Journal articles on the topic 'Private security services – United States'

In the United States, significant variation regarding the quality of public goods exists across local governments. In this article, I seek to explain these patterns. I argue that economically and racially homogenous communities are collectively willing to invest more resources in public goods relative to diverse communities. I provide evidence in support of this claim by analyzing the relationship between race and income diversity and the share of community security and education that is provided by private entities. I find that as racial diversity and income inequality increase, the share of private security guards and white children enrolled in private school is higher.

This article discusses the issues of decriminalization of the security services market, the author’s definition of this concept is proposed; the functions of private security companies in the implementation of public and private interests, the scheme of interaction between security officers, security companies, customer organizations and the state in the security services market are presented. The characteristic features of the implementation of security activities in Russia are considered, the powers of security officers are determined, including the protection of the life and health of citizens, the protection of objects and property, consulting, ensuring public order, conducting inspections while ensuring intra-object and access control. The analysis of foreign experience in the implementation of security services in the United States, Germany, Bulgaria and China, as well as the interaction of private security companies with private military companies. The level of salaries of security officers in Russia and foreign countries is presented.

The work of private military and security contractors is extremely controversial from the point of view of international law and of practice. Sometimes there are doubts as to whether some of their activities should be considered legal activities or illegal mercenarism. Like any other entities using force, they can violate human rights as well as international humanitarian law. They provide their services to, amongst others, states and intergovernmental organisations, including the un. This requires a precise definition of the rules under which such contractors operate, both with regard to the law of treaties and the domestic law of the entities using their services. A question also arises as to whether there is any legal limit to their services being used by intergovernmental organisations, i.e. entities deriving their competences from the will of their member states. The work of the un is an interesting example here. The organisation uses such contractors, but on the other hand, it undertakes various activities to eliminate any potential threats in this respect.

Research suggests that states that fail to provide political goods, such as security, have low citizens’ confidence in state apparatuses, resulting in greater demand for services by non-state actors like private security. The present study seeks to compare citizen trust and confidence in private security guards, in 6 developed, emerging, and transitional economies in the Americas (the United States), Asia (India, Singapore, South Korea), and Europe (The Netherlands, Slovenia). This study seeks to assess whether democracy levels across the countries and/or contextual factors such as contact, perceived professionalism, nature of work, and civility of security guards affect citizens’ trust across various levels of democracy. The findings show that citizens in countries with full-democracy rankings have less trust in private police compared to citizens in lower democracy levels. Findings also suggest that across all democracies, perceived civility and professionalism of private security officers significantly influence citizens’ trust of private police.

The US space activities from their inception have been closely connected with the private sector. However, only in 2010s private space companies have come to play a prominent role not only on the global market of space services but in the field of international security as well. At the same time, this trend towards commercialization of outer space use and the growing role of the private space sector in ensuring national security is still understudied. This paper aims to partially fill this gap by assessing approaches to these issues adopted by the administration of D. Trump. In the first section the author notes that both conceptual and legal frameworks of private space activities lack clarity and proposes an operational definition of the phenomenon. The second section provides a brief overview of the key strategic policy documents of the Trump’s administration including those on commercial use of space in general and its implications for the US national security in particular. The third section identifies the trend towards the institutionalization of the US Space Forces as one of the priorities of the Trump’s administration military policy. The fourth section thoroughly examines key forms and areas of the public–private partnership in commercial use of space, including launch services, communication services, intelligence gathering, as well as production and maintenance of satellites. Finally, the fifth section assesses the prospects for private space activities given the current tightness of the space services market and growing competition. The author concludes that private space plays a subsidiary role within the US national security and is still heavily dependent on state support. Nevertheless, the scope of public–private cooperation is expanding and the models of interaction are changing. The Trump’s administration has contributed to the development of the industry through liberalization of regulations and involvement of private sector in the new large-scale projects, such as the Artemis program. The other important outcome of the space policy of the 45th President of the United States is anchoring of private space activities in the US national security strategy documents.

AbstractPromoting Private Security Company (PSC) self-regulation has become a key focus due to high profile scandals during the military interventions in Iraq and Afghanistan. Related efforts include the Montreux Document, the International Code of Conduct for Private Security Service Providers (ICoC), American National Standards Institute/ASIS certification, and the new International Standards Organization (ISO) Management System Standard for Private Security Operations. Implicit in industry self-regulation, however, is the assumption that the consumers of private security services will help facilitate and enforce professional standards by shifting their custom to PSCs which have signed up to these codes of conduct or certification schemes. This article investigates the validity of this assumption with regard to government contracting. To what degree are public agencies able – and willing – to let professional standards guide their contracting behaviour? To answer this question, this article develops a general framework for the analysis of public consumer influence through choice, voice, and exit which draws on insights from microeconomics and Albert Hirschman’s classical treatiseExit, Voice, Loyalty.Taking the United States government as an illustrative example, the analysis observes several obstacles to encouraging security industry self-regulation through consumer power.

Libraries in the United States handle sensitive patron information, including personally identifiable information and circulation records. With libraries providing services to millions of patrons across the U.S., it is important that they understand the importance of patron privacy and how to protect it. This study investigates how knowledge transferred within an online cybersecurity education affects library employee information security practices. The results of this study suggest that knowledge transfer does have a positive effect on library employee information security and risk management practices.

AbstractThis article examines the involvement of Private Military and Security Companies (PMSCs) in both shaping and implementing the European Agenda on Migration (European Agenda), launched by the European Union in May 2015. The migration policies which have since been adopted have increasingly enabled the outsourcing to private security contractors of various border control operations, including those related to forced returns, administrative detention and security services for the Italian and Greek ‘hotspots’. The article argues that PMSCs frame, shape and entrench militarized responses in the European Agenda. It also contends that the current context of the European refugee ‘crisis’ meets the conditions of a high-risk context, as understood within the United Nations Guiding Principles on Business and Human Rights (UNGPs). This re-definition of the refugee ‘crisis’ as a high-risk context, in turn, enables the identification of heightened human rights obligations of home states and responsibilities of companies when implementing the UNGPs.

The withdrawal of troops on 31 August 2021 which was carried out in accordance with the Agreement signed on 29 February 2020 between the U.S. government and the Taliban (an international terrorist organization banned in the Russian Federation) marked the end of the international military campaign in Afghanistan which lasted twenty years. Assessing the preliminary outcomes of nearly a quarter-century of the US military and their NATO allies’ presence in Afghanistan, U.S. President Joseph Biden announced the end of “an era of major military operations to remake other countries”. Though the consequences of the Western coalition campaign in the area remain to be evaluated and they are unlikely to turn out to be unequivocal, the Atlantic strategy aimed at rebuilding and democratization of Afghanistan proved itself as bankrupt. Our research focuses on the way the twenty-year military campaign in Afghanistan affected the development of the U.S. private military and security companies (PMSC) industry. For these purposes, we, firstly, studied and traced the transformation of the private military and security services market in the U.S., and examined the changes of approaches and mechanisms used to contract PMSCs. Secondly, we analyzed the way the U.S. authorities addressed the challenges new market evoked, focusing on the measures of legal regulation that were applied to PMSCs, and the way the working of the U.S. institutional mechanisms was transforming. The final part of the research contains conclusions on the perspectives for the development of the American PMSC industry after the withdrawal of the U.S. troops from Afghanistan. We believe that due to its duration and continuity, the Afghan operation ensured a launchpad for the PMSC industry and provided conditions for private military and security companies to acquire and master high-end experience which in turn, contributed to the development of a certain market that goes well beyond the involvement of conventional human capital. It provided solutions for the production, utilization, and maintenance of the equipment and technologies, allowing the minimization of the direct participation of specialists in hostilities. Alongside the development of the American PMSC industry itself, the research studies the investigations conducted by the U.S. authorities into the cases of abuse committed by the contractors during their participation in Afghan war. It discusses the way this practice encouraged the transformations of United States procedures and mechanisms aimed at reducing malpractice when performing contracts and launched changes in U.S. legislation. It also demonstrates the lessons learned by the U.S. from the contractual practice with regard to the regulation of PMSCs. The research reveals the strengths and weaknesses of the American policy regarding PMSCs during the whole period of the military conflict in Afghanistan and helps to evaluate the success of the U.S. efforts in monitoring contractors across Afghanistan. To conclude, we reckon that considerable contractual experience acquired in Afghanistan ensures technological and procedural progress of the U.S. PMSC industry. Given the enduring rivalry between the U.S., Russia, and China, including in the military and technological spheres, the twenty-year experience of direct participation in hostilities by U.S. PMSCs boosted its competitive advantage compared to Russia and China, whose PMSCs still lack such an experience.

Amerika Serikat (AS) melibatkan Perusahaan Militer dan Keamanan Swasta atau “Private Military and Security Companies” (PMSC) dalam jumlah besar atas misi rekonstruksi Irak sejak tahun 2003. Keterlibatan dari PMSC telah menimbulkan banyak permasalahan khususnya kejahatan terhadap kemanusiaan (Crime Against Humanity) yang dilakukan kepada warga sipil dalam misi rekonstruksi Irak ini. Adapun tulisan ini bertujuan untuk mengetahui status hukum dari PMSC dalam invasi Irak oleh Amerika Serikat (AS) berdasarkan hukum internasional yang berlaku serta untuk menganalisa pertanggungjawaban dari Amerika Serikat (AS) selaku pihak yang menggunakan PMSC dalam invasi ke Irak yang telah menyebabkan banyak permasalahan bagi Irak. Tulisan ini merupakan penelitian yuridis normatif yang menggunakan pendekatan peraturan perundang-undangan, dalam hal ini perjanjian, konvensi dan instrumen internasional yang relevan, pendekatan kasus serta pendekatan sejarah. Kesimpulan yang didapatkan adalah PMSC merupakan sebuah perusahaan yang bergerak pada pelayanan jasa berupa bantuan militer atau keamanan. Kontraktor PMSC yang melakukan Penembakan terhadap warga sipil di Irak telah mengubah statusnya dari civilian menjadi seseorang yang tidak berhak diberi status sebagai kombatan ataupun tawanan perang. Adapun hal ini telah sesuai dengan unsur-unsur daripada pasal 47 Protokol Tambahan 1 1977 United Nation Mercenary Convention dan The Montreux Document. Dapat pula disimpulkan mengenai pertanggungjawaban dibebankan kepada Amerika Serikat selaku pihak penyewa PMSC yang telah melakukan banyak permasalahan khususnya kejahatan terhadap kemanusiaan (Crime Against Humanity) kepada warga sipil wajib dikarenakan telah terjadi pelanggaran terhadap Konvensi Jenewa 1949, Pasal 51 Protokol Tambahan I 1977 dan Statuta Roma 1998. The United States of America (US) has engaged a large number of Private Military and Security Companies (PMSC) in Iraq reconstruction missions since 2003. The involvement of the PMSC has created many problems of crimes against humanity committed against civilians on this Iraq reconstruction mission. This paper aims to see the legal status of the PMSC in the invasion of Iraq by the United States of America (US) based on applicable international law and to analyze the accountability of the United States of America (US) as the party who used PMSC in the invasion of Iraq which has caused many problems. This paper is a normative legal research that uses statute approach, in terms of treaties, conventions and relevant international instruments, case approach and historical approach. The conclusion is that PMSC is a company engaged in services such as military or security assistance. PMSC contractors who carried out shootings on civilians in Iraq have changed their status from civilian to someone who is not entitled to the status of a combatant or prisoner of war. As for this, it is in accordance with the elements of Article 47 of Additional Protocol 1 of the 1977 United Nations Mercenary Convention and The Montreux Document. It can also be concluded that the responsibility imposed on the United of America States as the charterer of PMSC which has committed many problems, especially crimes against humanity (Crime Against Humanity), to civilians is obliged due to violations of the 1949 Geneva Conventions, Article 51 Additional Protocol I 1977 and the Rome Statute 1998.

