148 cases of Guinea worm disease remain worldwide

148 cases of Guinea worm disease remain worldwide

The Carter Center has announced that 148 Guinea worm cases were reported worldwide in 2013. These provisional numbers, reported by ministries of health in the remaining four endemic nations and compiled by the Center, show that cases of the debilitating disease were reduced by 73 percent in 2013 compared to 542 cases in 2012. When the Center began leading the first international campaign to eradicate a parasitic disease, there were an estimated 3.5 million Guinea worm cases occurring annually in Africa and Asia.

"As we near the finish line in this eradication campaign, The Carter Center and its partners remain committed to ending the devastating suffering caused by Guinea worm disease, recognizing that the final cases of any eradication campaign are the most challenging and most expensive to eliminate," said former U.S. President Jimmy Carter.

In 1991, when the number of endemic villages reached its peak, there were 23,735 villages in 21 countries in Africa and Asia reporting Guinea worm disease. In 2013, there were only 63 endemic villages in four countries - all in Africa.

South Sudan, the world's youngest nation, reported 113 cases or 76 percent of the worldwide case total in 2013. Most of those cases were in Eastern Equatoria state. The remaining indigenous cases in 2013 were reported in isolated areas of Chad (14), Mali (11), and Ethiopia (7). Under investigation are three cases reported in Sudan along the South Sudan-Sudan border.

Considered a neglected tropical disease, Guinea worm disease (dracunculiasis) is contracted when people consume water contaminated with Guinea worm larvae. After a year, a meter-long worm slowly emerges from the body through a painful blister in the skin. In the absence of a vaccine or medical treatment, the ancient disease is being wiped out mainly through community-based interventions to educate and change behavior, such as teaching people to filter all drinking water and preventing contamination by keeping anyone with an emerging worm from entering water sources.

The Carter Center together with its partners, ministries of health, and local communities, has reduced cases by more than 99.9 percent since 1986. The Center estimates that the eradication campaign has averted more than 80 million cases among the world's poorest and most neglected people. Guinea worm disease is positioned to be the second human disease, after smallpox, to be eradicated.

Remaining Guinea Worm Countries

"The final Guinea worm-endemic areas are not random," said Dr. Donald R. Hopkins, Carter Center vice president for health programs and head of the International Task Force for Disease Eradication. "These last countries continue to have Guinea worm cases because of geographic remoteness, insecurity, or inadequate political will."

The South Sudan Guinea Worm Eradication Program reported 113 cases January-November 2013 compared to 520 cases for the same period in 2012, a reduction of 78 percent. Until political and ethnic hostilities broke out on Dec. 15, 2013, the program had reported zero cases for that month. The current insecurity is not occurring in the country's most endemic area and coincides with the lowest transmission season for the disease there.

"South Sudan's Guinea Worm Eradication Program has overcome exceptional challenges while reducing cases by 99 percent since 2006. The program operated at its highest level in 2013, and we expect the team's hard work to bear fruit this year," said Dr. Hopkins. "Immediate and sustained peace is critical to restore the program's momentum and resume full operational surveillance and supervision to prevent any transmission in 2014."

The Carter Center has worked with the people of Sudan and South Sudan for nearly three decades to improve health and resolve conflict. The Center also observed national elections in 2010 and witnessed the birth of South Sudan during its referendum in 2011. In 2014, The Carter Center continues to fight neglected diseases (Guinea worm, river blindness, and trachoma) and encourage dialogue between the two countries to create a lasting peace.

In Ethiopia, the federal ministry, including the minister of health, redoubled its efforts to stop transmission by the end of 2014 in the only remaining Guinea worm-endemic area, the Gambella region.

In Chad, the program continued to investigate the unusual epidemiology of its Guinea worm cases in 2013, and the government is preparing additional control measures to address remaining transmission.

In Mali, insecurity that began in April 2012 continues to delay interruption of Guinea worm disease transmission because the national program has not been able to operate fully and consistently in all of its Guinea worm-endemic regions. In 2013, the program was partially operational in three regions and not at all operational in one region due to insecurity.

The Carter Center leads the international Guinea worm eradication campaign and works in close partnership with national programs, the World Health Organization (WHO), U.S. Centers for Disease Control and Prevention (CDC), UNICEF, and many other partners. The Carter Center provides technical and financial assistance to national Guinea worm eradication programs to interrupt transmission of the disease. CDC provides technical assistance and verifies whether worms from these final patients are truly Guinea worms or not. The presence of Guinea worm disease in a geographic area indicates abject poverty, including the absence of safe drinking water; UNICEF mainly assists countries by providing safe sources of drinking water to priority areas identified by the national Guinea worm eradication programs. WHO also helps countries prepare for certification and assists them to develop or strengthen surveillance in Guinea worm-free areas. The WHO is the only organization that can officially certify the eradication of a disease.

Five Additional Countries Declared Guinea Worm Free

After transmission is interrupted in individual countries, the WHO's International Commission for the Certification of Dracunculiasis Eradication (ICCDE) sends certification teams to assess whether transmission of the disease continues or whether it has been stopped for three or more years after the last indigenous case has been reported.

In December 2013, the ICCDE recommended that five additional countries be certified by the WHO as free of Guinea worm disease, bringing the total to 197 countries and territories. Of the newly recommended counties, Cote d'Ivoire, Niger, and Nigeria were endemic when the Guinea worm eradication campaign began and have worked since then with The Carter Center and others to stop transmission of Guinea worm disease in their nations. When the campaign began, Nigeria had more than 650,000 of the estimated 3.5 million Guinea worm cases worldwide, more than any other country. The other two nations recommended for certification in 2013, South Africa and Somalia, did not have endemic transmission of Guinea worm disease during the current campaign but had not been certified previously as Guinea worm-free.

For a disease to be eradicated, every country must be certified, even if transmission has never taken place there.

