49 results
COVID-19: What paramedics need to know!
- Jason E. Buick, Sheldon Cheskes, Michael Feldman, P. Richard Verbeek, Morgan Hillier, Yuen Chin Leong, Ian R. Drennan
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 22 / Issue 4 / July 2020
- Published online by Cambridge University Press:
- 15 April 2020, pp. 426-430
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- July 2020
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A new way of rapidly screening for depression in multiple sclerosis using Emotional Thermometers
- Andrew G. B. Thompson, Rollo Sheldon, Norman Poole, Rita Varela, Sarah White, Paula Jones, Carole Mulley, Amy Berg, Camilla R. V. Blain, Niruj Agrawal
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- Journal:
- Acta Neuropsychiatrica / Volume 31 / Issue 3 / June 2019
- Published online by Cambridge University Press:
- 27 March 2019, pp. 151-158
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Objective
Depression is a common, serious, but under-recognised problem in multiple sclerosis (MS). The primary objective of this study was to assess whether a rapid visual analogue screening tool for depression could operate as a quick and reliable screening method for depression, in patients with MS.
MethodPatients attending a regional MS outpatient clinic completed the Emotional Thermometer 7 tool (ET7), the Hospital Anxiety and Depression Scale – Depression Subscale (HADS-D) and the Major Depression Inventory (MDI) to establish a Diagnostic and Statistical Manual, 4th edition (DSM-IV) diagnosis of Major Depression. Full ET7, briefer subset ET4 version and depression and distress thermometers alone were compared with HADS-D and MDI. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and receiver operating characteristic (ROC) curve were calculated to compare the performance of all the screening tools.
ResultsIn total, 190 patients were included. ET4 performed well as a ‘rule-out’ screening step (sensitivity 0.91, specificity 0.72, NPV 0.98, PPV 0.32). ET4 performance was comparable to HADS-D (sensitivity 0.96, specificity 0.77, NPV 0.99, PPV 0.37) without need for clinician scoring. The briefer ET4 performed as well as the full ET7.
ConclusionET are quick, sensitive and useful screening tools for depression in this MS population, to be complemented by further questioning or more detailed psychiatric assessment where indicated. Given that ET4 and ET7 perform equally well, we recommend the use of ET4 as it is briefer. It has the potential to be widely implemented across busy neurology clinics to assist in depression screening in this under diagnosed group.
Si-doped high-energy Li1.2Mn0.54Ni0.13Co0.13O2 cathode with improved capacity for lithium-ion batteries
- Leah Nation, Yan Wu, Christine James, Yue Qi, Bob R. Powell, Brian W. Sheldon
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- Journal:
- Journal of Materials Research / Volume 33 / Issue 24 / 28 December 2018
- Published online by Cambridge University Press:
- 07 December 2018, pp. 4182-4191
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- 28 December 2018
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Li[Lix/3Mn2x/3M1−x]O2 (M = Ni, Mn, Co) (HE-NMC) materials, which can be expressed as a combination of trigonal LiTMO2 (TM = transition metal) and monoclinic Li2MnO3 phases, are of great interest as high capacity cathodes for lithium-ion batteries. However, structural stability prevents their commercial adoption. To address this, Si doping was applied, resulting in improved stability. Raman and differential capacity analyses suggest that silicon doping improves the structural stability during electrochemical cycling. Furthermore, the doped material exhibits a 10% higher capacity relative to the control. The superior capacity likely results from the increased lattice parameters as determined by X-ray diffraction (XRD) and the lower resistance during the first cycle found by impedance and direct current resistance (DCR) measurements. Density functional theory (DFT) predictions suggest that the observed lattice expansion is an indication of increased oxygen vacancy concentration and may be due to the Si doping.
Overlap in avian communities produces unimodal richness peaks on Bornean mountains
- Ryan C. Burner, Alison R. Styring, Chandradewana Boer, Frederick H. Sheldon
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- Journal of Tropical Ecology / Volume 34 / Issue 2 / March 2018
- Published online by Cambridge University Press:
- 21 March 2018, pp. 75-92
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Altitudinal gradients provide tractable, replicated systems in which to study changes in species richness and community composition over relatively short distances. Previously, richness was often assumed to follow a monotonic decline with altitude, but recent meta-analyses show that more complex patterns, including mid-altitude richness peaks, are also prevalent in birds. In this study, we used point counts to survey birds at multiple altitudes on three mountains on the island of Borneo in Sundaland, an area for which quantitative analyses of avian altitudinal distribution are unavailable. In total we conducted 1088 point counts and collected associated habitat data at 527 locations to estimate species richness by altitude on Mt Mulu (2376 m), Mt Pueh (1550 m) and Mt Topap Oso (1450 m). On Mulu, the only mountain with an intact habitat gradient, bird species richness peaks at 600 m. Richness appeared to peak at 600 m on Totap Oso as well, but on Pueh it peaked several hundred metres higher. The richness peak on Mulu differs from that predicted by null models and is instead caused by the overlap of distinct lowland and montane avifaunas, supporting the faunal overlap hypothesis. This finding provides further evidence that a lack of coincidence between peak turnover and peak richness is not sufficient evidence to rule out faunal overlap as a causal factor.
Spatial and temporal variability in snowmelt onset over Arctic sea ice
- Mark R. Anderson, Sheldon D. Drobot
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- Journal:
- Annals of Glaciology / Volume 33 / 2001
- Published online by Cambridge University Press:
- 14 September 2017, pp. 74-78
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Climate models suggest surface warming in the Arctic will be rapid and pronounced, implying substantial changes in snowmelt onset are likely. This research therefore examines spatial and temporal variability in passive-microwave derived snow-melt-onset dates over Arctic sea ice. The objectives are to understand better the regional characteristics of snowmelt and to document whether the snowmelt-onset record shows signs of climate change. Snowmelt-onset dates are derived with Scanning Multichannel Microwave Radiometer and Special Sensor Microwave/Imager brightness-temperature data, and they are subsequently stratified into 13 regions to analyze spatial and temporal variability. Results illustrate significant spatial variability in snowmelt onset, with the median annual snowmelt-onset date in one region of the Arctic typically being statistically different from most other regions. The examination of temporal variability also shows large interannual differences in the median snowmelt-onset date in most regions. Additionally, trends towards earlier snowmelt onset are documented in the West Central Arctic, Lincoln Sea, Beaufort Sea and Canadian Arctic Archipelago regions.