Les Affreux en Irak. The partial privatisation of professional bloodshed in modern warfare exemplified by the Iraq WarAfter the launch of "Operation Iraqi Freedom", the United States of America were engaged in war for the next eight years, in which they heavily relied on the assistance of private companies, known as Private Military Companies (PMC). The following paper uses the Iraq War respectively the following occupation of Iraq as a case study to examine the role of PMCs in modern warfare. It analyses the military branches in which PMCs provided support to the USA, including logistics, training, security, and even intelligence services. It also discusses the advantages as well as disadvantages of PMCs in current combat operations.

Discussions about the legitimacy of private security companies (PSCs) in multilateral military interventions abound. This article looks at how the United States has sought to legitimize the outsourcing of security services to PSCs through performance-based contracting and performance assessments. Both mechanisms aim to demonstrate the effective provision of publicly desirable outcomes. However, the immaterial and socially constructed nature of security presents major problems for performance assessments in terms of observable and measurable outcomes. Performance has therefore given way to performativity – that is, the repetitive enactment of particular forms of behaviour and capabilities that are simply equated with security as an outcome. The implications of this development for the ways in which security has been conceptualized, implemented and experienced within US interventions have been profound. Ironically, the concern with performance has not encouraged PSCs to pay increased attention to their impacts on security environments and civilian populations, but has fostered a preoccupation with activities and measurable capabilities that can be easily assessed by government auditors.

Telemedicine has recently garnered more attention from healthcare professionals because it provides access to health services to patients in rural areas while making patient healthcare information more vulnerable to security breaches. The objective of this research is to identify factors that play a critical role in possible adoption of telemedicine in the United States and Brazil. A model with eight hypotheses was used to establish a research framework. A survey was conducted involving healthcare professionals in the aforementioned countries. The results show that telemedicine adoption is influenced by policies and culture in both countries and influenced by security and privacy in the United States. It can be inferred from the research that perceptions of the American and Brazilian healthcare professionals are similar in telemedicine issues covered in this research. These healthcare professionals, however, disagree on how patients’ privacy should be preserved in the two countries.

Abstract Available online public/governmental services requiring authentication by citizens have considerably expanded in recent years. This has hindered the usability and security associated with credential management by users and service providers. To address the problem, some countries have proposed nation-scale identification/authentication systems that intend to greatly reduce the burden of credential management, while seemingly offering desirable privacy benefits. In this paper we analyze two such systems: the Federal Cloud Credential Exchange (FCCX) in the United States and GOV.UK Verify in the United Kingdom, which altogether aim at serving more than a hundred million citizens. Both systems propose a brokered identification architecture, where an online central hub mediates user authentications between identity providers and service providers. We show that both FCCX and GOV.UK Verify suffer from serious privacy and security shortcomings, fail to comply with privacy-preserving guidelines they are meant to follow, and may actually degrade user privacy. Notably, the hub can link interactions of the same user across different service providers and has visibility over private identifiable information of citizens. In case of malicious compromise it is also able to undetectably impersonate users. Within the structural design constraints placed on these nation-scale brokered identification systems, we propose feasible technical solutions to the privacy and security issues we identified. We conclude with a strong recommendation that FCCX and GOV.UK Verify be subject to a more in-depth technical and public review, based on a defined and comprehensive threat model, and adopt adequate structural adjustments.

Abstract:In recent years, the Islamic State in Iraq and the Levant (ISIL)1 as well as several Al-Qaida affiliates have used the systematic and large-scale looting of antiquities as one of their income streams. Due to the large-scale and organized looting activities of these groups, in particular, in Iraq and the Syrian Arab Republic, the United Nations Security Council (UNSC), following various reports and recommendations by the ISIL, Al-Qaida and Taliban Monitoring Team has adopted a range of measures, chiefly among them the landmark UNSC Resolution 2347 (2017) to counter this threat. These measures demand that both member states’ regulators as well as private sector stakeholders take specific action to ensure that the art and antiquity trading industry is capable of defending itself against the misuse of their services to finance terrorism. This article outlines the various challenges member states and private industry are facing in this regard and explains how the various new UNSC provisions, including the measures outlined in UNSC Resolution 2347 (2017), could be employed effectively to counter this threat.

Este artigo tem como problema central o fenômeno das Empresas Militares e de Segurança Privada e seu papel no uso da força. O objetivo é analisar os processos de regulação para controlar este setor que floresceu a partir da década de 1990. Analisar-se-ão duas propostas negociadas internacionalmente: o “Projeto de Convenção” do Grupo de Trabalho sobre Mercenários das Nações Unidas que configura uma opção pelo controle tradicional através de tratado multilateral; e o “Documento de Montreux”, projeto de iniciativa suíça que congrega Estados e integrantes do setor privado para a criação de um Código Internacional de Conduta. A hipótese do artigo aponta que países exportadores de serviços de segurança, notadamente Estados Unidos e Reino Unido, favorecem uma saída de regulação pró-mercado que beneficia a iniciativa privada. Ao apoiar a iniciativa suíça, os Estados exportadores conduzem o debate e indicam que estas empresas não serão desmobilizadas, senão que este mercado crescerá nas próximas décadas apesar das preocupações sobre os efeitos da alienação do monopólio estatal do uso da força e suas conseqüências sobre os direitos humanos e accountability democrático. Para conduzir a análise, proceder-se-á uma observação detalhada dos principais documentos que formam a constelação de propostas de regulação, assim como notas sobre os processos decisórios através dos quais estes marcos foram elaborados e votados. Será possível apreciar como o tema da regulação das EMSPs não é somente um problema de natureza técnica ou jurídica, e sim um debate político onde prevalecem interesses econômicos e estratégicos que dominam a segurança internacional contemporânea.Palavras-Chave: Empresas Militares e de Segurança Privada; Mercenários; Segurança Internacional. Abstract: This article faces the problem of Private Military and Security Companies (PMSCs) and their role in the use of force. The objective is to analyze the regulation projects that aim to control this sector that has flourished since 1990. Here, two main international proposals will be analyzed: the United Nations’ Project sponsored by the Working Group on the use of Mercenaries, an option that emphasizes control through a conventional multilateral treaty; and the “Montreaux Document” originated from the Swiss Initiative and that congregates States and private sector in order to create an International Code of Conduct. The hypothesis of this article points that countries that are major exporters of security services, notably the United States and United Kingdom, prefer the Montreaux option and its pro-market character. By sponsoring the Swiss initiative, the exporting states lead the debate and indicate that these companies will not be demobilized and the market will grow in the coming decades, despite concerns about the effects of these companies on the state monopoly on violence and on human rights and democratic accountability. To achieve these objectives, we will conduct a detailed observation of the key documents that form the constellation of regulatory proposals, as well some notes about the decision-making processes by which these projects were drafted and voted. By doing this, it will be possible to understand how the issue of regulation of PMSCs is not only a problem of technical or legal nature, but a political debate where economic and strategic interests related to international security become visible. Keywords: Private Military and Security Companies; Mercenaries; International Security.DOI: 10.20424/2237-7743/bjir.v4n2p273-299

Abstract Objective During a Phase 2 rectal microbicide trial, men who have sex with men and transgender women (n = 187) in 4 countries (Peru, South Africa, Thailand, United States) reported product use daily via short message service (SMS). To prevent disclosure of study participation, the SMS system program included privacy and security features. We evaluated participants’ perceptions of privacy while using the system and acceptability of privacy/security features. Materials and Methods To protect privacy, the SMS system: (1) confirmed participant availability before sending the study questions, (2) required a password, and (3) did not reveal product name or study participation. To ensure security, the system reminded participants to lock phone/delete messages. A computer-assisted self-interview (CASI), administered at the final visit, measured burden of privacy and security features and SMS privacy concerns. A subsample of 33 participants underwent an in-depth interview (IDI). Results Based on CASI, 85% had no privacy concerns; only 5% were very concerned. Most were not bothered by the need for a password (73%) or instructions to delete messages (82%). Based on IDI, reasons for low privacy concerns included sending SMS in private or feeling that texting would not draw attention. A few IDI participants found the password unnecessary and more than half did not delete messages. Discussion Most participants were not concerned that the SMS system would compromise their confidentiality. SMS privacy and security features were effective and not burdensome. Conclusion Short ID-related passwords, ambiguous language, and reminders to implement privacy and security-enhancing behaviors are recommended for SMS systems.

The COVID-19 pandemic catapulted the use of telehealth services across the United States (US). In response to the public health emergency, the Office for Civil Rights (OCR) at the US Department for Health and Human Services (HHS) issued a notice relaxing privacy and security safeguards outlined in the Health Insurance Portability and Accountability Act (HIPAA). During the past two years, several novel legal issues have arisen due to these lenient standards. The US government has not adequately considered standardizing rules for remote telehealth consultations and regulating the flow of sensitive patient data in a post-COVID world. This article addresses key legal issues associated with telehealth services while recommending national standards to mitigate physician liability while prioritizing patient care.