Many generous foundations, corporations, governments, and individuals have made the Carter Center's work to eradicate Guinea worm disease possible, including major support since 2000 from the Bill & Melinda Gates Foundation, as well as major recent support from the United Kingdom's Department for International Development (DFID); Children's Investment Fund Foundation (CIFF) - United Kingdom; and His Highness General Sheikh Mohamed bin Zayed Al Nahyan, Crown Prince of Abu Dhabi, in the name of His Highness Sheikh Khalifa bin Zayed, President of the United Arab Emirates (UAE). The DuPont Corporation and Precision Fabrics Group donated nylon filter cloth early in the campaign; Vestergaard Frandsen in recent years donated pipe filters and filter material. ABATE® larvicide (temephos) was donated by American Cyanamid early on, and now by BASF. Key implementing partners include the ministries of health in endemic countries, The Carter Center, WHO, CDC, and UNICEF.

The Carter Center

Indigenous response to natural disaster could be replicated elsewhere

Indigenous response to natural disaster could be replicated elsewhere

When a tsunami struck American Samoa in 2009, indigenous institutions on the islands provided effective disaster relief that could help federal emergency managers in similar communities nationwide, according to a study from the University of Colorado Denver and the University of Hawaii at Manoa.

The study found that following the tsunami, residents of the remote U.S. territory in the South Pacific relied on Fa'aSamoa or The Samoan Way, an umbrella term incorporating a variety of traditional institutions governing the lives of its citizens.

"We found that communities like this have strong traditions that may not fit into the Federal Emergency Management Agency (FEMA) model but they are still highly effective," said study author Andrew Rumbach, PhD, assistant professor of planning and design at CU Denver's College of Architecture and Planning. "We think these same kinds of traditions could play important roles in disaster preparation, response and recovery in American Indian communities, Alaskan villages, and among other indigenous people."

The study was published in the journal Ecology and Society.*

The 2009 tsunami resulted from three undersea earthquakes that sent a wall of water crashing into American Samoa, killing 34, injuring hundreds more and causing tens of millions of dollars in damage.

Immediately after, the leaders or matai began organizing the young men or aumaga to begin rescuing tsunami victims and clearing debris from roads and critical infrastructure, said Rumbach.

"The aumaga were crucially important for emergency response because with such widespread devastation across the island, they were the de facto first responders," he said. "Based in each village they are capable of responding to events locally and without having to be dispatched from larger population centers."

The association of village women, aualuma, provided first aid, food and water to the victims.

Another traditional institution, the pulenu'u or village mayors, helped mitigate the destruction by sounding alarms in each community to warn of the impending tsunami. That action is credited with saving Amanave, a community of 300 that was able to evacuate before water destroyed virtually the entire village.

All the while, extended families known as aigas offered shelter, food and other aid to vulnerable individuals.

"Supporting indigenous institutions through disaster management policies and programs leverages existing networks with high levels of social capital, while simultaneously strengthening those institutions and making them relevant to contemporary challenges," the study said. "It's a `win-win' scenario."

Rumbach said FEMA's recent turn toward more community-based disaster management efforts offers the chance to create more flexible response plans for diverse conditions, needs and priorities.

"In times of crisis these institutions played role of first responder all without specific training," said Rumbach. "That response could be improved by being trained in CPR, evacuation of the elderly and other skills. But we could incorporate these kinds of traditional responses into FEMA."

The lessons learned from American Samoa could be used in other island territories or traditional communities in the U.S.

"We often come in after disasters and set up whole new systems but in these places we could use institutions already in place," Rumbach said. "Traditional communities have a lot of capacity.

Seven recommendations to enhance preparedness for public health emergencies in the U.S.

Seven recommendations to enhance preparedness for public health emergencies in the U.S.

The Sept. 11, 2001 attacks in New York City prompted large increases in government funding to help communities respond and recover after man-made and natural disasters. But, this funding has fallen considerably since the economic crisis in 2008. Furthermore, disaster funding distribution is deeply inefficient: huge cash infusions are disbursed right after a disaster, only to fall abruptly after interest wanes. These issues have exposed significant problems with our nation's preparedness for public health emergencies.

In a report published by the Institute of Medicine, authors Jesse Pines, M.D., director of the Office of Clinical Practice Innovation at the George Washington University (GW) School of Medicine and Health Sciences (SMHS); Seth Seabury, Ph.D., associate professor of emergency medicine at the Keck School of Medicine of the University of Southern California (USC); and William Pilkington, DPA, of the Cabarrus Health Alliance, make seven recommendations to provide a road map to enhance the sustainability of preparedness efforts in the United States.

"With more limited government funding in the foreseeable future, the government needs to be smarter about how it spends its money on emergency preparedness in this country," said Seabury, who is also with the Leonard D. Schaeffer Center for Health Policy & Economics at USC. "We need to know which communities are prepared and which aren't, when money is spent, and whether it's really making these communities better off in handling a disaster."

The authors make the following recommendations:

The federal government should develop and assess measures of emergency preparedness both at the community-level and across communities in the U.S. Measures developed by the federal government should be used to conduct a nation-wide gap analysis of community preparedness. Alternative ways of distributing funding should be considered to ensure all communities have the ability to build and sustain local coalitions to support sufficient infrastructure. When monies are released for projects, there should be clear metrics of grant effectiveness. There should be better coordination at the federal level, including funding and grant guidance. Local communities should build coalitions or use existing coalitions to build public-private partnerships with local hospitals and other businesses with a stake in preparedness. Communities should be encouraged to engage in ways to finance local preparedness efforts.

"A lot of communities out there have found creative ways to get local businesses to invest in preparedness. The more locals buying into the importance of preparedness, the more resilient a community is," said Pines, who is also a professor of emergency medicine at GW SMHS and professor of health policy at the GW School of Public Health and Health Services. "How Boston responded and recovered so effectively after the marathon bombings is a great example of a prepared community."

