Peter R Chai, Stephanie Carreiro, Megan L Ranney, Ketki Karanam, Marko Ahtisaari, Robert Edwards, Kristin L Schreiber, Lubabah Ben-Ghaly, Timothy B Erickson, and Edward W Boyer. 2017. “Music as an Adjunct to Opioid-Based Analgesia.” J Med Toxicol, 13, 3, Pp. 249-254.Abstract
Epidemic increases in opioid use in the USA and globally highlight the need for effective adjunctive therapies to opioid-based analgesia. Given the shortcomings of behavioral adjuncts to opioid-based pain treatment, an urgent need exists for pain-related behavioral interventions that resonate with broad patient populations, can be delivered confidentially in any environment, and can incorporate new content automatically. Understanding the potential for automated behavioral therapies like music therapy in modulating the experience of pain may unlock methods to transition patients to lower doses of pharmacologic therapy or provide alternatives to opioids during acute exacerbations of pain. This manuscript describes the neurologic mechanism of action, theoretical basis, and potential applications of personalized music as a smartphone-based mHealth intervention for acute and chronic pain management.
The wars in the Middle East have led to unprecedented threats and attacks on patients, healthcare workers, and purposeful targeting of hospitals and medical facilities. It is crucial that every healthcare provider, both civilian and military, on either side of the conflict become aware of the unique and inherent protections afforded to them under International Humanitarian Law. However, these protections come with obligations. Whereas Governments must guarantee these protections, when violated, medical providers have equal duty and obligations under the Law to ensure that they will neither commit nor assist in these violations nor take part in any act of hostility. Healthcare providers must not allow any inhuman or degrading treatment of which they are aware and must report such actions to the appropriate authorities. Failure to do so leads to risks of moral, ethical and legal consequences as well as penalties for their actions and inactions. There must be immediate recognition by all parties of the neutrality of health care workers and their rights and responsibilities to care for any sick and injured patient, regardless of their nationality, race, religion, or political point of view.
Signal Program Standards and Ethics Series - Issue 1
Data are a central component of humanitarian response. Frequently, however, there is a disconnect between data, decision-making and response. Informed decisions need to be made in the first hours and days of an emergency, and if the elements to effectively gather, manage and analyse data are not in place before a crisis, then the evidence needed to inform response will not be available quickly enough to matter. What's more, a lack of readiness to use data can even cause "big data disasters".
Organizations need to be prepared to responsibly and effectively deploy and manage data collection and analysis tools, techniques, skilled staff and strategies in a specific operational context to be ready before a disaster strikes. This process is called “data preparedness”. The concept of data preparedness complements and expands on existing OCHA principles on the use of information management in disaster scenarios. This paper, which was reviewed by OCHA and other UN organizations, seeks to provide a blueprint for how the concept of data preparedness may be put into practice by members of the humanitarian data ecosystem. It is the first issue in the Signal Program's ongoing "Standards and Ethics" white paper series.
Negotiations for access are crucial for the success of humanitarian operations. They also occur in contexts of armed conflict and violence that typically entrench gender identities. Building on the vast research showing that gender affects the conduct and outcome of negotiations, this paper explores gender dynamics in a humanitarian setting. After outlining its methodology and surveying the relevant literature, this paper sketches out the ways 21 practitioners at the International Committee of the Red Cross see gender dynamics affecting their work in the field. These interviews support previous findings on men and women’s diverging conceptions of gender’s impact and relevance, as well as on the cross-cultural consistency of gender dynamics in war. In a context where, unlike in many corporate settings, women’s work as humanitarian actors is congruent with prescriptive gender stereotypes, this study shows that they can be perceived as more legitimate because they are thought of as selfless caregivers and potential mothers. This paper ultimately argues that, rather than studying the impact of gender in isolation, further research should explore how the intersectionality of different diversity dimensions—such as gender, race/ethnicity, age, and religion—affect humanitarian negotiations. In terms of policy implications, this study makes the case for actively fostering diversity, including in terms of gender, within negotiating teams to ensure they are more flexible in adapting to different scenarios and more creative in dealing with complex problems.
Given the current humanitarian crisis in Syria where patients, healthcare workers, and hospitals are under attack, we the undersigned, without presumption of authority or judgment, stand in solidarity with our healthcare colleagues and declare their right to international health neutrality. For many decades, we have provided global healthcare professionals with education and training in humanitarian assistance in sudden onset disasters and conflicts worldwide. In this training and education, each and every healthcare provider, both civilian and military, is made aware of the inherent protections provided to them under international humanitarian law (IHL), including the four Geneva Conventions of 1949, as well as the principles and rules of IHL applicable to the conduct of hostilities, including the targeting of hospitals and medical facilities. These must be upheld.