Abstract In recent years cyber terrorism has become increasingly used with the globalization of technology and people’s access to high-speed internet. It takes place exclusively in the online environment, the advantage being that it offers an increased level of anonymity to users. Terrorist groups are targeting the misappropriation of social media accounts, focused on Distributed Denial of Service activities, exploiting communications services and banking services for fraudulent misappropriation of financial accounts. Cyberterrorism generates very high costs for the national economy, such as the involvement of specialists for detecting and correcting intrusion, declining productivity and income, costs of information theft, regaining the reputation of an institution or company, the costs relating to the resumption of production and the provision of services, the loss of information concerning intellectual property, financial manipulation using stolen information, the cost of securing computer networks and assuring them in the event of intrusion, costs generated by the time spent on recovering stolen data. In 2018 both the US and Egypt took action on these activities, the US modified its national cyber strategy and Egypt adopted the new law project to combat cybercrime. The main cyber threats they face are: threats of intrusion and sabotage of IT infrastructures, cyberterrorism and cyberwar, threats to digital identity and theft of private data, malware programs. The targets of the attacks were public sector entities, financial organizations, health care organizations, retail and accommodation. The reasons for why hackers attack these organizations are money-related, malware infected by emails, commercial and industrial espionage.

There is an increasing demand for sharing documents for process integration among organizations. Web services technology has recently been widely proposed and gradually adopted as a platform for supporting such an integration. There are no holistic solutions thus far that are able to tackle the various protection issues, specifically regarding the security and privacy protection requirements in cross-organizational progress integration. This paper proposes the exchange of documents through a Document / Image Exchange Platform (DIEP), replacing traditional ad-hoc and manual exchange practices. The authors show how the contemporary technologies of Web services under a Service-Oriented Architecture (SOA), together with watermarking, can help protect document exchanges with layered implementation architecture. Furthermore, to facilitate governance and regulation compliance against protection policy violation attempts, the management and the affected parties are notified with alerts for warning and possible handling. The authors discuss the applicability of the proposed platform with a physician towards security and privacy protection requirements based on the Health Insurance Portability and Accountability Act (HIPAA) in the United States, which imposes national regulations to protect individuals’ healthcare information. The proposed approach aims at facilitating the whole governance process from technical to management level with a single unified platform.

This article presents a discussion of the probable implications for the Mexican health sector of the Free Trade Agreement (FTA) between the United States, Canada, and Mexico. The authors argue that the FTA should be seen as part of neoliberal policies adopted by the Mexican government in 1983 that are based on large-scale privatization and deregulation of labor relations. In this general context the health sector, which traditionally has been dominated by public institutions, is undergoing a deep restructuring. The main trends are the decapitalization of the public sector and a selective process of privatization that tends to constitute the private health sector in a field of capital accumulation. The FTA is likely to force a change in Mexican health legislation, which includes health services in the public social security system and recognizes the right to health, and to accelerate selective privatization. The U.S. insurance industry and hospital corporations are interested in promoting these changes in order to gain access to the Mexican market, estimated at 20 to 25 million persons. This would lead to further deterioration of the public institutions, increasing inequalities in health and strengthening the private sector. The historical trend toward the integration of a National Health Service in Mexico would be interrupted in favor of formation of a dual private-public system.

Abstract The United States and Mexico differ greatly in the organization and financing of their old-age welfare states. They also differ politically and organizationally in government response at all levels to the needs of low-income and frail citizens. While both countries are aging rapidly, Mexico faces more serious challenges in old-age support that arise from a less developed old-age welfare state and economy. For Mexico, financial support and medical care for older low-income citizens are universal rights, however, limited fiscal resources for a large low-income population create inevitable competition among the old and the young alike. Although the United States has a more developed economy and well-developed Social Security and health care financing systems for the elderly, older Mexican-origin individuals in the U.S. do not necessarily benefit fully from these programs. These institutional and financial problems to aging are compounded in both countries by longer life spans, smaller families, as well as changing gender roles and cultural norms. In this interdisciplinary panel, the authors of five papers deal with the following topics: (1) an analysis of old age health and dependency conditions, the supply of aging and disability services, and related norms and policies, including the role of the government and the private sector; (2) a binational comparison of federal safety net programs for low-income elderly in U.S. and Mexico; (3) when strangers become family: the role of civil society in addressing the needs of aging populations; and (4) unmet needs for dementia care for Latinos in the Hispanic-EPESE.

Background The United States, unlike other high-income countries, currently has no national unique patient identifier to facilitate health information exchange. Because of security and privacy concerns, Congress, in 1998, prevented the government from promulgating a unique patient identifier. The Health and Human Services funding bill that was enacted in 2019 requires that Health and Human Services report their recommendations on patient identification to Congress. While there are anecdotes of incomplete health care data due to patient misidentification, to date there have been insufficient large-scale analyses measuring improvements to patient care that a unique patient identifier might provide. This lack of measurement has made it difficult for policymakers to balance security and privacy concerns against the value of potential improvements. Objective We sought to determine the frequency of serious drug-drug interaction alerts discovered because a pharmacy benefits manager uses a universal patient identifier and estimate undiscovered serious drug-drug interactions because pharmacy benefit managers do not yet fully share patient records. Methods We conducted a retrospective study of serious drug-drug interaction alerts provided from September 1, 2016 to August 31, 2019 to retail pharmacies by a national pharmacy benefit manager that uses a unique patient identifier. We compared each alert to the contributing prescription and determined whether the unique patient identifier was necessary in order to identify the crossover alert. We classified each alert’s disposition as override, abandonment, or replacement. Using the crossover alert rate and sample population size, we inferred a rate of missing serious drug-drug interaction alerts for the United States. We performed logistic regression in order to identify factors correlated with crossover and alert outcomes. Results Among a population of 49.7 million patients, 242,646 serious drug-drug interaction alerts occurred in 3 years. Of these, 2388 (1.0%) crossed insurance and were discovered because the pharmacy benefit manager used a unique patient identifier. We estimate that up to 10% of serious drug-drug alerts in the United States go undetected by pharmacy benefit managers because of unexchanged information or pharmacy benefit managers that do not use a unique patient identifier. These information gaps may contribute, annually, to up to 6000 patients in the United States receiving a contraindicated medication. Conclusions Comprehensive patient identification across disparate data sources can help protect patients from serious drug-drug interactions. To better safeguard patients, providers should (1) adopt a comprehensive patient identification strategy and (2) share patient prescription history to improve clinical decision support.

Background: Commodity security is essential for effective delivery of quality health services. Commodity security exists when people are able to choose, obtain and use products whenever they need them. With leadership of Government of Nepal’s Logistics Management Division and with technical assistance from United States Aid for International Development funded projects have been consistently working toward this goal with priority to Family Planning (FP), Reproductive Health, and Maternal Child Health commodities. Methods: A National Consensus Contraceptive Security Forecast meeting is held annually at center. The meeting is participated by Regional, District, Program Divisions, National Planning Commission, Ministry of Finance, External Donor Partners, Social Marketing agencies, and Non Governmental Organizations (NGO). The quantity needed, shipment schedule, funding requirement and funding shortfall, distribution and storage strategies for the Public, Social Marketing, and NGO sectors are presented for next five years. Results: With secured funding, increased availability of family planning commodities (stock-outs rate is less than 2%) at service delivery sites have contributed to improve national health indicators like Total Fertility Rate and Contraceptive Prevalence Rate. Key program interventions have ensured FP commodity security through effective coordination of public, private and external donor partners. Conclusion: Key lessons learned was a spirit of ‘Teamwork’ and good coordination –active involvement of other stakeholders is essential for ensuring FP commodity security. Other was an importance of ‘Advocacy’ for commodity security at district, regional and central levels of government and among stakeholders. Challenges are complexity of public procurement procedure and frequent transfer of trained staff, and distribution and transportation of health commodities from district to health facilities still poses a challenge to supply chain management. Nepal Journal of Medical Sciences | Volume 03 | Number 01 | January-June 2014 | Page 51-56 DOI: http://dx.doi.org/10.3126/njms.v3i1.10359

In 2019, the majority of companies used at least one cloud computing service and it is expected that by the end of 2021, cloud data centres will process 94% of workloads. The financial and operational advantages of moving IT infrastructure to specialised cloud providers are clearly compelling. However, with such volumes of private and personal data being stored in cloud computing infrastructures, security concerns have risen. Motivated to monitor and analyze adversarial activities, we deploy multiple honeypots on the popular cloud providers, namely Amazon Web Services (AWS), Google Cloud Platform (GCP) and Microsoft Azure, and operate them in multiple regions. Logs were collected over a period of three weeks in May 2020 and then comparatively analysed, evaluated and visualised. Our work revealed heterogeneous attackers’ activity on each cloud provider, both when one considers the volume and origin of attacks, as well as the targeted services and vulnerabilities. Our results highlight the attempt of threat actors to abuse popular services, which were widely used during the COVID-19 pandemic for remote working, such as remote desktop sharing. Furthermore, the attacks seem to exit not only from countries that are commonly found to be the source of attacks, such as China, Russia and the United States, but also from uncommon ones such as Vietnam, India and Venezuela. Our results provide insights on the adversarial activity during our experiments, which can be used to inform the Situational Awareness operations of an organisation.

"Global governance brings together various actors to coordinate collective action around the world. This concept encompasses all the institutions, policies, rules, procedures and initiatives by which states and their citizens seek to bring more predictability, stability and order into their responses to transnational challenges and is largely achieved through international organisations. In fact, the goal of global governance is to provide global policies and services, in particular peace and security systems, justice and conflict mediation, functioning markets and unified standards for trade and industry. In the current international context, sustainable development is an important goal of global policy, and intergovernmental and governmental agencies as well as private sector companies have a duty to explore different approaches to how national intergovernmental and national strategies, policies and projects address issues. Global governance guidelines are formulated, implemented and evaluated to support the achievement of the 2030 Agenda objectives."

