Medical GIS Guide
8.9K views | +0 today
Medical GIS Guide
Recommended tools , resources, and methods. Examples of what can be done, what should be done, and what has been done.
Curated by Brian Altonen
Your new post is loading...
Your new post is loading...
Scooped by Brian Altonen!

"Tighten vaccination loopholes: Our view" (vs. my view)

"Tighten vaccination loopholes: Our view" (vs. my view) | Medical GIS Guide |

USA Today Editorial states:  "Last year, the U.S. saw 668 cases. Midway through 2015, about 180 people across half the states have been sickened. Many cases were linked to an outbreak at California's Disneyland, and most of those who've fallen ill were never vaccinated. Last week, Washington state reported the first death from measles in the U.S. in 12 years."  and  "States that still allow easy opt-outs should follow Vermont and California. . . . "

Brian Altonens insight:

Let's apply Prochaska's Transtheoretical Model of Behavioral Change to this public health/healthcare administration problem.


The healthcare programs in the US are for the most part either in the pre-contemplative or contemplative stage for GIS implementation.  The more engaged programs are focused on skill building.  Utilization of just a simple spatial program to map your data is early "Preparation"  Unless you have a GIS established that deals with all QIAs, PIPs, MUs, Chronic Diseases, and the majority of HEDIS metrics, reported yearly, your agency, company, or facility is not in the Action stage.


Based on my national GIS/NPHG study outcomes, my recommendations are as follows:


#1 - regarding refusals to immunize, focus on the Seattle, Portland, San Francisco, and maybe Los Angeles areas.  


#2 - approach insurance companies and physicians' businesses in the Pacific NW urban settings and ask them why they have facilitated this problem for 25 years.


#3 - develop mandatory rural health monitoring programs for the Pacific Northwest


#4 - research the in-migration track from NYC to Albany where the hot spots develop due to tourism and immigration.


#5 - improve public health security programs designed to prevent the spread of immunizable diseases into Canada via the Buffalo area and other Great Lakes related paths into Canada; apply this to all other high fatality diseases capable of crossing borders (this is possibly the chief route for unexpected yellow fever entry).


#6 - continue to vamp up Mex-Tex border security, and establish plans for the south the north route these individual take with their disease, from the border to Midwestern cities along the Mississippi and Chicago.


#7 - increase public health security along the Haiti/Cuba-to-Florida route (chikungunya and naturalized Ebola/Ebola host routes).


#8 - set up a plan for potential polio re-emergence around the Great Lakes; consider Canada or Chicago a possible direct or indirect (via NYC) point of entry.


#9 - require the largest health insurance companies like Aetna, Anthem BCBS, Blue Cross Blue Shield, Cambia, Cigna, Emblem, Fortis, Kaiser Permanente, UnitedHealth, to initiate a medical GIS program immediately, that is capable of working in 9 months, to begin quarterly reporting in 12 months.


#10 - Retire all CIOs, CTOs, Directors, VPs, managers, in charge of IT/HIT/QI/QA, who lack spatial epidemiological background and experience, and have not published or presented a demonstration of their unique skills by the implementation of new programs and/or publication of spatial epidemiology results that are more than just descriptive statistics.


For those highly adventurous, I recommend:


#11 develop a program that separates and spatially evaluates sociocultural and socioeconomic classes of diseases and quality of care (in descending order of priority) for: lowest income classes, highest cost CDMs, african/african-american, hispanic and subgroups, asian/asian-american, native american groups.



No comment yet.
Scooped by Brian Altonen!

Worries of ISIS-Inspired Attacks Cloud July 4 Holiday Weekend

Worries of ISIS-Inspired Attacks Cloud July 4 Holiday Weekend | Medical GIS Guide |
The year-long rise of ISIS, and its leaders' appeals for supporters to carry out attacks around the world, has authorities on high alert.
Brian Altonens insight:

Visiting New York City yesterday, it was clear that the southern tip of Manhattan is now the center of homeland security surveillance.


New York City should be the center of surveillance for any spatial epidemiology program.  


The very first disease map was produced in the late 1790s by Dr. Valentine Seaman.  He was trying to determine if yellow fever was of local origin or imported by ships (our famous Benjamin Rush blamed it on imported coffee beans that went sour).  


Many past outbreaks made their way into this country via these slips and piers. 


The rates at which people move in and out of this location are unimaginable.   In just fifteen minutes, I saw more than a hundred ferries and tourist boats, helicopters, subways, air, land and water taxis, city and tourist buses, and private tourism vehicles, all dropping off more than a thousand locals and tourists right around dinnertime.  


The routes leading from South Street Seaport to the 911 Memorial Museum were filled with thrice as many people.  All routes to the Memorial were well defined, and secured by nearly a dozen different types of public service, military, guard, national park, and homeland security units.   Need I say, surveillance cameras were everywhere, and as this new story indicates--way overhead.  


Now, imagine having to trace the source and predict the path of a biological outbreak that originated here in upcoming days.  That is what a Biosecurity Unit can do using GIS.

No comment yet.
Scooped by Brian Altonen!

We produce future victims, by ignoring the past

We produce future victims, by ignoring the past | Medical GIS Guide |
Although Dr. Andrew Wakefield lost his medical license years ago and allegedly committed numerous ethical violations, the father of the anti-vaccine movement's message remains.
Brian Altonens insight:

We learn from the past. .  . this past event, from a century ago, behaved very much like past year's measles outbreak.  


Allow me to paraphrase the beginning an article on this public health concern in the vicinity of Buffalo, NY:  


"History Repeats Itself.


"It is too bad that as small pox appears epidemically in one town after another throughout the State, each in turn has to commit identically the same series of costly follies before it finally settles down to intelligently meet the situation."


[end quote]


This is what led to a large outbreak of Small Pox in the Town and Village of Niagara Falls in 1914.  


The story of what caused this outbreak has a number of social, political, professional, household and individual reasons as to why the outbreak spread like it did.


Many of these same causes and subsequent events are seen today (for measles, mumps, etc.):


1.  A New York law requiring children who go to a public school to be vaccinated was passed in 1860.  Trustees and officers of the school were required to enforce this law.  Due to community behaviors, beliefs, and philosophies, areas developed where this law was not heeded.


2.  Soon after the town and village of Niagara Falls officially incorporated (1883), a medical department was formed at the 26 year old college Catholic college in this Town, known as Niagara University.  This medical school supported enactment of the vaccination law as a compulsory requirement, meaning parents and students could refuse vaccinations if they wanted to, and still be allowed to attend public schools.


3.  Members of the Town, School and University Boards were largely unvaccinated.  The President of the Board of Education and the City's main attorney were both antivaccinationists.  Due to the nature of the philosophy used to argue against vaccines, entire households were typically unvaccinated, not just a child or two.


4.  In 1913, doctors in Niagara Falls noted their concern for being unable to differentiate Small Pox from Chicken Pox, making it easier for the Small Pox cases to go undetected for too long.  This led many families and communities to claim that small pox was not present when small outbreaks ensued.


5.  The editor of the Chicago Tribune, between January and March 1913, called Niagara Falls a "Plague spot."  This term was adopted and re-published by 'The Public Health Journal', published out of Toronto, Canada, in April 1913, and repeated by other subsequent writers.  Two outside opinions were formed, stating that due to leadership, the general public was at major risk for an outbreak.  According to The Public Heath Journal (Toronto), "Niagara Falls is paying for having the luxury of having an anti-vaccination school board."  


6.  Besides regular or "allopathic" doctors, the region was rich in alternative medical doctors (then called "irregulars" by some), who received state approved MD degrees specializing in Eclectic medicine and homeopathy.   These two practitioners were against vaccinations, although eclectic physicians much less than homeopaths due to the philosophy of their profession.


7.  There were much lower numbers of Chiropractors and Osteopaths in the state, but they were avantly against the promotion of vaccinations.  Christian Scientists argued the same, and brought the regular doctors in Tennessee to court due to their claims.  These special groups supported and promoted the writings of Niagara Falls resident, John W. Hodge, M.D.


8. John W. Hodge was hired by the American Society for the Prevention of Cruelty to Animals (ASPCA); the use of horses to produce the typhoid vaccine "lymph" and cattle to produce the cow pox vaccine were a primary concern for the organization.  He served as the local representative for ASPCA for the Niagara area.  He was also an anti-vivisectionist (against the use of live animals for performing medical or health experiments.)  Hodge was heavily favored in the press by homeopaths, chiropractors, and osteopaths. 


9.  After the outbreak in 1914, attempts were made, some successful, to pass a law that would make vaccinating your child compulsory; in Massachusetts, it was called the Bagshaw Bill.


10.  Many religious leaders and institutions continued to promote the antivaccination movement.   In primarily religious-sponsored schools and teaching hospitals like  Niagara University, medical students who graduated were often allowed to adhere as much to their theological beliefs as their medical teachings.   As a result, communes or communities formed where clusters of unvaccinated people could be found, often with one of the utopian or religious communities common to the region.


11.  The underlying pressure to avoid immediate initiation of an immunization program was cost related.  Three examples are provided to explain:


Ex. 1:  The Town of Niagara Falls was Incorporated in order to promote Niagara Falls as a healthy retreat, forming a business venture focused on tourism.  Its leaders felt threatened by the publication of any deaths resulting from childhood vaccinations (one death of a daughter had just resulted in a local lawsuit).  Leaders of this plan therefore ignored warnings that customers travelling to the Falls could bring these diseases in with them and infect unvaccinated children.  


