Most people with mental illness in low and middle-income countries (LMICs) do not receive biomedical treatment, though many seek care from traditional healers and faith healers. We conducted a qualitative study in Buyende District, Uganda, using framework analysis. Data collection included interviews with 24 traditional healers, 20 faith healers, and 23 biomedical providers, plus 4 focus group discussions. Interviews explored treatment approaches, provider relationships, and collaboration potential until theoretical saturation was reached. Three main themes emerged: (1) Biomedical providers’ perspectives on traditional and faith healers; (2) Traditional and faith healers’ views on biomedical providers; and (3) Collaboration opportunities and barriers. Biomedical providers viewed faith healers positively but traditional healers as potentially harmful. Traditional and faith healers valued biomedical approaches while feeling variably accepted. Interest in collaboration existed across groups but was complicated by power dynamics, economic concerns, and differing mental illness conceptualizations. Traditional healers and faith healers routinely referred patients to biomedical providers, though reciprocal referrals were rare. The study reveals distinct dynamics among providers in rural Uganda, with historical colonial influences continuing to shape relationships and highlighting the need for integrated, contextually appropriate mental healthcare systems.

Methods developed by Bernbach [1966] and Millward [1969] permit increased generality in analyses of identifiability. Matrix equations are presented that solve part of the identifiability problem for a class of Markov models. Results of several earlier analyses are shown to involve special cases of the equations developed here. And it is shown that a general four-state chain has the same parameter space as an all-or-none model if and only if its representation with an observable absorbing state is lumpable into a Markov chain with three states.

A national need is to prepare for and respond to accidental or intentional disasters categorized as chemical, biological, radiological, nuclear, or explosive (CBRNE). These incidents require specific subject-matter expertise, yet have commonalities. We identify 7 core elements comprising CBRNE science that require integration for effective preparedness planning and public health and medical response and recovery. These core elements are (1) basic and clinical sciences, (2) modeling and systems management, (3) planning, (4) response and incident management, (5) recovery and resilience, (6) lessons learned, and (7) continuous improvement. A key feature is the ability of relevant subject matter experts to integrate information into response operations. We propose the CBRNE medical operations science support expert as a professional who (1) understands that CBRNE incidents require an integrated systems approach, (2) understands the key functions and contributions of CBRNE science practitioners, (3) helps direct strategic and tactical CBRNE planning and responses through first-hand experience, and (4) provides advice to senior decision-makers managing response activities. Recognition of both CBRNE science as a distinct competency and the establishment of the CBRNE medical operations science support expert informs the public of the enormous progress made, broadcasts opportunities for new talent, and enhances the sophistication and analytic expertise of senior managers planning for and responding to CBRNE incidents.

We describe a new tide model for the seas surrounding Antarctica, including the ocean cavities under the floating ice shelves. The model uses data assimilation to improve its fit to available data. Typical peak-to-peak tide ranges on ice shelves are 1–2 m but can exceed 3 m for the Filchner–Ronne and Larsen Ice Shelves in the Weddell Sea. Spring tidal ranges are about twice these values. Model performance is judged relative to the ~5–10 cm accuracy that is needed to fully utilize ice-shelf height data that will be collected with the Geoscience Laser Altimeter System, scheduled to be launched on the Ice, Cloud and land Elevation Satellite in late 2002. The model does not yet achieve this level of accuracy except very near the few high-quality tidal records that have been assimilated into the model. Some improvement in predictive skill is expected from increased sophistication of model physics, but we also require better definition of ice-shelf grounding lines and more accurate water-column thickness data in shelf seas and under the ice shelves. Long-duration tide measurements (bottom pressure gauge or global positioning system) in critical data-sparse areas, particularly near and on the Filchner–Ronne and Ross Ice Shelves and Pine Island Bay, are required to improve the performance of the data-assimilation model.

Comparisons between computed balance velocities, obtained from two different computing schemes, and global positioning system (GPS)-derived velocities were made in the Lambert Glacier basin region, East Antarctica. The two computing schemes used for the balance-velocity computations (a flowline (FL) scheme (Remy and Minster, 1993) and a finite-difference (BW) scheme (Budd and Warner, 1996; Fricker and others, 2000)) were first evaluated and compared. One of the key issues studied was the spatial resolution of the digital elevation model (DEM), representing the surface topography of the ice sheet, and the sensitivity of the balance velocities to the length of smoothing applied to the DEM. Comparison with the GPS velocities validated the two schemes to within 5–25% but showed the high sensitivity of the flowline method to the length scale of the smoothing. The finite-difference scheme was found to be robust to the chosen smoothing scale, but the balance-velocity values increased when a finer-resolution DEM was used. Both FL and BW computing schemes tended to overestimate the balance velocities in comparison with the GPS values; some of this discrepancy can be attributed to ice-sheet sliding.