The study, titled "Value-Based Models for Sustaining Emergency Preparedness Capacity and Capability in the United States," was published by The Institute of Medicine Preparedness Forum.

Multidisciplinary teams helped marathon bombing survivors rebuild their lives

Multidisciplinary teams helped marathon bombing survivors rebuild their lives

Due to rigorous disaster preparedness and the heroic actions of first responders and emergency and trauma personnel, not a single one of the nearly 200 people hospitalized after the 2013 Boston Marathon bombings died, despite many grave injuries. And, thanks to the orthopaedic surgeons and physical therapists who have helped those affected, survivors are now well on the road to recovery.

The Journal of Orthopaedic & Sports Physical Therapy (JOSPT) and The Journal of Bone & Joint Surgery (JBJS) co-published a Special Report entitled It Takes a Team: The 2013 Boston Marathon - Preparing for and Recovering from a Mass-Casualty Event. This unique report highlights multidisciplinary planning, integrated clinical teamwork, and continuity of care and is being distributed in a cooperative arrangement to JBJS and JOSPT subscribers. Because it is of interest to all emergency preparedness and health care professionals, both journals are also making it available for download at no cost.

It Takes a Team explains how multidisciplinary health care teams prepared for a mass-casualty event, responded to it, and helped survivors rebuild their lives afterward. The lessons and best practices that emerged are universally applicable for any clinician or professional in the emergency-preparedness/response, surgical, and rehabilitation fields.

The report explores how key players helped transform a tragic situation through testimony from:

Marathon bombing patients First responders Orthopaedic and trauma surgeons Physical therapists Physical medicine and rehabilitation physicians Psychotherapists Nurses Hospital, city, and state emergency preparedness and response leaders

The interviews included in It Takes a Team detail how collaborations among physicians, physical therapists, and other clinicians led to improved outcomes, quicker patient recoveries, and fewer complications.

The report pinpoints many lessons learned from the Marathon bombings and other mass-casualty incidents, among them:

Be broad and collaborative in mass-casualty planning; an occasional emergency preparedness exercise isn't enough. Practice frequently, and include low-frequency, high-impact scenarios such as an active shooter. Senior-level commitment to preparedness in hospitals and government agencies is essential. Identify the gaps in response to nonlocal disasters, and practice to eliminate them in your community. Any communication you make during a disaster should be clear, quick, and truthful. Provide ample emotional support for both patients and clinical caregivers during and after a mass-casualty event. Everyone has a role and responsibility in an emergency; know where to go and from whom you will get information and instructions.

The full text of the report can be found here: http://sites.jbjs.org/ittakesateam/2014/ and http://www.jospt.org/page/special-reports/it_takes_a_team

Hurricanes Katrina and Rita may have caused up to half of recorded stillbirths in worst hit areas

Hurricanes Katrina and Rita may have caused up to half of recorded stillbirths in worst hit areas

Hurricanes Katrina and Rita may have been responsible for up to half of all recorded stillbirths in the worst hit areas, suggests research published online in the Journal of Epidemiology & Community Health.

And the true fetal death toll may even be higher, because of the displacement of people whose homes and way of life were destroyed, suggest the authors.

Hurricane Katrina struck the state of Louisiana, USA, on August 29 2005, followed by Hurricane Rita a month later on September 24. Katrina was the costliest natural disaster in American history, while Rita was the fourth most intense hurricane ever recorded.

Both hurricanes caused widespread damage to property and infrastructure and left a trail of injury, death, and trauma in their wake.

The researchers used composite figures from several government agencies, showing that the hurricanes caused damage in 38 out of 64 areas (parishes) in the state, with almost 205,000 housing units affected.

In four parishes, more than half of the local housing stock was damaged; in three others, between 10% and 50% was damaged. Elsewhere, the level of damage to housing stock was categorised as 1%-10%, or less than 1%.

The researchers then calculated the odds of a pregnancy resulting in a stillbirth in damaged and undamaged areas (less than 1% damage) in the 20 months before, and the 28 months after, Katrina struck.

But they also looked at all birth data between 1999 and 2009 in Louisiana to gauge usual patterns: during this period, 5194 stillbirths were recorded.

They then used space-time models to assess whether the extent of damage wrought by the hurricanes was linked to the risk of stillbirths in a given area.

Their calculations indicated that the risk of a pregnancy ending in a stillbirth was 40% higher in parishes where 10-50% of housing stock had been damaged, and more than twice as high in areas where over 50% of the housing stock had taken a hit.

After taking account of known risk factors, every 1% increase in the extent of damage to housing stock was associated with a corresponding 7% rise in the number of stillbirths.

Based on these figures, the researchers calculated that of the 410 stillbirths officially recorded in extensively damaged parishes, up to half (117-205) may have been directly caused by the hurricanes and the subsequent devastation.

Their estimates suggest that stillbirths made up around 17.5% to 30.5% of the total death toll in the wake of the hurricanes.

But the risk of stillbirth may have been even higher, suggest the researchers. In the hardest hit areas, the number of live births was more than 40% lower in 2007 than it was in 2004. And in parishes with more half of the housing stock damaged, the live birth rate fell by 79% in the three months following Katrina.

This "precipitous decline" is likely to reflect the well documented exodus of residents from the coastal parishes of Louisiana into other areas, they suggest.

They point to previously published research, showing a link between maternal stress, depression, and trauma and birth complications, including stillbirths.

And they warn that climate change scientists have predicted an increase in the frequency, intensity, and duration of North Atlantic tropical cyclones like Hurricanes Katrina and Rita.

"Insofar as our empirical findings meaningfully generalise in time, the health risks to the unborn and their perinatal development will likely increase with more frequent and intense hurricanes," they write.