Ex. 2:  The primary victims of small pox were people 15 to 45 years of age, and mostly represented the working class.  Vaccinating employees cost large businesses too much money.  Therefore, businesses set their goal at vaccinating just 50% of the employees at most (and not necessarily their families).


Ex 3: the projected cost for vaccinating children was $500 per year for a year's supply to meet the needs of a town with 100,000 inhabitants--all children had to be vaccinated by 2, and every 10 years there after.  Add to this $2000 per year for the related work requirements.  Insurance cost for "guaranteed protection" against small pox was estimated to be $5000 per year, or "5 cents an inhabitant" for a theoretical population of 100,000.  The total costs for this process served as a deterrent to initiating a full fledged vaccination program.  


[References will be in the follow-up to this]






No comment yet.
Scooped by Brian Altonen!

Dozens of new Ebola cases reported in West Africa -

Dozens of new Ebola cases reported in West Africa - | Medical GIS Guide |

LAST YEAR's unpredicted outbreak, in case anyone forgot . . . . and the News:  "Officials say the trend of a decline in the number of Ebola cases has stalled, with dozens of new cases reported so far this month in West Africa."

Brian Altonens insight:

We spent a lot of time assuming occasional peaks, when in fact history has show that cycles in nature can reverberate, demonstrate harmonic rhythms in the same season, and may even spend a year or two building towards a crescendo.  


West Nile comes back, it doesn't decrease over time.  The same could be true now for Ebola, once it finds and maintains its ecological foothold.  


Ebola could very well demonstrate another spurt of growth this season, and along with this, demonstrate in more detail the next stage in vertebrate host-disease relationships.  Exactly how the kinds of hosts related to Ebola may cause it to find a secondary nidus, is what we may be able to learn more about this season.


Understanding a much truer spatio-temporal pattern for Ebola than the one we tried to convince ourselves with these past few decades, is an important outcome of this.  Should Ebola cases rise again like they did last season, they will provide us with more complete genetic findings, more detailed ecological relationships to study, a second opportunity to demonstrate these new pharmaceutical products work, and a second chance to negate our failures by not having adequate spatial surveillance staff, tools, and guidelines in place.

Brian Altonen's curator insight, July 2, 2015 8:39 AM

It is not even a month later and the worry continues to grow.  

Keep close track of the Ebola and Chikungunya dates, as news of concerns for outbreaks continues to grow during the next 6 weeks.  

If this year is at all like last year, the MERS issue will fade away.  However, it is too early to tell if this problem in Korea might continue to escalate in the weeks ahead. 

Both time and temperature are on the side of pathogens and vectors in this case.  Time--because not enough has been spent trying to prepare for this season's outbreaks.  Temperature--because seasonal changes are typically in favor of nature as a whole, including these ecological causes for disease.  



Scooped by Brian Altonen!

Four Diseases in Prussia

Four Diseases in Prussia | Medical GIS Guide |

These four maps demonstrate the significant spatial differences in distributions of four disease patterns.  The four mapped diseases are Diphtherie (Diphtheria), Unterliebstyphus (Typhus),  Lungenwindsucht (Tuberculosis or Consumption), and Sumpffieber or Wechselfieber (Malaria).   Diphtheria is dependent primarily upon people.  Typhus is due to a combination of transportation, population density and people.  Tuberculosis distribution is defined by a combination of topography, climate and pedological (soil) features in relation to people.  Malaria is an example of the classic host-vector zoonotic disease migration problem that plagues the world for nearly two centuries by the time this was published.

Brian Altonens insight:

The influences of Prussian (German) cartographers and medical topographers/medical climatologists dominated the medical and disease geography profession between 1800 and 1850.  When the first influential disease geographer became famous, Alexander Keith Johnston, the map he produced (  ) was up against three very reputable maps produced by three German medical cartographers.   


The most famous map that was published about the time of Johnston's map was produced by Adolph Muhry (1856) (image with review is at ).  Its emphasis on climate, global wind flow patterns, travel routes, and latitude-longitude global features made it a tough map to follow to physicians in the more Anglican communities.  The predecessor to this map, produced in 1848 by Heinrich Berghaus (‘Planiglob . . . der vornehmsten Krankheiten’, image with review is at ) served the German readership with the needed background to interpreting and understanding Muhry's map. 


British mapmakers had less a sense of authority in this profession globally at the time.  Supplementing the German leadership in this field was the purely geographic taxonomy for diseases developed by another Prussian/Germanic cartographer and specialist in this field in 1847 –- Dr. Carl Friedrich Canstatt and his book Handbuch der medicinischen Klinik (  ), in which the classification of diseases was perfected based upon a combination of environmental and human population features, including topography, climate, population patterns, wildlife and plants, natural disaster events, solar and even barometric influences.


Prior to the perfection of the climate-topography philosophy of disease in the 1840s was the work of German cartographer and sociologist Freidrich Schnurrer (coarse image with review is at ; my complete translation and review of this map is now in process).  


Like many broadly read and trained professors, he had the knowledge base needed to map out the underlying climatic, environments, temperamental, evolutionary (pre- or Social Darwinian), cultural, anthropic, toxicologic, geologic, climatic and biological nature of the large numbers of diseases documented by explorers and missionaries around the world. He was not a physician, but an expert in Oriental culture, history and economics.  On his famous map, Schnurrer also managed to review the plague epidemics going back the the 16th Century; he also covered a variety of race-ethnicity related histories of diseases, and placed these observations on his map along with a number of culturally linked diseases and even culturally bound conditions we have since forgotten. 


In light of these findings from my review of the earlier German/Prussian history of medical geography and cartography (a history ignored by Anglican scientists), the popularity of these four maps in the history of medical geography now makes sense, and why an 1880 map on Prussian diseases remains one of my top visitor sites.


I review extensively the evolution of disease map philosophy and history at 

No comment yet.
Scooped by Brian Altonen!

Man diagnosed with Lassa fever dies in US after Liberia trip

Man diagnosed with Lassa fever dies in US after Liberia trip | Medical GIS Guide |
NEW YORK (AP) — A New Jersey man died Monday evening after been diagnosed with Lassa fever — a frightening infectious disease from West Africa that is rarely seen in the United States, a federal health official said.
Brian Altonens insight:
This news could be blowing up overnight, tonight. Lassa Fever spatial behaviors will mimic other disease pattern in-migration behaviors. It is very closely related to Ebola and has spatial behavior similarities. Knowing this human ecology spread process can sometimes be the first step to ecologically securing a pathogen in a new environment. The more integrated the pathogen is with nature in its homeland, the less likely it is to spread. The higher the animals engaged in the zoonotic processes for this diffusion process, the harder it is to cause a new ecological setting to form. With GIS, we can better define the ecological requirements for this pathogen and its vectors, hosts or carriers. We can also evaluate its seasonal and climate/meteorologic requirements, and even use these findings to define high risk areas for disease outbreaks and pathogen-vector-host ecology stabilization. Certain parts of the U.S. have a higher likelihood for seasonally supporting Lassa Fever diffusion processes. Fortunately, new Jersey isn't one of them, although as part of the megalopolis and three airport "Bermuda triangle" link to tropical disease patterns, it is one of the centers for ongoing surveillance and prediction modeling using GIS.
No comment yet.
Scooped by Brian Altonen!

Unexpected Lessons From the Ebola Outbreak -- the GIS angle to all of this

Unexpected Lessons From the Ebola Outbreak -- the GIS angle to all of this | Medical GIS Guide |
It's been just over a year since the Ebola outbreak erupted in Africa. The outbreak and its aftermath in Africa are devastating. We should not add to the toll by ignoring critical lessons for health care systems in developed countries. It has resulted in the largest emergency response from both the World Health Organization and U.S. Centers for Disease Control and Prevention in history, with a price tag of $1 billion.
Brian Altonens insight:

I would be curious to see how much or what percent of the responses to this public health matter really receive the HIT-GIS attention it is due.  


Let me start by admitting I am biased about the need for and potential applications for GIS to any outbreak prevention surveillance program, at the civilian level as well as at the government national security/CDC/WHO level.


The failures we experience with the ebola outbreak, and the recent measles outbreaks in the United States, are due mostly to the lack of ongoing, regular GIS surveillance.  The cause for these failures can go in any of several directions--but my attitude is that this blame has to be placed almost completely on administration and health leaders.  If they cannot implement and utilize GIS on their own PC, in order to solve a public health dilemma or answer an important question, they lack the expertise needed to understand the power and potential of their business.   A business leader who promotes and pushes a certain technology, but cannot do the same himself, should be escorted out the door.


Being so hypercritical, I find that each paragraph of Elaine Cox's article "Unexpected Lessons from the Ebola Outbreak" has its counter ideas and statements.  This is not the author's fault, for Cox is only speaking "truth" and it interpretations.  It is the healthcare system's fault that each of these failures occurred. 