This paper introduces a preliminary analytical framework that re-conceptualizes fragility and resilience at the city level. It aligns the two concepts across a range of political, social, economic and environmental factors enabling comparison across thousands of cities globally based on existing data. The framework was then partially applied to map out fragility in over 2,100 cities. It finds that roughly 14 percent of the sample score in the highly fragile range. Another 66 percent report average levels of fragility while 16 percent report low fragility.4 Of course, fragility and resilience are both dynamic and change over time. The paper finds that all cities are fragile to some degree, though intensity varies in relation to the aggregation of risk.
This paper presents an overview of key challenges and dilemmas faced in the protection of humanitarian action and aims to provide an initial overview of the legal, policy, and operational trends and issues identified by ATHA through its ongoing research and discussions with practitioners. On the basis of this analysis, this paper addresses three key areas. The first section highlights knowledge and questions regarding security incidents, trends, and causes of violence, including around causes and motives for attacks, and tensions between individual and collective responses. The next section then explores the role of the humanitarian principles, and the perceptions of humanitarian actors, in affecting their security in the field. Building on this, the final section examines the protection of humanitarian action under international law, and the impunity gap resulting from effective implementation or enforcement of the law. The purpose of this paper is to provide key background information and to serve as a starting point for dialogue and reflection on the protection of humanitarian action from attack. It is based on research and consultations with experts and humanitarian practitioners in the field.
This report focuses on the role that laws and norms play in humanitarian negotiations. The report is based on an initial set of 35 interviews that conducted by the Advanced Training Program on Humanitarian Action (ATHA) with humanitarian professionals between May and August 2016. This document will sketch out ATHA’s preliminary findings and analysis. The report is divided into five sections. Section I offers information about the methodology of the interviews that constitute the core empirical foundation for this report’s findings. Section II focuses on the role of international laws and norms in humanitarian negotiations. Section III addresses other sources of laws and norms (e.g., national laws and Islamic Law) that humanitarian practitioners have integrated into their negotiations. Section IV examines the relationship between interests and legal norms in the practice of humanitarian negotiation. Section V offers concluding remarks.
The Philippines is one of the top countries in the world at risk of climate-related disasters. For populations subsisting at the poverty line in particular, but also the nation as a whole, daily lives and wellbeing are routinely challenged. The Philippines government takes disaster risk seriously and has devoted significant resources to build disaster capacity and reduce population exposure and vulnerability, nationally and locally. This paper explores the policy and institutional mechanisms for disaster risk reduction management and research which have been conducted in the Philippines related to disaster preparedness, management and resilience.
Building data responsibility into humanitarian action is the first UN Office for Coordination of Humanitarian Affairs think brief to explore what constitutes the responsible use of data in humanitarian response. It was co written by the Signal Program, NYU Gov Lab and the Center for Innovation at Leiden University.
This paper identifies the critical issues humanitarians face as they strive to responsibly use data in operations. It also proposes an initial framework for data responsibility.
Globally, an estimated 300,000 children under the age of 18 participate in combat situations; those in armed groups in particular suffer prolonged exposure to psychological and physical abuse. The Lord’s Resistance Army (LRA) is a rebel movement known for its widespread conscription of children; yet little is known about this process once the group moved beyond northern Uganda. In this paper, we describe the processes related to abduction and indoctrination of youth by the LRA in northeastern Democratic Republic of the Congo ( DRC).
This paper examines the role of mixed and multi-level methods datasets used to inform evaluations of transitional justice mechanisms. The Colombia reparation program for victims of war is used to illustrate how a convergent design involving multiple datasets can be used to evaluate the effectiveness of a complex transitional justice mechanism. This was achieved through a unique combination of (1) macro-level analysis enabled by a global dataset of transitional justice mechanisms, in this case the reparations data gathered by the Transitional Justice Research Collaborative, (2) meso-level data gathered at the organizational level on the Unidad para las Victimas (Victims Unit), the organization in charge of implementing the reparations program and overseeing the domestic database of victims registered in the reparations program, and (3) micro-level population- based perception datasets on the Colombian reparations program collected in the Peacebuilding Data database. The methods used to define measures, access existing data, and assemble new datasets are discussed, as are some of the challenges faced by the inter-disciplinary team. The results illustrate how the use of global, domestic, and micro- level datasets together yields high quality data, with multiple perspectives permitting the use of innovative evaluation methods and the development of important findings and recommendations for transitional justice mechanisms.
Typhoon Haiyan devastated the central Philippines in November 2013, claiming more than 6,300 lives, displacing more than 4 million people, and disrupting the economy and livelihoods in some of the country’s poorest regions for years to come.