Abstract Background Patients may seek health care services from various providers during treatment. These providers could serve in a network (affiliated) or practice separately (unaffiliated). Thus, using secure and reliable health information exchange (HIE) mechanisms would be critical to transfer sensitive personal health information (PHI) across distances. Studying patients' perceptions and opinions about exchange mechanisms could help health care providers build more complete HIEs' databases and develop robust privacy policies, consent processes, and patient education programs. Objectives Due to the exploratory nature of this study, we aim to shed more light on public perspectives (benefits, concerns, and risks) associated with the four data exchange practices in the health care sector. Methods In this study, we compared public perceptions and expectations regarding four common types of exchange mechanisms used in the United States (i.e., traditional, direct, query-based, patient-mediated exchange mechanisms). Traditional is an exchange through fax, paper mailing, or phone calls, direct is a provider-to-provider exchange, query-based is sharing patient data with a central repository, and patient-mediated is an exchange mechanism in which patients can access data and monitor sharing. Data were collected from 1,624 subjects using an online survey to examine the benefits, risks, and concerns associated with the four exchange mechanisms from patients' perspectives. Results Findings indicate that several concerns and risks such as privacy concerns, security risks, trust issues, and psychological risks are raised. Besides, multiple benefits such as access to complete information, communication improvement, timely and convenient information sharing, cost-saving, and medical error reduction are highlighted by respondents. Through consideration of all risks and benefits associated with the four exchange mechanisms, the direct HIE mechanism was selected by respondents as the most preferred mechanism of information exchange among providers. More than half of the respondents (56.18%) stated that overall they favored direct exchange over the other mechanisms. 42.70% of respondents expected to be more likely to share their PHI with health care providers who implemented and utilized a direct exchange mechanism. 43.26% of respondents believed that they would support health care providers to leverage a direct HIE mechanism for sharing their PHI with other providers. The results exhibit that individuals expect greater benefits and fewer adverse effects from direct HIE among health care providers. Overall, the general public sentiment is more in favor of direct data transfer. Our results highlight that greater public trust in exchange mechanisms is required, and information privacy and security risks must be addressed before the widespread implementation of such mechanisms. Conclusion This exploratory study's findings could be interesting for health care providers and HIE policymakers to analyze how consumers perceive the current exchange mechanisms, what concerns should be addressed, and how the exchange mechanisms could be modified to meet consumers' needs.

College-aged adults are an overrepresented group in the uninsured population of the United States, and traditionally underserved minorities are disproportionately affected. Students with private health insurance are often functionally uninsured as well, since most schools refuse to accept this traditionally elite calling card on campus. Consequently, the large uninsured and functionally uninsured populations often rely on school-sponsored health insurance plans for access to care. These plans have uneven coverage, limited benefits, exclusions and high co-pays and deductibles, and provide little health care security for their beneficiaries. Further, schools and insurance companies have profited substantially from these student plans, raising the possibility of a conflict of interest, with school-sponsored plans that may be focused on financial benefits to schools rather than the health of students. In addition, these plans may violate public policy and consumer protection laws by charging those who do not enroll in school-sponsored plans higher prices and by disingenuously claiming "competitive" rates when advertising to students. Public efforts at a student mandate, such as in Massachusetts, although successful in increasing the number of students with health insurance, have failed to provide adequate access to care. A focused policy must be put into place to ensure that students can effectively and efficiently access needed health care services on campus. In support of this effort, a proposed statute is provided herein. This bill would amend the Higher Education Opportunity Act to create a student health insurance mandate. School-sponsored plans, as well as private plans with comparable coverage, would be required to fulfill a minimum standard benefits plan. Reasonable exclusions and limitations would be allowed, based on standard practices in commercial health insurance plans. The statute would require a minimum percentage of premiums to be spent on health care, with any excess rebated to students. It would also require schools to accept a student's private health insurance for campus services to avoid forcing students to pay more than once for care. As part of this mandate, a portion of the surplus retained by schools billing private insurers would be allocated to create health insurance scholarships for uninsured students. Finally, the definition of "cost of attendance" would be adjusted to ensure that financial aid calculations take into account health insurance premiums.

The complexity and privacy issues inherent in social science research data makes research data management (RDM) an essential skill for future researchers. Data management training has not fully addressed the needs of graduate students in the social sciences. To address this gap, this study used a mixed methods design to investigate the RDM awareness, preparation, confidence, and challenges of social science graduate students. A survey measuring RDM preparedness and training needs was completed by 98 graduate students in a school of education at a research university in the southern United States. Then, interviews exploring data awareness, knowledge of RDM, and challenges related to RDM were conducted with 10 randomly selected graduate students. All participants had low confidence in using RDM, but United States citizens had higher confidence than international graduate students. Most participants were not aware of on-campus RDM services, and were not familiar with data repositories or data sharing. Training needs identified for social science graduate students included support with data documentation and organization when collaborating, using naming procedures to track versions, data analysis using open access software, and data preservation and security. These findings are significant in highlighting the topics to cover in RDM training for social science graduate students. Additionally, RDM confidence and preparation differ between populations so being aware of the backgrounds of students taking the training will be essential for designing student-centered instruction.

The aim of the law is to maintain social order, peace, and justice in society, whereas the aim of ethics is to provide codes of ethics and conduct that help people to decide what is wrong, and how to act and behave. Laws provide a minimum set of standards for obtaining good human behavior. Ethics often provides standards that exceed the legal minimum. Therefore, for the best behavior, both law and ethics should be respected. The Internet of Things (IoT) involves a large number of objects and humans that are connected via the Internet ‘anytime’ and ‘anyplace’ to provide homogeneous communication and contextual services. Thus, it creates a new social, economic, political, and ethical landscape that needs new enhanced legal and ethical measures for privacy protection, data security, ownership protection, trust improvement, and the development of proper standards. This survey and opinion article is concerned with the ethics and legislation of the IoT and provides an overview of the following: definition and history of the IoT; general ethical principles and theories that are available for application in the IoT; the role of governments in the IoT; regulations in the European Union (EU) and United States for the IoT’ IoT characteristics that have the potential to create ethical problems; IoT ethical questions and principles; IoT security, privacy, and trust aspects; and the ethical culture of IoT-related companies.

The Transatlantic Trade and Investment Partnership (TTIP) is projected high-standard and inclusive free trade agreement which is being conversed between the United States (US) and European Union (EU). Transatlantic Trade and Investment Partnership is a chain of trade negotiations operating between EU and US. The TTIP is mainly about decreasing the regulatory obstacles to trade to open up a way for bigger businesses such as environmental legislation, food safety, sovereign powers of the individual nations and also banking regulations. The US and EU are two of the most integrated countries when it comes to economy globally. It is as a result of their trade in services, investments and the high commercial presence in each other's financial prudence. These two regions support each other when it comes to the economy, and that's why they are good trading partners in products and services. The EU and U.S trade and investment partnership which is sometimes referred to as transatlantic economy has a significant global relationship and creates a mutually beneficial understanding between the two states (Hoekman and Kostecki, 2009). The TTIP is one of the largest trade and investment partnership in the world and also the most significant because of its absolute size. It has many for example the European Union has 28 member states which include: Bulgaria, Cyprus, Belgium, Austria, Czech Republic, Estonia, Germany, Denmark, Finland. Greece, Ireland, Hungary, Italy, Netherlands, Poland, Slovenia, Lithuania, Romania, Spain, Latvia, Sweden, Portugal and United Kingdom are also part of the partnership. The initial negotiations on TTIP which was to become the first largest bilateral free trade and investment partnership agreement were earlier supported by a paramount and independent study of the Center for Economic Policy Research (CEPR). The study by CEPR was called Reduction of the Transatlantic Barriers to Trade and investment. The negotiations were mainly to provide independent advice to the two negotiators based on the additional research. Despite, TTIP being one of the largest trade and investment partnership, it has created both negative and positive impacts on the two states. There are benefits t being enjoyed by the member states such as job creation and home growth. The EU depends on the US exports; they can get investments from the US and also import the goods and services they require (Khanna, Palepu, and Sinha, 2005). Other positive impacts of the TTIP includes; upholding and promoting human rights, governing in a transparent manner that can hold to account individuals in authority and also has markets that can be open to free and reasonable competition and is well-regulated market areas. TTIP also protects the people and the planet through their international rules. For example, the rules look at everyone's health, their condition at workplaces, the endangered species around them and the entire environment. There are also challenges that have come out from TTIP in the field of politics and economics, poor labor standards, workers' rights and security of their workplaces, democracy, and state authority. Foreign shareholder protection, public health and the environment as a whole, health care, consumer safety and food security, climate change and environment protection, banking regulation and privacy and many others. Some competitors challenge the TTIP on slowness in services than in goods leading to difficulty in opening markets in service areas.

In September of 2017 Equifax, one of the three major consumer credit reporting agencies in the United States, announced its system security had been breached and confidential consumer information may have fallen into the hands of hackers. Although reports of system intrusions are released almost daily, this breach was of particular significance: sensitive data, including personal, identifying and financial data, was compromised for an estimated 143 million consumers in the United States. Just this week, Equifax further disclosed another 15 million client records were breached in the United Kingdom. Any consumer who has received credit of any kind is familiar with the big three credit reporting agencies—Equifax, TransUnion, and Experian—as these agencies house the financial identities American consumers. With such vast data stores, credit reporting agencies are prime and potentially profitable targets for hackers. All the information a hacker needs to steal a financial identify of a victim resides in the agencies’ files. Clearly, credit reporting agencies play a critical role in the financial marketplace. How these agencies became the powerful guardians and suppliers of consumer financial information is the topic of Josh Lauer’s book, Creditworthy: A History of Consumer Surveillance and Financial Identity in America. This is the first book authored by Lauer, who is an associate professor of media studies at the University of New Hampshire with specialties in media history and theory, communication technology, consumer and financial culture, and surveillance. Lauer relates in great detail how we moved from a society of relationships and human interaction to one of faceless data designed to symbolize character and reputation. Lauer’s history takes us from a time when Americans desired access to goods and services more than they valued confidentiality, to the financial privacy concerns of these surveillance systems today.