Para 1,2.  Given:  Outbreaks continue.  Have we learned?  Can we?  Response:  The cases continue and the chance for a new outbreak still exists because we weren't prepared.  We are right now barely engaged in 10-15 use of the GIS technology; attempting to map our data at some superficial state, county, zip code or census block level.  The more highly detailed methods for evaluating public health have been out there since 2004; only the IT requirements and fluiduity of the GIS process were then lacking.  


Lesson: Failure to establish an adequate surveillance program before the Ebola outbreak is why it dominated.  Its history makes it more sucessful over time, a feature noted for nearly all recurring outbreak diseases in human history.  


Para 3.  Given:  The statistics gathered about this ebola outbreak may be underestimates, because we were not prepared.  Response: Lack of financiers and/or willingness to spend made it impossible to develop a surveillance system at the agency and global health level.   


Lesson: we need to develop systems that monitor and prepare teams at the pre-outbreak level.  Government responses are traditionally bureaucratic, too late, and therefore unnecessarily fatal to some.  This can be prevented by having teams in place.  A rapidly growing outbreaks results in skyrocketing costs.  Increase preparedness and you may reduce overall costs.  Any and all outbreaks will results in $US costs that are in the billions.


Para 4,5. Given: The high impact on health workers resulted in further unexpected stress in the system.  "there is little ability to respond rapidly to an urgent situation."  Result: Poorly trained and non-trained professionals resulted in delayed or missed opportunities for interventions and aggressive reactions.  Poorly trained and/or untrained leaders fed into this non-decision making system.  This is a reiteration of the post 9-11 activities that were commenced and the post-Katrina events, that are still being planned and tested.  Post-Ebola plans will not be any better and may even further the confusion that this system imposed upon itself. 


Lesson:  Removed unskilled workers and administrators; hire true experts not pseudo- or quasi-experts.  Administrators themselves must be true experts, not just "best bureaucratic fits".


Para 6.  Lack of preparedness.  Reason: lack of knowledge base, lack of protocols, lack of practical experience, lack of attention.  The human response prevented progress from being made.  The change in "opinion" from 'no concern' to 'high concern' in twenty four hours suggests lack of personal and professional knowledge base or experience on behalf of the spokesperson/leader.


Lesson: see the prior.


Para 7.   Internal lessons can be drawn from this.  Reason:  Poor use of best human resources resulted in problems at each step in the patient transfer process, and the sense of responsibility for preventing further spread by various levels of clinical and non-clinical health care professionals.  Individual health care providers felt they were excluded from common public health safety procedures.


Lesson:  A physician with a gun (or virus), is still someone with a gun, even though he is a physician.  Academicians provide important insights and input into the process.  


Para 8.  Much time was spent getting the pharma products involved, tested and evaluated.  Reason: pressure from these industries.  The institutions took a gamble, hoping something might work.  In the end, there were no indisputable, absolute successes.  In the end, there were few tests that were totally completed.  Profession pride overpowered logic and even common sense in this case.


Lesson:  This is an example of how corporate power leads to financial success more than political or intervention success. 


Para 9.  The Human lessons.  An extension of Para 7, with more emphasis on the irresponsible nature of human behavior, even for doctors and nurses.   


Lesson: see Para 7.


Para 10, 11.  Unfortunately, these are mostly palliative statements meant to appease the public.  Only time will tell is the real message here.


Lesson:  This is a recurrence of mistakes seen prior for cholera (19th C), spanish flu (e20th C), and most recently measles (21st C).   The lack of "herding" is a ubiquitous problem with people.  The lack of learning from repeated experiences even more.  "History repeats itself".


There are really just three changes that are of utmost importance:


1.  Replace failed leaders and staff with highly skilled leaders and experts, in spite of higher cost.


2.  Make better use of the EHR/EMR data available; if PBMs and Insurance Companies cannot utilize their data to the fullest extent, their public health (claims, billing/$, demog, med, rx) information should be released in a workable form to more highly skilled and trained professionals or corporate overseers.


3.  Implement a GIS surveillance, prediction model and have it working completely one year from now--June 2016--and in use by the more savvy epidemiology/preventive health programs.  These should have the ability to be used or implemented on a daily, weekly, monthly and quarterly basis, and should be in the public or community sector, not the local or regional government public health sector.




Cox's article (in case the link is temporary): 



Unexpected Lessons From the Ebola Outbreak
US News By Elaine Cox, M.D.
19 hours ago

It's been just over a year since the Ebola outbreak erupted in Africa. And while its spotlight in the news cycle has faded, cases continue to plague a very vulnerable area of the world. The outbreak and its aftermath in Africa are devastating. We should not add to the toll by ignoring critical lessons for health care systems in developed countries.


The most recent statistics available show that 24,842 suspected cases of Ebola have been identified in the African hot zone. More than 10,200 people are known to have died. Both of these statistics are likely underestimates as there could be many more victims of the virus that never make it to a care facility.


Financial metrics show a different type of cost from this yearlong outbreak. It has resulted in the largest emergency response from both the World Health Organization and U.S. Centers for Disease Control and Prevention in history, with a price tag of $1 billion. The incredible need for clinicians to go and serve in the affected countries is often going unmet, perhaps due to the documented deaths of at least 500 health care workers among the known statistics. The devastation has been widespread.


Lessons learned have been shared across the health care domain -- a few insights into the virus itself and how to prevent it. The majority of patients who've received care in the U.S. have recovered. As we celebrate those successes, we must make sure we face certain harsh realities that have come to light. The most unsettling? We are a less-than-nimble care system.


The ability of our massive U.S. health care system to adjust to emergencies is limited. Despite significant time investment by institutions on emergency management protocols, there is little ability to respond rapidly to an urgent situation. Most of the planning is focused on surviving forces of nature such as tornadoes and hurricanes -- not on responding to emerging health threats, which are all-too real in today's climate of global travel. Despite the constant drumbeat of news reports from every outlet for months regarding the growing numbers of Ebola cases in Africa, there was no urgency to plan for potential influx into the U.S.


Take, for example, the situation at Texas Health Presbyterian Hospital in Dallas.The lack of infection-prevention protocols to respond to an Ebola-like situation was not unique to that institution: It's a truth faced by most U.S. health care institutions. Minimal supplies; lack of ongoing emergency simulation and training of dedicated staff; and slow public health responses like monitoring travel are system issues that belie a level of complacency in our disease preparedness. Texas Health Presbyterian, which had the tough luck of being first, unfortunately became the poster child for the inertia of the hospital- preparedness effort.


As with all lessons, there were many positives that emerged in the last year as well. Texas Health Presbyterian upheld the long-standing tradition of academic medicine by sharing their experience, both the good and the bad, so that others could learn and not repeat less-than-optimal situations. Their willingness to be transparent not only impacted medical care, but also showed the true spirit of those who provide care to others by going in where others might fear to tread. The pain they felt over their colleagues who became ill, while almost unbearable to watch, made everyone stop and take notice, not wanting to walk in their shoes. It sounded an alarm to the rest of the nation, including the CDC, to take stock and improve -- a huge price for Texas Health Presbyterian but a stroke of luck for other health care systems.


As more patients were treated in the U.S., several other positives occurred. We learned more about the enigmatic Ebola virus, such as how to better prevent its spread and that transfusions from survivors could hold therapeutic value. We've also discovered new leads that might jump-start vaccine research. In addition, the CDC began identifying hospitals to care for patients with the deadly virus, and started offering support for their development, including updating current facilities and building new, highly specialized hospitals to deal with these emerging threats. These findings and activities will not only improve care in the U.S., but have the potential to change the face of fighting this disease in areas where it has taken life after life.


We have also learned many human lessons. A recent symposium at Emory illustrated that teamwork has rarely been as obviously important in patient care as in this situation, where truly the patient's life -- and your teammate's life -- reside in your hands. Professional pride swelled at what we can accomplish in health care when the stakes are incredibly high. We learned that the true culture of safety is achievable and necessary to really care for others in grave times of need. We learned that great clinicians and researchers are still asking the questions and finding the answers to eradicate the next plague lying in wait, regardless of where it is.


To ensure that each of these lessons is lived out to the fullest, our public health system must step up and help us prepare for medical, not just natural, emergencies. We need better reflexes so that we can respond early with set protocols for safety, faster diagnostic tests, better and more flexible facilities and teams that work together in a true and total environment of safety. Perhaps we should take a cue from the Department of Defense and begin honing early warning systems for emerging health care threats, so we can be in the offensive -- not defensive -- position. We must have a plan for when the alarm sounds.


One U.S. Ebola survivor recently spoke at Emory and likened dealing with these deadly diseases to cutting down a tree. You spend four hours sharpening the ax and only two hours actually cutting down the tree. Yes, planning for these emerging medical threats will take resources in people, physical plant and dollars, but will position us to be able to respond to the next emerging invader, be it infection, bioterrorism or some unanticipated scourge we have yet to encounter. In a nation that spends the most on health care than any other country, we need to fight hard against complacency. We must keep sharpening our ax.


Dr. Elaine Cox is the medical director of infection prevention at Riley Hospital for Children at Indiana University Health in Indianapolis. She is also the Riley clinical safety officer. Dr. Cox practices as a pediatric infectious disease specialist and also instructs students as a professor of clinical pediatrics at the Indiana University School of Medicine. The former director of the pediatric HIV and AIDS program, Ryan White Center for Pediatric Infectious Diseases at Riley, Dr. Cox helped lead the effort to change Indiana law to provide universal HIV testing for expectant mothers.