Comparison of interannual snowmelt-onset dates with atmospheric conditions
- Sheldon D. Drobot, Mark R. Anderson
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- Journal:
- Annals of Glaciology / Volume 33 / 2001
- Published online by Cambridge University Press:
- 14 September 2017, pp. 79-84
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The snowmelt-onset date represents an important transitional point in the Arctic surface energy balance, when albedo decreases and energy absorption increases rapidly in response to the appearance of liquid water. Interannual variations in snowmelt onset are likely related to large-scale variations in atmospheric circulation, such as described by the Arctic Oscillation (AO). This research therefore examines the relationship between monthly-averaged AO values and mean annual snowmelt-onset dates over Arctic sea ice in 13 regions, from 1979 to 1998. The objective is to statistically relate variations in mean annual regional snowmelt-onset dates to variations in the AO. Additionally, monthly-averaged 500 hPa heights and 2 m air temperatures are used to illustrate a physical link between snow-melt onset and a positive AO phase. Regression analyses demonstrate that variations in the AO explain a significant portion of the variations in snowmelt onset in the West Central Arctic, Laptev Sea, East Siberian Sea, Hudson Bay and Baffin Bay. Synoptic analyses suggest earlier (later) than average snowmelt onset occurs where warm (cold) air advection and increased (decreased) cyclonic activity are present.
The onset of Arctic sea-ice snowmelt as detected with passive- and active-microwave remote sensing
- Richard R. Forster, David G. Long, Kenneth C. Jezek, Sheldon D. Drobot, Mark R. Anderson
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- Journal:
- Annals of Glaciology / Volume 33 / 2001
- Published online by Cambridge University Press:
- 14 September 2017, pp. 85-93
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Daily acquisitions from satellite microwave sensors can be used to observe the spatial and temporal characteristics of the Arctic sea-ice snowmelt onset because the initial presence of liquid water in a dry snowpack causes a dramatic change in the active-and passive-microwave response. A daily sequence of backscatter coefficient images from the NASA scatterometer (NSCAT) clearly shows the spatially continuous progression of decreasing backscatter associated with snowmelt onset across the Arctic Ocean during spring 1997. A time series of the active NSCAT backscatter and a scattering index from the passive Special Sensor Microwave/Imager (SSM/I) show similar trends during the time of the melt onset. An NSCATsnowmelt-onset detection algorithm is developed using the derivative of the backscatter with respect to time to select a melt-onset date for each pixel, generating a melt map for the Arctic sea ice. Comparison between this melt map and one previously generated from an SSM/I scattering index shows the NSCAT algorithm predicts the onset occurs 1−10 days earlier than the SSM/I-based algorithm for most portions of multi-year ice.
The EPICA Dronning Maud Land deep drilling operation
- Frank Wilhelms, Heinrich Miller, Michael D. Gerasimoff, Cord Drücker, Andreas Frenzel, Diedrich Fritzsche, Hannes Grobe, Steffen Bo Hansen, Sverrir Æ. Hilmarsson, Georg Hoffmann, Kerstin Hörnby, Andrea Jaeschke, Steinunn S. Jakobsdóttir, Paul Juckschat, Achim Karsten, Lorenz Karsten, Patrik R. Kaufmann, Torbjörn Karlin, Eberhard Kohlberg, Guido Kleffel, Anja Lambrecht, Astrid Lambrecht, Gunther Lawer, Ivan Schärmeli, Jochen Schmitt, Simon G. Sheldon, Morimasa Takata, Marcus Trenke, Birthe Twarloh, Fernando Valero-Delgado, Dorothee Wilhelms-Dick
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- Journal:
- Annals of Glaciology / Volume 55 / Issue 68 / 2014
- Published online by Cambridge University Press:
- 26 July 2017, pp. 355-366
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We report on the EPICA Dronning Maud Land (East Antarctica) deep drilling operation. Starting with the scientific questions that led to the outline of the EPICA project, we introduce the setting of sister drillings at NorthGRIP and EPICA Dome C within the European ice-coring community. The progress of the drilling operation is described within the context of three parallel, deep-drilling operations, the problems that occurred and the solutions we developed. Modified procedures are described, such as the monitoring of penetration rate via cable weight rather than motor torque, and modifications to the system (e.g. closing the openings at the lower end of the outer barrel to reduce the risk of immersing the drill in highly concentrated chip suspension). Parameters of the drilling (e.g. core-break force, cutter pitch, chips balance, liquid level, core production rate and piece number) are discussed. We also review the operational mode, particularly in the context of achieved core length and piece length, which have to be optimized for drilling efficiency and core quality respectively. We conclude with recommendations addressing the design of the chip-collection openings and strictly limiting the cable-load drop with respect to the load at the start of the run.
P109: Characterizing spontaneous improvements in vasovagal syncope
- I. Sahota, C. Maxey, R. Sheldon
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 19 / Issue S1 / May 2017
- Published online by Cambridge University Press:
- 15 May 2017, p. S115
- Print publication:
- May 2017
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Introduction: Syncope is responsible for up to 5% of emergency department visits. Vasovagal syncope (VVS) is the most common subtype and can have significant quality of life implications as it is often recurrent. Clinicians treating VVS have limited treatment options available to them and often struggle with prognostication. The aim of our study was to identify patient-specific determinants of VVS improvement or cessation. Methods: Patients (pts) from the Prevention of Syncope Trials (POST) 1 and 2 were included in this study. All patients had VVS according to tilt table testing or a diagnostic point score. Patients had fainted ≥1 time in the previous year and all were followed for up to 1 year after enrollment. Data are presented as median (IQR). Complete responders (CR) did not faint in follow-up; partial responders (PR) fainted ≥1/year less than prior year but did not stop; and non-responders (NR) did not improve or stop. Results: There were 392 patients: 126 males, median age 34 (23,50) who had fainted for 10 (3,22) years and followed for a median of 363 (148,376) days. There were 225 CR (57%), 120 PR (31%) and 47 NR (12%). PR subjects were younger: 27 (24,33) years compared to CR (36 (32,42)) years and NR (36 (29,47)) years (p<0.05). Receiver operator characteristic analysis showed age predicted PR (AUC=0.62). Lifetime fainting frequency was 0.67 (0.14,2.00) faints per year, increasing to 4 (2,10) faints in the pre-year and decreasing to 0 (0,1.9) faints in the post-year (p<0.0001). Pts had similar syncope frequency in the distant past (PR, 1.14 faints/year; CR, 0.68 faints/year; NR, 0.58 faints/year) but PR pts worsened markedly prior to enrollment. PR subjects fainted much more in the prior year: 10 (6,18) faints compared CR (3 (2,3) faints, p<0.0001) and NR (2 (2,4) faints, p<0.05). Receiver operator characteristic analysis showed prior year faints predicted PR well (AUC=0.81). There was no significant interaction with treatment (metoprolol in POST 1, fludrocortisone in POST 2). Conclusion: After specialist consultation, 57% of VVS patients stop fainting and 31% improve incompletely without a significant treatment effect. Patients who will improve incompletely can be accurately selected based on younger age and more frequent syncope. Older patients with less frequent syncope are 83% likely to stop fainting. These findings will help counsel pts and select candidates for medical therapy.