Mental health care model reduced symptoms in those most affected by BP oil spill

Mental health care model reduced symptoms in those most affected by BP oil spill

A model of care developed by the Department of Psychiatry at LSU Health Sciences Center New Orleans School of Medicine to provide mental health services after the Deepwater Horizon Gulf Oil Spill reduced both mental health and general medical symptoms. The novel approach embedded psychiatrists, psychologists, social workers and telemedicine resources into primary care clinics in the most affected areas. This new model can be used in communities at risk for disasters and rural communities with limited mental health resources. The initiative is featured in the March 2014 issue of the journal, Psychiatric Services, now available online.

"After researching existing models of care nationally, we found none fully adaptable to the postdisaster needs of close-knit, rural communities with inadequate availability of mental health resources," notes Dr. Howard Osofsky, Professor and Chair of Psychiatry at LSU Health Sciences Center New Orleans School of Medicine. "So, we integrated behavioral health with primary care to build sustainable services along with community resilience. This was especially important given the limited resources and the increase in mental disorders the Gulf Oil Spill compounded in communities still recovering from Hurricane Katrina."

The mental health surveillance conducted by the LSUHSC Department of Psychiatry in communities highly affected by the oil spill from the fall of 2010 through 2012 found even greater increases in psychiatric symptoms than indicated by the Centers for Disease Control and Prevention. Symptoms included those of posttraumatic stress disorder (PTSD), depression and generalized anxiety disorder. Additionally, residents reported increases in physical symptoms.

Part of the Gulf Region Health Outreach Program funded by the Deepwater Horizon Medical Benefits Class Action Settlement, LSUHSC, with input from stakeholders, provides services in clinics, schools and communities. The model of integrative behavioral health in primary care clinics is based upon a team approach with centralized care management to coordinate the field efforts of the mental health specialists, extended by the use of telemedicine. A network of care tailored to the individual needs of each clinic and provider supports behavioral health screening, acute and emergency care, as well as ongoing treatment. Real-time emergency evaluations of patients are conducted during clinic hours, and telemedicine consultations are conducted 24 hours a day, seven days a week.

"It's an interprofessional stepped-care collaborative where primary care providers can treat behavioral health issues in regular consultation with mental health professionals and clinical decision support," says Dr. Osofsky. "However, if the behavioral health problem is outside of the comfort level of the primary care provider, treatment is managed by direct assessment by the mental health professional along with on-site and telemedicine care."

The five primary care clinics currently being served refer a total of 50 to 75 new patients a week to the team; the numbers will increase in 2014 with the addition of clinics in affected areas that are being rebuilt.

Significant decreases in psychiatric symptoms were found at the one-month follow-up with further declines at the three-month follow-up. General medical symptoms have also shown significant improvement.

In addition to Dr. Osofsky, coauthors at LSU Health Sciences Center New Orleans include Dr. Joy Osofsky, Professor or Pediatrics and Psychiatry, and Dr. John Wells, Assistant Professor of Psychiatry, along with Dr. Carl Weems at the University of New Orleans.

"These efforts have resulted in fewer hospitalizations and barriers to care, and they provide the highest-quality mental health care, with continuity between primary care providers and specialist mental health clinicians" concludes Dr. Osofsky.

Guided only by simple rules, termite-inspired robots build complex structures

Guided only by simple rules, termite-inspired robots build complex structures

Termites are what inspired this whole research topic for us," said the study's lead author Justin Werfel, a researcher at the Wyss Institute for Biologically Inspired Engineering in Cambridge, Massachusetts. "We learned the incredible things these tiny insects can build and said: Fantastic. Now how do we create and program robots that work in similar ways but build what humans want?"

Unlike humans, who require a high-level blueprint to build something complicated, termites can build complex mounds hundreds of times their size without a detailed plan. Instead, they take simple cues from each other and their environment to know where to lay the next clump of dirt, and ultimately, to know how to build a structure that suits their surroundings.

This use of local information in this way is called stigmergy. Justin Werfel and colleagues leveraged stigmergy to design algorithms that reflect termite behavior, and then implemented these algorithms in their robots.

Their bots need only the ability to sense a brick or bot nearby to make their next move. Equipped with sensors, they move along a grid, lifting and depositing bricks. If they sense a brick in their path, they carry their cargo to the next open spot.

And they do all this without a detailed plan or centralized communication; instead, the bots are programmed with just a few simple rules.

"There are two kinds of rules," Werfel explained. "The rules that are the same for any structure the robots build, and the 'traffic laws' that correspond to the specific structure. The [traffic laws] tell robots at any site which sites they're allowed to go to next: traffic can only flow in one direction between any two adjacent sites, which keeps a flow of robots and material moving through the structure."

Werfel further explained why the robots won't place bricks just anywhere. "If they built carelessly, it would be easy for them to build in a way where they got stuck," he said. "The safety checks involve a robot looking at the sites immediately around itself, paying attention to where the bricks already are and where others are supposed to be, and making sure certain conditions in that local area are satisfied."

Though each robot "knows" only simple rules -- like when to put a brick down, turn around, or climb one step higher - together, the robots exhibit intelligent behavior, completing user-defined structures.

And critically, it's the unique user-defined structure that determines the rules the robots need to follow. In other words, simple rules guide the design process instead of the high-level plans and planning needed for human construction projects.

Robots like this -- independent, with decentralized control -- have numerous advantages. "Individual robots can break down but the rest can carry on," Werfel explained. "There's no one critical element that brings everything down if one fails."

Such systems are also scalable. "For a bigger job, you can just add more robots (even mid-job) without needing to change how they're programmed." By contrast, a robotic system with a centralized controller could create a bottleneck, with a limit in terms of how much it could coordinate as new robots came onto the scene.

"A long-term vision is for robot teams like this to build full-scale structures for human use, maybe with particular utility in settings where it's difficult or dangerous for humans to work (e.g., building shelters after an earthquake or habitats underwater or on other planets). While that's likely a long way out," Werfel said, "a shorter-term application could be something like building levees out of sandbags for flood protection."