No comment yet.
Scooped by Brian Altonen!

Cuban-Developed Lung Cancer Vaccine Could Arrive in US

Cuban-Developed Lung Cancer Vaccine Could Arrive in US | Medical GIS Guide |
As U.S. relations with Cuba thaw, one unexpected byproduct could be the introduction of a Cuban-developed lung cancer vaccine in the U.S. Called Cimavax, an innovative vaccine that was developed to help treat lung cancer patients in Cuba, where lung cancer is one of the leading causes of death. The immunotherapy treatment could be coming to the U.S. thanks in part to the Roswell Park Cancer Institute in Buffalo, New York, which is working with Cuba's Center for Molecular Immunology to bring the treatment to the U.S. ABC News spoke to Dr. Kelvin Lee, the chairman of the Department of Immunology at the Roswell Park Cancer Institute, to learn more about the new medication. Cimavax is a vaccine designed by Cuba’s Center for Molecular Immunology to help lung cancer patients by targeting a specific hormone that can encourage tumors to grow.
Brian Altonens insight:

A few years of losing competitions with Cuba, and maybe then the U.S. health care system will use the Cuban Polyclinic System as an example.  Either that, or the healthcare consumer needs to have more options to select from, including those linked to medical tourism and the less expensive cost for care abroad.

No comment yet.
Scooped by Brian Altonen!

Like it or not, GIS is here to stay in Health Care and Managed Care Responsibilities

Like it or not, GIS is here to stay in Health Care and Managed Care Responsibilities | Medical GIS Guide |

The map I produced of companies not implementing GIS, that should be implementing GIS, has a distribution parallel to other social metrics.  An example of the highest risk area demographically for the return of polio mimics the findings already seen for measles in 2014 and 2015.  The results of recent surveys on GIS use in the healthcare field, demonstrate there is some isolated pockets of interest in insurance program related GIS use, but non adequate to achieve any of the potential cost-savings that GIS will provide (in particular the low cost, non-GIS method of spatial analysis - NPHG.).

Brian Altonens insight:

And so this tale continues . . . .   


This week, another colleague of mine left his Spatial epidemiology GIS / Population health monitoring position due to the slow progress healthcare and insurance programs are making when it comes to spatial epidemiology and Medical GIS applications to managed care.    


Currently, there are less than a handful of us who are fully devoted to this topic.  There are a few others, perhaps even dozens, that understand the need for spatial analysis in health, but are unwilling to commit to this inevitable change in the field. Quite a few people who work with GIS regularly--just how many produce more than 10,000 maps per year, for numerous age groups, numerous ICDs, and even more metrics, I am uncertain of.


Currently, I can analyze and map several hundred to thousands of health metrics per week, an understatement I may add, since in traditional GIS your limit will be in the dozens per day; I doubt many GIS'ers can produce 100 maps per day, every day of the week, or for one week per month or quarter, each year.  My non-traditional mapping routine makes it possible to produce more than 10,000 per day, enough to produce a dozen videos of your results with.  A half million per year (a conservative estimate.)


Insurance companies, pharma, PBMs and consultants in this group are all struggling to initiate a stable GIS they can use to watch over just a few studies.  But it is already possible to engage in the bulk of your HEDIS, MU and PIP using GIS.  That is to say, report on 750 to 1000 HEDIS clinical and administrative metrics as needed.


So why can't this high productivity be accomplished?


Experience tells us experienced analysts that management and the lack of experience are the primary causes for failure to advance your MC program into a GIS ready, GIS productive program.  These are also the main causes for failure to improve your technology--HIT should only take under a year to initiate and 3-12 months to test.  It is now going on another full year period beyond that goal which I set, a year ago--such an advancement in the health insurance/population health monitoring field is proving to be impossible.  


Now, these companies do not advance their HIT-GIS for numerous reasons, but all of those reasons point to poor leadership . . . . and lack of experience.


When a GIS pro, one of the best in the field leaves the workplace, that means there is a problem--and that other companies may be out there that are not willing to advance, not willing to improve, not willing to risk advancing over the competition, not willing to set the example.


Several years ago, PBMs proved to us that they are limited in the complexity with which they can understand and use GIS to the fullest potential.  Pharma is still floundering, trying to make ends meet at even the most basic HEOR level of understanding things; zip codes appear in tables for pharma, not insightful maps.  Expert consulting companies for the above are also just a small step ahead of pharma; I do not see any top notch competitors in this part of the pharma industry producing a reliable reporting system for national health by the end of 2015.  And finally, managed care in general still cannot manage its skill requirements, there is no GIS goal in the traditional MC program.   

The health care field would benefit most by making people healthier through the cost-saving, time-saving use of GIS.


When you fail to see this error within your system, how can you adequately service the populations you are supposedly responsible for?  



No comment yet.
Scooped by Brian Altonen!

Dog infects humans with plague for first time in U.S.

Dog infects humans with plague for first time in U.S. | Medical GIS Guide |

Watch the video Dog infects humans with plague for first time in U.S. on Yahoo Finance . Vet Emergency & Referral Group Director Dr. Brett Levitzke on a plague-infected dog that spread the disease to people in Colorado.   [Image source: ]

Brian Altonens insight:

When diseases are heavily dependent upon human populations and factors strongly related to human populations, like domestic pets, the standard behaviors for these diseases result in a diffusion pattern that can sometimes demonstrate preference for population centers.  This particular outbreak in Colorado appears to demonstrate this change in behavior.  Important to note however is that there is an ecological aspect to this cluster of plague cases that prevents the plague from easily migrating in an eastern direction.  However, an increase in the role of  domestic animals in forming the migration patterns could change these traditional diffuse patterns considerably.   


My review of the plague, in US EMR/EHR, does demonstrate a density in the population centers of the eastern US.  See 

No comment yet.
Scooped by Brian Altonen!

Refusal of Vaccines - How and Where this Controversy Erupted

Refusal of Vaccinations in the Pacific Northwest, by Parents of Children less than 6 years of age - - Tetanus Vaccine

Brian Altonens insight:

Public Health news for the past several months has focused on refusal of measles vaccines.  But this vaccine refusal behavior is seen for all vaccines, not just the MMR.  This suggests that concerns from parents relating mercury to ADHD are not the primary cause all of these years, but rather this refusal exists due to a more universal belief system.  


My mapping of V-codes depicting the refusals of specific vaccines (as well as several generic vaccination V-codes), provided undeniable evidence supporting my claims during the late 1990s.  


My studies have since shown that this behavior migrated from Utah to Oregon and California in the late 1950s (when schools were opened between 1957-1963 in OR and WA), making the Pacific Northwest the primary region for these behaviors since the late 1980s.  


These observations were first made as part of my research of complementary alternative medicine in the Pacific Northwest back back in 1993, and ignored throughout the late 1990s and early 2000s by regional insurance companies that I shared my findings with.  These mid-to-late-2000s video maps verified my findings, using national public health EMR/EHR data.


Some of the notes from this review are posted on a number of pages at my blog site; begin with : ;


The following note I include here because it details the origins of this non-vaccinations behavior of naturopaths, an event that took place during the late 1950s due to a decision made by a Utah Attorney General in 1956. (this decision was later no longer valid; notes from these documents are also on my site) i.e.:




The availability of the Polio Vaccine by mid 1950s put the question of naturopathy back up front. Therefore, the questions asked of the Attorney General were:


“Is naturopathy actually a legal classification?”

“May a naturopath engage in the administration of drugs and surgery?”


“Which professions are allowed to give shots (vaccines)?” [Attorney General’s Opinion, 55-101, pp. 191-195, Biennial Report Atty. General, June 30, 1956.]


The Attorney General concluded “a naturopath cannot prescribe drugs or perform surgery as part of the practice of naturopathy.” (p. 3)



[End Quote]



[Source: ]




For more on this matter. . . .


A rather "schizophrenic writing" on this topic dated to 2009, by David Gorski, is 'Naturopaths and the anti-vaccine movement: Hijacking the law in service of pseudoscience' at ;  (An example of cross-cultural cross analysis and writing that is heavily simplified and poorly managed.  Demonstrates a limited understanding in the long run of these professions.)


A more "stable writing" on this topic  is 'Naturopathic Opposition to Immunization' by Kimball C. Atwood IV, M.D. and Stephen Barrett, M.D. at




An interesting Australian review of this problem in Australia is 

Dr Sherri Tenpenny Banning Me From Talking In Australia Won't Suppress Debate On Vaccine Damage  at 

(37 mins, short version; link to the more than an hour-long version is on the right side of the screen.)





No comment yet.
Scooped by Brian Altonen!

REGIONS & HEALTH - the Pacific Northwest as an Example

REGIONS & HEALTH - the Pacific Northwest as an Example | Medical GIS Guide |
Regional Health Planning and the Pacific Northwest Medical GIS and Regions series . Part I - Introduction Part II - History Part III - Examples Part IV - the 3D Mapping     LINK Part V - Pacific No...
Brian Altonens insight:

It's hard to believe, but going on 6 years ago I published a major commentary and warning about the immunization problem in the Pacific Northwest.  


