Episurveillance
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Episurveillance
21st century Epidemiological Surveillance. New maps, new formulas, new techniques.
Curated by Brian Altonen
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When HIV Infects the Brain

When HIV Infects the Brain | Episurveillance | Scoop.it
Just over 30 years ago, an international group of scientists discovered the HIV virus. While much progress has been made since the early days of the epidemic (in terms of awareness, prevention, and treatment), HIV and AIDS remain a leading cause of death worldwide, and rank as the number one cause of death both in Africa and among women of reproductive age. A study published Thursday in the online journal PLOS Pathogens gives reason for pause, showing that HIV can behave more insidiously than previously seen. In turn, HIV in the brain can genetically mutate—differentiating itself from the type circulating in the blood—which means that certain drugs used to treat the virus may not work as well in the central nervous system as they do in other parts of the body.
Brian Altonens insight:

This mutation that occurs during a non-pathogenic period residing in the nervous system is also a behavior that measles demonstrates.  Once considered rare, we are seeing more and more cases erupt as the years pass.  Preventing and treating a disease during its earliest stages prevents this.  Measles takes its victims about 5-15 years after the childhood or young adult infection period.  

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Measles outbreak prompts schools to push immunizations

Measles outbreak prompts schools to push immunizations | Episurveillance | Scoop.it
The largest outbreak of measles in California in years is prompting school officials to redouble their efforts to convince parents to vaccinate their children.
Brian Altonens insight:

A detailed looks at the California data on opt outs, for kids entering Kindergarten.  Scroll over the graph to determine which county each line represents.

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MSF and WHO trade blame over slow global Ebola response

MSF and WHO trade blame over slow global Ebola response | Episurveillance | Scoop.it
A war of words broke out Monday between aid agency Doctors Without Borders and the World Health Organization over who was to blame for the slow response to the Ebola epidemic that broke out a year ago. Doctors Without Borders released a scathing report on the global response to the epidemic, which has killed more than 10,000 people and infected nearly 25,000 since it was identified in March 2014, mostly in Guinea, Liberia and Sierra Leone. The aid agency -- known by its French initials MSF -- said "months were wasted and lives were lost" because the UN's World Health Organization, which is charged with leading on global health emergencies, and "possesses the know-how to bring Ebola under control," failed to respond quickly or adequately.
Brian Altonens insight:

It helps to see a calendar of these events (the figure with this post).  

 

Following a review of the pages/headlines/etc. posted on Ebola since February 2014, a few observations may be worth noting.   

 

WHO mentions the Ebola outbreak throughout March and April, including some reports on its status, and even notes the various actions it is taking.  But there are minimal concerns for a potential outbreak.  One of the earliest predictions posted for this outbreak states it will be over by August 2014.     

 

Doctors Without Borders had noted numerous times the "out of control" nature of this outbreak.  These were posted before the most noted press release of the same, published numerous times in the press during the third week and fourth week of June.     

 

It can be argued that the earliest concerns posted in March and April could have been treated as overreaction to the outbreak; the numbers of cases were very small, and an "out of control" outbreak may easily be published following just a handful of cases.   

 

According to a Google Search I did months ago, the Washington Times posted a description of one of their news pages, which stated: 

 

"Apr 29, 2014 - Environmental Protection Agency Administrator Gina McCarthy personally intervened to delay an ... An out of control agency of an out of control gov't is an understatement. .... Emails: U.N. health agency resisted declaring Ebola emergency"

 

(from http://www.washingtontimes.com/news/2014/apr/29/epa-chief-gina-mccarthy-intervened-to-halt-to-inte/?page=all -- but this link may now be dead).

 

On May 6th, 2014, The Indian Express also published a news item stating that "Emails show WHO resisted declaring Ebola emergency", for economic and political reasons. (link, also lacking text from that day due to changes in text; this phrase appeared as a Promoted News Item at the bottom of the page, at  http://indianexpress.com/article/india/india-others/home-ministry-fears-attacks-from-both-sides-in-assam/ 

 

Many of the articles published on the web in May 2014 state clearly that the epidemic is spiraling out of control, referring more to a continental or international sense than just a local sense.  

 

The possibility that Ebola was out of control in May is well documented on the web.  WHO could have and should have responded in June, (We can allow them the 2+ months of hoping for better; but realize it was a fiscal decision, not a health-conscious decision.)

 

WHO's activities as documented in the email activity were clearly noted by two separate agencies, about the same time, probably from similar sources.  WHO can try to steer this decision in another direction, but the outcome is and was the same: 10,000 deaths -- at least ten times more than there could have been.

 

It is interesting to note that, only in retrospect, do we suddenly have that experience that leads us to ask so seriously: "What happened!?!"  Now that the ebola outbreak is in a lull (sort of), we have time to react to these past discoveries, or in some cases, rediscover them.

 

The fact is, we could have and should have pursued this email event, when it was fresh.  This delay of 11 months may have cost us plenty in the end, about knowing the truth it is "most original" form.   

 

Like some of the first posts about Ebola in March 2014 stated, the worst may be yet to come.  

 

Epidemics grow and mature over time.  They get better at spreading.  Then maybe, they bottom out naturally (not necessarily due to interventions like sanitative engineering).  So the next epidemic of Ebola could transform like cholera did between 1817 and 1829 (England, then US), and again for 1847/8 (US, and then perfecting the US disease process).  Ebola like any disease may perfect its diffusion process over time.  [If I were to make a guess: next time I anticipate many more cases will make their way to the US/neotropical America, via definable routes, as well as western Europe, and perhaps even result in a major secondary outbreak that is highly successful in China or SE Asia.]