Objective – To explore how collection development policies currently support the role and purpose of prison libraries, and to explore if the accessibility of circulation records impacts on patron privacy. Design – Online survey questionnaire and a case study analysis of the existing policy statements of selected correctional institutions. Setting – The prison library sector in the United States. Subjects – 17 librarians and library staff across ten states in the United States. Methods – An eight-question online questionnaire was used to explore the existing collection development and circulation policies in prison libraries, and the level of adherence to the guidelines of the Association of Specialized and Cooperative Library Agencies (ASCLA) and the American Correctional Association (ACA). In addition, participants were encouraged to forward any circulation or collection development policy statements for more detailed analysis. Each policy was then reviewed to assess the degree of alignment or otherwise with the American Library Association’s (ALA) Prisoners’ Right to Read guidelines (2010). Main Results – The results of the survey found that 24% of libraries had no formal collection development policy, and at least 53% of libraries had no circulation policy statement. In these instances, the libraries were typically subject to the local policies and procedures of the correctional institution. The purpose of the library and its collection was primarily viewed as: providing recreational reading material; maintaining contact with the outside world and enabling re-entry into the community; and supporting vocational skills and lifelong learning. In selecting materials, the results indicated that a broadly similar approach to that of public libraries was adopted by most institutions, with the exception of any material that may pose a safety or security threat to the institution. In one institution the use of library services or resources for legal purposes or to provide legal assistance was also clearly prohibited in the collection development policy, although approximately half of the libraries did state that providing legal material was one of their roles. The lengthy and arduous approval process for ordering books and other materials (up to ten months in one instance) was reported by several participants due to the layers of bureaucracy and controls inherent in the prison setting. With regard to circulation records and confidentiality issues, 35% of libraries deleted such records instantly upon return of the items, compared with 30% that archived them. A further 29% only retained information from the current and most recent patrons for the purposes of assessing and charging for damaged items. Conclusion – The author found the prison library sector to be a relatively challenging environment. In this context, following the existing guidelines and best practice as recommended by the ALA and others, and establishing clear and ethical policy statements can help libraries to support the needs and rights of patrons more effectively.

Abstract The beef industry has come under scrutiny in recent decades over its perceived impacts on climate change from both climate scientists and the public. In the United States, only 3.8% of greenhouse gas (GHG) emissions come directly from livestock primarily from enteric methane (CH4) and nitrous oxide (N2O) emissions (EPA, 2021). While this is a small contribution, relative to other industries, beef cattle are important sources of atmospheric CH4, and mitigation of this gaseous emission has been highlighted as a tool to slow global climate change (Lynch et al., 2021). Unfortunately, there has not been significant investment in practical GHG mitigation solutions outside of continued progress in improvements in efficiency, which result in reduced emissions per unit of meat produced but has not decreased absolute GHG emissions. Recently, there has been an expansion of corporate sustainability programs and since the start of the COVID-19 pandemic, significant growth in environmental-social-governance investments which are creating more pressure for companies to act to reduce GHG emissions in their supply chains, referred to as scope 3 GHG emissions. This has spurred many companies in the meat, poultry, and dairy industries to make net-zero climate commitments that will impact producers. To meet these goals public-private partnerships will be crucial to develop strategies that are viable for producers to adopt while simultaneously accounting for regional differences in climate and management. This may include examining the potential for soil carbon sequestration, direct inhibitors of enteric CH4, reducing volatile N loss, and the adoption of GWP. In summary, while climate is the primary sustainability issue for today’s beef producers, we have the potential to be part of the solution while simultaneously improving food security, economic viability of produces, more resilient supply-chains, and the provision of other ecosystem services.

The implementation and continued expansion of telehealth services assists a variety of health care organizations in the delivery of care during the current COVID-19 global pandemic. However, limited research has been conducted on recent, rapid telehealth implementation and expansion initiatives regarding facilitators and barriers surrounding the provision of quality patient care. Our rapid review evaluated the literature specific to rapid telehealth implementation during the current COVID-19 pandemic from three research databases between January 2020 and May 2020 and reported using preferred reporting items for systematic reviews and meta-analyses (PRISMA). The results indicate the rapid implementation and enhanced use of telehealth during the COVID-19 pandemic in the United States surrounding the facilitators and barriers to the provision of patient care, which are categorized into three identified themes: (1) descriptive process-oriented implementations, (2) the interpretation and infusion of the CARES Act of 2020 telehealth exemptions related to the relaxation of patient privacy and security (HIPAA) protocols, and (3) the standard of care protocols and experiences addressing organizational liability and the standard of care. While the study limitation of sample size exists (n = 21), an identification of rapid telehealth implementation advancements and challenges during the current pandemic may assist health care organizations in the delivery of ongoing quality care during the COVID-19 pandemic.

European start-up companies must overcome more ‘transfer hurdles’ when personal data is transferred from the European Union to the US (United States of America) as part of crowdfunding campaign activities. Transfer of personal data is commonly not associated with (small scale) crowdfunding activities. However, the strict rules of the EU GDPR (European General Data Protection Regulation) on safeguarding personal data apply to all companies when data is transferred from the EU to the US - regardless the size of the business. This article identifies exchange of personal data that takes place between primarily fundraiser and crowdfunding service provider in different steps of fundraising campaigns. The framework for rewardbased crowdfunding for goods production that is provided by the US based Indiegogo platform is used as example and context. The article highlights by way of example the obligations that must be met by European fundraisers as "data controllers" when personal data is transferred to Indiegogo. No easy solutions are provided by either European Union or national data protection authorities on how to establish an adequate level of personal data protection. Paradigms on how to secure transfer of personal data to third countries are available in form of so-called standard contractual clauses, but still conditions for transfer of personal data from Europe to the US are hard to comply with. Apart from entering into an inter partes agreement on use of standard contractual clauses with the crowdfunding platform provider, a European fundraiser must furthermore make a so-called "transfer impact assessment" to ensure that third party access to personal data is avoided. In the case of transfer of personal data from the EU to the US the fundraiser must consider using encryption of data as a "supplementary measure" to block third party access. Encryption of data is however not suitable for exchange of data in a dynamic crowdfunding campaign so other means for protection of data must be found and applied. The reason and explanation for making data transfers from the EU to the US that hard for e.g., fundraisers are thus to be found at interstate level in the relation between the EU and the US. According to EU law, more specifically the GDPR and several of the provision of the Charter of Fundamental Rights of the European Union, US security legislation authorises a disproportionate access for US intelligence services to citizens' personal data. A solution on manageable transfer of personal data from the EU to the US may be found before the end of 2022, since a new TADP (Trans-Atlantic Data Privacy Framework) is currently being negotiated between EU and US at top politician level. However, the implementation of the TADP may take som time since the EU legislative framework needs adjustments to make the new transfer possibilities operational.

With the advent of GPS enabled smartphones, an increasing number of users is actively sharing their location through a variety of applications and services. Along with the continuing growth of Location-Based Social Networks (LBSNs), security experts have increasingly warned the public of the dangers of exposing sensitive information such as personal location data. Most importantly, in addition to the geographical coordinates of the user's location, LBSNs allow easy access to an additional set of characteristics of that location, such as the venue type or popularity. In this paper, we investigate the role of location semantics in the identification of LBSN users. We simulate a scenario in which the attacker's goal is to reveal the identity of a set of LBSN users by observing their check-in activity. We then propose to answer the following question: what are the types of venues that a malicious user has to monitor to maximize the probability of success? Conversely, when should a user decide whether to make his/her check-in to a location public or not? We perform our study on more than 1 million check-ins distributed over 17 urban regions of the United States. Our analysis shows that different types of venues display different discriminative power in terms of user identity, with most of the venues in the "Residence" category providing the highest re-identification success across the urban regions. Interestingly, we also find that users with a high entropy of their check-ins distribution are not necessarily the hardest to identify, suggesting that it is the collective behaviour of the users' population that determines the complexity of the identification task, rather than the individual behaviour.

Background Governments and health care providers are keen to find innovative ways to deliver care more efficiently. Interest in electronic consultation (e-consultation) has grown, but the evidence of benefit is uncertain. Objective This study aimed to assess the evidence of delivering e-consultation using secure email and messaging or video links in primary care. Methods A systematic review was conducted on the use and application of e-consultations in primary care. We searched 7 international databases (MEDLINE, EMBASE, CINAHL, Cochrane Library, PsycINFO, EconLit, and Web of Science; 1999-2017), identifying 52 relevant studies. Papers were screened against a detailed inclusion and exclusion criteria. Independent dual data extraction was conducted and assessed for quality. The resulting evidence was synthesized using thematic analysis. Results This review included 57 studies from a range of countries, mainly the United States (n=30) and the United Kingdom (n=13). There were disparities in uptake and utilization toward more use by younger, employed adults. Patient responses to e-consultation were mixed. Patients reported satisfaction with services and improved self-care, communication, and engagement with clinicians. Evidence for the acceptability and ease of use was strong, especially for those with long-term conditions and patients located in remote regions. However, patients were concerned about the privacy and security of their data. For primary health care staff, e-consultation delivers challenges around time management, having the correct technological infrastructure, whether it offers a comparable standard of clinical quality, and whether it improves health outcomes. Conclusions E-consultations may improve aspects of care delivery, but the small scale of many of the studies and low adoption rates leave unanswered questions about usage, quality, cost, and sustainability. We need to improve e-consultation implementation, demonstrate how e-consultations will not increase disparities in access, provide better reassurance to patients about privacy, and incorporate e-consultation as part of a manageable clinical workflow.

