Syndromic surveillance: faulty alarm system or useful tool?

first_imgMay 16, 2007 (CIDRAP News) – At first glance, the Web page looks like an overhead shot of a fantastic game board: a map—identifiably Los Angeles—sprinkled with faceted roundels in a half-dozen colors.But the data graphically displayed at are from the real world. The roundels represent reports of symptoms volunteered by site users: runny nose, cough, fever, headache, muscle aches, and digestive trouble. The site’s founder, a California tech entrepreneur named PT Lee, drew on the new Web technology of Google Maps and the Web trend toward user participation to create a 21st-century service that a 19th-century epidemiologist would recognize: geographic surveillance of illness trends.WhoIsSick, which went live 2 months ago after a year of planning, grew out of Lee’s frustration over his wife’s holiday bout with a gastrointestinal bug.”We sat in the emergency room for 4 hours, just to find 5 minutes into seeing the doctor that there was a horrible stomach flu going around,” Lee said. “Afterward, I thought: How does someone find out if something is going around? Traditionally they ask their friends, or maybe their doctor—but that’s inefficient. Maybe the Web could provide a way to tap the wisdom of crowds.”The site has registered about 200,000 visitors so far. Its roughly 20,000 illness reports have come from the United States, Canada, the United Kingdom, Germany, and Australia. On May 11, there were 846 illnesses reported in San Francisco, 155 in Atlanta, 154 in Minneapolis, and 657 in New York City. Parents love the site because it alerts them their kids might bring something home, Lee said, though some observers have called it “a hypochondriac’s dream.”Like other user-generated Web sites such as Wikipedia and the FluWiki, WhoIsSick takes data from anyone who is interested and has an Internet connection that can handle its data-rich pages. But whether the data it gathers prove useful or merely amusing, the site confirms something that long predates the Internet: the intuitive appeal of symptom information collected from many people—otherwise known as syndromic surveillance—as a tool for monitoring public health.Enthusiasm wanesWhoIsSick’s citizen-generated syndromic surveillance has emerged just as official syndromic surveillance, conducted by federal, state, and local health authorities, is facing significant reexamination and challenge.Small-scale syndromic surveillance—pencil-and-paper monitoring of school absenteeism or cruise-ship stomach bugs—has a long history. But the practice received a huge boost after the 2001 anthrax letter attacks. Planners fixed on electronic syndromic surveillance as the best hope for providing an early warning of the next bioterrorist attack, contending that rapid monitoring and analysis of symptom clusters, emergency department complaints, over-the-counter drug sales, and other data sources could alert them to health anomalies faster than traditional paper-based reports of diagnoses.The spike in interest was followed by a vast increase in funding. Congress has appropriated more than $1 billion for state and local health departments to improve their preparedness, and given $230 million to the largest syndromic surveillance program, the Centers for Disease Control and Prevention’s BioSense, intended to connect the CDC to hospitals nationwide. About 30 syndromic surveillance programs, some of them predating BioSense, now operate around the United States; potentially thousands could be created if every public health jurisdiction constructed one.But 5 years after the initial burst of enthusiasm, syndromic surveillance is losing adherents. In a Senate hearing a year ago, two prominent public health scientists, Dr. Tara O’Toole of the Center for Biosecurity of the University of Pittsburgh Medical Center and Dr. Nicole Lurie of the RAND Corp., recommended that Congress cease funding the BioSense program until fundamental information-sharing issues are worked out. And last December, a number of speakers at a 2-day meeting convened by the Institute of Medicine (IOM) expressed skepticism over how well syndromic surveillance is working.”The expectations for syndromic surveillance were unrealistic, initially; there was the expectation it would magically give us, immediately, all kinds of advantages,” said Stephen S. Morse, PhD, a member of the IOM Forum on Microbial Threats, which called the meeting, and director of the Center for Public Health Preparedness at Columbia University. “We still don’t know how to use it most effectively, what kinds of systems work best and what the limitations are. Syndromic surveillance is very promising, but obviously it is still a work in progress.”The reexamination of syndromic surveillance comes as both US and global public health agencies turn increasingly toward it. The Pandemic and All-Hazards Preparedness Act, passed Dec 7, 2006, requires the Department of Health and Human Services to use information technology to create a national surveillance network. And the World Health Organization’s new International Health Regulations, which take effect Jun 15, require countries to monitor not just specific diseases, but any apparent outbreak that could constitute a “public health emergency of international concern.”Too many false alarmsThe new skepticism over syndromic surveillance is directed at its claimed usefulness for early detection of a bioterror attack. That claim is hard to test, since—as far as anyone can tell—there has been no bioterrorism to warn of.”It is not fair to say that no attack has ever been discovered by syndromic surveillance,” Morse pointed out, “because how many attacks have we had? There have been two in the United States, the Rajneeshees and the anthrax letters” in 1984 and 2001—both before current syndromic surveillance systems were built.But those concerned with syndromic surveillance’s failings point not to the systems’ failure to warn, but to