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Roll over Ebola: measles is the deadly new threat

Roll over Ebola: measles is the deadly new threat | Episurveillance | Scoop.it
The people of Monrovia's Peace Island ghetto, refugees of civil war who found themselves suddenly overwhelmed and outmanoeuvred by the deadly Ebola epidemic, are used to life under siege. Yet with Liberia emerging from the worst outbreak in history a year to the day since Ebola was first identified in west Africa, the slum-dwellers are facing an even deadlier threat -- the measles virus. Experts say Liberia and its neighbours Guinea and Sierra Leone are ripe for an outbreak that could infect hundreds of thousands, dwarfing the carnage wrought by Ebola. Death once again stalks impoverished communities like Peace Island, a cramped spit of land surrounded by swamp where 30,000 people sought refuge behind the abandoned Ministry of Defence after Liberia's 1989-2003 civil wars.
Brian Altonens insight:

This fits into a paradigm I have been promoting with medical geography.  Regressive Disease patterns and behavior.

 

Regressive disease behavior is when the state of a national or culture reverts back to its earlier state.  Since this interpretation of change is common sense, why make a point of it? 

 

The point is made because it related to two other paradigms in disease and public health research.  Epidemiological transition is something that can occur in both directions.  The problem with ET philosophy however is that, since it mostly applied to developed versus developing country status, it is hard to visualize a developed country turning back to a prior state.

 

But this is where sequent occupancy or sequential disease patterns come into play.  In medical geography, there has been this temporal disease pattern theory in the field since the late 1800s, about 125 years ago.

 

Sequent occupancy [SO] theory provided the details about the kinds of diseases that happen at certain stages in economic and lifestyle development.  The initial SO concept states that we advance from wilderness, to homestead, to farming, to industrial and technical societies as we evolve, and that the diseases for each of these level will differ significantly from those of the period(s) before.  

 

This implies for example that infectious diseases for example are more likely to happen in certain environmental settings conducive to the required host-vector-patient relationship.  Certain occupational diseases require the occupation they require to be practiced.  Coal miner's lung is expected of a certain community and place, engaging in certain physical activities, but would be rare in a megalopolis setting, and if and when present due to some prior history or unique environmental relationship with the region.

 

Sequent occupancy works better than epidemiological transition theory when it comes to looking at regressive changes in a society.  The transgression of African disease patterns from Ebola to Measles doesn't require much change, industry wise or temporally in terms of history.  

 

The regression of disease patterns that can be vaccinated again in the U.S. is a serious issue to contend with.   The ability of one such disease to re-emerge implies the abilities of others.  

Right now we are troubled by measles.  But the U.S. still has spikes in diphtheria according to recent EMRs reviewed.  Scarlet Fever is also just around the corner.  But most importantly, a serious 'digression' in the programs meant to eradicated polio could result in some very serious consequences.  Such a regression the U.S. can live without.

 

Anyone into the history of disease at the ICD level will see that certain processes are apparent in the current health care system.  Inequity makes it possible for regressive disease patterns to develop.  The elimination of inequity was the goal of the Alma-Ata Declaration in 1978.  Yet we continue to see inequity prevailing and defining the public health and disease patterns that impact the world at all levels.  

 

In the health care profession, most leaders and staff are very much myopic about what events are the actual cause for possible disease regression.  Without knowledge of the cause, we cannot produce effective preventative programs.  So disease regression, in an almost perfect temporal order, could be inevitable, I hate to say.  This means there is a logic to disease re-emergence, and we know what to look for in the near future and how.  Has any agency with the goal of monitoring the health and safety of a country taken that into consideration?

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CDC's 'inconsistent' lab practices threaten its credibility, report says - CNN.com

CDC's 'inconsistent' lab practices threaten its credibility, report says - CNN.com | Episurveillance | Scoop.it

QUOTE:  "A report calls CDC's commitment to lab safety "inconsistent and insufficient." The report also says "laboratory safety training is inadequate.""  

 

A reminder that respect from the public is also very important.  These are the events from this past year which were preventable (even if just in an ideological sense).  They should be used to define the goals for the up-coming year.  Notice that two quality of care related needs have been included (limited coverage by SES, and ethnicity/race).  

Brian Altonens insight:

A good reminder of how we got this way is to simply look back at the past year's events.  Since March 2014, we have had several global disease outbreaks or concerns arise in the news, about 1/5th of which really could have been managed better--the rest are status quo for surprising outbreaks and such.  This 20% that weren't well handled have "issues", we can call it, with poor management and preventive health practices.  Another 10-20% also have public health related medical practice problems, that are the consequence of mistakes made at the clinical level, by provider or management and administration.  But the bulk of medical emergencies do have a certain amount of unpredictably that make them hard to predict will emerge--hard to prepare for.

 

But once the signs of a problem are there, those 20% (or maybe 30%) of events we could have taken preparatory action for, should have been managed professionally and quickly in due time.

 

The problems arise when we don't respond to an emergency in time.  The fact that this in the past years has involved several kinds of emergencies, tells us the system is in really deep trouble.  Now if we add to this our poor responses to natural disasters, there is much more to complain about, and god forbid, should another 9-11 event happen, odds are we will not respond any better to this disaster as we did to the prior.  

 

October 2013 (the cases of measles that struck the Palisades Mall in Hudson Valley NY) gave us the warning we needed to be prepared for the 2014 Measles outbreak via Disneyland.  My April 2014 posting noted our lack of preparedness in this matter (need I say, living in close proximity to the  2013 outbreak, I have the right to know and experience needed to realize the dilemma we are in.)

 

The medical field itself knew it was not ready in May 2014, before the famed 2014 outbreak, it was realized that "Measles is making a comeback." [The Disney outbreak initiated in December  2014.]

 

The border crisis with people coming into this country caused some hype, in June; that too became true and is the reason Disneyland could be so successfully infected.  