Pandemic emergency response considered by AAAS panel

Pandemic emergency response considered by AAAS panel

When a pandemic spreads, health officials must quickly formulate a strategy to limit infections and deaths. That requires sifting through massive amounts of data in a short amount of time and organizing medical personnel who may have little information on the pandemic.

To help coordinate a rapid response to pandemics, a professor at the Georgia Institute of Technology in Atlanta has designed software that combines biological data on the pandemic with demographic data of the at-risk population so that health officials can develop a game plan to limit the pandemic's spread. The software also combs social media sites for real-time information on the pandemic and activities of the population.

Eva Lee, director of the Center for Operations Research in Medicine and HealthCare at the H. Milton Stewart School of Industrial and Systems Engineering at the Georgia Institute of Technology in Atlanta, talked about her emergency response software at the 2014 AAAS annual meeting in Chicago.

"We have developed a real-time system that will gather the demographics of the region that is being affected, and also pick up on-the-ground-data about who is available and doing what, and about movement of the affected population," Lee said. "Our work is the first to take demographic information and real-time population behavior and interlace it with the biological information to come up with a decision that health officials can actually use."

Lee was the chair of the panel titled "Emergency Response and Community Resilience via Engineering and Computational Advances."

Lee shareed her experience helping federal officials respond to the H1N1 flu in 2009, as well as her experience planning an emergency response to a potential anthrax outbreak. Lee was also involved in coordinating a response to the 2010 earthquake in Haiti, and the decontamination and health screening effort in Japan after the 2011 Fukushima radiological disaster.

Other speakers on the panel include Ronald Eguchi of ImageCat Inc. in Long Beach, Calif, who talked about inventory data capture tools to assess risk from natural disasters. Yasuaki Sakamoto, of Stevens Institute of Technology in Hoboken, N.J., spoke about improving social media for disaster response.

Emergency responders to a pandemic must quickly gather information on the biological agent to assess the characteristics of the pandemic and decide which treatment would be most effective. They also collect data on the risk factors of the individuals in the pandemic, such as the severity of patient's sickness, and if children or pregnant women are infected.

"The big challenge in a pandemic is how do you use all of this information to determine the best strategy that will give you the minimum number of total infections and mortality rate," Lee said.

Information from Lee's systems approach allows health official to determine where to allocate medical resources and personnel in the best way so that operations will be most successful. Through the software developed in her lab at Georgia Tech, officials can determine, for example, how much vaccine to give at-risk populations and how much to give to the general populations to limit the spread of infection and mortality. Officials can also map where to set up medical sites to avoid traffic gridlock and worsening the pandemic as infected patients converge on treatment sites.

"We can do a real-time optimization to tell you exactly what are the sites that you should set up and who should be going where," Lee said.

"Emergency Response and Community Resilience via Engineering and Computational Advances" Feb. 14, 2014 2014 at the AAAS annual meeting in Chicago.

Georgia Institute of Technology

Drones could save lives in the hands of firefighters and other first responders

Drones could save lives in the hands of firefighters and other first responders

University of Cincinnati engineering researchers are finding new and unique approaches to developing autopilots for unmanned aerial vehicles and getting them into the hands of firefighters and other first responders.

In the not too distant future, you may hear the hum of a drone's rotors as it descends upon you and be filled with a sense of relief, not panic.

After all, it's coming to save you, not harm you.

Research at the University of Cincinnati could soon enable unmanned aerial vehicles (UAV) - similar to U.S. military drones patrolling the skies of Afghanistan - to track down missing persons on search-and-rescue missions, to penetrate curtains of smoke during wildfire suppression or possibly even to navigate urban landscapes on delivery runs for online retailers like Amazon. And it all could be done autonomously with a human acting only as a supervisor.

"Drones have gotten a very bad rap for various reasons," says Kelly Cohen, associate professor of aerospace engineering and engineering mechanics at UC. "But our students see that unmanned systems can have a positive impact on society."

Cohen and a team of researchers have developed an experimental capability to capture the dynamic behavior of the UAV platform, which complements other work they've done with UAVs in disaster management operations. Wei Wei, one of Cohen's students and the lead author of "Frequency-Domain System Identification and Simulation of a Quadrotor Controller," presented the UAV dynamics research at the American Institute of Aeronautics and Astronautics' SciTech 2014 conference in National Harbor, Md. The event unites international aerospace scholars and professionals to collaborate on advances in research, development and technology.

In his research, Wei used special engineering software to develop the dynamic model essential for autopilot design for a wide variety of unmanned aircraft having multiple rotors. He's applied his method to quadrotors - UAVs with four propellers - and other types of drones, but it can work with nearly any aircraft.

Plus, Cohen says there is nothing on the market today like Wei's system because of its low cost and fast, highly accurate results. Cincinnati-based entrepreneur Steve Burns is already working with UC on a concept vehicle using Wei's simulations, through a recent University of Cincinnati Research Institute (UCRI) contract.

"A selling point for this configuration is its efficiency, in both time and money, and the accuracy," Wei says. "We're already proving it using flight-test data, and it has matched nearly perfectly. This would enable not only quadrotors, but any flying objects to operate on autopilot."

First responders see advantages to drones

Wei's research overlaps with work on the Surveillance for Intelligent Emergency Response Robotic Aircraft (SIERRA) project out of UC's College of Engineering and Applied Science. SIERRA integrates UAVs outfitted with global positioning systems, environmental data, video and fire-prediction software to give real-time information to firefighters about where a fire is burning and where it is moving - information that could save lives.

UC's SIERRA team, partnering with the University of Toledo team led by associate professor Manish Kumar, has tested the system on a controlled fire in collaboration with the West Virginia Division of Forestry. Rodger Ozburn, a regional fire specialist with the West Virginia Division of Forestry, has been working with the SIERRA team. He says the eye-in-the-sky perspective of a UAV combined with UC's fire-prediction technology could provide first responders a major time- and money-saving advantage.