The Haiyan response has been held up as a largely effective humanitarian operation, and the transition from response to recovery phases was swift. However, evaluations have also found that the international operation failed to adequately join with national systems and overlooked civil society coordination opportunities.
With these coordination gaps and potential opportunities in mind, this discussion paper examines factors that affected the Philippine government’s ability to coordinate the Haiyan response and the international community’s ability to participate.
A limited body of research has examined satisfaction with work–life balance of expatriate workers who live abroad, residing outside the typical “family” or “life” domain. This study aims to demonstrate how and under which organizational circumstances job autonomy can increase work–life balance satisfaction of humanitarian aid expatriates. We hypothesize that especially in humanitarian work, trust in management can buffer potential negative effects of high autonomy. We test our hypothesis by means of ordinal logistic regression, using survey data collected among expatriates of the Operational Center Amsterdam of Médecins Sans Frontières (N = 142). Results reveal that high levels of autonomy are positively related with work–life balance satisfaction when trust in the management of the organization is high. When trust in management is low, the effect of high autonomy on work–life balance satisfaction is negative. This implies that trust in management indeed buffers negative effects of high autonomy among expatriate humanitarian aid workers.
At present, accepted methodologies for wind disaster damage assessments rely almost exclusively on responders having ground access to the affected area to document damage to housing structures. This approach can prove both time consuming and inefficient, and does not support the use of drones and satellites.
Geospatially-based damage assessments offer potential improvements to this process in terms of providing responding agencies with previously unavailable information about hard to reach, often non-permissive environments, at a scale and speed not possible through ground-based counts of damaged structures.
This guide provides the first standard method for conducting these types of damage assessments through the analysis of drone and satellite imagery. The “BAR Methodology” has been developed by the Signal Program on Human Security and Technology at HHI to address this critical gap in this evolving area humanitarian practice.
This scoping study maps government, community-based organizations, national and international non-governmental organizations, private sector initiatives, and research and academic institutions working on disaster preparedness and response in the Philippines.
The study provides the basis for undertaking a series of research studies to designed to identify the leading contributing factors that determine effective disaster preparedness measures and the antecedents of high measures of community-based disaster resilience.
This poll is the fifth in a series of polls that will be conducted to provide reliable data and analysis on peace, security, justice and reconstruction in the Democratic Republic of the Congo. The project is a joint initiative of the Harvard Humanitarian Initiative (HHI) and the United Nations Development Programme (UNDP), in collaboration with MONUSCO Civil Affairs. HHI is responsible for the data collection, and independent analysis, and reporting of the results, in collaboration with partners at the Université Libre des Pays des Grands Lacs, Université Catholique de Bukavu, and Université de Bunia.
As cities, especially coastal megacities, continue to grow often through rapid unplanned urbanization, populations are increasingly concentrated in climate change-affected hazard-prone spaces. How these populations interact with their environments will ultimately influence their vulnerability to climate-related disaster. Yet the interdependence between human and environmental systems, especially in the urban slum context, is under-researched and represents an important gap in our understanding. Using a socio-ecological system approach provides a holistic framework to understand vulnerability.
Burns are a common source of injuries worldwide, with a high burden of disease in low- and middle-income countries. Burns also account for 2%-8% of wilderness injuries. Although many are minor, the potential for serious morbidity and mortality exists, and standard treatments used in high-resource settings are not readily available in the backcountry. A literature review was performed to find evidence from low-resource settings that supports alternative or improvised therapies that may be adapted to care of burns in the wilderness. There is good evidence for use of oral rehydration to support volume status in burn patients. There is moderate evidence to support cold therapy as first aid and adjunct for pain control. Some evidence supports use of alternative dressings such as boiled potato peel, banana leaf, aloe vera, honey, sugar paste, and papaya when standard therapies are not available.
This briefing note aims to support the humanitarian sector’s efforts to apply a deeper level of analytical and strategic thinking to humanitarian negotiation. Toward this end, it provides an overview of how the rich body of literature focused on negotiations in other contexts—political, commercial, and legal settings, for example—can inform our understanding of humanitarian negotiation. In particular, this briefing note focuses on five analytical approaches to negotiation: (1) distributive, or power-based, negotiation; (2) integrative, or interest-based, negotiation; (3) basic human needs-based negotiation; (4) the behavioral approach to negotiation; and (5) culture as a factor in negotiation. By examining humanitarian negotiation through the lens of these five approaches, this briefing note seeks to shed light on the potential factors that drive humanitarian negotiations and to promote further scholarly analysis and professional reflection in this field.