 

But these are not the main concern with this posting.  The main concern here boils down to one thing--poor management and leadership.   Safety procedures are not abided by at CDC.  Record keeping was historically poor, and so we are still finding those old 1950s vials of small pox we put away for the moment, perhaps to send later to some biosecurity/bioterrorism storage facility.  Imagine what might have happen had that rubbish made it to the landfills instead of the incinerator, by a third party company hired to clean out the building for renovation or leveling.

 

Technology wise, the public masses are better informed that the leaders.  I know that childhood diseases can spread because of what I saw in my neighborhood for twenty years in the Pacific Northwest, after talking openly with neighbors who weren't on any health insurance (even MCD), and who refused to immunize their children.  The fact that Bot users knew about Ebola before other in WHO or healthcare is a scary finding--it's like having to rely upon your ham radios more than your TV or regular battery-run AM/FM radio during the cold war era.  If I were a survivalist, I would interpret this as a sign to invest in a new multifaceted high tech shortwave communicator.

 

The medical world in general has been lazy about some technology.  GIS is one of the best examples of this.  It is heavily used by national programs, for internal reasons only.  Theoretically it has epidemiological, preventive care use, but is rarely employed by experts for meeting such needs.  We know this because neither the spatial diffusion prediction models nor ecological models for what Ebola was have rarely been mentioned or published with much determination.  Even more, as always, this technology is used mostly as a retrospective tool; not a preventive tool.  Could the flight of Ebola positive cases to Houston, to New York, where ever, been prevented?  It's easy to say no, not having developed a system to base your decisions upon.  The Middle Eastern respiratory Infection and Chikunkunya could not have been predicted for their outbreaks.  The latter could have been ecologically assessed more thoroughly and successfully.  Makes you wonder which ones (zoonotics) are going to arrive in 2015, the some tick disease, or perhaps a south american encephalitis, or perhaps Bos Tb infecting our cattle?  Like the one article states: "Mapping could help stop ____ spread", if it were engaged by the right experts.

 

Our concerns about polio are too few.  We use the Herd Theory as the reason for this.  But disease regression is happening apparently; if the herd theory continues to fall apart as a useful paradigm, we'll need to address once more the return of poliomyelitis (but there are still several more countries that have to be penetrated first by it). 

 

Because we have done little to deal with ethnicity differences in health, and poverty related differences, we do have even worse issues to contend with in upcoming years.  Cultural emergence in the US is going to make some diagnoses and diseases become more prominent, be they of an infectious or physical/ physiological nature (culturally-link cardiac abnormalities, genetics diagnoses, etc.) , or of a cultural philosophy and behavioral cause (infibulation, culturally-bound syndromes).

 

These are not so much directly CDC related--CDC cannot regulate the in-migration of people who believe is some of these controversial behaviors and practices.

 

But CDC can oversee and regulate its own workers and their fellow workers in the health care field more efficiently--like teaching MDs not to be so self-egotistical about the improbability that they could cause the next epidemic, by allowing a patient to not be treated, or refusing to place their own self into CDC-recommended quarantine.  Common sense is apparently not a physician's (or nurse's) primary skillset.

 

In the end, we must link these problems to managers and directors.  Of course, the president or CEO is often who we try to blame and expel.    But that individual alone is not the cause.

 

Rewriting the rules does not eliminate the problems.  Having a committee developed to oversee past behaviors and uncover the mistakes will not suffice.  Ultimately, leadership has to change for this program to get better.  Then the policies need to be rewritten.  Finally, the right skilled individuals need to be hired, so the agencies can catch up on their IT skills, especially the ones they cannot employ that well, for the moment.  

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It’s Official: Anti-Vaxxers Caused The Disneyland Measles Outbreak

It’s Official: Anti-Vaxxers Caused The Disneyland Measles Outbreak | Episurveillance | Scoop.it
New research definitively links the spread of measles with people who are refusing vaccines.
Brian Altonens insight:

Great Preventive Medicine Line there!  

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Ebola: Mapping the outbreak

Ebola: Mapping the outbreak | Episurveillance | Scoop.it
Maps illustrate the regions worst affected by Ebola in West Africa
Brian Altonens insight:

An update map on the Ebola outbreak.

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Canada measles outbreak spreads

Canada measles outbreak spreads | Episurveillance | Scoop.it
A measles outbreak linked to a flareup of the virus in the United States has spiked in neighboring Canada's Quebec province to 119 cases, health officials said Wednesday. Infection disease specialist Johanne Desilets said the virus spread further among children and adults who have not been vaccinated and are members of large families. "You have to realize that measles are highly contagious. If one person has measles in a family of 10, everybody will be exposed and will probably get it," she said.
Brian Altonens insight:

See my posting on Michigan outbreak.  February 17, 2015.   There, I ask the question "how long will it take to get into Canada?"

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Measles outbreak

Measles outbreak | Episurveillance | Scoop.it
Measles cases in the U.S. are on the rise.
Brian Altonens insight:

For those interested in keeping track of measles, in 2015

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Dangerous Bacteria Mysteriously Escapes From Louisiana Monkey Lab

Dangerous Bacteria Mysteriously Escapes From Louisiana Monkey Lab | Episurveillance | Scoop.it
How a potentially deadly strain of bacteria escaped from a primate research lab infecting four monkeys is a mystery, government officials said, but they added the incident poses no threat to the public. The bacterium in question, burkholderia pseudomallei, is widespread throughout Southeast Asia and northern Australia, infecting humans and animals via contaminated soil and water entering the blood stream through cuts in the skin, according to the Centers for Disease Control and Prevention. The high-security laboratory at the Tulane National Primate Research Center in Louisiana, which is studying the bacteria, reported that at least five rhesus macaques not used in studies were infected with the bug, possibly as early as November of last year, according to spokesman Michael Strecker. How the bacteria made its way from the lab to animals not used in experiments is still an open question despite weeks of investigation by multiple federal and state agencies, including the CDC, the U.S. Department of Agriculture and the Environmental Protection Agency.
Brian Altonens insight:

YES LOUISIANA, Burkholderia pseudomallei is now out there.  But did you now? . . . .  It was first reported as potentially released about one month ago!

