Mars exploration motivates the search for extraterrestrial life, the development of space technologies, and the design of human missions and habitations. Here, we seek new insights and pose unresolved questions relating to the natural history of Mars, habitability, robotic and human exploration, planetary protection, and the impacts on human society. Key observations and findings include:

1. – high escape rates of early Mars' atmosphere, including loss of water, impact present-day habitability;

2. – putative fossils on Mars will likely be ambiguous biomarkers for life;

3. – microbial contamination resulting from human habitation is unavoidable; and

4. – based on Mars' current planetary protection category, robotic payload(s) should characterize the local martian environment for any life-forms prior to human habitation.

Some of the outstanding questions are:

1. – which interpretation of the hemispheric dichotomy of the planet is correct;

2. – to what degree did deep-penetrating faults transport subsurface liquids to Mars' surface;

3. – in what abundance are carbonates formed by atmospheric processes;

4. – what properties of martian meteorites could be used to constrain their source locations;

5. – the origin(s) of organic macromolecules;

6. – was/is Mars inhabited;

7. – how can missions designed to uncover microbial activity in the subsurface eliminate potential false positives caused by microbial contaminants from Earth;

8. – how can we ensure that humans and microbes form a stable and benign biosphere; and

9. – should humans relate to putative extraterrestrial life from a biocentric viewpoint (preservation of all biology), or anthropocentric viewpoint of expanding habitation of space?

Studies of Mars' evolution can shed light on the habitability of extrasolar planets. In addition, Mars exploration can drive future policy developments and confirm (or put into question) the feasibility and/or extent of human habitability of space.

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

The hallmark of a successful response to a nuclear detonation will be the resilience of the community, region, and nation. An incident of this magnitude will rapidly become a national incident; however, the initial critical steps to reduce lives lost, save the lives that can be saved with the resources available, and understand and apply resources available to a complex and dynamic situation will be the responsibility of the local and regional responders and planners. Expectations of the public health and health care systems will be met to the extent possible by coordination, cooperation, and an effort to produce as consistent a response as possible for the victims. Responders will face extraordinarily stressful situations, and their own physical and psychological health is of great importance to optimizing the response. This article illustrates through vignettes and supporting text how the incident may unfold for the various components of the health and medical systems and provides additional context for the discipline-related actions outlined in the state and local planners’ playbook.

(Disaster Med Public Health Preparedness. 2011;5:S73-S88)

Based on background information in this special issue of the journal, possible triage recommendations for the first 4 days following a nuclear detonation, when response resources will be limited, are provided. The series includes: modeling for physical infrastructure damage; severity and number of injuries; expected outcome of triage to immediate, delayed, or expectant management; resources required for treating injuries of varying severity; and how resource scarcity (particularly medical personnel) worsens outcome. Four key underlying considerations are: 1.) resource adequacy will vary greatly across the response areas by time and location; 2.) to achieve fairness in resource allocation, a common triage approach is important; 3.) at some times and locations, it will be necessary to change from “conventional” to “contingency” or “crisis” standards of medical care (with a resulting change in triage approach from treating the “sickest first” to treating those “most likely to survive” first); and 4.) clinical reassessment and repeat triage are critical, as resource scarcity worsens or improves. Changing triage order and conserving and allocating resources for both lifesaving and palliative care can maintain fairness, support symptomatic care, and save more lives. Included in this article are printable triage cards that reflect our recommendations. These are not formal guidelines. With new research, data, and discussion, these recommendations will undoubtedly evolve.

(Disaster Med Public Health Preparedness. 2011;5:S111-S121)

For efficient and effective medical responses to mass casualty events, detailed advanced planning is required. For federal responders, this is an ongoing responsibility. The US Department of Health and Human Services (DHHS) prepares playbooks with formal, written plans that are reviewed, updated, and exercised regularly. Recognizing that state and local responders with fewer resources may be helped in creating their own event-specific response plans, subject matter experts from the range of sectors comprising the Scarce Resources for a Nuclear Detonation Project, provided for this first time a state and local planner's playbook template for responding to a nuclear detonation. The playbook elements are adapted from DHHS playbooks with appropriate modification for state and local planners. Individualization by venue is expected, reflecting specific assets, populations, geography, preferences, and expertise. This playbook template is designed to be a practical tool with sufficient background information and options for step-by-step individualized planning and response.

(Disaster Med Public Health Preparedness. 2011;5:S89-S97)

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

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

A 10-kiloton (kT) nuclear detonation within a US city could expose hundreds of thousands of people to radiation. The Scarce Resources for a Nuclear Detonation Project was undertaken to guide community planning and response in the aftermath of a nuclear detonation, when demand will greatly exceed available resources. This article reviews the pertinent literature on radiation injuries from human exposures and animal models to provide a foundation for the triage and management approaches outlined in this special issue. Whole-body doses >2 Gy can produce clinically significant acute radiation syndrome (ARS), which classically involves the hematologic, gastrointestinal, cutaneous, and cardiovascular/central nervous systems. The severity and presentation of ARS are affected by several factors, including radiation dose and dose rate, interindividual variability in radiation response, type of radiation (eg, gamma alone, gamma plus neutrons), partial-body shielding, and possibly age, sex, and certain preexisting medical conditions. The combination of radiation with trauma, burns, or both (ie, combined injury) confers a worse prognosis than the same dose of radiation alone. Supportive care measures, including fluid support, antibiotics, and possibly myeloid cytokines (eg, granulocyte colony-stimulating factor), can improve the prognosis for some irradiated casualties. Finally, expert guidance and surge capacity for casualties with ARS are available from the Radiation Emergency Medical Management Web site and the Radiation Injury Treatment Network.