how often they warn of outbreaks that do not exist.The New York City Department of Health and Mental Hygiene has more experience with syndromic surveillance than any other public health jurisdiction: It created its first system in 1994 and in the ensuing decade tested, and often rejected, a number of means of monitoring health data. It now runs six separate detection systems that electronically monitor patient complaints in emergency departments, dispatch codes for 911 calls, prescription and over-the-counter drug sales, reports from school nurses, and some outpatient information. Much of its early experience involved checking out false alarms.”We were spending a lot of time investigating things that we quickly came to realize were not of public health significance,” said Assistant Commissioner Dr. Marci Layton.Every false positive, she said, required a decision whether to mobilize health department resources to track down a possible victim, take a history, and obtain specimens for testing. “We were wasting the public health infrastructure, our communicable-disease folks, having them go in and investigate things that in the end didn’t mean something, while at the same time they were not working on other issues,” Layton said.Because bioterror events are so rare, the probability of any alarm being false is high, according to Michael Stoto, PhD, and colleagues at Georgetown University. They estimate that if 1,000 US jurisdictions created syndromic surveillance systems, they would collectively experience more than one false alarm per day.But making a system less sensitive, so that it rings fewer false alarms, risks making it less timely—thereby undermining the early-warning mission for which it exists.Many health departments that receive a syndromic surveillance alarm will wait 1 or 2 days and look for corresponding blips in other types of data before launching an investigation, said Stoto, a professor of health systems administration and population health at Georgetown. Simulations by Stoto and his collaborators and by two other research teams have found that, with the detection algorithms that syndromic surveillance systems use to process data, they would take days to spot a large bioterror attack. The signal of smaller outbreaks would not rise through the surrounding noise—though they might be spotted by an alert clinician first.Harvesting data on natural outbreaksBut while syndromic surveillance is being questioned as an early-warning system for new outbreaks, it is gaining backers for a different use: to deliver richer information on existing, naturally occurring outbreaks.New York City, for example, has used the same surveillance systems that returned unsatisfying early-warning data to gather very detailed information about outbreaks of norovirus and the start and progress of influenza season. The automated system that analyzes patients’ chief complaints in emergency departments delivers sensitive and specific reports of flu-like illness.”This is not something we could do with previous systems in anything close to the same level of detail,” said Rick Heffernan, director of the data unit in the city’s Bureau of Communicable Disease. “In a severe year, we would be able to document whether severity and the ages affected were atypical. In a pandemic there would be a lot of interest in as much data as possible, so there is a real value and role there.”The Clark County Health District in Las Vegas gathered enough data from its syndromic surveillance system to detect the start of flu season 2 weeks earlier than usual, according to a presentation published by the National Association of City and County Health Officials. The extra time let local health officials push test kits out to sentinel physicians, allowing for early identification of the circulating strain; it also gave them enough lead time to communicate with the local media to encourage flu vaccination before the local epidemic.And the city government of Lubbock, Tex., and the Texas Department of State Health Services reported at last year’s National Syndromic Surveillance Conference that a private-label system called SYRIS (not part of the BioSense program) allowed officials to assess illnesses among Hurricane Katrina refugees evacuated to the area and determine that the outbreaks were limited and would not spread.In each case, syndromic surveillance systems did not deliver warnings within hours of the presence of unusual pathogens. Instead, they returned detailed information within several days about outbreaks of common organisms—information that local jurisdictions used to make decisions about alerting residents and deploying resources.”Syndromic surveillance is potentially a very valuable technique,” Stoto said, “but we have been concentrating on one potential use that is probably not the most promising one.”Some question fundingGiven the evidence that syndromic surveillance may not work as it was intended to, users in the public health system are beginning to ask whether funding should still be directed chiefly toward obtaining early warnings.At the 2006 Senate hearing that questioned the BioSense program, Dr. Lisa Kaplowitz, deputy commissioner of the Virginia Department of Health, urged lawmakers to allocate funds for staff as well as technology. “I just want to put in a plea that, while we build our electronic IT systems, we make sure that we have the people who can analyze the data and who can generate the rapid response,” she said.Layton, of New York City, said the same.”It’s a question of whether you invest in the smoke alarm, or the firemen and the trucks to respond to the alarm,” she said. “To me, syndromic surveillance is just a smoke alarm. If we do not equally invest in the ability to respond when there is a concerning alarm, that would be naive.”See also:WhoIsSick.org by Lubbock and Texas state health officials on use of SYRIS system to detect illnesses among Katrina victims Surveillance Conf2006.doclast_img read more