 

Let's cut to the chase.  And I quote:  "The bacterium has been studied for use as a potential bioweapon, according to the UPMC Center for Health Security, an independent biosecurity think tank."

 

News/Photo story linked to this post.  https://gma.yahoo.com/dangerous-bacteria-mysteriously-escapes-louisiana-monkey-lab-174110897--abc-news-health.html

 

MOST IMPORTANT HISTORY:  Feb. 9, 2015.  Juan Sanchez, WDSU News.  Woman becomes ill while investigating death of monkey at Tulane research center. Health officials: Bacteria confined to research center.   http://www.wdsu.com/news/local-news/new-orleans/woman-becomes-ill-while-investigating-death-of-monkey-at-tulane-research-center/31154340 ;


AND THE SEARCH IS ON !!!!!


Mar 2, 2015 5:35 PM CST. High-Tech Lab Leaks Deadly Bacteria.  INVESTIGATORS SCOUR LOUISIANA LAB FOR CLUES.  By Neal Colgrass, Newser Staff.  

 http://www.newser.com/story/203401/deadly-bacteria-leaks-out-of-high-tech-lab.html

 

Mar 2, 2015, 12:39 PM ET.  Dangerous Bacteria Mysteriously Escapes From Louisiana Monkey Lab.  By LIZ NEPORENT, via GOOD MORNING AMERICA.  http://abcnews.go.com/Health/dangerous-bacteria-mysteriously-escapes-louisiana-monkey-lab/story?id=29327907

 

March 2, 2015.  Deadly bacterium that is potential bio-terror agent escapes from US research lab.  By Jayalakshmi K.  International Business Times.  http://www.ibtimes.co.uk/us-deadly-bacteria-that-potential-bio-terror-agent-escapes-research-lab-1490001 ;

 

March 2, 2015.  Escape of dangerous bacterium leads to halt of risky studies at Tulane.  Jocelyn Kaiser, staff writer for Science magazine. http://news.sciencemag.org/biology/2015/03/escape-dangerous-bacterium-leads-halt-risky-studies-tulane


It's value in medical research:


Wildaliz Nieves, Hailey Petersen, Barbara M. Judy, Carla A. Blumentritt, Kasi Russell-Lodrigue, Chad J. Roy, Alfredo G. Torres, and Lisa A. Morici.   A Burkholderia pseudomallei Outer Membrane Vesicle Vaccine Provides Protection against Lethal Sepsis.  Clin Vaccine Immunol. 2014 May; 21(5): 747–754.

doi: 10.1128/CVI.00119-14 .  Accessed at : 

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4018892/

 

Vaithy K Anandraj, Anbarasu Priyadharshini, Shivekar S Sunil, Raj K Ambedkar.  Burkholderia pseudomallei infection in a healthy adult from a rural area of South India. Indian Jl of Path and Microbiol, 2012; 55(4),578-9.  Accessed at

http://www.ijpmonline.org/article.asp?issn=0377-4929;year=2012;volume=55;issue=4;spage=578;epage=579;aulast=Anandraj

 

Finally, for a second opinion, see GlobalDefense, "M.D." (MD for "Medical Defense")  http://globalbiodefense.com/tag/burkholderia/

 

A New Era of Biological Warfare. 29 August 2013 by Annelie Wendeberg.  http://www.scilogs.com/sciencezest/a-new-era-of-biological-warfare/ ;

 

First Biowarfare Ally:  CDC site on Burkholderia (Glanders & Melioidosis).  http://www.sfcdcp.org/burkholderia.html ;

 

Second Ally of this biowarfare, B. cepacea, in healthcare settings:  http://www.cdc.gov/HAI/organisms/bCepacia.html

 

 

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Parents Concerned After Students Fall Ill At Philadelphia School | CBS Local - Yahoo Screen

Parents Concerned After Students Fall Ill At Philadelphia School | CBS Local - Yahoo Screen | Episurveillance | Scoop.it

Clostridium difficile strikes a school in Philadelphia

Brian Altonens insight:

It's not just hospitals that turned C-diff into a national public health concern

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A Message for the Anti-Vaccine Movement - Jimmy Kimmel Live | Facebook

Real doctors share their thoughts on vaccinations...
Brian Altonens insight:
And the antivaccs think they're smarter than all docs. How is this distributed across two genders? Do paternally raised kids or kids raised with health decision made by father's experience this parental decision as much as the maternally raised or maternally decided health practices? Maybe this is just another one of those culturally based pubic health problems. Think about the barriers that communities in Africa displayed when it came to the ebola outbreak. Lack of adequate knowledge base and limited education are shared features for both of these cultural settings.
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Toddler dies of measles in Berlin, first death in outbreak

Toddler dies of measles in Berlin, first death in outbreak | Episurveillance | Scoop.it
BERLIN (AP) — An 18-month-old boy has died of measles in Berlin, the first known death in an outbreak of the disease that has seen more than 570 cases in the German capital since October.
Brian Altonens insight:

Since basic stats reviewed by this article.     

 

To understand the consequences of children experiencing the actual disease, go to the 26 minute video (minus audio) at :  https://www.youtube.com/watch?v=LOp-KGd4hV0.     

 

This is a lesson no longer taught in medical schools.  It consists  mostly of figures from my collection of 1920s to 1950s medical school textbooks of the consequences of immunizable diseases, published just before the full-fledged vaccination movement for this country finally took hold. 