A global threats overview for Numeniini populations: synthesising expert knowledge for a group of declining migratory birds
- JAMES W. PEARCE-HIGGINS, DANIEL J. BROWN, DAVID J. T. DOUGLAS, JOSÉ A. ALVES, MARIAGRAZIA BELLIO, PIERRICK BOCHER, GRAEME M. BUCHANAN, ROB P. CLAY, JESSE CONKLIN, NICOLA CROCKFORD, PETER DANN, JAANUS ELTS, CHRISTIAN FRIIS, RICHARD A. FULLER, JENNIFER A. GILL, KEN GOSBELL, JAMES A. JOHNSON, ROCIO MARQUEZ-FERRANDO, JOSE A. MASERO, DAVID S. MELVILLE, SPIKE MILLINGTON, CLIVE MINTON, TAEJ MUNDKUR, ERICA NOL, HANNES PEHLAK, THEUNIS PIERSMA, FRÉDÉRIC ROBIN, DANNY I. ROGERS, DANIEL R. RUTHRAUFF, NATHAN R. SENNER, JUNID N. SHAH, ROB D. SHELDON, SERGEJ A. SOLOVIEV, PAVEL S. TOMKOVICH, YVONNE I. VERKUIL
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- Journal:
- Bird Conservation International / Volume 27 / Issue 1 / March 2017
- Published online by Cambridge University Press:
- 01 March 2017, pp. 6-34
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The Numeniini is a tribe of 13 wader species (Scolopacidae, Charadriiformes) of which seven are Near Threatened or globally threatened, including two Critically Endangered. To help inform conservation management and policy responses, we present the results of an expert assessment of the threats that members of this taxonomic group face across migratory flyways. Most threats are increasing in intensity, particularly in non-breeding areas, where habitat loss resulting from residential and commercial development, aquaculture, mining, transport, disturbance, problematic invasive species, pollution and climate change were regarded as having the greatest detrimental impact. Fewer threats (mining, disturbance, problematic native species and climate change) were identified as widely affecting breeding areas. Numeniini populations face the greatest number of non-breeding threats in the East Asian-Australasian Flyway, especially those associated with coastal reclamation; related threats were also identified across the Central and Atlantic Americas, and East Atlantic flyways. Threats on the breeding grounds were greatest in Central and Atlantic Americas, East Atlantic and West Asian flyways. Three priority actions were associated with monitoring and research: to monitor breeding population trends (which for species breeding in remote areas may best be achieved through surveys at key non-breeding sites), to deploy tracking technologies to identify migratory connectivity, and to monitor land-cover change across breeding and non-breeding areas. Two priority actions were focused on conservation and policy responses: to identify and effectively protect key non-breeding sites across all flyways (particularly in the East Asian- Australasian Flyway), and to implement successful conservation interventions at a sufficient scale across human-dominated landscapes for species’ recovery to be achieved. If implemented urgently, these measures in combination have the potential to alter the current population declines of many Numeniini species and provide a template for the conservation of other groups of threatened species.
A Cross-Section Analysis of Intra-Industry Trade in the U.S. Processed Food and Beverage Sectors
- Darcy A. Hartman, Dennis R. Henderson, Ian M. Sheldon
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- Agricultural and Resource Economics Review / Volume 22 / Issue 2 / October 1993
- Published online by Cambridge University Press:
- 15 September 2016, pp. 189-198
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This paper analyzes the determinants of variation across industries in levels of intra-industry trade (IIT) for a sample of thirty-six U.S. processed food and beverage industries in 1987, previous studies of intra-industry trade having focussed on industry characteristics in the manufacturing sectors. The determinants predicted by IIT theory are measures of product differentiation, economies of scale, and imperfect competition; the results of this analysis indicate that IIT variation across the food and beverage industries is positively related to product differentiation, economies of scope, and similarity of tariff barriers among trade partners, but negatively related to industry concentration.
LO004: Short-term risk of arrhythmias among syncope patients presenting with atrial fibrillation/flutter to Canadian emergency departments
- C. Toarta, K. Kwong, I.G. Stiell, M.A. Mukarram, M. Taljaard, R. Sheldon, G.A. Wells, V. Thiruganasambandamoorthy
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- Journal:
- Canadian Journal of Emergency Medicine / Volume 18 / Issue S1 / May 2016
- Published online by Cambridge University Press:
- 02 June 2016, p. S31
- Print publication:
- May 2016
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Introduction: Short-term risk of arrhythmia or death among emergency department (ED) syncope patients with atrial fibrillation/flutter (AFF) has not been reported in the literature. Our objectives were to assess the incidence and the independent risk of 30-day arrhythmia or death for syncope patients with AFF after ED disposition. Methods: We conducted a prospective study at 6 Canadian academic EDs to include adults with syncope. We collected demographic, clinical and ECG characteristics while our outcome assessments were completed by medical records review and by telephone follow-up of patients after 30 days. Primary outcome was arrhythmia or death within 30-days after ED disposition and secondary outcomes included non-arrhythmic cardiac and non-cardiac outcomes. We performed descriptive and logistic regression analyses. Results: We enrolled 4,266 patients: mean age 53.4 years, 55.4% females, and 8.5% with AFF. After excluding those with outcomes in the ED, lost to follow-up and those with other non-sinus rhythms, 3,417 patients in the sinus and 280 patients in the AFF groups were analyzed. The incidence of arrhythmia or death was significantly higher in the AFF group (Relative Risk 5.1; 95% CI 3.1-8.4; p<0.0001) but there were no significant differences in secondary outcomes between the groups. The unadjusted odds ratio for 30-days arrhythmia or deaths among ED syncope patients with AFF was 5.4 (95% CI 3.2- 9.2). After adjusting for important baseline risk factors by multivariable analysis, the odds ratio for arrhythmia or death in patients with AFF was 1.5 (95% CI 0.8-2.7). Conclusion: The risk of AFF for 30-day arrhythmia or death among syncope patients after ED disposition is higher but is attenuated when adjusted for important patient characteristics. Future research should assess long-term outcomes among syncope patients with AFF to guide follow-up after ED discharge.