We investigate the iceberg-calving cycle of the Amery Ice Shelf (AIS), East Antarctica, using evidence acquired between 1936 and 2000. The most recent major iceberg-calving event occurred between late 1963 and early 1964, when a large berg totalling about 10 000 km2 in area broke from the ice front. The rate of forward advance of the ice front is presently 1300–1400ma–1. At this rate of advance, based on the present ice-front position from recent RADARSAT imagery, it would take 20–25 years to attain the 1963 (pre-calve) position, suggesting that the AIS calving cycle has a period of approximately 60–70 years. Two longitudinal (parallel-to-flow) rifts, approximately 25 km apart at the AIS front, are observed in satellite imagery acquired over the last 14+years. These rifts have formed at suture zones in the ice shelf, where neighbouring flow-bands have separated in association with transverse spreading. The rifts were 15 km (rift A) and 26 km (rift B) in length in September 2000, and will probably become the sides of a large tabular iceberg (25 km 625 km). Atransverse (perpendicular-to-flow) fracture, visible at the upstream end of rift A in 1996, had propagated 6 km towards rift B by September 2000; when it meets rift B the iceberg will calve. A satellite image acquired in 1962 shows an embayment of this size in the AIS front, hence we deduce that this calving pattern also occurred during the last calving cycle, and therefore that the calving behaviour of the AIS apparently follows a regular pattern.

The inverse barometer effect (IBE) is the isostatic response of ocean surface height to changes in atmospheric pressure (P air) at a rate of about 1 cm hPa−1. The IBE is a significant contributor to variability of ice-shelf surface elevation (η ice), as we demonstrate with simultaneous global positioning system measurements of η ice and local measurements of P air from the Amery, Brunt and Ross Ice Shelves, Antarctica. We find that an IBE correction is justified for frequencies (ω) covering the “weather band”, 0.03 < ω < 0.5 cpd (cycles per day). The IBE correction reduces the standard deviation of the weather-band signal of η ice from ∼9 cm to ∼3 cm. With this correction, the largest remaining high-frequency error signal in η ice is the inaccuracy of the present generation of Antarctic tide models, estimated to be of order 10 cm for most of Antarctica.

The Lambert Glacier–Amery Ice Shelf system is a major component of the East Antarctic ice sheet. This paper presents two digital elevation models (DEMs) that have been generated for the Lambert–Amery system from validated European Remote-sensing Satellite (ERS-1) radar altimeter waveform data. The first DEM covers the Amery Ice Shelf only, and was produced using kriging on a 1 km grid. The second is a coarser (5 km) DEM of the entire Lambert–Amery system, generated via simple averaging procedures. The DEMs provide unprecedented surface elevation information for the Lambert–Amery system and allow new insight into the glaciology of the region.

Previous observations have shown that rift propagation on the Amery Ice Shelf (AIS), East Antarctica, is episodic, occurring in bursts of several hours with typical recurrence times of several weeks. Propagation events were deduced from seismic swarms (detected with seismometers) concurrent with rapid rift widening (detected with GPS receivers). In this study, we extend these results by deploying seismometers and GPS receivers in a dense network around the tip of a propagating rift on the AIS over three field seasons (2002/03, 2004/05 and 2005/06). The pattern of seismic event locations shows that icequakes cluster along the rift axis, extending several kilometers back from where the rift tip was visible in the field. Patterns of icequake event locations also appear aligned with the ice-shelf flow direction, along transverse-to-rift crevasses. However, we found some key differences in the seismicity between field seasons. Both the number of swarms and the number of events within each swarm decreased during the final field season. The timing of the slowdown closely corresponds to the rift tip entering a suture zone, formed where two ice streams merge upstream. Beneath the suture zone lies a thick band of marine ice. We propose two hypotheses for the observed slowdown: (1) defects within the ice in the suture zone cause a reduction in stress concentration ahead of the rift tip; (2) increased marine ice thickness in the rift path slows propagation. We show that the size–frequency distribution of icequakes approximately follows a power law, similar to the well-known Gutenberg–Richter law for earthquakes. However, large icequakes are not preceded by foreshocks nor are they followed by aftershocks. Thus rift-related seismicity differs from the classic foreshock and aftershock distribution that is characteristic of large earth quakes.