I produced this page following my discovery of more evidence demonstrating the susceptibility of the region to infectious disease outbreaks, namely the diseases children used to be immunized against.  


This posting was in response to two major Pacific NW health insurance companies posting positive reports about their annual NCQA related HEDIS scores pertaining to childhood immunization.  Slightly earlier, my studies inferred a completely opposite outcome and not so glamorous report on Pacific NW health in the future.  The following year, one of the largest of these companies, with one of its centers in Portland, Oregon, failed significantly, losing the chance to repeat its results and prove it's program had produced any solid change.  (This company and I underwent "permanent separation" at the professional level after I noted their deception; after eliminating its negative core name, it came up with a new name but unfortunately had no new successes to show.)


From 2010 to 2013, the news was quiet about this decade of growing failure, providing enough time for more risks to develop within the local schools (even colleges), public recreation sites, the dancing and martial arts classroom settings, and even the line and country dance rooms where rebellious parents often frequented.  


There is and was a unique culture to the Pacific NW that only long time residents of the area will truly understand.


It is this culture that puts regular medicine and public health at its risk occasionally.  Not frequently, since after all, much of the popular culture for the region is much healthier that other standardized forms of care--fewer hepatotoxic and renotoxic drugs, less malnutrition and poor diets, much stronger mindbody healing components, actual belief in the possible role and important of non-traditional thinking, even from other cultures.  


But this other healing philosophy also has its holes, as much as any well prepared soy milk lactose-free substitute for Swiss cheese.  These problems are infrequent, but look worse at times only due to biased reporting.


 Unfortunately, these two disciplines of maintaining optimal health find it hard to work together.


The ongoing dilemma these past few months in California, and from there to other places throughout the country, was and always has been preventable.  The evidence was readily available, for the more health minded programs to compose surveillance tools and preventive health for.  


The segregation of uninsured from the insured by major insurance companies for this reason is why this public health problem arose during the last decade or more.   You never heard about it a decade ago because these agencies did not know it was there.  It's not that they made an attempt to look.  The herd theory made it seem alright to ignore a few unimmunized households.  


Well from households come communities, and from communities come similar minded districts, communal settings and regions.  The development of these latter is what these agencies responsible for monitoring public health missed in the Western United States.  


The evidence this problem existed was always out there.  Well, at least since May 2009, when I first posted this page.  We will soon see that this inattentiveness goes back even further, playing a steady unaltering roles since the 1960s, as evidenced by my report on this matter, and a review of the professional medical school documents for the time.



No comment yet.
Scooped by Brian Altonen!

Shigella: A Look At The Drug-Resistant Bacteria Spreading In The U.S.

Shigella: A Look At The Drug-Resistant Bacteria Spreading In The U.S. | Medical GIS Guide |
The bacteria causes a condition called shigellosis, which is marked by bloody diarrhea and abdominal pain.
Brian Altonens insight:

There are some very unique regional differences in the distribution of cases linked to the four major Shigella species in the USA over the past decade . . . . .  


It is one of a number of important epidemiology topics proposed in my dissertation that are in need of extensive development at the GIS-spatial analysis level in the next few years.  


In order to surveill more than 2500 diagnostic metrics per day, an effective tool has to be implemented which can manage that task.  


The NPHG algorithms I developed are designed for spatial analyses without the need for standard GIS implementation.  


The results of this surveillance technique can be used to define whatever special topics, case report clusters, and population health indicator metrics are in need of a more extensive implemetation of GIS for detailed, routine analysis.  


This method was specifically designed for use in rapid surveillance and small area analysis, to be performed on a daily or weekly basis.  It can perform a de novo surveillance request in just a few minutes.


With the following four videos, I demonstrate the important spatial differences of Shigella case distribution for the U.S., via the following 3D videos of cases:


Shigella A  (Shigella dysenterica) -- 


Shigella B  (S. flexneri) --


Shigella C  (S. boydii) --


Shigella D  (S. sonnei) --

No comment yet.
Scooped by Brian Altonen!

Peru declares emergency in 14 regions on El Nino worries

Peru declares emergency in 14 regions on El Nino worries | Medical GIS Guide |
Peru has declared a 60-day state of emergency in towns in 14 regions to brace for possible damage from the climate pattern El Nino in the rainy season, state media reported Sunday. Peru has forecast a "moderate to strong" El Nino in the winter season and has not ruled out an extraordinary event in the summer, which begins in December in the southern hemisphere. The phenomenon, a warming of Pacific sea-surface temperatures, has wreaked havoc on local fishing in Peru and triggered landslides in years past.
Brian Altonens insight:

What has this got to do with health?  Everything!


Back around the turn of the 19th century (the late 1800s), cycles became a pop culture craze (like dozens of times before, and after).  During the early 1900s, professional journals came about talking about the cycling of trends in finances, crop production, political and social turmoil.  


The American Meteorological Association came to be, and a number of theories for cyclic weather patterns were published.  The most popular one was the Sunspots Theory, which claims that weather patterns were impacted by the changes in solar radiation related to sunspot activity due to the solar flares and "solar wind" that were produced.  Now, all of these changes in the energy patterns for the Solar System were in fact quite true.  But the association of these natural events with manmade events on the earth's surface was hard to accept.


So those in favor of this theory found many more ways to support it.  Some even proposed secondary cyclic patterns, which went in and out of resonance with the sunspot cycle.  This explained still more events then awaiting recognition.


The cycling of finances, in particular stock prices were still hard to accept this as an explanation for.  We could easily accept this argument for food industry products like corn, soy bean, grains.   Meteorologists had demonstrated some links between drought and the solar cycles.  That was enough to hush everyone who was against this theory--it had indirect implications--hard to provide either way.


But then out came a new rendering of this sunspot theory in the 1980s--the La Nina-El Nino cycle theory.  It provided another explanation for atmospheric changes, that couldn't always be correlated with the solar winds (which are true events, the winds are energy related).   


When I returned to college it was my intent to link the Asiatic Cholera outbreaks over time to this philosophy.  I spent several years researching this, even returning to some of my dendrochronology work that I did back in the 70s.  But then, I turned to the Cycles journals again, and took issue with how the natural cycles were being compared once again to finances, automobile manufacturing and sales, changes in gas and electricity stock prices.  An ecological approach to studying cholera cyclicity and peak outbreak times, based upon La Nina-El Nino theory, was in fact possible, due to the use of GIS to review these past popular culture themes.  


Naturally, over time, my interest in the cyclicity diminished once GIS came to be my tool at hand, instead of my handy increment borer for extracting tree rings and using the tree ring cycle data sets shipped to me from the leader in this field (evaluated on a 286 PC).


EMR/EHR, Big Data, the iCloud, and GIS can now be used to test these older pop culture theories.  We can prove once and for all whether or not the cost for growing coffee beans in parts of Africa will influence the country's ability to control its other social and economic problems, not to mention the events leading to the next spread of Ebola.


Yes, there is another cycle starting, but now we can begin to monitor it from day one.  If and when there is an outbreak, we can define how and why it had everything to do with El Nino, or nothing at all to do with the oscillation of global energy patterns.  


This cyclicity and global energy phenomenon was also used to explain global outbreak patterns in the mid-19th century.  The British Surgeon in Charge at the Military Hospital in Crimea, Ukraine, was removed to Jamaica in the Caribbean following the medical disaster that struck that place during the Crimean War (see ;).


In Jamaica, he came up with his theory as to how the magnetic fields generated by the earth could be the cause for the moving and cycling of yellow fever outbreaks around the world.  The earth's magnetic fields moved about, as did the yellow fever outbreaks.   As a result, his theory--Robert Lawson’s Pandemic Waves Theory--was published by esteemed medical journals. After all, he was a member of some of the Royal medical societies.  He drew up what he called "the World Isoclines Map" ca. 1860-1875, and used it to explain the outbreaks.


Sound familiar?  


We are back to square one with evaluating the impacts of climate and natural cycles on disease patterns and outbreak behaviors.  


With the right GIS in place, this controversial issue could have been resolved ten or fifteen years ago, all except the cycling periods of indecisiveness that politics and medicine--global health patterns--are riddled with.  Perhaps it may take a recurrence of a past disastrous outbreak, to lead to enough research, to at least resolve this issue once and for all.  And even then. we may still be left not knowing how and why Chikungunya, MERS and Ebola behave the way they do--but of course that may also be due to the lack of GIS implementation, for people health, not just ecological health.  


Peru by the way is a hot spot for vibrio ecology studies and a natural setting where vibrio has become naturalized.  It bears the classical and two most dangerous strains are linked to this Asiatic Cholera disease nidus, in particular the El Tor.

Brian Altonen's curator insight, July 8, 2015 1:14 PM

Disease ecology and recurring epidemics like Ebola, Vibrio cholera, Hanta Virus, hemorrhagic shellfish born diseases, and even Lyme Disease can be better understood once we begin to better understand the El Nino-Southern Oscillation theory, and relate it to global disease ecology.   


This issue and its news related links are updated:

Scooped by Brian Altonen!

Deadly Vibrio Vulnificus Bacteria Kills Florida Swimmer: Are You in Danger?