The Medicare Program is the second-largest insurance program in the United States, with approximately 64 million beneficiaries and total expenditures of over $839 billion in 2021 [1]. There are two separate trust funds in the Medicare Program, namely the Hospital Insurance Trust Fund (HI Trust Fund) and the Supplementary Medical Insurance Trust Fund (SMI Trust Fund); both trust funds are held by the U.S. Treasury [2]. The first trust fund covers hospital in-patient expenses; and the second trust fund covers medically necessary services by medical doctors and doctors of osteopathy, preventive services, brand-name prescription drugs, and generic drug coverage [3,4]. Prior to the COVID-19 pandemic, the latest financial calculations projected that the HI Trust Fund would be insolvent by the year 2026. It is a fact that the Medicare HI Trust Fund has never been insolvent because there are no provisions in the Social Security Act that govern what would happen if insolvency were to occur. Ten of the last twelve years have witnessed expenditure outflows outpacing the HI Trust inflows, resulting in total Medicare spending obligations outpacing the increasing demands on the Federal budget as the number of beneficiaries and the per capita healthcare costs increase each year [5]. Uncompensated care refers to uninsured patients who receive care upon hospital emergency room admissions but not ever paying the hospital bill after discharge or death. Uncompensated care is the kryptonite of hospital financing because it is unpredictable and can easily destabilize the monies that hospitals depend on to cover overhead expenses. Nationwide, hospitals protect themselves against the uncertainty of uncompensated care by drastically overcharging prices to different patients receiving the same or similar medical procedures at the very same hospital locations. For all intents and purposes, the creation of Obamacare failed to address this kryptonite. However, it is a fact that the legal system places limitations upon what the federal government can do to deal with this Achilles’ heel of the American healthcare system. State governments truly hold the power to effect change towards the future of healthcare in 2030, both private healthcare and government-sponsored healthcare. Since 1970, one state has proactively protected its statewide healthcare system against the dangers of uncompensated care: Maryland. It is the only state in the entire nation to receive a federal waiver from the U.S. Centers for Medicare & Medicaid Services (CMS) because their specific design for accounting for a plethora of poor patients. This effort started with a group of hospital administrators meeting for coffee on a consistent basis to brainstorm the solution from their collective hospitals. Driven by the pride to help their communities, their involvement with the Maryland government led to the creation of the Maryland Health Services Cost Review Commission (Maryland HSCRC). This impartial government institution is backed by Maryland law that gives it the necessary legal powers to set stated singular hospital prices for all services statewide; these prices include the adjustments for uncompensated medical care that is distributed among all stakeholders equally. In fact, the Maryland HSCRC wrote the law that requires all stakeholders to comply with detailed auditing and data submission requirements for the purpose of providing the federal government with complete transparency regarding healthcare information without violating HIIPA federal patient privacy regulations. With this powerful information, the agency restricts hospital costs without limiting hospital profits, accurately measuring patient volume, and predicting the financial condition of all inpatient and outpatient services in Maryland. Because the Maryland HSCRC is both funded by resident’s money and accountable to the public, the hospital savings are as follows: Maryland markups for hospital services increased from 18 percent in 1980 to only 22 percent in 2008. During the same period, the average nationwide markup for hospital services skyrocketed from less than 20 percent in 1980 to over 187 percent by 2008. It is because of these significant savings to the Medicare Program that the Maryland HSCRC continues to receive a CMS waiver every year. In terms of prices, Maryland hospitals are prohibited from giving volume discounts and shifting costs to 4 other payers. The agency enforces a simple and clear mandate: same prices for the same medical services at the same hospitals, no exceptions! Before leaving office, President Trump instructed the CMS to enforce a price transparency rule though separate machinereadable prices as a protection against the kryptonite of uncompensated medical care. After the authors studied the CMS proposal, it became clear that single-handedly imposing penalties for noncompliance is only one factor in this multidimensional problem. Unlike the extremely efficient Maryland system, the CMS has threatened all hospitals with what will be shown below, to be ineffective measures that yield worthless results. The “Price Transparency Final Rule” penalizes hospitals with fewer than 30 beds at $300 daily for each licensed bed at small hospitals, and large hospitals (more than 30 beds) at $10 daily per licensed bed (cannot exceed the daily penalty of $5,500). Our financial analysis in a prior article on this point, focuses on Free Cash Flow because it represented the cash that a hospital can generate after disbursing the money required to maintain and pursue opportunities that enhance shareholder value. We argued that the proposed CMS civil monetary penalties imposed on hospitals was doomed from the start for failure. Our financial analysis focuses on business valuation, and specifically an accounting term called Free Cash Flows (FCF), which represents the cash that a company can generate after laying out the money required to maintain or expand its asset base; FCF is important because it allows a company to 5 pursue opportunities that enhance shareholder value [6]. At Pettingill Analytics, we looked at three publicly traded hospitals in the United States reported the following (Figure 1) [7].