For three field seasons (2002/03, 2004/05, 2005/06) we have deployed a network of GPS receivers and seismometers around the tip of a propagating rift on the Amery Ice Shelf, East Antarctica. During these campaigns we detected seven bursts of episodic rift propagation. To determine whether these rift propagation events were triggered by short-term environmental forcings, we analyzed simultaneous ancillary data such as wind speeds, tidal amplitudes and sea-ice fraction (a proxy variable for ocean swell). We find that none of these environmental forcings, separately or together, correlated with rift propagation. This apparent insensitivity of ice-shelf rift propagation to short-term environmental forcings leads us to suggest that the rifting process is primarily driven by the internal glaciological stress. Our hypothesis is supported by order-of-magnitude calculations that the glaciological stress is the dominant term in the force balance. However, our calculations also indicate that as the ice shelf thins or the rift system matures and iceberg detachment becomes imminent, short-term stresses due to winds and ocean swell may become more important.

Observations of the water level in Beaver Lake, an epishelf lake in East Antarctica, show a regular tidal signal that is lagged and attenuated from the tides beneath the adjacent Amery Ice Shelf. The phase lag and amplitude attenuation can be created by a narrow inlet connection between Beaver Lake and the cavity beneath the Amery Ice Shelf. A forced linear damped oscillator is used to determine the inlet dimensions that are required to produce the observed phase lag and amplitude attenuation. The model shows that the observations are consistent with a tidal flow that is restricted by the drag created by flow in the narrow inlet. Analysis shows that the phase lag and amplitude attenuation of the tides in Beaver Lake has increased over the years 1991-2002, probably due to a thickening of the overlying ice shelf. The response is sensitive to subtle variations in the dimensions of the inlet.

The purpose of this article is to set the context for this special issue of Disaster Medicine and Public Health Preparedness on the allocation of scarce resources in an improvised nuclear device incident. A nuclear detonation occurs when a sufficient amount of fissile material is brought suddenly together to reach critical mass and cause an explosion. Although the chance of a nuclear detonation is thought to be small, the consequences are potentially catastrophic, so planning for an effective medical response is necessary, albeit complex. A substantial nuclear detonation will result in physical effects and a great number of casualties that will require an organized medical response to save lives. With this type of incident, the demand for resources to treat casualties will far exceed what is available. To meet the goal of providing medical care (including symptomatic/palliative care) with fairness as the underlying ethical principle, planning for allocation of scarce resources among all involved sectors needs to be integrated and practiced. With thoughtful and realistic planning, the medical response in the chaotic environment may be made more effective and efficient for both victims and medical responders.

(Disaster Med Public Health Preparedness. 2011;5:S20-S31)

The user-managed inventory (UMI) is an emerging idea for enhancing the current distribution and maintenance system for emergency medical countermeasures (MCMs). It increases current capabilities for the dispensing and distribution of MCMs and enhances local/regional preparedness and resilience. In the UMI, critical MCMs, especially those in routine medical use (“dual utility”) and those that must be administered soon after an incident before outside supplies can arrive, are stored at multiple medical facilities (including medical supply or distribution networks) across the United States. The medical facilities store a sufficient cache to meet part of the surge needs but not so much that the resources expire before they would be used in the normal course of business. In an emergency, these extra supplies can be used locally to treat casualties, including evacuees from incidents in other localities. This system, which is at the interface of local/regional and federal response, provides response capacity before the arrival of supplies from the Strategic National Stockpile (SNS) and thus enhances the local/regional medical responders' ability to provide life-saving MCMs that otherwise would be delayed. The UMI can be more cost-effective than stockpiling by avoiding costs due to drug expiration, disposal of expired stockpiled supplies, and repurchase for replacement.

(Disaster Med Public Health Preparedness. 2012;6:408-414)

In this article we report on reading ability of twin children in kindergarten to Grade 2 as a function of whether members of the pairs are assigned to the same or different classrooms. All analyses were run using mixed model regressions to account for the interdependence between twin pairs. The samples, total N = 1505, are from Australia and the United States. We found a close-to-significant difference in favor of same-class children in kindergarten and Grade 1. However, when results were adjusted to take account of pre-existing differences in disruptive behavior and in preliteracy ability, the class assignment effects disappeared. We suggest that these pre-existing differences, particularly disruptive behavior, are influencing decisions about whether to separate twins or not and also affecting early reading performance, a conclusion supported by significant correlations between the behavioral measures, preliteracy, and school-based reading. We conclude that, on average, early literacy in twins is not directly affected by their assignment to the same or different classrooms.