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Concept: United States Department of Homeland Security


Immigrant children seeking safe haven in the United States, whether arriving unaccompanied or in family units, face a complicated evaluation and legal process from the point of arrival through permanent resettlement in communities. The conditions in which children are detained and the support services that are available to them are of great concern to pediatricians and other advocates for children. In accordance with internationally accepted rights of the child, immigrant and refugee children should be treated with dignity and respect and should not be exposed to conditions that may harm or traumatize them. The Department of Homeland Security facilities do not meet the basic standards for the care of children in residential settings. The recommendations in this statement call for limited exposure of any child to current Department of Homeland Security facilities (ie, Customs and Border Protection and Immigration and Customs Enforcement facilities) and for longitudinal evaluation of the health consequences of detention of immigrant children in the United States. From the moment children are in the custody of the United States, they deserve health care that meets guideline-based standards, treatment that mitigates harm or traumatization, and services that support their health and well-being. This policy statement also provides specific recommendations regarding postrelease services once a child is released into communities across the country, including a coordinated system that facilitates access to a medical home and consistent access to education, child care, interpretation services, and legal services.

Concepts: Health care, Medicine, European Union, United States, Immigration, Barack Obama, Immigration to the United States, United States Department of Homeland Security


The United States system of immigrant detention centers has been the subject of considerable scrutiny with respect to health care of detainees. We sought to characterize the rates and types of deaths that have occurred within this system between the years 2003-2015. We analyzed a file of detainee deaths released by the U.S. Department of Homeland Security as part of a freedom of information request. Between 2003 and 2015, 150 deaths were recorded. During this time period, the annual rate of death among detainees dropped dramatically, whether measured by annual admissions or by person years of exposure. The most common causes of death were cardiovascular, cancer and suicide. More research is needed to adequately account for the contributors to these declining rates of death in immigration detention settings.

Concepts: Death, Demography, Population, United States, Immigration to the United States, Detention, United States Department of Homeland Security, Immigration detention


During June-July 2015, Public Health-Seattle & King County (PHSKC) and Washington State Department of Health (WADOH) investigated 22 clusters of Salmonella serotype I 4,[5], 12:i:- infections. Serotype I 4,[5], 12:i:- is the fifth most frequently reported Salmonella serotype in the United States, but is uncommon in Washington.* On July 29, 2015, WADOH and PHSKC requested assistance from CDC to identify the infection source, determine risk factors, and make recommendations for prevention.

Concepts: United States, Saudi Arabia, Poverty in the United States, U.S. state, Alaska, Washington, Martin Luther King, Jr., United States Department of Homeland Security


Recent clinical practice guidelines from major national organizations, including a joint United States Department of Veterans Affairs (VA) and Department of Defense (DoD) committee, have substantially changed recommendations for the use of the cholesterol-lowering statin medications after years of relative stability. Because statin medications are among the most commonly prescribed treatments in the United States, any change in their use may have significant implications for patients and providers alike. Prior research has shown that effective implementation interventions should be both user centered and specifically chosen to address identified barriers.

Concepts: Clinical trial, United States, Statin, Implementation, Design, United States Marine Corps, United States Department of Defense, United States Department of Homeland Security


Excessive alcohol consumption is associated with a substantial number of emergency department visits annually and is responsible for a significant number of lives lost each year in the United States. However, a minimal amount is known about the impact of alcohol on the EMS system.

Concepts: Alcohol, United States, Ethanol, Wheat, Saudi Arabia, U.S. state, Wine, United States Department of Homeland Security



Obesity is a worldwide epidemic, and its prevalence is higher among Veterans in the United States. Based on our prior research, primary care teams at a Veterans Affairs (VA) hospital do not feel well-equipped to deliver effective weight management counseling and often lack sufficient time. Further, effective and intensive lifestyle-based weight management programs (e.g. VA MOVE! program) are underutilized despite implementation of systematic screening and referral at all VA sites. The 5As behavior change model (Assess, Advise, Agree, Assist, Arrange) is endorsed by the United States Preventive Service Task Force for use in counseling patients about weight management in primary care and reimbursed by Medicare. In this paper, we describe the iterative development of a technology-assisted intervention designed to provide primary care-based 5As counseling within Patient-Centered Medical Homes without overburdening providers/healthcare teams.

Concepts: United States, United Kingdom, Poverty in the United States, U.S. state, Program management, Primary election, United States Department of Homeland Security


The Livestock Emergency Response Plan (LERP) was published in 2014 as a toolkit to assist state agricultural emergency planners in writing or modifying state foreign animal disease/high-consequence disease (FAD/HCD) plans. This research serves as a follow-up to and expands on an initial survey conducted in 2011 by the Department of Homeland Security Office of Health Affairs, Food, Ag, and Veterinary Defense Branch. The purpose of this project is to describe the status of current state animal disease response plans in relation to how closely their content, order, and terminology relate to that described in the LERP template. The analysis was compared to the 2011 study to identify advances, trends, continued areas for increased alignment, and fulfillment of planning gaps in individual state plans. While vast improvements were made in the status of state animal disease response plans from 2011 to 2016, there is nonetheless significant room for enhancing consistency between and identifying gaps in FAD/HCD plans. As awareness of the LERP toolkit grows, the authors hope its use as a template by the states will expand accordingly, thereby increasing consistency between plans and more thoroughly addressing challenges in an FAD/HCD outbreak. The results of this study support the need for curriculum planning resources at the state level. Development of a training curriculum and planning workshops for state agriculture emergency planners will produce a consistent planning philosophy and skill set among state planners-another means of indirectly addressing current planning gaps in agricultural emergency response.

Concepts: Agriculture, Management, Project management, State, Planning, Plan, Consistency, United States Department of Homeland Security


This article presents a public value measure that can be used to aid executives in the public sector to better assess policy decisions and maximize value to the American people. Using Transportation Security Administration (TSA) programs as an example, we first identify the basic components of public value. We then propose a public value account to quantify the outcomes of various risk scenarios, and we determine the certain equivalent of several important TSA programs. We illustrate how this proposed measure can quantify the effects of two main challenges that government organizations face when conducting enterprise risk management: (1) short-term versus long-term incentives and (2) avoiding potential negative consequences even if they occur with low probability. Finally, we illustrate how this measure enables the use of various tools from decision analysis to be applied in government settings, such as stochastic dominance arguments and certain equivalent calculations. Regarding the TSA case study, our analysis demonstrates the value of continued expansion of the TSA trusted traveler initiative and increasing the background vetting for passengers who are afforded expedited security screening.

Concepts: Risk, Decision theory, Probability, Uncertainty, Government, Airport security, United States Department of Homeland Security, Transportation Security Administration


Introduction Members of faith-based organizations (FBOs) are in a unique position to provide support and services to their local communities during disasters. Because of their close community ties and well-established trust, they can play an especially critical role in helping communities heal in the aftermath of a mass-fatality incident (MFI). Faith-based organizations are considered an important disaster resource and partner under the National Response Plan (NRP) and National Response Framework; however, their level of preparedness and response capabilities with respect to MFIs has never been evaluated. The purpose of this study was threefold: (1) to develop appropriate measures of preparedness for this sector; (2) to assess MFI preparedness among United States FBOs; and (3) to identify key factors associated with MFI preparedness. Problem New metrics for MFI preparedness, comprised of three domains (organizational capabilities, operational capabilities, and resource sharing partnerships), were developed and tested in a national convenience sample of FBO members.

Concepts: United States, Organization, Disaster, Partnership, Faith-based, United States Department of Homeland Security, National Response Plan, National Response Framework