In this issue of Journal of Disaster Research, we introduce nine papers on societal responses to recent catastrophic disasters with special focus on long-term recovery processes in Japan and the United States. As disaster impacts increase, we also find that recovery times take longer and the processes for recovery become more complicated. On January 17th of 1995, a magnitude 7.2 earthquake hit the Hanshin and Awaji regions of Japan, resulting in the largest disaster in Japan in 50 years. In this disaster which we call the Kobe earthquake hereafter, over 6,000 people were killed and the damage and losses totaled more than 100 billion US dollars. The long-term recovery from the Kobe earthquake disaster took more than ten years to complete. One of the most important responsibilities of disaster researchers has been to scientifically monitor and record the long-term recovery process following this unprecedented disaster and discern the lessons that can be applied to future disasters. The first seven papers in this issue present some of the key lessons our research team learned from the studying the long-term recovery following the Kobe earthquake disaster. We have two additional papers that deal with two recent disasters in the United States – the terrorist attacks on World Trade Center in New York on September 11 of 2001 and the devastation of New Orleans by the 2005 Hurricane Katrina and subsequent levee failures. These disasters have raised a number of new research questions about long-term recovery that US researchers are studying because of the unprecedented size and nature of these disasters’ impacts. Mr. Mammen’s paper reviews the long-term recovery processes observed at and around the World Trade Center site over the last six years. Ms. Johnson’s paper provides a detailed account of the protracted reconstruction planning efforts in the city of New Orleans to illustrate a set of sufficient and necessary conditions for successful recovery. All nine papers in this issue share a theoretical framework for long-term recovery processes which we developed based first upon the lessons learned from the Kobe earthquake and later expanded through observations made following other recent disasters in the world. The following sections provide a brief description of each paper as an introduction to this special issue. 1. The Need for Multiple Recovery Goals After the 1995 Kobe earthquake, the long-term recovery process began with the formulation of disaster recovery plans by the City of Kobe – the most severely impacted municipality – and an overarching plan by Hyogo Prefecture which coordinated 20 impacted municipalities; this planning effort took six months. Before the Kobe earthquake, as indicated in Mr. Maki’s paper in this issue, Japanese theories about, and approaches to, recovery focused mainly on physical recovery, particularly: the redevelopment plans for destroyed areas; the location and standards for housing and building reconstruction; and, the repair and rehabilitation of utility systems. But the lingering problems of some of the recent catastrophes in Japan and elsewhere indicate that there are multiple dimensions of recovery that must be considered. We propose that two other key dimensions are economic recovery and life recovery. The goal of economic recovery is the revitalization of the local disaster impacted economy, including both major industries and small businesses. The goal of life recovery is the restoration of the livelihoods of disaster victims. The recovery plans formulated following the 1995 Kobe earthquake, including the City of Kobe’s and Hyogo Prefecture’s plans, all stressed these two dimensions in addition to physical recovery. The basic structure of both the City of Kobe’s and Hyogo Prefecture’s recovery plans are summarized in Fig. 1. Each plan has three elements that work simultaneously. The first and most basic element of recovery is the restoration of damaged infrastructure. This helps both physical recovery and economic recovery. Once homes and work places are recovered, Life recovery of the impacted people can be achieved as the final goal of recovery. Figure 2 provides a “recovery report card” of the progress made by 2006 – 11 years into Kobe’s recovery. Infrastructure was restored in two years, which was probably the fastest infrastructure restoration ever, after such a major disaster; it astonished the world. Within five years, more than 140,000 housing units were constructed using a variety of financial means and ownership patterns, and exceeding the number of demolished housing units. Governments at all levels – municipal, prefectural, and national – provided affordable public rental apartments. Private developers, both local and national, also built condominiums and apartments. Disaster victims themselves also invested a lot to reconstruct their homes. Eleven major redevelopment projects were undertaken and all were completed in 10 years. In sum, the physical recovery following the 1995 Kobe earthquake was extensive and has been viewed as a major success. In contrast, economic recovery and life recovery are still underway more than 13 years later. Before the Kobe earthquake, Japan’s policy approaches to recovery assumed that economic recovery and life recovery would be achieved by infusing ample amounts of public funding for physical recovery into the disaster area. Even though the City of Kobe’s and Hyogo Prefecture’s recovery plans set economic recovery and life recovery as key goals, there was not clear policy guidance to accomplish them. Without a clear articulation of the desired end-state, economic recovery programs for both large and small businesses were ill-timed and ill-matched to the needs of these businesses trying to recover amidst a prolonged slump in the overall Japanese economy that began in 1997. “Life recovery” programs implemented as part of Kobe’s recovery were essentially social welfare programs for low-income and/or senior citizens. 2. Requirements for Successful Physical Recovery Why was the physical recovery following the 1995 Kobe earthquake so successful in terms of infrastructure restoration, the replacement of damaged housing units, and completion of urban redevelopment projects? There are at least three key success factors that can be applied to other disaster recovery efforts: 1) citizen participation in recovery planning efforts, 2) strong local leadership, and 3) the establishment of numerical targets for recovery. Citizen participation As pointed out in the three papers on recovery planning processes by Mr. Maki, Mr. Mammen, and Ms. Johnson, citizen participation is one of the indispensable factors for successful recovery plans. Thousands of citizens participated in planning workshops organized by America Speaks as part of both the World Trade Center and City of New Orleans recovery planning efforts. Although no such workshops were held as part of the City of Kobe’s recovery planning process, citizen participation had been part of the City of Kobe’s general plan update that had occurred shortly before the earthquake. The City of Kobe’s recovery plan is, in large part, an adaptation of the 1995-2005 general plan. On January 13 of 1995, the City of Kobe formally approved its new, 1995-2005 general plan which had been developed over the course of three years with full of citizen participation. City officials, responsible for drafting the City of Kobe’s recovery plan, have later admitted that they were able to prepare the city’s recovery plan in six months because they had the preceding three years of planning for the new general plan with citizen participation. Based on this lesson, Odiya City compiled its recovery plan based on the recommendations obtained from a series of five stakeholder workshops after the 2004 Niigata Chuetsu earthquake. <strong>Fig. 1. </strong> Basic structure of recovery plans from the 1995 Kobe earthquake. <strong>Fig. 2. </strong> “Disaster recovery report card” of the progress made by 2006. Strong leadership In the aftermath of the Kobe earthquake, local leadership had a defining role in the recovery process. Kobe’s former Mayor, Mr. Yukitoshi Sasayama, was hired to work in Kobe City government as an urban planner, rebuilding Kobe following World War II. He knew the city intimately. When he saw damage in one area on his way to the City Hall right after the earthquake, he knew what levels of damage to expect in other parts of the city. It was he who called for the two-month moratorium on rebuilding in Kobe city on the day of the earthquake. The moratorium provided time for the city to formulate a vision and policies to guide the various levels of government, private investors, and residents in rebuilding. It was a quite unpopular policy when Mayor Sasayama announced it. Citizens expected the city to be focusing on shelters and mass care, not a ban on reconstruction. Based on his experience in rebuilding Kobe following WWII, he was determined not to allow haphazard reconstruction in the city. It took several years before Kobe citizens appreciated the moratorium. Numerical targets Former Governor Mr. Toshitami Kaihara provided some key numerical targets for recovery which were announced in the prefecture and municipal recovery plans. They were: 1) Hyogo Prefecture would rebuild all the damaged housing units in three years, 2) all the temporary housing would be removed within five years, and 3) physical recovery would be completed in ten years. All of these numerical targets were achieved. Having numerical targets was critical to directing and motivating all the stakeholders including the national government’s investment, and it proved to be the foundation for Japan’s fundamental approach to recovery following the 1995 earthquake. 3. Economic Recovery as the Prime Goal of Disaster Recovery In Japan, it is the responsibility of the national government to supply the financial support to restore damaged infrastructure and public facilities in the impacted area as soon as possible. The long-term recovery following the Kobe earthquake is the first time, in Japan’s modern history, that a major rebuilding effort occurred during a time when there was not also strong national economic growth. In contrast, between 1945 and 1990, Japan enjoyed a high level of national economic growth which helped facilitate the recoveries following WWII and other large fires. In the first year after the Kobe earthquake, Japan’s national government invested more than US$ 80 billion in recovery. These funds went mainly towards the repair and reconstruction of infrastructure and public facilities. Now, looking back, we can also see that these investments also nearly crushed the local economy. Too much money flowed into the local economy over too short a period of time and it also did not have the “trickle-down” effect that might have been intended. To accomplish numerical targets for physical recovery, the national government awarded contracts to large companies from Osaka and Tokyo. But, these large out-of-town contractors also tended to have their own labor and supply chains already intact, and did not use local resources and labor, as might have been expected. Essentially, ten years of housing supply was completed in less than three years, which led to a significant local economic slump. Large amounts of public investment for recovery are not necessarily a panacea for local businesses, and local economic recovery, as shown in the following two examples from the Kobe earthquake. A significant national investment was made to rebuild the Port of Kobe to a higher seismic standard, but both its foreign export and import trade never recovered to pre-disaster levels. While the Kobe Port was out of business, both the Yokohama Port and the Osaka Port increased their business, even though many economists initially predicted that the Kaohsiung Port in Chinese Taipei or the Pusan Port in Korea would capture this business. Business stayed at all of these ports even after the reopening of the Kobe Port. Similarly, the Hanshin Railway was severely damaged and it took half a year to resume its operation, but it never regained its pre-disaster readership. In this case, two other local railway services, the JR and Hankyu lines, maintained their increased readership even after the Hanshin railway resumed operation. As illustrated by these examples, pre-disaster customers who relied on previous economic output could not necessarily afford to wait for local industries to recover and may have had to take their business elsewhere. Our research suggests that the significant recovery investment made by Japan’s national government may have been a disincentive for new economic development in the impacted area. Government may have been the only significant financial risk-taker in the impacted area during the national economic slow-down. But, its focus was on restoring what had been lost rather than promoting new or emerging economic development. Thus, there may have been a missed opportunity to provide incentives or put pressure on major businesses and industries to develop new businesses and attract new customers in return for the public investment. The significant recovery investment by Japan’s national government may have also created an over-reliance of individuals on public spending and government support. As indicated in Ms. Karatani’s paper, individual savings of Kobe’s residents has continued to rise since the earthquake and the number of individuals on social welfare has also decreased below pre-disaster levels. Based on our research on economic recovery from the Kobe earthquake, at least two lessons emerge: 1) Successful economic recovery requires coordination among all three recovery goals – Economic, Physical and Life Recovery, and 2) “Recovery indices” are needed to better chart recovery progress in real-time and help ensure that the recovery investments are being used effectively. Economic recovery as the prime goal of recovery Physical recovery, especially the restoration of infrastructure and public facilities, may be the most direct and socially accepted provision of outside financial assistance into an impacted area. However, lessons learned from the Kobe earthquake suggest that the sheer amount of such assistance may not be effective as it should be. Thus, as shown in Fig. 3, economic recovery should be the top priority goal for recovery among the three goals and serve as a guiding force for physical recovery and life recovery. Physical recovery can be a powerful facilitator of post-disaster economic development by upgrading social infrastructure and public facilities in compliance with economic recovery plans. In this way, it is possible to turn a disaster into an opportunity for future sustainable development. Life recovery may also be achieved with a healthy economic recovery that increases tax revenue in the impacted area. In order to achieve this coordination among all three recovery goals, municipalities in the impacted areas should have access to flexible forms of post-disaster financing. The community development block grant program that has been used after several large disasters in the United States, provide impacted municipalities with a more flexible form of funding and the ability to better determine what to do and when. The participation of key stakeholders is also an indispensable element of success that enables block grant programs to transform local needs into concrete businesses. In sum, an effective economic recovery combines good coordination of national support to restore infrastructure and public facilities and local initiatives that promote community recovery. Developing Recovery Indices Long-term recovery takes time. As Mr. Tatsuki’s paper explains, periodical social survey data indicates that it took ten years before the initial impacts of the Kobe earthquake were no longer affecting the well-being of disaster victims and the recovery was completed. In order to manage this long-term recovery process effectively, it is important to have some indices to visualize the recovery processes. In this issue, three papers by Mr. Takashima, Ms. Karatani, and Mr. Kimura define three different kinds of recovery indices that can be used to continually monitor the progress of the recovery. Mr. Takashima focuses on electric power consumption in the impacted area as an index for impact and recovery. Chronological change in electric power consumption can be obtained from the monthly reports of power company branches. Daily estimates can also be made by tracking changes in city lights using a satellite called DMSP. Changes in city lights can be a very useful recovery measure especially at the early stages since it can be updated daily for anywhere in the world. Ms. Karatani focuses on the chronological patterns of monthly macro-statistics that prefecture and city governments collect as part of their routine monitoring of services and operations. For researchers, it is extremely costly and virtually impossible to launch post-disaster projects that collect recovery data continuously for ten years. It is more practical for researchers to utilize data that is already being collected by local governments or other agencies and use this data to create disaster impact and recovery indices. Ms. Karatani found three basic patterns of disaster impact and recovery in the local government data that she studied: 1) Some activities increased soon after the disaster event and then slumped, such as housing construction; 2) Some activities reduced sharply for a period of time after the disaster and then rebounded to previous levels, such as grocery consumption; and 3) Some activities reduced sharply for a while and never returned to previous levels, such as the Kobe Port and Hanshin Railway. Mr. Kimura focuses on the psychology of disaster victims. He developed a “recovery and reconstruction calendar” that clarifies the process that disaster victims undergo in rebuilding their shattered lives. His work is based on the results of random surveys. Despite differences in disaster size and locality, survey data from the 1995 Kobe earthquake and the 2004 Niigata-ken Chuetsu earthquake indicate that the recovery and reconstruction calendar is highly reliable and stable in clarifying the recovery and reconstruction process. <strong>Fig. 3.</strong> Integrated plan of disaster recovery. 4. Life Recovery as the Ultimate Goal of Disaster Recovery Life recovery starts with the identification of the disaster victims. In Japan, local governments in the impacted area issue a “damage certificate” to disaster victims by household, recording the extent of each victim’s housing damage. After the Kobe earthquake, a total of 500,000 certificates were issued. These certificates, in turn, were used by both public and private organizations to determine victim’s eligibility for individual assistance programs. However, about 30% of those victims who received certificates after the Kobe earthquake were dissatisfied with the results of assessment. This caused long and severe disputes for more than three years. Based on the lessons learned from the Kobe earthquake, Mr. Horie’s paper presents (1) a standardized procedure for building damage assessment and (2) an inspector training system. This system has been adopted as the official building damage assessment system for issuing damage certificates to victims of the 2004 Niigata-ken Chuetsu earthquake, the 2007 Noto-Peninsula earthquake, and the 2007 Niigata-ken Chuetsu Oki earthquake. Personal and family recovery, which we term life recovery, was one of the explicit goals of the recovery plan from the Kobe earthquake, but it was unclear in both recovery theory and practice as to how this would be measured and accomplished. Now, after studying the recovery in Kobe and other regions, Ms. Tamura’s paper proposes that there are seven elements that define the meaning of life recovery for disaster victims. She recently tested this model in a workshop with Kobe disaster victims. The seven elements and victims’ rankings are shown in Fig. 4. Regaining housing and restoring social networks were, by far, the top recovery indicators for victims. Restoration of neighborhood character ranked third. Demographic shifts and redevelopment plans implemented following the Kobe earthquake forced significant neighborhood changes upon many victims. Next in line were: having a sense of being better prepared and reducing their vulnerability to future disasters; regaining their physical and mental health; and restoration of their income, job, and the economy. The provision of government assistance also provided victims with a sense of life recovery. Mr. Tatsuki’s paper summarizes the results of four random-sample surveys of residents within the most severely impacted areas of Hyogo Prefecture. These surveys were conducted biannually since 1999,. Based on the results of survey data from 1999, 2001, 2003, and 2005, it is our conclusion that life recovery took ten years for victims in the area impacted significantly by the Kobe earthquake. Fig. 5 shows that by comparing the two structural equation models of disaster recovery (from 2003 and 2005), damage caused by the Kobe earthquake was no longer a determinant of life recovery in the 2005 model. It was still one of the major determinants in the 2003 model as it was in 1999 and 2001. This is the first time in the history of disaster research that the entire recovery process has been scientifically described. It can be utilized as a resource and provide benchmarks for monitoring the recovery from future disasters. <strong>Fig. 4.</strong> Ethnographical meaning of “life recovery” obtained from the 5th year review of the Kobe earthquake by the City of Kobe. <strong>Fig. 5.</strong> Life recovery models of 2003 and 2005. 6. The Need for an Integrated Recovery Plan The recovery lessons from Kobe and other regions suggest that we need more integrated recovery plans that use physical recovery as a tool for economic recovery, which in turn helps disaster victims. Furthermore, we believe that economic recovery should be the top priority for recovery, and physical recovery should be regarded as a tool for stimulating economic recovery and upgrading social infrastructure (as shown in Fig. 6). With this approach, disaster recovery can help build the foundation for a long-lasting and sustainable community. Figure 6 proposes a more detailed model for a more holistic recovery process. The ultimate goal of any recovery process should be achieving life recovery for all disaster victims. We believe that to get there, both direct and indirect approaches must be taken. Direct approaches include: the provision of funds and goods for victims, for physical and mental health care, and for housing reconstruction. Indirect approaches for life recovery are those which facilitate economic recovery, which also has both direct and indirect approaches. Direct approaches to economic recovery include: subsidies, loans, and tax exemptions. Indirect approaches to economic recovery include, most significantly, the direct projects to restore infrastructure and public buildings. More subtle approaches include: setting new regulations or deregulations, providing technical support, and creating new businesses. A holistic recovery process needs to strategically combine all of these approaches, and there must be collaborative implementation by all the key stakeholders, including local governments, non-profit and non-governmental organizations (NPOs and NGOs), community-based organizations (CBOs), and the private sector. Therefore, community and stakeholder participation in the planning process is essential to achieve buy-in for the vision and desired outcomes of the recovery plan. Securing the required financial resources is also critical to successful implementation. In thinking of stakeholders, it is important to differentiate between supporting entities and operating agencies. Supporting entities are those organizations that supply the necessary funding for recovery. Both Japan’s national government and the federal government in the U.S. are the prime supporting entities in the recovery from the 1995 Kobe earthquake and the 2001 World Trade Center recovery. In Taiwan, the Buddhist organization and the national government of Taiwan were major supporting entities in the recovery from the 1999 Chi-Chi earthquake. Operating agencies are those organizations that implement various recovery measures. In Japan, local governments in the impacted area are operating agencies, while the national government is a supporting entity. In the United States, community development block grants provide an opportunity for many operating agencies to implement various recovery measures. As Mr. Mammen’ paper describes, many NPOs, NGOs, and/or CBOs in addition to local governments have had major roles in implementing various kinds programs funded by block grants as part of the World Trade Center recovery. No one, single organization can provide effective help for all kinds of disaster victims individually or collectively. The needs of disaster victims may be conflicting with each other because of their diversity. Their divergent needs can be successfully met by the diversity of operating agencies that have responsibility for implementing recovery measures. In a similar context, block grants made to individual households, such as microfinance, has been a vital recovery mechanism for victims in Thailand who suffered from the 2004 Sumatra earthquake and tsunami disaster. Both disaster victims and government officers at all levels strongly supported the microfinance so that disaster victims themselves would become operating agencies for recovery. Empowering individuals in sustainable life recovery is indeed the ultimate goal of recovery. <strong>Fig. 6.</strong> A holistic recovery policy model.