"So many times after a natural disaster, the West Virginia Division of Forestry is the first agency called to aid in determination of damage or loss, and having UAV technology at our fingertips will be an extreme asset, compared to high-cost aerial flights with a helicopter or airplane," Ozburn says. "We would be able to obtain quick, low-cost images and video footage of damaged areas, and would be able to transfer that information to other agencies in minutes, rather than hours or days."

The Cincinnati Fire Department (CFD) is also interested in UC's UAV research. Bryan Brown, leader of the SIERRA team and a student of Cohen's, has been working with CFD District Fire Chief Tom Lakamp to determine opportunities where a UAV could be helpful on an emergency scene.

Brown and Lakamp are planning a joint SIERRA-CFD search-and-rescue drill this spring. Typically, search-and-rescue missions require firefighters to scour broad swaths of difficult terrain on foot while encumbered with heavy gear and visually impaired by smoke or darkness. But those challenges don't exist for drones.

"With a UAV, you don't have to worry about terrain or time of day," says Brown, noting a UAV can be equipped with a thermal camera. "You just go and find what you're looking for."

The research by Cohen, Wei, Brown, UC Fire Science & Emergency Management Program Chair Lawrence Bennett and the SIERRA team supports the UC2019 Academic Master Plan by producing new ways of understanding and transforming the world through research and scholarship. The team's collaborations with the West Virginia Division of Forestry and the Cincinnati Fire Department are also Cincinnati Smart - a unique and effective way of learning that combines excellent classroom experiences with real-world opportunities through experiential options made possible at UC.

UC prepared to be leader in UAV operations

For now, Federal Aviation Administration regulations greatly limit the use of drones. Cohen predicts that in the next few years FAA guidelines will adapt to this technology, and he believes disaster management and public safety officials such as firefighters and police will be among the first to be licensed to operate drones in national airspace.

Meanwhile, state Rep. Rick Perales is promoting a bill in the Ohio legislature that would help make the Buckeye State a leading hub of UAV research and development. In addition to federal and state government interest in UAVs, Cohen anticipates a surge in commercial involvement too. He says UC is uniquely positioned to capitalize on all the attention surrounding the burgeoning industry.

"We are playing to our strengths: UAV operations and cooperative control for multi-UAV operations; system identification; autopilot design; and the desire to make a difference with first responders. That will set us apart. We will have a unique identity," Cohen says. "We don't want to be just another player in the world of UAVs. We want to have our specific niche, and we want to be the best in the world in that niche."

Contributors to Wei's research are Mark Tischler, senior scientist and flight control group lead for the Aeroflightdynamics Directorate of the U.S. Army Research, Development and Engineering Command; Cohen; and UC engineering student Nicholas Schwartz. Additional support was provided by Burns through UCRI.

Some support for the SIERRA project was provided by NASA through the Ohio Space Grant Consortium with the University of Cincinnati providing more than 50 percent of the cost share. Further research contributions were provided by UC's Bennett and the University of Toledo's Kumar.

Planners need to think carefully about costs and benefits to outsmart nature during disasters

Planners need to think carefully about costs and benefits to outsmart nature during disasters

The dramatic images of natural disasters in recent years, including hurricanes Katrina and Sandy and the Tohoku, Japan, earthquake and tsunami, show that nature, not the people preparing for hazards, often wins the high-stakes game of chance.

"We're playing a high-stakes game against nature without thinking about what we're doing," geophysicist Seth Stein of Northwestern University said. "We're mostly winging it instead of carefully thinking through the costs and benefits of different strategies. Sometimes we overprepare, and sometimes we underprepare."

Stein discussed his research in a presentation titled "How Much Natural Hazard Mitigation is Enough?" at the American Association for the Advancement of Science (AAAS) annual meeting in Chicago. His presentation was part of the symposium "Hazards: What Do We Build For?" held at the Hyatt Regency Chicago.

Stein is the William Deering Professor of Geological Sciences in Northwestern's Weinberg College of Arts and Sciences. He is the author of a new book, "Playing Against Nature: Integrating Science and Economics to Mitigate Natural Hazards in an Uncertain World" (Wiley, 2014) and the book "Disaster Deferred: A New View of Earthquake Hazards in the New Madrid Seismic Zone" (Columbia University Press, 2010).

Sometimes nature surprises us when an earthquake, hurricane or flood is bigger or has greater effects than expected. In other cases, nature outsmarts us, doing great damage despite expensive mitigation measures or causing us to divert limited resources to mitigate hazards that are overestimated.

"To do better we need to get smarter," Stein said. "This means thoughtfully tackling the tough questions about how much natural hazard mitigation is enough. Choices have to be made in a very uncertain world."

Stein's talk used general principles and case studies to explore how communities can do better by taking an integrated view of natural hazards issues, rather than treating the relevant geoscience, engineering, economics and policy formulation separately.

Some of the tough questions included:

How should a community allocate its budget between measures that could reduce the effect of future natural disasters and many other applications, some of which could do more good? For example, how to balance making schools earthquake resistant with hiring teachers to improve instruction? Does it make more sense to build levees to protect against floods or to prevent development in the areas at risk? Would more lives be saved by making hospitals earthquake resistant or by using the funds for patient care?

The choice is difficult because although science has learned a lot about natural hazards, Stein says, our ability to predict the future is much more limited than often assumed. Much of the problem comes from the fact that formulating effective natural hazard policy involves combining science, economics and risk analysis to analyze a problem and explore costs and benefits of different options in situations where the future is very uncertain.

Because mitigation policies are typically chosen without such analysis -- often by a government mandate that does not consider the costs to the affected communities -- the results are often disappointing.