Preliminary assessment of the scope and scale of illegal killing and taking of birds in the Mediterranean
- ANNE-LAURE BROCHET, WILLEM VAN DEN BOSSCHE, SHARIF JBOUR, P. KARIUKI NDANG’ANG’A, VICTORIA R. JONES, WED ABDEL LATIF IBRAHIM ABDOU, ABDEL RAZZAQ AL- HMOUD, NABEGH GHAZAL ASSWAD, JUAN CARLOS ATIENZA, IMAD ATRASH, NICHOLAS BARBARA, KEITH BENSUSAN, TAULANT BINO, CLAUDIO CELADA, SIDI IMAD CHERKAOUI, JULIETA COSTA, BERNARD DECEUNINCK, KHALED SALEM ETAYEB, CLAUDIA FELTRUP-AZAFZAF, JERNEJ FIGELJ, MARCO GUSTIN, PRIMOŽ KMECL, VLADO KOCEVSKI, MALAMO KORBETI, DRAŽEN KOTROŠAN, JUAN MULA LAGUNA, MATTEO LATTUADA, DOMINGOS LEITÃO, PAULA LOPES, NICOLÁS LÓPEZ-JIMÉNEZ, VEDRAN LUCIĆ, THIERRY MICOL, AÏSSA MOALI, YOAV PERLMAN, NICOLA PILUDU, DANAE PORTOLOU, KSENIJA PUTILIN, GWENAEL QUAINTENNE, GHASSAN RAMADAN-JARADI, MILAN RUŽIĆ, ANNA SANDOR, NERMINA SARAJLI, DARKO SAVELJIĆ, ROBERT D. SHELDON, TASSOS SHIALIS, NIKOS TSIOPELAS, FRAN VARGAS, CLAIRE THOMPSON, ARIEL BRUNNER, RICHARD GRIMMETT, STUART H.M. BUTCHART
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- Journal:
- Bird Conservation International / Volume 26 / Issue 1 / March 2016
- Published online by Cambridge University Press:
- 03 March 2016, pp. 1-28
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Illegal killing/taking of birds is a growing concern across the Mediterranean. However, there are few quantitative data on the species and countries involved. We assessed numbers of individual birds of each species killed/taken illegally in each Mediterranean country per year, using a diverse range of data sources and incorporating expert knowledge. We estimated that 11–36 million individuals per year may be killed/taken illegally in the region, many of them on migration. In each of Cyprus, Egypt, Italy, Lebanon and Syria, more than two million birds may be killed/taken on average each year. For species such as Blackcap Sylvia atricapilla, Common Quail Coturnix coturnix, Eurasian Chaffinch Fringilla coelebs, House Sparrow Passer domesticus and Song Thrush Turdus philomelos, more than one million individuals of each species are estimated to be killed/taken illegally on average every year. Several species of global conservation concern are also reported to be killed/taken illegally in substantial numbers: Eurasian Curlew Numenius arquata, Ferruginous Duck Aythya nyroca and Rock Partridge Alectoris graeca. Birds in the Mediterranean are illegally killed/taken primarily for food, sport and for use as cage-birds or decoys. At the 20 worst locations with the highest reported numbers, 7.9 million individuals may be illegally killed/taken per year, representing 34% of the mean estimated annual regional total number of birds illegally killed/taken for all species combined. Our study highlighted the paucity of data on illegal killing/taking of birds. Monitoring schemes which use systematic sampling protocols are needed to generate increasingly robust data on trends in illegal killing/taking over time and help stakeholders prioritise conservation actions to address this international conservation problem. Large numbers of birds are also hunted legally in the region, but specific totals are generally unavailable. Such data, in combination with improved estimates for illegal killing/taking, are needed for robustly assessing the sustainability of exploitation of birds.
Integrating Paleobotanical, Paleosol, and Stratigraphic Data to Study Critical Transitions: A Case Study From The Late Cretaceous–Paleocene Of India
- Selena Y. Smith, Steven R. Manchester, Bandana Samant, Dhananjay M. Mohabey, Elisabeth Wheeler, Pieter Baas, Dashrath Kapgate, Rashmi Srivastava, Nathan D. Sheldon
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- Journal:
- The Paleontological Society Papers / Volume 21 / October 2015
- Published online by Cambridge University Press:
- 21 July 2017, pp. 137-166
- Print publication:
- October 2015
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During the Cretaceous and Paleogene, the Indian subcontinent was isolated as it migrated north from the east coast of Africa to collide with Asia. As it passed over the Reunion hotspot in the late Maastrichtian–early Danian, a series of lava flows extruded, known as the Deccan Traps. Also during this interval, there was a major mass-extinction event at the Cretaceous–Paleogene boundary, punctuated by a meteorite impact at Chicxulub, Mexico. What were the biological implications of these changes in paleogeography and the extensive volcanism in terms of biodiversity, evolution, and biogeography? By combining chronostratigraphic, paleosol, and paleobotanical data, an understanding of how the ecosystems and climates changed and the relative contributions of the Chicxulub impact, Deccan Traps volcanism, and paleogeographic isolation can be gained. Understanding relative ages of paleobotanical localities is crucial to determining floristic changes, and is challenging because different methods (e.g., magnetostratigraphy, radiometric dating, vertebrate and microfossil biostratigraphy) sometimes give conflicting answers, or have not been done for paleobotanical localities. Climatic data can be obtained quantitatively by studying paleosol geochemistry, as well as qualitatively by examining functional traits and nearest living relatives of fossil plants. An additional challenge is revising macrofossil data, which includes some confidently identified taxa and others with uncertain affinities. This is important for understanding ecosystem composition both spatially and temporally, as well as the biogeographic implications of an isolated India.