The smallest of the nation's uniformed armed services, the United States Coast Guard's basic missions relate to maritime safety, mobility, and security; national defense, and natural resources protection. It is responsible for enforcement of maritime laws and marine environmental pollution response. The Coast Guard offers many career opportunities for enlisted personnel, including Marine Science Technician (MST). MSTs conduct marine-safety activities such as investigating pollution incidents and monitoring pollution clean-ups. Possible scientific duties include responding to oil and hazardous-materials spills, observing and forecasting weather. An increasing number of civilian employers are becoming more aware of the unique strengths former military personnel can bring with them to a consultant position. A consultant is someone who has expertise in a specific area or areas and offers unbiased opinions and advice for a fee. There are many reasons why the private and public sector need consultants for problem solving. One very important reason; Government regulatory compliance. Government regulations at all levels are constantly changing, and companies are frequently not prepared or trained to comply. Consultants may be retained to provide expertise to assist a company in complying economically, efficiently, and with the least amount of trauma to the organization. They can also be hired to provide in-house training to keep staff informed of new management and supervisory techniques or technical knowledge and to improve employee safety. Successful consultants often possess certain attributes. They can be identified with good physical and mental health, professional etiquette and courtesy, stability of behavior and self-confident. In addition to these skills, here are two military-related attributes that most companies find attractive and will help any organization simplify the task at hand. Loyalty to the Team. Military personnel bring with them an intrinsic understanding of how loyalty adds to team proficiency and builds trust in a work environment. For business leaders looking to make an improvement in their company, military personnel often outperform other candidates as proven team players, as demonstrated by hard work, motivation, and dedication. Reliable Work Ethic. Knowing the importance of adhering to a schedule and consistently performing well at work demonstrates professional maturity. One of the most difficult challenges to hiring professionals is being able to accurately judge candidates in these areas. Through service, training, and lifestyle, former military personnel will typically have the work ethic that any business owner would be thrilled to replicate in all of the organization's employees.

Explanations for the recent decline in the labor force attachment of males 65 years of age and older include the introduction of Old Age and Survivors Insurance and the growth in private pension programs. Neither hypothesis can explain the sizable decline that occurred between 1930 and 1950, when aggregate social security and private pension payments were small. Estimates from pooled state aggregate data indicate that the means-tested Old Age Assistance program established by the Social Security Act of 1935 significantly increased retirement activity in this period, particularly among low-income individuals.

Long-term care expenditures constitute one of the largest uninsured financial risks facing the elderly in the United States and thus play a central role in determining the retirement security of elderly Americans. In this essay, we begin by providing some background on the nature and extent of long-term care expenditures and insurance against those expenditures, emphasizing in particular the large and variable nature of the expenditures and the extreme paucity of private insurance coverage. We then provide some detail on the nature of the private long-term care insurance market and the available evidence on the reasons for its small size, including private market imperfections and factors that limit the demand for such insurance. We highlight how the availability of public long-term care insurance through Medicaid is an important factor suppressing the market for private long-term care insurance. In the final section, we describe and discuss recent long-term care insurance public policy initiatives at both the state and federal level.

Governments may perform health technology assessment (HTA) in their roles as a regulator in the public interest, as a source of information for decision makers in the public and private sectors, and/or as a purchaser or provider of healthcare services. The U.S. government's roles in the health sector as a regulator, source of information, and purchaser and provider of services are influenced both by characteristics of that sector and by its stakeholders' effectiveness in influencing national health policy debates.

A few years ago, a White Paper was published by the Confederation of European Security Services (CoESS) with the collaboration of the Institut National des Hautes Études de Sécurité (INHES) on the security market of the European Union. The authors identified several reasons why public and private security providers in the member states share the market and why they are bound to cooperate for the public good, that is, the security itself. However, the states’ law enforcement capacities cannot cover all security demands of the public due to the finite (mainly budgetary) resources that always set capacity limits hence congestions in the assignments of police services occur from time to time. Private security operatives fill into the supply gaps occurring in a fragmented security landscape in Europe. Due to the variables in the market share, countries made their patterns in public and private security components, the statutory frameworks, and the traditions concerning the role played by the commercial security sector in overall security provisions. Here a typology may be formed from the clusters of countries following alternative approaches, respectively. There is a border zone between the two sectors. The exclusive public security domain gives way to areas of common interest and moves on to where private security takes precedence, and public actors only play a supervisory role. This article examines the boundary zone in multiple approaches, attempting to stipulate the red line between the two security elements.

The healthcare systems of the United States and United Kingdom are vastly different. The former relies primarily on private sector incentives and market forces to allocate medical care services, while the latter is a centrally planned system funded almost entirely by the public sector. Therefore, each nation represents divergent views on the relative efficacy of the market or government in achieving social objectives in the area of medical care policy. Since its inception in 1948, the National Health Services (NHS) of the United Kingdom has consistently emphasized equity in the allocation of medical services. It has done so by creating a system whereby services are universally free of charge at the point of entry. Conversely, the United States has relied upon the evolution of a perplexing array of public and private sector insurance schemes centered more around consumer choice than equity in allocation.

Background With increased specialization of health care services and high levels of patient mobility, accessing health care services across multiple hospitals or clinics has become very common for diagnosis and treatment, particularly for patients with chronic diseases such as cancer. With informed knowledge of a patient’s history, physicians can make prompt clinical decisions for smarter, safer, and more efficient care. However, due to the privacy and high sensitivity of electronic health records (EHR), most EHR data sharing still happens through fax or mail due to the lack of systematic infrastructure support for secure, trustable health data sharing, which can also cause major delays in patient care. Objective Our goal was to develop a system that will facilitate secure, trustable management, sharing, and aggregation of EHR data. Our patient-centric system allows patients to manage their own health records across multiple hospitals. The system will ensure patient privacy protection and guarantee security with respect to the requirements for health care data management, including the access control policy specified by the patient. Methods We propose a permissioned blockchain-based system for EHR data sharing and integration. Each hospital will provide a blockchain node integrated with its own EHR system to form the blockchain network. A web-based interface will be used for patients and doctors to initiate EHR sharing transactions. We take a hybrid data management approach, where only management metadata will be stored on the chain. Actual EHR data, on the other hand, will be encrypted and stored off-chain in Health Insurance Portability and Accountability Act–compliant cloud-based storage. The system uses public key infrastructure–based asymmetric encryption and digital signatures to secure shared EHR data. Results In collaboration with Stony Brook University Hospital, we developed ACTION-EHR, a system for patient-centric, blockchain-based EHR data sharing and management for patient care, in particular radiation treatment for cancer. The prototype was built on Hyperledger Fabric, an open-source, permissioned blockchain framework. Data sharing transactions were implemented using chaincode and exposed as representational state transfer application programming interfaces used for the web portal for patients and users. The HL7 Fast Healthcare Interoperability Resources standard was adopted to represent shared EHR data, making it easy to interface with hospital EHR systems and integrate a patient’s EHR data. We tested the system in a distributed environment at Stony Brook University using deidentified patient data. Conclusions We studied and developed the critical technology components to enable patient-centric, blockchain-based EHR sharing to support cancer care. The prototype demonstrated the feasibility of our approach as well as some of the major challenges. The next step will be a pilot study with health care providers in both the United States and Switzerland. Our work provides an exemplar testbed to build next-generation EHR sharing infrastructures.

AbstractUnited States policy for national space launch capability provides for a balanced mix of launches, utilizing the Space Shuttle and Expendable Launch Vehicles (ELVs). It also directs government agencies to encourage and support the development of a domestic commercial expendable launch vehicle industry. This is to be accomplished by contracting for necessary ELV launch services directly from the private sector and by facilitating access by commercial launch firms to national launch and launch-related property and services they request to support these commercial operations.The current mixed fleet includes the Space Shuttle and four expendable launch vehicles - Titan, Atlas, Delta and Scout. New small class launch vehicles, including Pegasus, are in development. In addition, studies are underway to assure that the United States has cost-effective, reliable access to space, heavy-lift launch capability, and a new manned spacecraft after the current Space Shuttle reaches the end of its operational life. This paper will highlight the current capabilities of the mixed fleet and summarize the plans for new or modified United States launch vehicles through the first decade of the next century.

The un is increasingly relying on private military and security companies (pmscs) for a wide range of services. Until recently, un use of pmscs was not governed by systemwide rules and standards. The establishment of guidelines on the use of armed private security in late 2012 has led to greater accountability and transparency around this practice. The guidelines clarify the decision-making process and the criteria for the selection and hiring of companies providing armed security. However, they are overly reliant on self-regulation by pmscs and remain limited, raising questions about their capacity to avoid companies with objectionable records and prevent potential incidents. Moreover, the guidelines raise concerns that the use of pmscs by the un may become normalised, with yet unexamined effects on the organisation’s security policies and its image.