WHO officials respond to criticisms of polio vaccination campaign in Syria

 WHO officials respond to criticisms of polio vaccination campaign in Syria

In a Comment published in The Lancet, Ala Alwan and Bruce Aylward from the World Health Organisation (WHO) respond to recent allegations that UN agencies including WHO have blocked vaccination campaigns and obstructed the testing of polio samples. Outlining the actions which have been taken by WHO and other agencies to address the rising threat of polio in the Middle East, Alwan and Aylward state that, "Fully implementing this response plan has required overcoming immense hurdles to reach every child amid the wreckage of Syria's public infrastructure and health system, the active conflict and insecurity, the dearth of trust, and one of the largest refugee crises since the second World War. These challenges have been compounded by erroneous allegations that - rather than doing everything possible to protect all Syrian children and the huge international investment in global polio eradication - United Nations agencies, and the World Health Organization (WHO) in particular, had 'blocked a vaccination campaign', were 'obstructing the testing of polio samples', and by extension disregarding fundamental humanitarian principles."

"Every day, thousands of local and international public health workers, community members and volunteers on all sides of this conflict risk their lives to deliver basic services - including and especially immunization - to all Syrians. It is essential that the complexities of the environment in which they are working is properly understood and that where information is incomplete, or is not shared for security reasons, it is not replaced with speculation or accusation...Halfway through the Syrian polio outbreak response, many critical programme indicators are improving, particularly in terms of access to vaccine, coverage and surveillance performance. Addressing the remaining gaps in programme implementation in Syria is a deadly serious issue; compounding this challenge with inaccurate information significantly and unnecessarily complicates an already very difficult and dangerous operating environment."

Healthcare exec pay gets some fresh media attention

By Harris Meyer 

While Medicare's large payments to physicians have received lots of scrutiny recently, high pay for healthcare executives drew critical attention over the weekend.

In a May 17 news analysis examining the issue of executive salaries, the New York Times' Elisabeth Rosenthal reported that the base pay of health insurance and hospital executives often far exceeds doctors' salaries, according to an analysis done by Compdata Surveys.

The survey found an average salary of $584,000 for insurance CEOs, $386,000 for hospital CEOs, and $237,000 for hospital administrators, compared with $306,000 for surgeons and $185,000 for “general doctors.”

And the figures for executives did not include often-large non-salary compensation, such as a $21.7 million retirement package in 2012 for former Barnabas Health president Ronald Del Mauro or the nearly $35 million in non-salary pay in 2012 for Aetna CEO Mark Bertolini.

Rosenthal, a physician-journalist who has written an eye-opening series of articles for the Times over the past year on why U.S. healthcare costs are so high, wrote that big executive salaries are part of the reason the U.S. healthcare system spends an estimated 20% to 30% on administrative costs, far higher than in other advanced countries.

“At large hospitals there are senior V.P.s, V.P.s of this, that and the other,” the Times quoted Cathy Schoen, a senior vice president at the Commonwealth Fund, as saying. “Each one of them is paid more than before, and more than in any other country.”

Rosenthal's article also points out something that anyone who pays even modest attention to the U.S. healthcare industry has noticed. There are specialized jobs and companies—brokers, consultants, detailers and suppliers of various products and services—that you never thought of before. That also contributes to high healthcare costs. You meet these nice, hard-working folks at conferences and cocktail parties and marvel at how many Americans make their living off some niche of the healthcare system.

Those folks, of course, include healthcare journalists like us.

e Rx passes 1 billion mark, SureScripts reports

By Joseph Conn

Electronic prescription network as handles more than 1 billion e recipes moved the bulk of e-Rx country last year by SureScripts, traffic. More than 70% of doctors are now e prescriber. Delaware, for the second year in a row, as the top state for e-Rx, with 81% of its physicians routinely reported with the technology, SureScripts.

The data are part of the SureScripts ' 2013 national progress report and the SafeRx rankings. "

All scheduled drugs excluded - and currently e-prescribing some permitted 48 States of a certain level - 1.04 billion recipes, including 106 million mines, according to SureScripts acting CEO Paul Uhrig were e prescribed i.e. 32% in 2013, more than in the year before.

Another way saw, were 58% of all "eligible" securities (written and completed within a hospital are also excluded) routed electronically over the network according to the report.

In 2001, the two most important pharmacy associations, the National Association of chain drug stores and community pharmacist was association with both formed to promote the introduction and use of electronic prescribing of SureScripts. In 2006, SureScripts claimed only 16,000 e recipes.

E-prescribing lever, the Medicare improvements for patients joined the Federal and applied providers act 2008 and the American recovery and Reinvestment Act of 2009 which set both incentive payments and the threat sanctions by Medicare to encourage the use of the technology available.

Research shows that "There is no doubt", that both computer science in general have increased the incentives under MPPA and the ARRA using health and e-prescribing particular Uhrig said. And when providers begin to use the technology, to hold them, to use it, European Commission research shows, he said.

Patients are also more inclined to pick their initial notes, if they are written and electronically, Uhrig said. "If you have a paper script, put it in the glove box; Forget and never go." But if they know that the recipe was actually sent and waiting for them, they tend to go more and more frequently in the pharmacy.

Why Delaware?

Cooperation, said Uhrig. Prescribers, pharmacies, and health information technology developers have to work before a prescription from e-initiative can unfold, he said. And in Delaware, the level of cooperation is at its highest.

But it grows everywhere in the United States, show the SureScripts data. While Delaware among the top every year since 2007 5 States began ranking list was, Minnesota No. 2 for the second year in a row. In the meantime, 10 for the first time in the past year moved Wisconsin (No. 4), North Dakota (6) and Connecticut (7) at the top.

In the year 2013, at least 45% of eligible prescriptions routed electronically all States, a percentage rate that is high enough, been no. 1 by a margin of 13 percentage points, according to the report in 2009 would be.