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Chickenpox: Mom furious after school sends unvaccinated son home

Chickenpox: Mom furious after school sends unvaccinated son home | Episurveillance | Scoop.it
The boy was not vaccinated and, with confirmed cases in Birmingham schools, officials are worried about spread.
Brian Altonens insight:

Historically, the United States has been poorly managed in terms of public health for the past two decades.  Public health programs set themselves up for the events now happening.  If the officials had treated refusal immunize like they treated other diseases less contagious than measles, mumps, and the like, we would not be in this predicament.  Now it is up to the legal system to iron out these problems.  Since medicine is incapable of controlling human behavior in certain circumstances, who else can we rely upon.  People have a personal right to risk whatever they want, so long as they don't risk the lives of others.  People can smoke if they want--just don't do it in certain public places.  You have the right to drink and mess up your liver, or risk injecting drugs into your system--just don't mess up other peoples's great health and physique.  Be what you want, live the way you want, but accept the fact that this decision is only yours, and others shouldn't have to bear your health burdens induced by it.  Sending your dangerous kid to school is not a right that supercedes the other classmates' rights to safety or to live a full life without fear of seizures or disability onset due to some senseless, self-centered way of parenting.  Good parenting is both a personal and social responsibility; if you disagree, find an isolated community somewhere on a distant island--most of the world is changing, and much of it disagrees with you.  

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Political Favoritism . . . what about the Health Consequences for Homeland Security?

Political Favoritism . . . what about the Health Consequences for Homeland Security? | Episurveillance | Scoop.it
Deputy Homeland Security Secretary Alejandro Mayorkas tainted the image and integrity of the immigration program he oversaw by fostering “an appearance of favoritism and special access” in how the agency treated projects that would bring visas and Green Cards to wealthy foreign investors, a new report from the agency’s Inspector General says. “The juxtaposition of Mr. Mayorkas’ communication with external stakeholders on specific matters outside the normal procedures, coupled with favorable action that deviated from the regulatory scheme designed to ensure fairness and evenhandedness in adjudicating benefits, created an appearance of favoritism and special access,” the Inspector General’s report concluded. The DHS IG report specifically focused on allegations of special treatment afforded to a Las Vegas casino project championed by Sen. Harry Reid, then the Senate majority leader, and an electric car enterprise led by Terry McAuliffe, who is now Virginia governor, and involving Anthony Rodham, the brother of then-Secretary of State Hillary Clinton.
Brian Altonens insight:

We are reaching a new stage in the Homeland Security program.  We are either failing terribly when it comes to public health related concerns.  Or we need to reverse back to the isolationist period.  Better yet, why not try to 1950s once again, when the United States had a unique ability to provide its citizens with the best treatment in the world, but lacked the resources needed to share these skills, materials, and manpower with other nations.

 

Why don't we ever just simply shut the borders down as part of the new "Anti-Bioterrorism" era?

 

The differences between now and then is mostly our lack of adequate manpower.  The knowledge base is there, but the presence of gifted leaders in public health is greatly lacking.  And even worse, this is no longer the smartest place in the world when it comes to our country's public health surveillance.    Out leaders are making too many mistakes on a monthly basis to prevent much of anything from happening, if enough attempts are made by the pathogen, organism, contaminated animal or disease carrier.

 

Next to "anti-bioterrorism" and "anti-terrorism", preventing public health disasters should be our number one priority.  

 

This homeland security deputy jeopardizes more than just political stability, or the preemptive and preventive military tactics we are currently engaged in.  He jeopardizes the health of the United States should these behaviors result in an unexpected outbreak of a new emerging disease pattern.    

 

The trouble is we do not have the surveillance or manpower needed to monitor the mistakes that homeland security makes as a public health issue.  We do not and cannot produce the manpower needed to make sure all the rules that are being broken by homeland security don't in turn risk the population, our livestock and our crops, or our political leaders.   

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WHO denies politics swayed Ebola emergency declaration

WHO denies politics swayed Ebola emergency declaration | Episurveillance | Scoop.it
LONDON (AP) — The World Health Organization denied Monday that politics swayed the decision to declare an international emergency over the spread of the Ebola virus last year, despite evidence senior staffers repeatedly discussed the diplomatic and economic fallout of such a move.
Brian Altonens insight:

A mistake was made.  It's up to WHO as to where to lay the blame.  

WHO can claim 'we did not know', when no actions were taken in July for events escalated in June.  To people in the field, this means WHO was blinded by bureaucracy, and lack of knowing.  Or, WHO can claim it knew early on, but weighed out the odds and decided to take sides with politicians instead of people. To those in the field, this means WHO was blinded by intention instigated through bureaucracy. 

Either way, the reason for WHO's decision is wrong.

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One Year ago--Monday, Mar. 23rd. Emails: UN health agency resisted declaring Ebola emergency

One Year ago--Monday, Mar. 23rd.  Emails: UN health agency resisted declaring Ebola emergency | Episurveillance | Scoop.it
GENEVA (AP) — In a delay that some say may have cost lives, the World Health Organization resisted calling the Ebola outbreak in West Africa a public health emergency until last summer, two months after staff raised the possibility and long after a senior manager called for a drastic change in strategy, The Associated Press has learned.
Brian Altonens insight:

This is that moment--when we are shown that WHO is an agency that puts money and politics before health and human survival:  

 

"WHO announced the discovery of Ebola in Guinea on March 23 [2014], when it posted a two-sentence update on its website saying a "rapidly evolving outbreak" had been confirmed after months of mysterious deaths in the nation's forest region and capital city, Conakry."

 

Reasons for the delay and ignoring all the warning signs included concerns by the United Nations agency for "angering African countries", "hurting their economies" and/or "interfering with the Muslim pilgrimage to Mecca".