Liquidation business booms in South Korea as wave of small retailers close due to virus

first_imgYou Young-sik has tried his luck running businesses, but when his convenience store, a sausage factory and a second-hand furniture shop all failed, he realised he had found a niche, one that he understood well: helping people go out of business.You says he is now busier than ever, due to the resurgence in coronavirus, tearing down sign boards and cash registers at shuttered hair salons, BBQ buffets and other places whose business model is based around human contact.“This is my busiest year so far, having done this for 10 years. Inquiries are about four to five times higher,” said 54-year-old liquidation specialist, who added that his business started taking off about two years ago as a street-level economic downturn began. “Second-hand goods have been piling up and we have nowhere to sell them to, so the coronavirus has been really bad for us,” said Cho, pointing to used fridges, rice cookers and waffle makers all cleaned up and displayed in glass racks.Family retailers batteredInventory glut at recycled kitchenware stores and booming liquidation businesses point to battered family retailers in every corner of the country.While policymakers brag that retail sales returned to growth in June and per-day exports recorded the slowest decline in 7 months in August, small businesses are failing at a rate not seen since the global financial crisis, data from the Korea Statistics shows.The hardest hit sectors in Asia’s fourth largest economy include hospitality, retail and restaurants, which are traditionally small, family-run businesses.South Korea has one of the world’s highest proportion of self-employed people, about 25 percent of the job market, making it very vulnerable to downturns. A 2017 Bank of Korea study showed only 38 percent of the self-employed businesses survive three years.New retirees seeking to supplement pensions by opening fried chicken diners or coffee shops and unemployed youth starting their own cafes have driven demand for second-hand sales for liquidators like You.But unprecedented social distancing restrictions imposed on eateries in Seoul since late August, banning onsite dining after 9 p.m. and limiting coffee and bakery franchises to takeout and delivery, has made trading tough for new start-ups.The government has warned South Koreans for several years not to open more fried chicken shops or cafes as the small hospitality sector is saturated.Small business profit margins were thinning before COVID-19.On top of the coronavirus pandemic, that has also fuelled an acceleration of e-commerce, small businesses are fighting spiking rents, a shorter work week and higher minimum wages under the left-leaning President Moon Jae-in.Moon has raised the legal minimum wage by about a third in the past three years to 8,720 won (US$7.2) an hour for 2021 and capped weekly work hours to 52 hours, raising costs and making lay offs inevitable for small businesses.Statistics Korea data show the number of self-employed businesses were down by 128,000 in July from a year earlier to 5.55 million, logging the biggest drop since the comparable period of 2009.Kim Da-eun, 27, ran a private tuition school for the past three years in Anseong, south of Seoul, but is now shuttering it as the number of students has dropped below 10, down from 40 last year, as the coronavirus outbreak kept many at home.“I’m now looking for a job but I don’t see anyone hiring. So I will be sticking to my delivery part-time for a while,” Kim said, observing the demolition of her business.Topics : “I can’t do them all but I still take about twice the work I used to, which is why I need to head out at 4 or 5 in the morning,” said You in the city of Suwon, south of Seoul, as he answers telephone calls and tightens ropes around tables and chairs on his truck.Tough social distancing rules to curb a second wave of coronavirus have markedly slowed retail traffic and emptied cafes across Seoul since mid-August.The tables and chairs that You collects from closing businesses will end up in recycled kitchenware shops, such as Dajoobang in a run-down part of Seoul’s Hwanghakdong.“Our 600-pyeong (21,350 square feet) storage warehouse has been completely full for about two months,” said Cho Gye-su, a 53-year-old manager at Dajoobang.last_img read more