Deadly Vibrio Vulnificus Bacteria Kills Florida Swimmer: Are You in Danger? | Medical GIS Guide |
Nine people have been infected by the bacteria in Florida this year, and three have died.
Brian Altonens insight:

Vibrio parahaemolytic is the match for this.  


Both vibrios have the ability to resurface at times in the salt water environments.  As part of the vibrio ecology project I engaged in fifteen years ago, we reviewed the distributions of non-cholera related vibrio along the western shore, and found two ecological settings that routinely supported these species, according to publications, at the end of the Columbia River and in several harbor settings in southern California.


The upwelling of nutrient- and microbe-rich waters from the ocean bottom helped maintain them at times when outbreaks occurred.  This was an early confirmation of some of the El-nino-Cholera findings as well.  Temperatures seemed to prevent the vibrio from advancing beyond their consumption by molluscs.  


The Florida cases are interesting, due to the time of the year they are emerging.  A latitude-climate relationship may also exist on the east coast, with bays as far north as the Chesapeake Bay shown to support the ecology of vibrio species in unexpected ways.  


Some are going to want to attribute this change to global warming.  But remember, temperature isn't the only requirement here.  Alkalinity slightly above the neutral range, ample amounts of nutrient in specific forms, and places for vibrio organisms to settle and stabilize at the bottom end of the foodweb are also required for vibrio vulnificus and parahaemolytica to find their place in the ecosystem.  


The allies of vibrio, Mannheimia and Pasteurella, aren't too far behind in this evolutionary behavior either.  They add to this some zoonotic (livestock) related possibilities for new outbreaks in the U.S. in future years.  Thus the need for a very thorough ecological re-assessment of disease ecology with GIS.

No comment yet.
Scooped by Brian Altonen!

NAACP official falsely portrays herself as black, family says

NAACP official falsely portrays herself as black, family says | Medical GIS Guide |

"Civil Rights Spokane NAACP leader Rachel Dolezal falsely portrays herself as black, family says"  Watch the video NAACP official falsely portrays herself as black, family says on Yahoo News . A prominent civil rights activist in Washington state has been accused by her own family of falsely portraying herself as African-American.

Brian Altonens insight:

One of the disadvantages to a very multispectral culture are the extremes that develop.  


Back in 1992, there was this case which we probably forgot, the case of Azalea Cooley who was in the news for a variety of reasons.  One time it was due to discrimination claims due to her sex and race, another time it was because of her sexual preference, still another due to the cross was that found burning in her yard.  (See an original article, from the Bend Bulletin:,793898&hl=en ;)


'So much discrimination had to stopped!' everyone claimed.   So we held a parade in my neighborhood in which she led the procession, in a wheel chair.  


To some of us in the local community, the sudden permanent disability part of her history was news--but supposedly cancer could be the cause.  


Her explanation based upon cancer for the need of a wheel chair kept her off a list of suspected graffiti criminals and arsonists who were then purported destroying the house and property she was renting.


But then, through nighttime surveillance, we all learned she got the best of us--she could walk, and run, was in fact the arsonist who set the religious symbols on fire (a cross) in front of her house.


Today, she is listed as Number 1 on the list of Ten most Egregarious Hate Crime Hoaxes ( )


According to the local newspaper at the time, the Cooley story always seemed "too perfect and textbook like to be true."  ( " 

But we had other news items to tend to as well (I believe the Rajneeshi issue was still on our minds).  


Many years have passed since then (almost a quarter century in fact).  

It interesting to note that the Pacific Northwest offers people the opportunities to be themselves, even when they aren't the race, ethnicity, trait, character, phenotype, or even astrological sign they portray themselves to be.   


But there is gullibility for siding with these individuals on the other side as well--the local social scene, where different definitions of culture and rights can come into play.  


The current NAACP case is for a women (got the gender right) who earlier confessed herself to be American Indian.  ('Oops!' as Rachel Dolezal would later learn, 'they define membership differently now, don't they?').  


So psychologically, Rachel Dolezal had to fit in somewhere, and the varying appearances of African American community groups enabled her to fit right in.  Of course her parents weren't at all going to fall for it, or sign her up as such.  Still she managed to use it for her civil rights, applying for college, public programs, presentation rights, rights to represent, what have you.  At least she didn't go so far as portraying herself as physically disabled (yet).


We can counter argue all of this by stating that culturally and socially, she is a self-defined and admitted member of this group in need of special privileges and advantages.  Or can we?  


Her intentions are not in the right direction.  There is only so far you can go with trying to obtain your success and powers by stomping on other folks' cultural heritage.     


Looks like she may have "Ward Churchilled" everyone this time, even the people she wanted to be a symbol for.  Some slave owners from the south in the 1800s remain great symbols of their possessions as well to this day.  Their slaves or servants are the ones that gave them their fame and place in history.    


Rachel Dolezal made victims of black and white populations, as well as the civil rights groups and leaders she is supposed to represent.


Like Azalea, Rachel could soon be in need of a new community to guide and lead for more personal gain.  However, not sure if prisoners are really ready for whatever it is she wants to teach them.  

No comment yet.
Scooped by Brian Altonen!

Seoul mayor declares 'war' on MERS after fourth death

Seoul mayor declares 'war' on MERS after fourth death | Medical GIS Guide |
South Korea reported on Friday a fourth death from Middle East Respiratory Syndrome (MERS), as an infected doctor fuelled fears of a fresh surge in cases and prompted Seoul's mayor to declare "war" on the virus. Five new cases overnight took the number of infected people to 41 in what has become the largest MERS outbreak outside Saudi Arabia, with close to 2,000 people in quarantine or under observation. Criticised for its lack of transparency in addressing the health scare, the Health Ministry finally confirmed the name of the hospital where the first patient to be diagnosed with MERS was treated.
Brian Altonens insight:

SARS is old news.  This next northern hemisphere disease season is only warming up right now.  Do we have the GIS guidelines in place at the academic public health surveillance programs and agencies?  Is there a strategy to undergoing seasonal and quarterly updates on these recurring disease patterns, even those of a foreign born nature?


I recently noted that a new way for providing shots for influenza is in the news.  (I won't continue my criticisms on the failed immunization programs we are now dealing with, but will soon post a review of the same and retell exactly how it happened exactly a century ago.)


In the Hudson Valley of New York, I note that a new sociologically and culturally defined period of lyme disease prevention has arisen in this region, and from here this behavior should migrate across the United States.  There is a new interpretation of the lyme disease problem that is appearing in the press, much like the behaviors that ensued decades after the HIV-AIDS outbreak down on Long Island.  The focus is no longer on the acute, seasonal problem that Lyme Disease is, but on its long-lasting and sometimes fatal nature leading to unexpected deaths of children and young adults -- school mentors.  


Ebola risk is still drawing a substantial amount of attention each week.  New problems also seem to be arising due to herpes, listeria, and meningitis reaching the news.  


Last year, about this time, the US MERS episode in Chicago preceded the news about Chikungunya and Ebola that soonafter came to the Americas.


But as for now, officially, even though spring hatches and re-emergence have already initiated here, as far back as April, mosquito vectored diseases like West Nile and Chikungunya have yet to draw much of the public's or newswriters' attention, locally or nationally.  I personally still have much of my attention drawn to Chikungunya and the possibility that it may develop a series of permanent ecological domains in the Western hemisphere, perhaps in the Caribbean and maybe in the neotropical parts of the US.  

I am also waiting to see if Ebola behaves like I predicted more than a year ago, establishing a permanent residency in this hemisphere (I already published my ecological guess as to where) and re-erupting in its homelands with more human ecology potential than portrayed any previous years.  


Still, the most important global health question we all have to ask is:  what other new foreign disease(s) will reach the Americas for the first time this year?  Perhaps another mosquito-bred pattern--such as Powassan virus?  Or a new form of California encephalitis/meningitis?  


The import of a new foreign bred pathogen of unique origin, such as Crimean Congo or Omsk Hemorrhagic Fever, a new Ixodes (tick) born meningo-encephalitis, a relapsing fever, or heartland virus, would not be a surprise.  


It has also been a few years since the Hanta virus re-emerged out west.  Do they know that the last time it traveled to Oregon in the late 1980s, that the migration was due to a drought in Arizona and New Mexico, like the one that California is currently facing?   


Finally, these are all interesting topics in need of more than just speculation.  So, has anyone in the university setting out there tried GISing this important research topic as of yet, for the hundreds of potential outbreaks that could happen this year, or any year?


[This posting is part of a dissertation project I am engaged in, focused on the upscaling of GIS for more broadly applicable public and population health monitoring programs, manageable by managed care programs and applicable to most university hospital settings, for a more thorough cost/healthcare analysis using your demog, EMR/EHR, claims, billing, lab, Rx and other healthcare operations systems.]

No comment yet.
Scooped by Brian Altonen!

Anthrax, the Natural Strains

Anthrax, the Natural Strains | Medical GIS Guide |
There is the natural anthrax, and the bioweapons anthrax. This is how mostly the natural version is distributed.
Brian Altonens insight:
Today's accidental shipment of live anthrax demonstrates the likelihood for ongoing global public health safety concerns. It's like carrying a gun in a megalopolis. Even if you didn't intend to use it, you just have it for the sense of security and safety, sooner or later a mistake will be made.
No comment yet.
Scooped by Brian Altonen!