 

This means that the claim that WHO and the World were "caught by surprise" with the 2014 to present Ebola outbreak is also a lie.

 

According to WHO Director-General Dr. Margaret Chan, in a presentation in January:  "The disease was unexpected and unfamiliar to everyone, from (doctors) and laboratory staff to governments and their citizens."    

 

And even as recently as last week she continued this charade by claiming that WHO did not suspect Ebola until "late July, when a consultant fatally ill with the disease flew from Liberia to a Nigerian airport."

 

By late July, it was too late.

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Dozens die in North Darfur’s Jebel ‘Amer

Dozens die in North Darfur’s Jebel ‘Amer | Episurveillance | Scoop.it
Dozens of people died recently, owing to the spread of various diseases in the gold mining area of Jebel ‘Amer, El Sareif Beni Hussein locality in North Darfur.
“Smallpox and measles caused the death of a number of gold miners lately. Three others died of hemorrhagic fever,” an activist reported to Radio Dabanga from El Sareif town.
Brian Altonens insight:

Monitoring these diseases is important.  These cases were brought to my attention by colleague Ruth McClure, who added her comments about the possible causes:   "Smallpox (could not be), or other Hemorrhagic Fevers such as Crimean-Congo Hemorrhagic Fever (Pakistan had two cases in January 2015, or Monkey Pox, or Chickenpox could be the possible Infectious Diseases)."    [Reference to LinkedIn Post:  

GOLD MINING TOWN OF JEBEL AMER IN NORTH DARFUR, HIT BY MAJOR ILLNESS OR ILLNESSES WITH GREAT DEATH RATE<> MONKEYPOX,CHICKENPOX, YELLOW FEVER, OR DENGUE ??  Ruth McClure]

 

To see how this disease relates to the US EMR statistics spatially, at the small area national level (never before produced and published in this fashion), see the following:

 

Crimean Congo Fever:  https://www.youtube.com/watch?v=YWuMBOdB08k

 

Monkey Pox:  https://www.youtube.com/watch?v=1amd_QP3YHU&nbsp;

 

Note: my videos on important national health issues have been circulating so much over the past 4 or 5 years that all you have to do is type in my last name and the name of the disease to see if I produced anything (I still have to get back to the now dusty disks and post some more).

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#BlackLivesMatter: Is Our Health Care System Fundamentally Racist?

#BlackLivesMatter: Is Our Health Care System Fundamentally Racist? | Episurveillance | Scoop.it
Two young women visit a health clinic with identical symptoms. One is diagnosed with appendicitis. The other, with an STD-related illness. Guess which woman is black.
Brian Altonens insight:

I wonder how many statisticians would agree with the following:  if you want to really attach the race/ethnicity issue, produce EMR/EHR with fairly substantial set of data on this, and standardize it.  Our focus race and ethnicity in the structured data world has not demonstrated any signs of us really wanting it to get better.  Signed, more than one race . . . I think, or maybe this time it's  . . . . wait, do they have a separate ethnicity box, or once again, are race and ethnicity clumped all together?  (Oh well, I wish they had a better selection . . . . As usual, I am none of these - - I'll just enter "American, north, middle and south")

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Ageism at Work

Ageism at Work | Episurveillance | Scoop.it
Check out http://helenmdennis.com! Home Page
Brian Altonens insight:

Ageism is inevitable in the U.S. workplace.  We can see it where ever we work, whatever we are asked to do in work, whatever it is that we have accomplished.   

 

Now if this statement seems counter to what you believe you see happening at your place.  Then you too are a reason for this discriminatory behavior.  We don't take the time to search for signs of ageism.  And the younger we are (which only need be a few years beneath that culturally-defined limit for this attitude), the less likely we have the experience or the skill set needed to identify ageism when it is happening.     

 

Parallel with ageism are experience and intuitiveness.  The primary benefit of age is experience, but that's usually something we don't wish to see in the workplace.  If it was something we really appreciate, then ageism would be less a problem, there would be less people out there noting ageism as the primary reason for a company's failure to achieve--the reason why employees have to shuffle around every now and then due to lack of substantial development and performance in that same position.  You can only fool a company for so long about what you thought you could do as a young, fresh employee; then you have to move one because you haven't been able to achieve anything significant or innovative.   

 

Intuition is that additional sense, actually the thought process generated by knowledge, and if you believe in it, "wisdom".  The wisdom of being older is really like how a mouse behaves in a maze.  The mouse that has been through that maze numerous times before has the route perfected; those new to the maze might never come out when the maze is that good.  Wisdom is in part that ability to recall past experiences that relate, and to find you way out of the problem you are facing.  In the medical community, "wisdom" is that ability to get out of the predicament you are in.   But when inexperienced leaders prevail, no matter what your wisdom is, or how you present it, the others could ultimately create their own failure.  They cannot resolve the issue, and if their overseers are equally inexperienced, you have a disaster waiting to end the program you're in.   The most unethical part of this process is not lying to yourself, but instead to your clients, telling them what you thought you could do.  As you say good-bye to your profits.

 

The impact of ageism on an industry is very much the same thing as sexism and racism.  Except with ageism, you lose your best talent and learn to depend mostly on the average or underclass.   

 

In the clinical setting is medicine, ageism is less an issue--we know that if a nurse or surgeon is great due to experience, that such a worker should be retained, so long as he/she can perform.     

 

In the intellectual/office settings of healthcare industry, the ageism expressed results in insecure work environments for poor performing leaders and uninformed and/or inexperienced doers.  Because ageism is present in this work setting, the goal is to achieve--because your department hasn't achieved what it should as of yet.       

 

To the ageism perpetrators, there is an ongoing sense of frustration and lack of adequate accomplishment.  To the ageism victims, there is the sense that leaders wish you not to be there, not to perform.     

