diversity usage and facilitates a systematic organization of strategic approaches for coping with CCF vulnerabilities. Effectively, these baseline sets of diversity criteria constitute appropriate CCF mitigating strategies for digital safety systems. The strategies represent guidance on acceptable diversity usage and can be applied directly to ensure that CCF vulnerabilities identified through a D3 assessment have been adequately resolved. Additionally, a framework has been generated for capturing practices regarding diversity usage and a tool has been developed for the systematic assessment of the comparative effect of proposed diversity strategies (see Appendix A)

Middle Neolithic pits and a burial at West Amesbury, Wiltshire

Excavations on the south-eastern slopes of King Barrow Ridge, 1.5 km east of Stonehenge, revealed five pits, a grave and other features of Middle Neolithic date. Analysis of the pit assemblages and the partial inhumation interred in the grave has provided insights into lifeways in this landscape in the late fourth millennium cal BC. Evidence suggests that the area was visited by a pastoralist, mobile community on a semi-regular basis for a significant period, in late autumn or winter. Selected remnants of craft-working and consumption were deposited in pits, before deliberate infilling. These depositions repeatedly memorialised activity on the hillside at a time of contemporary activity elsewhere on King Barrow Ridge and at the future site of Stonehenge. Middle Neolithic pits are present in significant numbers across King Barrow Ridge, and alongside pits in the Durrington area, form one of the densest concentrations of such activity in the region. Long distance mobility is suggested by the possible Irish origins of the inhumation, the first Middle Neolithic individual excavated in the environs of Stonehenge. Whilst of significance for understanding the Middle Neolithic in the WHS and the region, this research also hints at the roots of Late Neolithic monumentalisation of this landscape

Moral Distress Amongst American Physician Trainees Regarding Futile Treatments at the End of Life: A Qualitative Study.

BACKGROUND: Ethical challenges are common in end of life care; the uncertainty of prognosis and the ethically permissible boundaries of treatment create confusion and conflict about the balance between benefits and burdens experienced by patients. OBJECTIVE: We asked physician trainees in internal medicine how they reacted and responded to ethical challenges arising in the context of perceived futile treatments at the end of life and how these challenges contribute to moral distress. DESIGN: Semi-structured in-depth qualitative interviews. PARTICIPANTS: Twenty-two internal medicine residents and fellows across three American academic medical centers. APPROACH: This study uses systematic qualitative methods of data gathering, analysis and interpretation. KEY RESULTS: Physician trainees experienced significant moral distress when they felt obligated to provide treatments at or near the end of life that they believed to be futile. Some trainees developed detached and dehumanizing attitudes towards patients as a coping mechanism, which may contribute to a loss of empathy. Successful coping strategies included formal and informal conversations with colleagues and superiors about the emotional and ethical challenges of providing care at the end of life. CONCLUSIONS: Moral distress amongst physician trainees may occur when they feel obligated to provide treatments at the end of life that they believe to be futile or harmful.This study was funded by the Health Resources and Service Administration T32 HP10025-20 Training Grant, the Gates Cambridge Scholarship, Society of General Internal Medicine Founders Grant, and the Ho-Chiang Palliative Care Research Fellowship at the Johns Hopkins School of Medicine.This is the author accepted manuscript. The final version is available from Springer via http://dx.doi.org/10.1007/s11606-015-3505-