Timeline/Stages for Collapse of our Way of Life
Mike, from the article in post #1677, Drones, missiles and gunships 4th paragraph…3 words:
disease tracking systems
5-16-2012 First published at TheNation.org
Criminals are not the only ones whose rights can be taken by force of justice…a mentally ill or a contagious person may also have rights taken by force…in the name of healing and health…
Oh, I found this assessment on disease tracking systems (I include all summary headings for context…please consider the excerpts in the scope of the full assessment summary available to the public…
note: bold emphasis added to excerpts:
Summary and Assessment
Surveillance, defined as “the continual scrutiny of all aspects of occurrence and spread of a disease that are pertinent to effective control” (IOM, 2003; Last, 1995; WHO, 2000), involves the “systematic collection, analysis, interpretation, and dissemination of health data” (WHO, 2000). Disease detection and diagnosis is the act of discovering a novel, emerging, or reemerging disease or disease event and identifying its cause. Diagnosis is “the cornerstone of effective disease control and prevention efforts, including surveillance” (IOM, 2003).
Organization of Workshop Summary
This workshop summary was prepared for the Forum membership in the name of the rapporteurs and includes a collection of individually authored papers and commentary.1 Sections of the workshop summary not specifically attributed to an individual reflect the views of the rapporteurs and not those of the Forum on Microbial Threats, its sponsors, or the IOM. The contents of the unattributed sections are based on the presentations and discussions at the workshop.
The workshop summary is organized into chapters as a topic-by-topic description of the presentations and discussions that took place at the workshop. Its purpose is to present lessons from relevant experience, to delineate a range of pivotal issues and their respective problems, and to offer potential responses as described by workshop participants.
Although this workshop summary provides an account of the individual presentations, it also reflects an important aspect of the Forum philosophy. The workshop functions as a dialogue among representatives from different sectors and presents their beliefs about which areas may merit further attention. The reader should be aware, however, that the material presented here expresses the views and opinions of the individuals participating in the workshop and not the deliberations and conclusions of a formally constituted IOM study committee. These proceedings summarize only what participants stated in the workshop and are not intended to be an exhaustive exploration of the subject matter or a representation of consensus evaluation.
The practice of infectious disease surveillance is no longer restricted to its original role in recognizing outbreaks of feared human diseases. Workshop presentations reflected diverse goals, approaches, and methodologies for disease surveillance in humans, animals, and plants. To place these presentations and ensuing discussions in context, we begin by briefly describing the multiple purposes served by public health surveillance, as well as current disease surveillance practices in animals and plants.
Surveillance Purposes and Practices
Public Health Surveillance
In the United States, public health surveillance for infectious disease is conducted through a variety of state and federal programs (GAO, 2004). Health-care providers and others report cases of “notifiable” infectious disease (as defined by local and state health codes) to health departments; health department officials verify disease reports, monitor disease incidence, identify possible outbreaks, and forward their findings to the Centers for Disease Control and Prevention (CDC). CDC and other federal agencies, including the Food and Drug Administration (FDA), the U.S. Department of Agriculture (USDA), and the Department of Defense (DoD), independently gather and analyze information for disease surveillance. In addition, these agencies fund domestic and international networks of disease surveillance laboratories that develop diagnostic tests and conduct disease diagnostic research. Although the CDC has provided guidelines for surveillance systems funded by the federal government, evaluation is generally lacking. Furthermore, as noted by Forum member Edward McSweegan, little evidence has been provided on the cost-effectiveness of massive federal public health surveillance investments (see also Eban, 2007).
Public Health Surveillance: A Local Perspective
Keynote speaker Patrick Kelley, director of the Institute of Medicine’s Board on Global Health, and presenter Michael Stoto, of the Georgetown University’s School of Nursing and Health Studies, reviewed the theoretical underpinnings and historical development of syndromic surveillance (see Kelley, Stoto in Chapter 1). When people first develop symptoms, following an exposure or first contact with a novel or rapidly emerging infectious disease, they may be much more likely to attempt to treat themselves and stay home from work or school rather than seeking care from a health-care provider to obtain a clinical or laboratory diagnosis (Stoto, 2005). Syndromic surveillance systems monitor existing descriptive data of these behaviors (e.g., school and work absenteeism, sales of over-the-counter medications, illness-related 911 calls, emergency room admissions for symptoms indicative of infectious disease) for patterns or clusters of behaviors suggestive of an illness outbreak. The concept of syndromic surveillance is doubly attractive because in addition to its potential to increase the speed and effectiveness of the public health response to natural or deliberate disease outbreaks, it costs far less to implement than traditional, labor-intensive approaches to disease surveillance (Stoto, 2005). However, the ability of syndromic surveillance to reduce disease-related morbidity and mortality remains to be demonstrated, as does its cost-effectiveness (Bravata et al., 2004; Reingold, 2003; RAND Corporation, 2004; Stoto, 2005; Sosin, 2003). Although rigorous evaluations of syndromic surveillance in general may be impossible, individual systems can be assessed under a variety of circumstances (Reingold, 2003). Moreover, because syndromic surveillance systems are warning devices, it will be critical to determine their utility within the context of health systems that respond to both “true” and “false” alarms (Pavlin, 2003; RAND Corporation, 2004).