Contributors
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- By Mitchell Aboulafia, Frederick Adams, Marilyn McCord Adams, Robert M. Adams, Laird Addis, James W. Allard, David Allison, William P. Alston, Karl Ameriks, C. Anthony Anderson, David Leech Anderson, Lanier Anderson, Roger Ariew, David Armstrong, Denis G. Arnold, E. J. Ashworth, Margaret Atherton, Robin Attfield, Bruce Aune, Edward Wilson Averill, Jody Azzouni, Kent Bach, Andrew Bailey, Lynne Rudder Baker, Thomas R. Baldwin, Jon Barwise, George Bealer, William Bechtel, Lawrence C. Becker, Mark A. Bedau, Ernst Behler, José A. Benardete, Ermanno Bencivenga, Jan Berg, Michael Bergmann, Robert L. Bernasconi, Sven Bernecker, Bernard Berofsky, Rod Bertolet, Charles J. Beyer, Christian Beyer, Joseph Bien, Joseph Bien, Peg Birmingham, Ivan Boh, James Bohman, Daniel Bonevac, Laurence BonJour, William J. Bouwsma, Raymond D. Bradley, Myles Brand, Richard B. Brandt, Michael E. Bratman, Stephen E. Braude, Daniel Breazeale, Angela Breitenbach, Jason Bridges, David O. Brink, Gordon G. Brittan, Justin Broackes, Dan W. Brock, Aaron Bronfman, Jeffrey E. Brower, Bartosz Brozek, Anthony Brueckner, Jeffrey Bub, Lara Buchak, Otavio Bueno, Ann E. Bumpus, Robert W. Burch, John Burgess, Arthur W. Burks, Panayot Butchvarov, Robert E. Butts, Marina Bykova, Patrick Byrne, David Carr, Noël Carroll, Edward S. Casey, Victor Caston, Victor Caston, Albert Casullo, Robert L. Causey, Alan K. L. Chan, Ruth Chang, Deen K. Chatterjee, Andrew Chignell, Roderick M. Chisholm, Kelly J. Clark, E. J. Coffman, Robin Collins, Brian P. Copenhaver, John Corcoran, John Cottingham, Roger Crisp, Frederick J. Crosson, Antonio S. Cua, Phillip D. Cummins, Martin Curd, Adam Cureton, Andrew Cutrofello, Stephen Darwall, Paul Sheldon Davies, Wayne A. Davis, Timothy Joseph Day, Claudio de Almeida, Mario De Caro, Mario De Caro, John Deigh, C. F. Delaney, Daniel C. Dennett, Michael R. DePaul, Michael Detlefsen, Daniel Trent Devereux, Philip E. Devine, John M. Dillon, Martin C. Dillon, Robert DiSalle, Mary Domski, Alan Donagan, Paul Draper, Fred Dretske, Mircea Dumitru, Wilhelm Dupré, Gerald Dworkin, John Earman, Ellery Eells, Catherine Z. Elgin, Berent Enç, Ronald P. Endicott, Edward Erwin, John Etchemendy, C. Stephen Evans, Susan L. Feagin, Solomon Feferman, Richard Feldman, Arthur Fine, Maurice A. Finocchiaro, William FitzPatrick, Richard E. Flathman, Gvozden Flego, Richard Foley, Graeme Forbes, Rainer Forst, Malcolm R. Forster, Daniel Fouke, Patrick Francken, Samuel Freeman, Elizabeth Fricker, Miranda Fricker, Michael Friedman, Michael Fuerstein, Richard A. Fumerton, Alan Gabbey, Pieranna Garavaso, Daniel Garber, Jorge L. A. Garcia, Robert K. Garcia, Don Garrett, Philip Gasper, Gerald Gaus, Berys Gaut, Bernard Gert, Roger F. Gibson, Cody Gilmore, Carl Ginet, Alan H. Goldman, Alvin I. Goldman, Alfonso Gömez-Lobo, Lenn E. Goodman, Robert M. Gordon, Stefan Gosepath, Jorge J. E. Gracia, Daniel W. Graham, George A. Graham, Peter J. Graham, Richard E. Grandy, I. Grattan-Guinness, John Greco, Philip T. Grier, Nicholas Griffin, Nicholas Griffin, David A. Griffiths, Paul J. Griffiths, Stephen R. Grimm, Charles L. Griswold, Charles B. Guignon, Pete A. Y. Gunter, Dimitri Gutas, Gary Gutting, Paul Guyer, Kwame Gyekye, Oscar A. Haac, Raul Hakli, Raul Hakli, Michael Hallett, Edward C. Halper, Jean Hampton, R. James Hankinson, K. R. Hanley, Russell Hardin, Robert M. Harnish, William Harper, David Harrah, Kevin Hart, Ali Hasan, William Hasker, John Haugeland, Roger Hausheer, William Heald, Peter Heath, Richard Heck, John F. Heil, Vincent F. Hendricks, Stephen Hetherington, Francis Heylighen, Kathleen Marie Higgins, Risto Hilpinen, Harold T. Hodes, Joshua Hoffman, Alan Holland, Robert L. Holmes, Richard Holton, Brad W. Hooker, Terence E. Horgan, Tamara Horowitz, Paul Horwich, Vittorio Hösle, Paul Hoβfeld, Daniel Howard-Snyder, Frances Howard-Snyder, Anne Hudson, Deal W. Hudson, Carl A. Huffman, David L. Hull, Patricia Huntington, Thomas Hurka, Paul Hurley, Rosalind Hursthouse, Guillermo Hurtado, Ronald E. Hustwit, Sarah Hutton, Jonathan Jenkins Ichikawa, Harry A. Ide, David Ingram, Philip J. Ivanhoe, Alfred L. Ivry, Frank Jackson, Dale Jacquette, Joseph Jedwab, Richard Jeffrey, David Alan Johnson, Edward Johnson, Mark D. Jordan, Richard Joyce, Hwa Yol Jung, Robert Hillary Kane, Tomis Kapitan, Jacquelyn Ann K. Kegley, James A. Keller, Ralph Kennedy, Sergei Khoruzhii, Jaegwon Kim, Yersu Kim, Nathan L. King, Patricia Kitcher, Peter D. Klein, E. D. Klemke, Virginia Klenk, George L. Kline, Christian Klotz, Simo Knuuttila, Joseph J. Kockelmans, Konstantin Kolenda, Sebastian Tomasz Kołodziejczyk, Isaac Kramnick, Richard Kraut, Fred Kroon, Manfred Kuehn, Steven T. Kuhn, Henry E. Kyburg, John Lachs, Jennifer Lackey, Stephen E. Lahey, Andrea Lavazza, Thomas H. Leahey, Joo Heung Lee, Keith Lehrer, Dorothy Leland, Noah M. Lemos, Ernest LePore, Sarah-Jane Leslie, Isaac Levi, Andrew Levine, Alan E. Lewis, Daniel E. Little, Shu-hsien Liu, Shu-hsien