 

The following signs of ageism-behaving work settings exist in the interview setting for applicants who could be victimized by this recurring form of prejudice.    

 

First, those engaged in the interview are substantially younger; you can ask them questions as an applicant, test their knowledge base; and when you see they don't have the background, intelligence or scholastic experience needed to know the answer to your important question, that they are looking for other younger ones to support their lacking skillset, but perhaps add slightly to it to make the department "smarter".       

 

Second, interviewers who are practicing ageism discrimination and do not know it mention something like, they wanted to meet with you or interview you because they are in search of a mentor for the rest of their team, or someone who has tricks of the trade, experience to share.  They say this with a half-grin--they want it, but will not hire you solely for this reason--they could even be insecure about losing their position or leadership status due to you.      

 

Third, when pretty much all managers or leaders are young, they set the example for others as to how to lead, how to treat the older applicants, behaviorally and in how they vocalize their attitudes.      

 

The sign of a company made unstable due to this problem is a one that moves management around, remains unable to decide which route to take with leadership, or projects, a company unwilling to determine which way to go, and unable to spend the time needed to make improvements.  The company that tries to get something done soon, without concerns for truthfulness is guilty of this immaturity.  Those that lay off or removes mostly upper level, older people are obviously thinking this way.  When companies have leadership that lack the experience of being innovative themselves, the company itself ultimately suffers.  Such a company is not intellectually absorbed in its goals and progress, but instead has leaders who are personally absorbed, in search of more personal gain, under the guise of corporate intention.    

   

Progress is slow right now because too many agencies are actively practicing ageism.  Fortunately, replacing these managers will be a younger generation. For they too are next on the chopping block.  They too will fail to succeed as much as they'd like, because they eliminated their most valuable human resource.   We have to consider ourselves lucky in that, ultimately, these current managers have to move on, or risk being replaced in five or ten years, for the failure of their department to grow and thrive.

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10 things your primary-care doctor won’t tell you

10 things your primary-care doctor won’t tell you | Episurveillance | Scoop.it
It’s harder than ever to get an appointment with a primary-care doctor, and when you do, you may not get much quality time.
Brian Altonens insight:

Regular visits is one of the easiest things to evaluate in EMRs.  Or at least it should be.  The coding of these visits is fairly self-explanatory once you've read the book on this.  The reasons for a well visit or regularly scheduled review of your long term medical history make it essential that a complete review be carried out of these vents--which in your routine reporting should be one of the most common claims codes identified, at least tenfold.    

 

For more than ten years we have heard repeated discussion about improving the quality of care received each time such events happen.  More than a decade ago, the quality of interactions between patients and providers were borderline--you doctor usually did not pay much attention to you as you would like.  

 

This process of providing care on a regular basis failed to demonstrate long term, ongoing practice of the "best provider" concept.   We may eliminate this apparent problem occasionally, but only for a short time.  There is a reason any good QIP/PIP asks for documentation of studies of such practice changes over a 3 year period.  One year's worth of improvement essentially means nothing--it is non-committal.  Three years provides additional proof for the earliest claims.  The third year simply means you made it happen again, not necessarily that such behaviors will continue.  

 

Ironically, sometimes undergoing a healthy and complete well visit, with adequate time spent engaging in the face to face with your provider, is as rare as getting a patient with a history of smoking to stop permanently.  The only difference is, the latter is easy to measure, to engage in interventions for, even at times to change through recommended guided behavioral change.  Trying to change the practice habits of a clinician can sometimes mean the difference between trying again tomorrow, again and again, versus committing to you changes and accomplishing them today.

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The First Decades of Homoeopathy, Part 2

The First Decades of Homoeopathy, Part 2 | Episurveillance | Scoop.it
Brian Altonens insight:

These data, obtained from a review of the profession by principal leaders in the early 20th century, demonstrate the phases of development homeopathy endured, as it was introduced (1825-1836), developed a substantial small following (1837-1845), went through an early growth period (1846-1852), then took off at an incredible rate  (1853-1857/8) [Plot 1].  This process is very much in agreement with the plots generated for studies of innovation.  If we consider the growth in popularity that ensued during the 20th century, we come up with something that closely resembles the Gartner plot (not displayed), referred to colloquially as "hype cycles".    

 

The peak years in annual growth in numbers of people becoming certified in this profession shows to major peaks at 1852 and 1857.  

 

The research question for this moment is "why are there these obvious peaks in acceptance?"

 

Since 1993, I have been teaching that cholera was the reason Americans began questioning the value of allopathy.  The failure of allopaths to explain, treat, or eliminate cholera from our nation's history made many question their controversial practices, in particular the administration of mineral remedies and the continued use of the lancet.  Homeopathy was one of three major alternatives to allopathy during this time.  The homeopaths had successfully taken the teachings of the great epidemiology mathematicians in England, an duplicated their studies on various institutions, hospitals, clinical facilities, prisons and asylums, and when mortality rates for patients were compared between homeopathy and allopathy treated patients, every study demonstrate allopathy mortality rates were at least twice those of the homeopaths (more on this to be posted).  

 

To  this day, the methodology, validity and outcomes for these results remain undeniable and are the crux of why allopathy was about to fail.

 

The return of cholera in 1854/5/6 renewed people's faith in the non-allopathic professions.  In addition, the recent history of the public health failure  that ensued in the military hospitals at the Crimean War solidified such claims for the borderline doubters still out there truing to decide (this is cited as a major reason in the homeopathy journals themselves).    

 

For whatever reason, there was an explosion in recruitment of individuals interested in learning and practicing homeopathy, about a quarter of whom were regular allopathic MDs.  The allopathic medical profession was now financially, politically, and at the government level, floundering.