(Disaster Med Public Health Preparedness. 2011;5:S32-S44)

Background: We describe the hospital system response to the Interstate 35W bridge collapse in Minneapolis into the Mississippi River on August 1, 2007, which resulted in 13 deaths and 127 injuries. Comparative analysis of response activities at the 3 hospitals that received critical or serious casualties is provided.

Methods: First-hand experiences of hospital physicians, issues identified in after-action reports, injury severity scores, and other relevant patient data were collected from the 3 hospitals that received seriously injured patients, including the closest hospitals to the collapse on each side of the river.

Results/Discussion: Injuries were consistent with major acceleration/deceleration force injuries. The most critical patients arrived first at each hospital, suggesting appropriate prehospital triage. Capacity of the health care system was not overwhelmed and the involved hospitals generally reported an overresponse by staff. Communication and patient tracking problems occurred at all of the hospitals. Situational awareness was limited due to the scope of structural collapse and incomplete information from the scene.

Conclusions: Hospitals were generally satisfied with their surge capacity and incident management plan activation. Issues such as communications, patient tracking, and staff overreporting that have been identified in past incidents also were problematic in this event. Hospitals will need to address deficiencies and build on successful actions to cope with future, potentially larger incidents. (Disaster Med Public Health Preparedness. 2008;2(Suppl 1):S11–S16)

C'est aux gouvemements qu'appartient la responsabilité premiàre de la mise en ceuvre du droit international des droits de l'homme et du droit humanitaire lors des conflits armés. En cas de conflit armé ne présentant pas un caractére international, la responsabilité de veiller au respect de ces normes incombe à la fois aux gouvemements et aux groupes armés d'opposition.

The traditional explanations of Italy's post-Renaissance decline are almost too well-known to bear repeating: northern economic competition, the opening of new trade routes bypassing the Mediterranean, the French and Spanish invasions and eventual Spanish domination of much of the peninsula, and so on. There is no doubt they were of significance. But explicit in all of them are “foreign” influences of one sort or another: Italy is pictured as simply an unwilling but helpless victim of the rise of the European nationstates. It is suggested that the northern Italian states also posessed within themselves the seeds of decline. Inherent in their economy, in the structure of their society, and in their political institutions were forces which, together with forces from outside, shaped the character of post-Renaissance Italy. It is suggested further that these forces were discernible in many states by the end of the fifteenth century.

Los Gobiemos son los principales responsables de la aplicación del derecho internacional de los derechos humanos y del derecho humanitario en tiempo de conflicto armado. En caso de conflicto armado no internacional, los Gobiernos y los grupos armados de la oposición tienen la obligación de respetar estas normas.

Las organizaciones internacionales pueden alentar a las partes implicadas en conflictos armados a respetar los derechos humanos y el derecho humanitario. El Comité Internacional de la Cruz Roja (CICR), que desempeña, desde hace mucho tiempo, un papel preponderante en la tarea de velar por la aplicación del derecho humanitario durante los conflictos armados, también ha comenzado a hacer referencia al derecho de los derechos humanos en las situaciones de disturbios interiores o tensiones internas no cubiertas por el derecho internacional humanitario. La Asamblea General de las Naciones Unidas, la Comisión de Derechos Humanos de las Naciones Unidas, la Corte Internacional de Justicia y otras varias organizaciones intergubernamentales han intentado en diversas oportunidades garantizar el respeto del derecho de los derechos humanos durante los conflictos armados, refiriéndose ocasionalmente en dichas tentativas al derecho humanitario. En sus decisiones, el Consejo de Seguridad de las Naciones Unidas se ha valido casi exclusivamente del derecho humanitario.

Las organizaciones internacionales no gubernamentales han reconocido que, durante los conflictos armados, pueden cometerse violaciones de los derechos humanos en sus respectivos ámbitos de incumbencia. Efectivamente, las violaciones graves de los derechos humanos, incluidos los malos tratos, las detenciones, las muertes arbitrarias, etc.

Governments are principally responsible for the implementation of international human rights and humanitarian law during periods of armed conflict. During non-international armed conflicts, governments and armed opposition groups each bear responsibility for their obedience to those norms.

International organizations can encourage the participants in armed conflicts to respect human rights and humanitarian law. The International Committee of the Red Cross (ICRC) has long played a leading role in working for the application of humanitarian law during armed conflicts; it has also begun to refer to human rights law in situations of internal strife or tensions not covered by international humanitarian law. The United Nations General Assembly, the UN Commission on Human Rights, the International Court of Justice, and several other intergovernmental organizations have occasionally attempted to secure respect for human rights law during armed conflicts and have referred on an irregular basis to humanitarian law in such endeavors. The UN Security Council has almost exclusively used humanitarian law in its decisions.

In the years following Charles VIII's inglorious retreat from Naples, Lodovico Sforza, duke of Milan, was Italy's busiest diplomat. Though the brief visit of the French king and his knights had brought Lodovico little except prestige (more concrete advantage came from the fortuitous death of the young Milanese pretender), it certainly provided him a broader field on which he could play his diplomatic game. Dispatches by the score went out from his chancery. To all the courts and princes they went, and many, perhaps most, of them concerned the affairs of Tuscany. For Lodovico had his calculating eye turned south. With Venice, he was supporting the desperate struggle of the Pisans to free themselves from Florence. He sent off money and cavalry and capped his gifts with another of his famous invitations, this one to Maximilian of Austria.