Liu, Alan K. L. Chan, Brian Loar, Lawrence B. Lombard, John Longeway, Dominic McIver Lopes, Michael J. Loux, E. J. Lowe, Steven Luper, Eugene C. Luschei, William G. Lycan, David Lyons, David Macarthur, Danielle Macbeth, Scott MacDonald, Jacob L. Mackey, Louis H. Mackey, Penelope Mackie, Edward H. Madden, Penelope Maddy, G. B. Madison, Bernd Magnus, Pekka Mäkelä, Rudolf A. Makkreel, David Manley, William E. Mann (W.E.M.), Vladimir Marchenkov, Peter Markie, Jean-Pierre Marquis, Ausonio Marras, Mike W. Martin, A. P. Martinich, William L. McBride, David McCabe, Storrs McCall, Hugh J. McCann, Robert N. McCauley, John J. McDermott, Sarah McGrath, Ralph McInerny, Daniel J. McKaughan, Thomas McKay, Michael McKinsey, Brian P. McLaughlin, Ernan McMullin, Anthonie Meijers, Jack W. Meiland, William Jason Melanson, Alfred R. Mele, Joseph R. Mendola, Christopher Menzel, Michael J. Meyer, Christian B. Miller, David W. Miller, Peter Millican, Robert N. Minor, Phillip Mitsis, James A. Montmarquet, Michael S. Moore, Tim Moore, Benjamin Morison, Donald R. Morrison, Stephen J. Morse, Paul K. Moser, Alexander P. D. Mourelatos, Ian Mueller, James Bernard Murphy, Mark C. Murphy, Steven Nadler, Jan Narveson, Alan Nelson, Jerome Neu, Samuel Newlands, Kai Nielsen, Ilkka Niiniluoto, Carlos G. Noreña, Calvin G. Normore, David Fate Norton, Nikolaj Nottelmann, Donald Nute, David S. Oderberg, Steve Odin, Michael O’Rourke, Willard G. Oxtoby, Heinz Paetzold, George S. Pappas, Anthony J. Parel, Lydia Patton, R. P. Peerenboom, Francis Jeffry Pelletier, Adriaan T. Peperzak, Derk Pereboom, Jaroslav Peregrin, Glen Pettigrove, Philip Pettit, Edmund L. Pincoffs, Andrew Pinsent, Robert B. Pippin, Alvin Plantinga, Louis P. Pojman, Richard H. Popkin, John F. Post, Carl J. Posy, William J. Prior, Richard Purtill, Michael Quante, Philip L. Quinn, Philip L. Quinn, Elizabeth S. Radcliffe, Diana Raffman, Gerard Raulet, Stephen L. Read, Andrews Reath, Andrew Reisner, Nicholas Rescher, Henry S. Richardson, Robert C. Richardson, Thomas Ricketts, Wayne D. Riggs, Mark Roberts, Robert C. Roberts, Luke Robinson, Alexander Rosenberg, Gary Rosenkranz, Bernice Glatzer Rosenthal, Adina L. Roskies, William L. Rowe, T. M. Rudavsky, Michael Ruse, Bruce Russell, Lilly-Marlene Russow, Dan Ryder, R. M. Sainsbury, Joseph Salerno, Nathan Salmon, Wesley C. Salmon, Constantine Sandis, David H. Sanford, Marco Santambrogio, David Sapire, Ruth A. Saunders, Geoffrey Sayre-McCord, Charles Sayward, James P. Scanlan, Richard Schacht, Tamar Schapiro, Frederick F. Schmitt, Jerome B. Schneewind, Calvin O. Schrag, Alan D. Schrift, George F. Schumm, Jean-Loup Seban, David N. Sedley, Kenneth Seeskin, Krister Segerberg, Charlene Haddock Seigfried, Dennis M. Senchuk, James F. Sennett, William Lad Sessions, Stewart Shapiro, Tommie Shelby, Donald W. Sherburne, Christopher Shields, Roger A. Shiner, Sydney Shoemaker, Robert K. Shope, Kwong-loi Shun, Wilfried Sieg, A. John Simmons, Robert L. Simon, Marcus G. Singer, Georgette Sinkler, Walter Sinnott-Armstrong, Matti T. Sintonen, Lawrence Sklar, Brian Skyrms, Robert C. Sleigh, Michael Anthony Slote, Hans Sluga, Barry Smith, Michael Smith, Robin Smith, Robert Sokolowski, Robert C. Solomon, Marta Soniewicka, Philip Soper, Ernest Sosa, Nicholas Southwood, Paul Vincent Spade, T. L. S. Sprigge, Eric O. Springsted, George J. Stack, Rebecca Stangl, Jason Stanley, Florian Steinberger, Sören Stenlund, Christopher Stephens, James P. Sterba, Josef Stern, Matthias Steup, M. A. Stewart, Leopold Stubenberg, Edith Dudley Sulla, Frederick Suppe, Jere Paul Surber, David George Sussman, Sigrún Svavarsdóttir, Zeno G. Swijtink, Richard Swinburne, Charles C. Taliaferro, Robert B. Talisse, John Tasioulas, Paul Teller, Larry S. Temkin, Mark Textor, H. S. Thayer, Peter Thielke, Alan Thomas, Amie L. Thomasson, Katherine Thomson-Jones, Joshua C. Thurow, Vzalerie Tiberius, Terrence N. Tice, Paul Tidman, Mark C. Timmons, William Tolhurst, James E. Tomberlin, Rosemarie Tong, Lawrence Torcello, Kelly Trogdon, J. D. Trout, Robert E. Tully, Raimo Tuomela, John Turri, Martin M. Tweedale, Thomas Uebel, Jennifer Uleman, James Van Cleve, Harry van der Linden, Peter van Inwagen, Bryan W. Van Norden, René van Woudenberg, Donald Phillip Verene, Samantha Vice, Thomas Vinci, Donald Wayne Viney, Barbara Von Eckardt, Peter B. M. Vranas, Steven J. Wagner, William J. Wainwright, Paul E. Walker, Robert E. Wall, Craig Walton, Douglas Walton, Eric Watkins, Richard A. Watson, Michael V. Wedin, Rudolph H. Weingartner, Paul Weirich, Paul J. Weithman, Carl Wellman, Howard Wettstein, Samuel C. Wheeler, Stephen A. White, Jennifer Whiting, Edward R. Wierenga, Michael Williams, Fred Wilson, W. Kent Wilson, Kenneth P. Winkler, John F. Wippel, Jan Woleński, Allan B. Wolter, Nicholas P. Wolterstorff, Rega Wood, W. Jay Wood, Paul Woodruff, Alison Wylie, Gideon Yaffe, Takashi Yagisawa, Yutaka Yamamoto, Keith E. Yandell, Xiaomei Yang, Dean Zimmerman, Günter Zoller, Catherine Zuckert, Michael Zuckert, Jack A. Zupko (J.A.Z.)