Medi-Cal registry success raises budget in California

By Andis Robeznieks

In his revised budget proposal this month California Governor Jerry Brown increase the resources for the Office of health and welfare of almost $840 million from what he originally proposed in January, but the State hospital and medical organisations concerned the new amount are not enough to cover themselves to the increase in the population of the State Medicaid.

Before Medicaid expansion under the patient safety and affordable care Act enrolled there were 7.9 million inhabitants in the Medi-Cal, the State Medicaid program. In the fiscal year 2014-2015, expected to be 11.5 million increase. A large part of these higher costs will be covered by the Federal Government, but the State General Fund $29.6 billion of the total budget is $136.7 billion SILVADOR, while "other funds" will contribute $107.1 billion.

The California Medical Association complained, as the Governor a 10% physician reimbursement has cut, the 2011 was adopted as the State in a more serious economic situation was.

"California has one of the lowest Medicaid reimbursement rates in the nation and probably also some of the highest practice costs nationwide" Dr. Richard Thorpe, CMA President, said in a release. "While California should be proud for the initial success of enrolling people in Medi-Cal, will not ensure alone can be accessed by patients on it."

The revised budget includes a total increase in revenue of $2.4 billion, reflecting higher than expected inflows of income taxes and other sources. California Hospital Association President and CEO C. Duane Dauner made this note.

"How the California budget to improve image, lawmakers should in turn restore certain cuts, to protect the weakest among us and receive a basic question of quality of life: access to health care for all," Dauner said in a release.

The State is expected to adopt a final budget plan next month.

Mobile health study predicts app revenue until the year 2017, grow tenfold

By John N. Frank

The global market for mobile health applications and services that go with them, $2.4 billion revenue in 2013 reaches and enlarged, to $26 billion by the end of 2017, according to a recently released report by research2guidance, a German market research down.

Apps on fitness monitoring card the greatest business potential for app developers today, according to the report of mHealth app developers economic 2014. But up to the year 2017, apps with remote monitoring and consultations of the highest business potential, with fitness apps responders fall to the fifth survey predicted.

The results are based on responses to an online survey of 2,000 mobile health app publishers and experts in this field.

The number of mobile health apps released for iOS (iPhone) and Android mobile operating systems more than doubled to reach 100,000 in the first quarter of this year, the report firmly in the last 2 years. Almost 70% of app developers of less the $10,000 in revenue (and many of them don't). Only 5% have more than $1 million.

With the release of new apps, traditional health care players such as hospitals, insurers and pharmaceutical and medical device companies, "have the longest way to go, their role in the ecosystem to find app mHealth" according to the report.

Those players who are publishers, for 3.4% of the total number of app publishers but seem not to get to notice consumer more productive app. Their range, measured by downloads, is "well below the average," the report says. "It seems that traditional health care in the mHealth app business stuck player effort, but have not yet found the right strategy. If she did, it would accelerate the development of the market."

But the future for those companies bright looks survey responders ahead.

"Traditional health care players like doctors and hospitals are the upper rank distribution channel for mHealth applications over the next five years", the report noted. "The underlying assumption is that within this time frame mHealth apps have processes well integrated into the healthcare again."

Improving patient compliance helps health systems mobile apps and predicted to reduce the readmission, survey responders.

Docs should make the most of online rating sites

The Wall Street Journal has a good piece today on how physicians are responding to online consumer rating sites, which a growing number of patients are using to select a doctor. A study cited by the Journal found that online reviews generally are reliable indicators of patients' opinions about doctors.

Modern Healthcare's Sabriya Rice reported in March on online doctor rating sites. Her story cited a study published recently in the Journal of the American Medical Association that found 35% of consumers surveyed reported selecting a physician based on good reviews, while 37% avoided a doctor based on bad reviews. However, 43% of survey respondents reported a “lack of trust” in physician-rating sites, and many still preferred word-of-mouth referrals from family and friends.

Doctors remain wary of such rating sites, and some have sued people who have posted negative comments about them.

But Sabriya's article quoted experts saying doctors should embrace the trend rather than fight it, and the Journal article gives an example of a savvy family medicine group in Orange County, Calif., Caduceus Medical Group, that did just that.

“Viewing the law as a way of dealing with this is very shortsighted,” David Ardia, co-director of the University of North Carolina Center for Media Law and Policy, told Modern Healthcare. Rather, doctors should regard these sites as potential opportunities to communicate excellence, he added.

First, doctors should differentiate opinion from false factual statements on these sites, said Ronnie Dean, vice president of sales and marketing for Medical Justice, a group that works with doctors on medical-legal matters. He recommended writing a diplomatically worded note to the website's administrator, asking the site to consider whether a particular post complies with its terms of use policies.

“Do not sweat an isolated negative review,” he advised. “The public understands you cannot make everyone happy. But the public also expects you will make most patients happy.”

Another consultant urges doctors to contact site posters directly if possible, acknowledge the patient's issue, and offer to rectify the situation if appropriate. The goal is to get a positive update from the consumer, said Gary Truitt, founder of Fat Brain Interactive, which helps healthcare providers manage their online presence.

Both Dean and Truitt suggested that doctors establish their own online system for seeking feedback from patients, especially those who have had a positive experience. “You have to be diligent in asking your patients for online feedback,” Dean said. Then, when the inevitable negative review does surface, “it will be placed in context of the multitude of positives.”

Finally, an apology in appropriate situations goes a long way, Dean said. He cited a case where a surgeon mistakenly performed a tummy tuck instead of liposuction, and the patient ripped the physician online. The surgeon responded by refunding the fee and offering financial assistance during the patient's recovery.

“When all was said and done, that patient recanted the slam, replacing it with a narrative of the physician's supportive actions,” Dean said.

It's not just the consumer-friendly sites taking off, though. In the drive toward transparency, quality and accountability in healthcare, a fast-proliferating array of professional organizations are rating hospitals for consumers, leading to criticisms that the various ratings, rankings and report cards are creating more confusion than clarity. Share your experience in this Modern Healthcare survey.