Global Syndromic Surveillance
In parts of the world where clinicians are in short supply, syndromic surveillance offers a promising model for disease detection, Kelley observed (see Chapter 1). Infectious disease is a major cause of morbidity and mortality in low-resource populations, and such environments frequently provide amplifying conditions for emerging pathogens. Recognition of this threat has spurred the World Health Organization (WHO) to revise the International Health Regulations (IHRs)—the legal framework for international cooperation on infectious disease surveillance. Once limited to a trio of internationally notifiable diseases (plague, cholera, and yellow fever), as of June 15, 2007, the revised IHRs became the “world’s first legally binding agreement in the fight against public health emergencies of international concern” (WHO, 2007). Reporting of new and reemerging diseases with epidemic or pandemic potential, as well as diseases associated with acute chemical or radionuclear events, will be mandatory regardless of their origin or source (WHO, 2007).
“The mandate for general global public health surveillance is moving beyond named diseases to encompass a global responsibility to detect and report in a timely manner internationally important disease events, whether they are individual cases or clusters, whether they are well-defined diseases or ill-defined diseases,” Kelley explained. Syndrome detection is central to this new paradigm, and should be viewed as one of a collection of approaches to global surveillance for infectious diseases, he said. However, he also noted considerable challenges in moving syndromic surveillance from theory to practice.
Syndromic Surveillance by Design
From Syndromic Surveillance to “Situational Awareness”
…This point is illustrated by a recent model of outbreak detection for inhalational anthrax by Buckeridge and colleagues (2006), who concluded that “when syndromic surveillance was sufficiently sensitive to detect a substantial proportion of outbreaks before clinical case finding, it generated frequent false alarms” (Buckeridge et al., 2006).
Case-Finding by Syndrome
Instead of bypassing health-care providers, Stoto said that syndromic surveillance technology could be used to “arm astute physicians and health departments with modern approaches to finding small numbers of cases” and allow health professionals to identify them before they are formally diagnosed.
Real-Time and Batched Reporting
Animal Disease Surveillance
Ebola Virus Surveillance in Central Africa
Global Surveillance for Avian Influenza
Plant Disease Surveillance and Detection
National Plant Diagnostic Network
National Center for Plant Biosecurity
Global Outbreak Alert and Response Network
The Global Public Health Intelligence Network (GPHIN)
The Voxiva Model for Resource-Constrained Environments
Considerations for Surveillance Networks
Detection and Diagnostics
The Diagnostic Landscape
On the Battlefield
The Road Ahead: Diagnostics in Development
Inspired in part by the image of the original Star Trek’s character “Bones”® diagnosing a patient with a wave of his medical tricorder (Figure SA-7), Wolcott and fellow DoD researchers are attempting to construct an “integrated diagnostic system” for field use that can detect viruses, bacteria, toxins, “and anything else that could possibly be thrown at us in the biological detection arena,” he said. The current prototype relies on automated real-time PCR, but DoD researchers are testing a wide range of diagnostic technologies (e.g., microarrays, handheld immunoassays, electrochemiluminescence) and targets (e.g., microbial toxins, as well as nucleic acids), according to Wolcott. “We have to have multiple platforms to give us the assurance that what we are reporting up the chain of command is actually there,” he said. The ultimate goal is to combine multiple platforms into a single, universal system for field diagnosis. While the time constraints and primitive conditions of battle present significant barriers to the use of microarrays, Wolcott speculated that chip technology eventually would be adapted to provide point-of-care diagnosis for soldiers in action.
The Far Horizon: Presymptomatic Diagnosis
In addition to offering the best chance of treatment for known, emerging, or bioengineered pathogens, detecting infectious disease at the earliest possible moment would permit diagnosis-based triage and increase the effectiveness of quarantine or other social distancing measures, Johnston predicted. He anticipated that presymptomatic diagnosis will have an even greater impact on everyday medical care. “We have a healthcare system that can’t be sustained in terms of physical economy,” he said, adding that care for ill patients accounts for nearly 90 percent of health-care spending. “Why does it cost so much? Because we are diagnosing sick people, taking care of sick people; we even develop our drugs for sick people.” Therefore, he insisted, our society has no choice but to move from postsymptomatic to presymptomatic diagnosis.
Considerations for Detection and Diagnosis
The Challenge of Coordination
Shifting the Public Health Paradigm
Optimal Surveillance for Risk Management
Needs and Opportunities
Critical Issues in Infectious Disease Surveillance and Detection
System Design and Development
Integration of Information
Information Transparency, Control, and Access
Recognizing that the reporting of unusual findings by health practitioners (and subsequently by governments) is essential to infectious disease surveillance and detection, workshop participants considered a range of incentives to promote the affirmative reporting of human, animal, and plant health status at all levels, including the following:
Develop and broadly implement standards for infectious disease reporting and sample submission to public health laboratories.
Pay clinicians, especially those in developing countries, to report findings to national public health authorities.
Ensure the confidentiality of health practitioners who report infectious disease, while recognizing their contribution to public health. In the case of agricultural diseases, provide financial support for farmers who report disease and guard intellectual property rights of seed companies who assist in identifying vulnerable germplasm.
From Alarm to Action
Copyright © 2007, National Academy of Sciences
Today, CNN reported that President Obama’s Tuesday address failed because it was written at a 10th grade level and, therefore, too smart for us idiot Americans. Tonight, Stephen Colbert dumbed it down in the most hilarious way possible. Video inside.
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