- Edited by Robert Audi, University of Notre Dame, Indiana
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- The Cambridge Dictionary of Philosophy
- Published online:
- 05 August 2015
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- 27 April 2015, pp ix-xxx
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Factors Associated with Concomitant Psychotropic Drug Use in the Treatment of Major Depression: A STAR*D Report
- Richard C. Shelton, Steve D. Hollon, Stephen R. Wisniewski, Jonathan E. Alpert, G.K. Balasubramani, Edward S. Friedman, A. John Rush, Madhukar H. Trivedi, Sheldon H. Preskorn
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- CNS Spectrums / Volume 14 / Issue 9 / September 2009
- Published online by Cambridge University Press:
- 07 November 2014, pp. 487-498
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Introduction: Concomitant psychotropic medication (CPM) treatment is common in persons with major depression (MDD). However, relationships with patient characteristics and response to treatment are unclear.
Methods: Participants with nonpsychotic MDD (N=2682) were treated with citalopram, 20–60 mg/day. Sociodemographic, clinical, and treatment outcome characteristics were compared between those using CPMs at study entry or during up to 14 weeks of citalopram treatment, and non-users.
Results: About 35% of participants used a CPM. Insomnia was the predominant indication (70.3%). CPM users were more likely to be seen in primary care settings (69.3% versus 30.7%), be white, of non-Hispanic ethnicity, married, and have a higher income, private insurance, and certain comorbid disorders. CPM users had greater depressive severity, poorer physical and mental functioning, and poorer quality of life than non-users. Response and remission rates were also lower. CPM users were more likely to achieve ≥50 mg/day of citalopram, to report greater side effect intensity, and to have serious adverse events, but less likely to be intolerant of citalopram.
Conclusion: CPMs are associated with greater illness burden, more Axis I comorbidities (especially anxiety disorders), and lower treatment effectiveness. This suggests that CPM use may identify a more difficult to treat population that needs more aggressive treatment.
Contributors
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- By Tom Abbott, Gareth L. Ackland, Hollman D. Aya, Berthold Bein, Karim Bendjelid, Matthieu Biais, Elizabeth J. Bridges, Maxime Cannesson, Cédric Carrié, Alice Carter, Maurizio Cecconi, Daniel Chappell, Jason H. Chua, Gary Colins, Diego Orbegozo Cortes, Lester A. H. Critchley, Daniel De Backer, Katia Donadello, Eric Edison, Byron D. Fergerson, Tong J. Gan, Michael T. Ganter, Leslie M. Garson, Christoph K. Hofer, Christoph Ilies, James M. Isbell, Matthias Jacob, Mazyar Javidroozi, Zeev N. Kain, Elisa Kam, Gautam Kumar, Yannick Le Manach, Sheldon Magder, Aman Mahajan, Gerard R. Manecke, Paul E. Marik, Joseph Meltzer, Debra R. Metter, Timothy E. Miller, Xavier Monnet, Michael Mythen, Rudolph Nguyen, Rupert Pearse, Michael R. Pinsky, Davinder Ramsingh, Steffen Rex, Andrew Rhodes, Joseph Rinehart, Mathieu Sèrié, Aryeh Shander, Nils Siegenthaler, Ann B. Singleton, Faraz Syed, Jean-Louis Teboul, Robert H. Thiele, Shermeen B. Vakharia, Trung Vu, Nathan H. Waldron, David Walker, William Wilson
- Edited by Maxime Cannesson, University of California, Irvine, Rupert Pearse
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- Book:
- Perioperative Hemodynamic Monitoring and Goal Directed Therapy
- Published online:
- 05 September 2014
- Print publication:
- 04 September 2014, pp vii-x
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Contributors
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- By Lenard A. Adler, Pinky Agarwal, Rehan Ahmed, Jagga Rao Alluri, Fawaz Al-Mufti, Samuel Alperin, Michael Amoashiy, Michael Andary, David J. Anschel, Padmaja Aradhya, Vandana Aspen, Esther Baldinger, Jee Bang, George D. Baquis, John J. Barry, Jason J. S. Barton, Julius Bazan, Amanda R. Bedford, Marlene Behrmann, Lourdes Bello-Espinosa, Ajay Berdia, Alan R. Berger, Mark Beyer, Don C. Bienfang, Kevin M. Biglan, Thomas M. Boes, Paul W. Brazis, Jonathan L. Brisman, Jeffrey A. Brown, Scott E. Brown, Ryan R. Byrne, Rina Caprarella, Casey A. Chamberlain, Wan-Tsu W. Chang, Grace M. Charles, Jasvinder Chawla, David Clark, Todd J. Cohen, Joe Colombo, Howard Crystal, Vladimir Dadashev, Sarita B. Dave, Jean Robert Desrouleaux, Richard L. Doty, Robert Duarte, Jeffrey S. Durmer, Christyn M. Edmundson, Eric R. Eggenberger, Steven Ender, Noam Epstein, Alberto J. Espay, Alan B. Ettinger, Niloofar (Nelly) Faghani, Amtul Farheen, Edward Firouztale, Rod Foroozan, Anne L. Foundas, David Elliot Friedman, Deborah I. Friedman, Steven J. Frucht, Oded Gerber, Tal Gilboa, Martin Gizzi, Teneille G. Gofton, Louis J. Goodrich, Malcolm H. Gottesman, Varda Gross-Tsur, Deepak Grover, David A. Gudis, John J. Halperin, Maxim D. Hammer, Andrew R. Harrison, L. Anne Hayman, Galen V. Henderson, Steven Herskovitz, Caitlin Hoffman, Laryssa A. Huryn, Andres M. Kanner, Gary P. Kaplan, Bashar Katirji, Kenneth R. Kaufman, Annie Killoran, Nina Kirz, Gad E. Klein, Danielle G. Koby, Christopher P. Kogut, W. Curt LaFrance, Patrick J.M. Lavin, Susan W. Law, James L. Levenson, Richard B. Lipton, Glenn Lopate, Daniel J. Luciano, Reema Maindiratta, Robert M. Mallery, Georgios Manousakis, Alan Mazurek, Luis J. Mejico, Dragana Micic, Ali Mokhtarzadeh, Walter J. Molofsky, Heather E. Moss, Mark L. Moster, Manpreet Multani, Siddhartha Nadkarni, George C. Newman, Rolla Nuoman, Paul A. Nyquist, Gaia Donata Oggioni, Odi Oguh, Denis Ostrovskiy, Kristina Y. Pao, Juwen Park, Anastas F. Pass, Victoria S. Pelak, Jeffrey Peterson, John Pile-Spellman, Misha L. Pless, Gregory M. Pontone, Aparna M. Prabhu, Michael T. Pulley, Philip Ragone, Prajwal Rajappa, Venkat Ramani, Sindhu Ramchandren, Ritesh A. Ramdhani, Ramses Ribot, Heidi D. Riney, Diana Rojas-Soto, Michael Ronthal, Daniel M. Rosenbaum, David B. Rosenfield, Durga Roy, Michael J. Ruckenstein, Max C. Rudansky, Eva Sahay, Friedhelm Sandbrink, Jade S. Schiffman, Angela Scicutella, Maroun T. Semaan, Robert C. Sergott, Aashit K. Shah, David M. Shaw, Amit M. Shelat, Claire A. Sheldon, Anant M. Shenoy, Yelizaveta Sher, Jessica A. Shields, Tanya Simuni, Rajpaul Singh, Eric E. Smouha, David Solomon, Mehri Songhorian, Steven A. Sparr, Egilius L. H. Spierings, Eve G. Spratt, Beth Stein, S.H. Subramony, Rosa Ana Tang, Cara Tannenbaum, Hakan Tekeli, Amanda J. Thompson, Michael J. Thorpy, Matthew J. Thurtell, Pedro J. Torrico, Ira M. Turner, Scott Uretsky, Ruth H. Walker, Deborah M. Weisbrot, Michael A. Williams, Jacques Winter, Randall J. Wright, Jay Elliot Yasen, Shicong Ye, G. Bryan Young, Huiying Yu, Ryan J. Zehnder