'You don't belong here' said racist letter sent to Long Island family

'You don't belong here' said racist letter sent to Long Island family | Medical GIS Guide |
Watch the video 'You don't belong here' said racist letter sent to Long Island family on Yahoo News . There is a disturbing case of racism on Long Island. An African-American family got a nasty letter claiming that the Suffolk County Village of Lindenhurst is overwhelmingly white and "you don't belong here."
Brian Altonens insight:

I first posted my impression of the troubles we have with racism a few days after walking by some racist graffiti I noted on the concrete barricades posted in a field on some high school property.   That was in April 2014.  


I wondered then, 'why hasn't the groundskeeper seen and removed this from public display?'  


Reviewing this topic on the internet at the time, I uncovered the possible meaning of the initials "N.B." that I saw on the barricades, and the reference to 2012.  I also found out the reason for this racist epitaph and the legal case that it led to in the form of a law suit for racism, which has since been legally settled.


Like any researcher of population health, this news story led me to ask:  How ubiquitous is this moral, social behavioral problem?  This new case that surfaced in the news today (5/23/15) reminds us that THIS PROBLEM IS EVERYWHERE.    


The family impacted by this rural case of racism happened in Upstate New York in a community that is between 98% and 100% white, depending upon the year that you check the statistics and the nature of the in-migration/out-migrations engaged in by farmworkers and renters for the time.  


It involved a family that removed from Brookhaven, Long Island, in order that their children (one African American, one Hispanic) could receive "better schooling", according to the parents, living in a less stressed, "less hyper" rural environment.   [For my coverage on this upstate NY case, go to ]


These same events have just occurred in the "84% white" town of Lindenhurst, Long Island.  


Due to skin color, mostly involving the mother, this mixed race family was discriminated against by the non-mixed race couples next door (or so these neighbors would like to believe in terms of genotype).


Since this societal problem cannot be eliminated, its related public health concerns must be better managed by healthcare officials.  


I identified a number of features of managed care planning that are not fully or appropriately engaged in, for managing the cultural needs of insured populations.  These are defined based on the following research questions:


**What are the racial profiles of your neighborhood subpopulations?  


**Which ICDs are most linked to the primary sociocultural groups (and their subgroups) in your region (AfrAmer, Hisp, Asian, NtvAmer).  


**Which of these are culturally bound?  Culturally-linked?  Culturally-related?


**How about the same question. applied to socioeconomic status and poverty stricken communities?


**Are there regions where certain culturally defined physiological, genetic and social and behavioral problems or conditions might surface due to lack of familiarity with your population and/or mismanagement?  


**How will these impact cost for providing care to the community?


**Are there specific subprograms in place for Managed Care such as special programs designed to assess different areas or places for culturally-bound, culturally-linked, or culturally-related diagnoses/ICDs?  




Specific methods for a more thorough evaluation of the culture of your managed care population are presented at my sites on this topic.  


For more, see my pages, focused on developing spatial analytic systems for engaging in this quality improvement process, at : and .


No comment yet.
Scooped by Brian Altonen!

Bioterrorism 101 - GIS

Bioterrorism 101 - GIS | Medical GIS Guide |

There are numerous ways to map out bioterrorism and bioterrorism/terrorism-like threats, and related behavioral and psychiatric diagnoses.  NPHG is the only method that has employed the E codes method to identify where these homeland security EMR/EHR-defined risks are clustered.  This NPHG method was also used to evaluate the age of the individual this was associated with, as well as gender, by region, state, and small area (10-20 mi sq).  Major categories of human behaviors linked to possible bioterrorism social and cultural behaviors were evaluated, for comparison with other GIS findings.

Brian Altonens insight:

The National Population Health Grid (NPHG) findings of this case review are detailed in the 3D disease mapping video at (E979 coding, using a 25-30% National EMR/EHR database).


The following are also recommended sites for review:


A List of Terrorist Groups by Type.


 Terrorist attacks: Five U.S. Urban Counties Lead ‘Terror Hot Spots’ List. ;


World Report.  A Hands-Off War on Violent Extremism.  Obama's attempt to end the war on terror by limiting its scope has failed miserably. ;


The Muslim Issue.  UK map charts soaring number of terror arrests and convictions. ;


The Wall Street Journal.  

New Laws for New Threats Like Drones and Bioterrorism
An era of futuristic, high-tech violence will require a new social contract. ;


USA Today.  CDC seeks more clues to bioterror lab accident. ;


NIH. Medline Plus.  Biodefense and Bioterrorism. ;

Interpol.  CBRNE  (chemical, biological, radiological, nuclear and explosives). ;


My personal blog: ;


My E979 video -


My NPHG Site: (Sorry!  Homeland Security applications page is still not finished)


My related YouTube, with many more NPHG videos -- ;

No comment yet.
Scooped by Brian Altonen!

Experts denounce WHO's slow Ebola response

Experts denounce WHO's slow Ebola response | Medical GIS Guide |
A UN-sponsored report on Monday denounced the World Health Organization's slow response to the Ebola outbreak and said the agency still did not have the capacity to tackle a similar crisis. "It is still unclear to the panel why early warnings approximately from May through to July 2014 did not result in an effective and adequate response," an interim report by a six-member expert team said. WHO only declared a global public health emergency on August 8 -- almost five months after the outbreak had taken hold in west Africa. The panel, set up on March 9, is led by Barbara Stocking, who formerly headed Oxfam.
Brian Altonens insight:

So what have we learned from the last 13 months?


It was April 10th, 2014 when I posted my first review and warning about Ebola's migration habits or patterns, and the need for Medical GIS to be available outside the WHO and CDC settings.  It is important to remember that WHO and CDC are organization, pretty much agencies behaving like businesses, that have other agendas to consider.  The primary agenda is world stability, politically, financially and, oh yeah, healthwise.


Two more months passed before either agency paid much attention to the facts about ebola.  Unfortunately, even the total facts about spatial habits of diseases like ebola. was a knowledge base both WHO and CDC lacked enough experience with to foresee the reasons for the upcoming cascading of this outbreak.  


Historical epidemics demonstrate these patterns.  They have their ebbs and flows just like the plagues and contagion before.  For medical historians, it is nice that history repeats itself; this concept however is most because people repeat themselves, including their bad habits and poor learning curve following recent and new outbreaks.


So what have we learned?  The news tells it all:


LESSON 1.  May 12:  As Ebola disappears, no useful data seen from vaccine trials -WHO. ;


We allocated money in the wrong directions.  Pharma companies effectively convince investors and health officials that they had the cure.  Internal benefits linked to these actions helped fuel these tests of the new medications.  The patenting of a bioengineered plant phenotype that produces an antiviral drug was one result; the proof that we (NIH and CDC) need to patent the deadliest ebola of all, because we need to have control of this bioweaponry - - against future outbreaks that is.


Instead, this money should have been completely allocated to just two things--surveillance and cessation/prevention activities to prevent the further spread of Ebola.


LESSON 2.  Adam Justice.  May 12.  Ebola: Liberia celebrates as WHO declares the nation clear. ;


FOX News.  May 11.  Liberia declared Ebola-free, but outbreak continues over border ;


When it comes to the global outbreak and rapid rise in numbers, nothing is final.   While Liberia celebrates, the disease remains active just across the border.  In fact, we saw this happen between at least 3 countries in Africa.  While you appease one side with money and tactics, the carriers remain at large.  This is due to ignoring the first warnings, lacking an effective intervention plan for when the outbreak ensues, lacking trained professionals with expert experience in the plague known as ebola, and inadequate education and experience as an organization--no proper foresight.    We always forget our mistakes deliberately--we can't accept them and handle them--and we certainly won't admit them--so the line in this articles taht states:  "Now comes the challenge. The challenge of working with our two neighbouring countries. To make sure they reach the same level of progress that we have reached" means you still have a lot of convincing of others to accomplish--this epidemic is not over.


The Solution:  Eliminate current plans and procedures, replace inadequate staff, invest more in the GIS/HIT needed for surveillance and reporting outside the two major agencies, and regional/state/county agencies with attached agendas.  Each business (insurance or tertiary care giver) has a responsibility for trusting only itself when it comes to smart corporate decision making.  Big Business suffers the most, when expenses needs to be covered for an outbreak their auditors and regulators failed to prevent.  Its like a government charging the taxpayers for not fixing up the roads.


LESSON 3.  Doctor Who Survived Ebola Nearly Lost His Vision. ;  


Too much favoritism and elitism are found in medical profession behaviors.   Crozier and others failed to abide by their own public health and safety rules.  And there is no way this will even NOT HAPPEN.  People are into "the self"--the self's desire for some fast food picked up by a drive through (where the card or paper money spreads the disease, like it did with cholera), the self's desire to get home or to a relative's place no matter what--no matter how many hundreds to thousands of people you potentially expose directly and indirectly.  We punished the newscaster who did not abide by her requirements; we failed to treat the others accordingly.  Nature showed Crozier that he made a terrible professional decision related, unethical mistake.


SOLUTION:  be more responsible in catching and/or quarantining these types.