Premier League could be declared null and void, warns West Ham chief

first_imgLONDON, England (Reuters) – West Ham United vice-chairman Karen Brady says hopes of re-starting the Premier League in three weeks are “dreamland” and believes this season could be declared null and void.England’s top-flight soccer league, like the rest of world sport, finds itself in unprecedented peace-time territory as it attempts to react to the coronavirus pandemic which has infected nearly 800 people so far in Britain.The Premier League moved to shut down until at least April 4 on Friday, joining top leagues in Spain, Italy, Germany and France where fixtures have also been suspended.With no certainty as to when things will return to normal, it has left the 20 clubs in limbo, with Liverpool tantalisingly close to a first title in 30 years and several clubs – including West Ham – in the thick of a relegation battle. “The Premier League hopes that an interlude of three weeks from today will enable it to restart but that may well be dreamland,” Brady said in her column in The Sun.“There is no dodging the possibility that all levels in the English Football League (EFL) as well as the Premier League will have to be cancelled and this season declared null and void because if the players can’t play the games can’t go ahead.”Brady says cancelling the Euro 2020 championships could allow more time for the Premier League season to be completed. West Ham, like most teams in the Premier League, have nine games remaining, which even if the suspension is limited to three weeks presents a huge challenge with the season originally scheduled to finish on May 17. There are also FA Cup, Champions League and Europa League matches to factor in.Premier League chiefs and the clubs will meet to discuss the options next week. They are not numerous, though.Stopping the season and declaring the current standings as final would be hugely controversial. While few would begrudge Liverpool a first title in 30 years – they are 25 points ahead of their nearest rivals – the relegation places are too close to call. Six points separate bottom club Norwich City from West Ham who are in 16th spot, two places above the drop zone.Likewise, nothing is yet decided in the second-tier Championship’s promotion race.“So, what if the league cannot be finished?” Brady says. “As games in both the Premier League and Football League are affected, the only fair and reasonable thing to do is declare the whole season null and void. “Who knows who would have gone down or come up if the games have not actually been played in full?“A huge blow to Liverpool who might be robbed of their first title in 30 years!” ,Brighton and Hove Albion’s chief executive Paul Barber said the decision to suspend the league was the only option.  “Our priority is to play out the remainder of the season but we have to be realistic in that we do not know where this virus is heading,” he told BB Sport.last_img read more