 

In the U.S. , the advancements made by the military due to the Civil War help suppress these previous failures in the profession.  The role of the lancet was reduced, although not eliminated, as homeopaths continued to publish their supporting statistics on lower mortality rates linked to homeopathic treatment.   

 

The bar charts in this presentation demonstrate the large numbers of stated that engaged in the enrollment of new homeopaths.  

 

The homeopathy profession also become a popular culture craze a short while later.  Even with a lesser number of MDs interested, due to a number of steps the AMA took to disenroll or delicense MDs practicing this profession, the public was still interested and the homeopathic schools and hospitals developed by then flourishing in spite of the legal and gubernatorial promotion of allopathy.  

 

Beginning around 1882/3, State Medical Licensure boards were required to have an Eclectic, Allopathic and Homeopathic MD on board, to monitor and maintain their specialty's credibility.  

 

For the next 50 years, what few officially trained homeopaths there were, continued to practice according to their faith.  Fortunately for the allopathic profession, the role of statistics in demonstrating success with regard to patient mortality rates became a less popular way to engage in this medical political argument.   

 

The ending of many major epidemic patterns helped solidify the support for allopathy.  Quarantine, not better practice or reduced death rates, was one major reason allopathy re-emerged around the turn of the century.  The other major reason allopathy began to prevail around 1900 was the development of a strong anti-fraud and "anti-quackery" program, with political and publishing power, more than support generated by way of clinical success.

 

 The strengthening of the bacterial theory for disease, accompanied by the refusal of homeopaths to accept the bacterial theory, were the reasons homeopathy ultimately lost much of its support by the public during the 1920s and 1930s.  Both World Wars continued to strengthen the basis of the bacterial theory, a concept the Civil War helped to initiate due to the sanitary/microbial theory it gave rise to.  

Homeopaths tried to counter this reduction in popularity during WW II by entering the war as a specially train medical group.   For the next 50 years, it was mostly the popular culture version of homeopathy and the naturopathic profession that kept this profession alive.

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Texas nurse sues Dallas hospital over Ebola infection

Texas nurse sues Dallas hospital over Ebola infection | Episurveillance | Scoop.it
A nurse filed a lawsuit on Monday against the Texas hospital where she worked, saying it did not do enough to prevent her from being infected with Ebola and invaded her privacy after she was diagnosed with the virus. In the suit Nina Pham brought against Texas Health Resources (THR) in Dallas County Court, she claims the hospital did not initially provide nurses with proper protective equipment or properly train staff on how to treat the disease.
Brian Altonens insight:

A new era, a new way to deal with natural and/or human made disasters.  

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Three infected with measles at Las Vegas seafood restaurant

Three infected with measles at Las Vegas seafood restaurant | Episurveillance | Scoop.it
Three new cases of measles have been confirmed in Las Vegas, in people believed infected by a contagious worker at an upscale MGM Grand Hotel and Casino seafood restaurant, Nevada public health officials said on Friday. The newly diagnosed patients, two staff members and a patron of Emeril's New Orleans Fish House at the MGM Grand, bring to nine the total number of measles cases reported in Clark County, Southern Nevada Health District spokeswoman Jennifer Sizemore said. None of those cases are believed linked to an outbreak of measles that began at Disneyland in December, she said.
Brian Altonens insight:

If these aren't linked to Disney, then they are mostly be linked to human behavior.  In about three years, if they study these cases correctly, CDC should have a much better insight into human behavior and the spread of immunizable diseases.  It's a shame we have to wait this long.  But then again, the leaders of these programs were too certain of  themselves, unprepared for a change in public health history, a change that was both predictable and preventable, and had all the warning lights turned on between 2012 and 2013 (including posted warnings from back then).

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NYC, Orthodox Jews Reach Deal On Circumcision Suction Ritual

NYC, Orthodox Jews Reach Deal On Circumcision Suction Ritual | Episurveillance | Scoop.it
By Ellen Wulfhorst NEW YORK, Feb 24 (Reuters) - New York City has reached a tentative agreement with local rabbinical leaders regarding the Jewish circumcision ritual of direct oral suction in an effort to minimize health risks to i...
Brian Altonens insight:

Public health matters - this is where culture and common sense clash.  Over the past decade, Jewish boys have gone away from their "briss" unknowingly infected by Herpes . . . or worst.    

 

The epidemiology of this outcome is quite disconcerting.  It means that somehow, the individual performing this ritual practice has been already infected.    

 

The question however is from whom? how and why?  

 

It is less likely the 'Mohel' performing this ritual was infected on his own (or 'her own' perhaps in some of today's Jewish social settings).  The Herpes had to come from somewhere, the newborn of an infected parent, or the Rabbi himself (herself), who spreads it unknowingly or even in some unconcerned fashion from one family to the next.  You may bless the child, hoping he has a better life.  But your activities as the Mohel might also become a curse for life.  Your respect and worthiness to your community might not change, in the immediate cultural setting.   But in the long run, the Scarlet letter has shown its face in your community.    

 

So why do "Mohels" insist they have the right to perform the ritual of circumcision, in such a way that it lessens the quality of life a child might live?  This is all a matter of ego over ritual.  Jewish cultural leaders trying to be the decision makers, and in the long run, insurers of life when it comes to their culture, symbolism first, people second.  

 

Many traditional religious behaviors have changed since the dawn of the Mosaic and Xian Periods.  Many of the remaining unhealthy practices designed to live healthy, have been replaced by symbolic moves, objects and gestures.  Public health  effectively prevented the spread of tuberculosis between churchgoers during the late 19th and early twentieth century.  Common sense prevailed in the minds of Catholic leaders.  But when common sense loses the battle against tradition, it is like religion telling you you have to jump over the cliff, it is after all a tradition.  If you are worthy, you will be around another generation or two, long enough to meet others who too become infected due to ancient, outdated practices.   

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