- Edited by Alan B. Ettinger, Albert Einstein College of Medicine, New York, Deborah M. Weisbrot, State University of New York, Stony Brook
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- Book:
- Neurologic Differential Diagnosis
- Published online:
- 05 June 2014
- Print publication:
- 17 April 2014, pp xi-xx
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Developing a Consensus Framework and Risk Profile for Agents of Opportunity in Academic Medical Centers: Implications for Public Health Preparedness
- Brenna M. Farmer, Lewis S. Nelson, Margaret E. Graham, Carly Bendzans, Aileen M. McCrillis, Ian Portelli, Meng Zhang, Judith Goldberg, Sheldon D. Rosenberg, Lewis R. Goldfrank, Michael Tunik
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- Journal:
- Disaster Medicine and Public Health Preparedness / Volume 4 / Issue 4 / December 2010
- Published online by Cambridge University Press:
- 08 April 2013, pp. 318-325
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Agents of opportunity (AO) in academic medical centers (AMC) are defined as unregulated or lightly regulated substances used for medical research or patient care that can be used as “dual purpose” substances by terrorists to inflict damage upon populations. Most of these agents are used routinely throughout AMC either during research or for general clinical practice. To date, the lack of careful regulations for AOs creates uncertain security conditions and increased malicious potential. Using a consensus-based approach, we collected information and opinions from staff working in an AMC and 4 AMC-affiliated hospitals concerning identification of AO, AO attributes, and AMC risk and preparedness, focusing on AO security and dissemination mechanisms and likely hospital response. The goal was to develop a risk profile and framework for AO in the institution. Agents of opportunity in 4 classes were identified and an AO profile was developed, comprising 16 attributes denoting information critical to preparedness for AO misuse. Agents of opportunity found in AMC present a unique and vital gap in public health preparedness. Findings of this project may provide a foundation for a discussion and consensus efforts to determine a nationally accepted risk profile framework for AO. This foundation may further lead to the implementation of appropriate regulatory policies to improve public health preparedness. Agents of opportunity modeling of dissemination properties should be developed to better predict AO risk.
(Disaster Med Public Health Preparedness. 2010;4:318-325)
Agent of Opportunity Risk Mitigation: People, Engineering, and Security Efficacy
- Margaret E. Graham, Michael G. Tunik, Brenna M. Farmer, Carly Bendzans, Aileen M. McCrillis, Lewis S. Nelson, Ian Portelli, Silas Smith, Judith D. Goldberg, Meng Zhang, Sheldon D. Rosenberg, Lewis R. Goldfrank
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- Journal:
- Disaster Medicine and Public Health Preparedness / Volume 4 / Issue 4 / December 2010
- Published online by Cambridge University Press:
- 08 April 2013, pp. 291-299
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Background: Agents of opportunity (AO) are potentially harmful biological, chemical, radiological, and pharmaceutical substances commonly used for health care delivery and research. AOs are present in all academic medical centers (AMC), creating vulnerability in the health care sector; AO attributes and dissemination methods likely predict risk; and AMCs are inadequately secured against a purposeful AO dissemination, with limited budgets and competing priorities. We explored health care workers' perceptions of AMC security and the impact of those perceptions on AO risk.
Methods: Qualitative methods (survey, interviews, and workshops) were used to collect opinions from staff working in a medical school and 4 AMC-affiliated hospitals concerning AOs and the risk to hospital infrastructure associated with their uncontrolled presence. Secondary to this goal, staff perception concerning security, or opinions about security behaviors of others, were extracted, analyzed, and grouped into themes.
Results: We provide a framework for depicting the interaction of staff behavior and access control engineering, including the tendency of staff to “defeat” inconvenient access controls. In addition, 8 security themes emerged: staff security behavior is a significant source of AO risk; the wide range of opinions about “open” front-door policies among AMC staff illustrates a disparity of perceptions about the need for security; interviewees expressed profound skepticism concerning the effectiveness of front-door access controls; an AO risk assessment requires reconsideration of the security levels historically assigned to areas such as the loading dock and central distribution sites, where many AOs are delivered and may remain unattended for substantial periods of time; researchers' view of AMC security is influenced by the ongoing debate within the scientific community about the wisdom of engaging in bioterrorism research; there was no agreement about which areas of the AMC should be subject to stronger access controls; security personnel play dual roles of security and customer service, creating the negative perception that neither role is done well; and budget was described as an important factor in explaining the state of security controls.
Conclusions: We determined that AMCs seeking to reduce AO risk should assess their institutionally unique AO risks, understand staff security perceptions, and install access controls that are responsive to the staff's tendency to defeat them. The development of AO attribute fact sheets is desirable for AO risk assessment; new funding and administrative or legislative tools to improve AMC security are required; and security practices and methods that are convenient and effective should be engineered.
(Disaster Med Public Health Preparedness. 2010;4:291-299)