LESSON 4.  May 12.  Experts denounce WHO's slow Ebola response. ;


Ebola: Expert panel urges 'unified entity' within WHO for emergency response


It is not over until it's over--and perhaps may never be over.  This in fact should say, "A third new group of experts who reviewed the outbreak of Ebola felt WHO and CDC could have performed better."    The "Unified Entity" some nations are talking about is idealistic, not realist.




LESSON 5.  May 12.  Experts denounce WHO's slow Ebola response (Update). ;


What happens to WHO influences and/or also happens to CDC.  Recall, there was a 180 turn around in CDCs claims in July 2014.  For just one day, WHO's statements were in disagreement with CDC's statements, claiming that there was a new outbreak that required immediate reaction.


SOLUTION: 90% of all surveillance per ICD/disease type should be done outside WHO and CDC.  Multiple agencies interacting with each other make it less likely for governmental decisions to endanger local, national or global public health.   90% of all public health activities, for an outbreak like ebola, or measles, or cholera, should be performed by local interest groups first using GIS, then the national and international groups.  And those local groups should encompass more than just your regional, county or state health departments.


No comment yet.
Scooped by Brian Altonen!

Tourists and FIFO workers hit by mosquito-borne virus

Tourists and FIFO workers hit by mosquito-borne virus | Medical GIS Guide |
More adults, tourists and fly-in fly-out (FIFO) workers were infected with the potentially fatal mosquito-borne arbovirus Murray Valley Encephalitis (MVE) during the most recent outbreak when WA experienced more than fifty per cent of the nation's recorded cases.
Brian Altonens insight:

There are literally hundreds of diseases that we and other countries are at risk for through travel and global migration patterns.   I cover these extensively using the national population health grid [NPHG] method for disease mapping.  Literally hundreds of these reviews, and growing, are available at a page I produced a number of years back; it is password protected  - - to view these, type "Homann" :  : ;

No comment yet.
Scooped by Brian Altonen!

CAHPS - A Unique Application for Medical GIS

CAHPS - A Unique Application for Medical GIS | Medical GIS Guide |

A large national health insurance company periodically has to review any questions it has designed for evaluating its unique performance indicators.   The two sets of figures demonstrate the result of a poorly worded survey question, with results trending towards two end responses, and a well designed question producing widely distributed results.   

Brian Altonens insight:

An easy way to evaluate both spatial cultural or ethnic differences, and question format generated bias in response patterns, is to evaluate average responses versus total individual responses based upon spatial address (point or area models may be used).  The better more reliable outcomes have homogenized results (no favored end responses).  Spatial and OLAP techniques can then be used to determine whether or not significant population size, SES, ethnic, age, patient address, service location, staffing, insurance type, or business hours related barriers exist.  This spatial approach to analyzing CAHPS enables a program to determine where barriers exist, and better target the subpopulations in need of intervention or change.

No comment yet.
Scooped by Brian Altonen!

The Next Outbreak in Evolving Disease Migration Patterns

The Next Outbreak in Evolving Disease Migration Patterns | Medical GIS Guide |

The last two or three years have demonstrates that the diseases that affect the earth are changing, and migrating, and increasing the likelihood of new populations becoming infected.  The increase in polio cases more than a year ago was a reminder to remain active and avoid certainty or complacency, behaviors further removed by this past year's measles outbreak in the U.S.  Vectored diseases are also in need of more attentiveness, and the fairly commonplace mosquito born disease patterns forming the top of this list.  

Brian Altonens insight:

Mosquito born disease patterns like West Nile and  Chikungunya constitute a very small part of this evolutionary process.  There are other insect vectored disease in need of increased attention.


Onchocerciasis and filariasis need to be placed high on our re-emerging diseases watch list. 


Onchocerciasis was one of the first diseases that WHO designed global health focused preventive health programs.  The Onchocerciasis Control Programme in West Africa (OCP) was developed by WHO in 1974.  Its efforts focused on the use of widespread aerial spraying tactics of the insecticide ivermectin, hoping to kill most of the blackfly vectors.  Forty years later, the world still has a very large number of onchocerciasis cases--42 million approximately.


This high prevalence supports the ecology of the pathogen, host, vector and/or reservoir.  


The following are information resources for this disease, and its very common co-disease filariasis.


J. Blanks, F. Richards, F. Beltran, et al. The Onchocerciasis Elimination Program for the Americas: a history of partnership. Rev Panam Salud Publica/Pan Am J Public Health 3(6), 1998 .


Training in the management of Onchocerciasis (River Blindness) and Lymphatic Filariasis. From a 2013 Global Health and Disasters Course.


Seth Elliott’s Onchocerciasis slide presentation.


Infective larvae ofwuchereria bancrofti (1947, Instructive Military video).


WHO. Preparing and Implementing a National Plan to Eliminate Lymphatic Filariasis (in countries where onchocerciasis is co-endemic). WHO/CDS/CPE/CEE/2000.16 .


Examples of related NPHG products (U.S. map videos):

Sickle Cell :

Bancroft Filaria :

Malayan Filaria :

Elephantiasis , IP :

Foreign Born Zoonotic Diseases :


My complete listing of these diseases from the preliminary dissertation work:


No comment yet.
Scooped by Brian Altonen!

Hex grids are Essential to developing a more effective Medical GIS workstation

Hex grids are Essential to developing a more effective Medical GIS workstation | Medical GIS Guide |
Brian Altonens insight:

The best way to reduce error in mapping is to convert from the use of square grids to hexagonal grids.  This reduced the 40%+ error generated by apices in the grid to 14%, a more than 25% reduction in total grid mapping and analytics error (this is allowing for the natural +/-3-5% error we often rely upon).


The popularity of this technique is demonstrated by the numbers of downloads my site is getting for the excel sheet I produced in winter of 2003/4.  There are also SQL formulas for this for limitless cells, but the traditional method uses a hexagon overlay for your analyses, calculated using the lat longs for your area, as defined by this page.  


To state bluntly what this method corrects for, if we are using grid analysis for intervention or surveillance (determining causality), there is error in our point-area relationships.  41% of the area mapped and assigned a point value for a findings may be assigned to the wrong centroid due to edge-centroid areal trigonomic or geometric features.  This math rule applies to all mapping techniques on a surface (flat or curved) with square grid monitoring techniques.  


Hex grid approaches to flat surfaces and sphere more accurately represent the area below, and produce results at least 25% more accurate than traditional grid mapping techniques.


We haven't used hex grids in the past due to ease of producing square grids in GIS.  Manually or even pseudo-automatically calculating grids, before excel and the PC days, was a time (in not labor and thought) intensive process.  These limits no longer exist today.  So why do we keep using this method capable of generating so many errors?


Another question to ask is do you wish to produce contour or isoline related risk analyses products?  If you do, then hexagonal grids produce more accurate and understandable contour images (the lines are smoother and more real).


In general, I have asked - which cultures or countries excel in Medical GIS and especially the use of innovative ways to produce your results?


The stats for my site indicate US visitors are the most frequent, but based on feedback from emails, comments, etc., Great Britain and Canada are most engaged in the use of this new GIS technique.  


Moreover, based upon my years of researching geographic medicine in general, the support of geographic approaches to health and disease, in a statistical spatial sense, is mostly a skillset adhered to and frequently used by geographers in Great Britain.  I blame this on the lull in interest in "Geography" that this country had through the mid to late 20th century.  


The largest support of this method at the professional level, from Canada, is perhaps the result of an offshoot of British culture and traditions into Canadian academic patterns and behaviors.  Fortunately, Canadians make excellent use of this more accurate technique, the respondents tell me.  


There have been very few outcomes of hex grid work in general in the refereed, academic publications on GIS.  I have also found it hard to convince the companies to accept my help in making this a standard tool available to GIS technicians. (But I admit I am also very brazen about this result of professional jealousy, now 20 years into this profession.)


It is important to note--that two changes related to GIS need to happen in medical GIS to make it more accurate, and useful at the professional level.


1.  Agencies, organizations, insurance companies, PBMs have to become fully engaged in GIS and spatial analyses--not just for that occasional research project (which is now the case), but at the 1000s of analytics per year, for each program they attend to.  Managed Care insurance agents and facilities have to catch up with this technology.  The current outbreaks are happening due to the failure of these programs to evolve over the past decade, change with the time, initiate new thoughts, recruit new thinkers (us GIS pros are under-employed and not at all respected).


2.  These companies etc. also have to slow down, hire and make better use of the skills of better trained GIS individuals, check their data and work for errors, change to spatial analyses, and go beyond just "the experimental stage" (a status now 10-15 years old).  

It doesn't help that some major GIS businesses or industries are non-supporting of the new ideas, methods, skillsets, and technology.  

It's been well over a decade since I began promoting this use of GIS at the statistical and administrative-clinical level.

Think of this as getting the wrong address for an emergency call--We don't want to send our services, products and staff to the wrong address.  We need to reduce that 41% error the traditional form of spatial grid analysis has, as much as possible.



My information sheets on Grid Analysis in general, and the hex grid technique I developed more than ten years ago, are as follows:



Grid mapping health and disease in the United States -


2. Grid Cell Analysis (and Ecology) -


3.  Sequential Series analyses using Hexagonal Grid Cell techniques - ;


4.  Applying Grids to Managed Care programs Medical GIS - ;


6.  Downloads Page for Hex Grid formulas/calculation sheets (the stats for which are cited above) -

No comment yet.