Norwegian football club Vålerenga partners with BX3 for esports venture

first_imgOne of Norway’s biggest football clubs, Vålerenga Fotball AS, have entered esports via a joint venture with local esports team BX3.The new joint venture will be called Nordavind AS. Thanks to the arrangement with the Oslo based football team, which itself is part of multi-sports club Vålerengens IF, Nordavind will gain access to the club’s impressive facilities such as the Intility Arena. This will include training facilities for the team and players, as well as office space for the business and administrative side of things. Vålerenga Fotball AS are owned by Magni Sports and this company has initially secured 80% of Nordavind. Tor Olav Trøim, Owner of Magni and the main shareholder in VIF, said this of the news: “We have found a team of very good people and practitioners led by Stein Wilmann and Steffen Willumsen (founders of BX3) who have gained much in a short period of time with limited funds. We hope to facilitate a solid international commitment and are excited about where we can work with Nordavind!”Steffen Willumsen, Commercial Manager of Nordavind AS, had this to say: “To take the stage to the international stage is a goal we have been working hard for the last seven years, and it is therefore extraordinary to announce our commitment and cooperation today. We have brought with us a team of people who have unique competence that we look forward to working with, as well as learning from. We look forward to starting the job at the New Year.”BX3 have had rosters across a number of games including CS:GO, League, Hearthstone, Rocket League, Overwatch, Street Fighter and Tekken and more. A post on the BX3 Facebook page sharing the news of the new investment on December 12th noted that the rebranded organisation will be looking for FIFA players. The original press release can be found here. Esports Insider says: BX3 were founded back in 2011 and this investment and partnership is a huge game changer for the organisation. It’s good to see Vålerenga Fotball AS involved in esports, and hopefully this partnership can mirror or even surpass the success of that of FC Copenhagen and North in nearby Denmark.last_img read more

Healthy Living by Tumwater Chiropractic Center- Laser Therapy for Tennis Elbow

first_imgSubmitted by Kelly Golob for Tumwater Chiropractic Center“Tennis Elbow”, or more technically, Lateral Epicondylitis, is inflammation and damage of the tendons in your arm that you are using right now to scroll down this page with your mouse, or navigate the web on your touchscreen.This injury is commonly seen in racquet-sport athletes, but is also common in “office athletes”, people who spend a lot of time using smart phones, or others who overuse those small muscles their arms some other way.  Initially this injury starts out as inflammation of a normal tendon, but over time this can become a chronic injury that actually changes the structure of the tendons involved (tendinosis).Some established techniques to treat chronic tennis elbow include eccentric exercises and soft-tissue mobilization.  But more recently many people are beginning to see good results using Low-Level Laser therapy to treat chronic tennis elbow.A new study was recently published in the journal Lasers in Surgery and Medicine (one of the coolest journal names out there) looking at treatment of tennis elbow with low-level Laser therapy.  In this study they treated 16 patients with the real Laser or a fake laser for 8 sessions over the course of three weeks.  At the beginning of the study all patients had severe pain and significant weakness in their elbows.  These patients were then re-evaluated after the initial treatment, and again 3 months, 6 months, and 12 months after the treatments ended.The results of this study found no significant differences between the two groups at the end of the treatments. However, at the 3, 6 and 12 month follow ups the group treated with the real Lasers had significant improvements in their pain and strength, while the group treated with the fake laser had no significant improvements even a year later!Therefore the authors of this study concluded that Laser therapy is an effective treatment for chronic tennis elbow (lateral epicondylitis).Our office is one of a few clinics in town offering Laser therapy, and in combination with other treatments we provide (i.e. adjustments, massage, traction, exercise) we see greater results than with treatment from any one of those alone.We have found Laser therapy to be particularly helpful in speeding up the recovery process for chronic injuries or slow healing injuries, such as fractures, cartilage injuries, chronic tendinitis, and many others.So if you have chronic pain, or want to speed up your recovery, call our office today to set up an exam to see if Laser treatment might be right for you.Kelly Golob, D.C. is a chiropractor at Tumwater Chiropractic Center at 128 D St SW in Tumwater.  Their clinic offers a variety of conservative and alternative treatments for musculoskeletal injuries and preventative wellness.  They can be contacted at 360-570-9580 or online or find them on Facebook. Facebook3Tweet0Pin0last_img read more