Monday, September 12, 2011

FYI: Managing Extreme Events in our Rivers and Coastal Areas:

http://www.rff.org/Events/Pages/Managing-Extreme-Events-in-our-Rivers-and-Coastal-Areas.aspx

Netherlands Embassy Logo
Managing Extreme Events in our Rivers and Coastal Areas:
Reflections on the Dutch ApproachPresented by Resources for the Future and the Royal Netherlands Embassy

September 14, 2011
8:30 a.m. – 10:00 a.m.
Pastries and coffee will be provided.

Resources for the Future

First Floor Conference Center
1616 P Street NW
Washington, D.C.

Please sign up to attend using our event registration system.
About the Event
In the Netherlands, water management is a daily activity.

Without dikes and coastal dunes, close to two-thirds of the country would be under water. Building on centuries of water management, the Netherlands has recently adopted a policy of "Room for the Rivers" as part of a new Delta Programme to improve flood risk management in the face of a changing climate.

What have the Dutch learned from their long history in managing water and their new flood policies?

Can their experience offer any lessons for the United States?

During this breakfast seminar, the Netherlands' Delta Commissioner will offer remarks on what his country has learned about floodplain and flood risk management and discuss new policies his country is adopting. Other panelists will provide commentary on the context of the issues in the United States, U.S. experiences with flood risk management, and emerging policy options going forward.

Speaker:   Wim Kuijken, Delta Commissioner of the Netherlands

Panelists: 
    Sandra Knight, Deputy Federal Insurance Mitigation Administrator, FEMA
    Len Shabman, Resident Scholar, Resources for the Future
    David Conrad, Representative of the Water Protection Network and Independent Consultant

Moderator:  Carolyn Kousky, Fellow, Resources for the Future

Friday, September 9, 2011

FYI: CDC. Outbreak Investigation: A Cheat Sheet

http://blogs.cdc.gov/publichealthmatters/2011/09/outbreak-investigation-a-cheat-sheet/?s_cid=fb1130

Public Health Matters Blog

Sharing our stories on preparing for and responding to public health events

Outbreak Investigation: A Cheat Sheet

Categories: General
Scientist in biocontainment suit examining a dead rat

With the approaching release of the movie ContagionExternal Web Site Icon., I thought it would be appropriate to post my cheat sheet on how to investigate a disease outbreak. Aspiring disease detectives take notes!

What do you think of when you hear the word “outbreak”?  Maybe you envision a population decimated by a terrible, novel, and incurable disease like in the aformentioned movie ContagionExternal Web Site Icon. or you think of Dustin HoffmanExternal Web Site Icon. roaming around California in a blue biocontainment suit with Rene RussoExternal Web Site Icon. trying to protect folks from a tiny monkey and narrowly preventing an airstrike by the US military?


Hollywood has done their best to capture what an outbreak is…but here are the facts. An outbreak, or epidemic, occurs when there are more cases of disease than would normally be expected in a specific time and place.  The disease may be something doctors have already seen before just in a new form or abnormally high numbers, such as foodborne or healthcare-associated infections, or it may be an emerging disease that we don’t know much about like SARS.  Either way, we need to investigate to determine why it is happening and how to prevent other people from getting sick or dying.

Several people in biocontainment suits collecting samples outside a building

Outbreaks are usually noticed by an astute clinician, such as those who first noticed AIDS in New York City and San Francisco, but there are also many high tech disease detection systems available to help us spot any increase in illness. PulseNet is a laboratory network that uses PFGE (pulsed-field gel electrophoresis) to help identify foodborne outbreaks by monitoring the genetic make-up of the bacteria causing what may otherwise look like unrelated illnesses. In the recent events of the Salmonella outbreak in ground turkey, PulseNet and the National Antimicrobial Resistance Monitoring SystemExternal Web Site Icon. helped identify the cause of the outbreak as well as determine how widely it had spread. Programs such as Biosense and First WatchExternal Web Site Icon. monitor the chief complaint or reason that someone called 9-1-1 or went to the hospital (aka syndromic surveillance).  We also monitor news media for reports of outbreaks and websites such as Google Flu trends, External Web Site Icon. which tracks circulating viruses and illnesses. With new technology ordinary citizens can also increasingly report outbreaks in their communities too.

The Magic Formula

So how do you figure out the who, what, when, and where of a disease outbreak? We usually teach our disease detectives a 10-step process for investigating outbreaks, which I’ve condensed into 5 steps below.

When we investigate outbreaks they are often in urgent situations with patients and their families wanting immediate answers and the news media asking why we are not working hard and fast enough.  This can be a lot of pressure when you are trying to make sure you gather all the clues and piece them together properly. If you’re wrong, not only do more people die, but you may implicate the wrong product, microbe, or disease transmission (such as the false accusation of Spanish cucumbers as the cause of the recent European E. coli outbreak). For that reason it’s important you follow each step.

 Step 1: Determine an outbreak is occurring (seems obvious, I know)

Too often an initial suspicious outbreak is just lots of different illnesses that are being confused for the same thing or an error from the lab or other monitoring system. So the first step involves lots of listening and then asking some basic questions:
  • What are the signs and/or symptoms?
  • Is this an increased number for this area, time of year, or age group?  Are the cases linked to a common source or agent?  Keep in mind that a change in disease monitoring, laboratory diagnostics, reporting requirements or even increased publicity might affect the number of cases reported without accurately reflecting a true disease outbreak.
  • How many cases are there?
  • The 5 “W’s” of any investigation apply here as well. Who? What? Where? When? Why?
The most critical piece here is often the “what is the problem” also referred to as verifying the diagnosis. This is where the Sherlock Holmes part of being a disease detective gets turbocharged with leading edge laboratories that should best be called CSI-CDC. The CDC labs were the first labs to identify the agents responsible for a long list of diseases such as Legionella, Hantavirus Pulmonary Syndrome, Ebola, West Nile virus in the US, SARS, and most recently the novel H1N1 influenza virusExternal Web Site Icon..

Step 2: Now that we have confirmed an outbreak, we need a case definition (not very sexy but critical)

Doctor reviewing chart with patients surrounding him
Photo courtesy of Kendra Helmer, USAID

All of the information we gathered in Step 1 allows us to piece together the person, place, and time aspects of the outbreak to develop a case definition for who we think is likely to be part of the outbreak. This is much easier if we have a lab test, but for a new disease – like AIDS or SARS – we often have to use clinical data instead (data aquired from patient observation and treatment). With a case definition we can ask if there are commonalities among all the cases. For example, are people of a certain age, race, ethnicity, location, occupation, underlying medical condition, or travel itinerary affected by this?

The case definition will create a standardized method for identifying past, present and future cases.  It should include clinical information, characteristics of those with the disease, and geographic and timing information about the cluster of cases.  A good case definition starts out very inclusive so as not to miss any potential cases that do not have the typically identified symptoms.  As the investigation continues for an unknown disease, this definition may become more restricted to ensure we focus on persons who truly have the illness of concern.  When the SARS outbreak occurred in 2003, the case definition continually changed as we learned more about the disease, its manifestations, and transmission patterns.  It started very general as a type of pneumonia, and then the definition became more specific when the transmission method and symptoms were further identified and finally a lab test was developed by CDC.

Step 3: Get a clue (often better known as throwing darts)

Doctor giving an injection to a child being held by their motherThis is the same step we learned in grade-school for coming up with a scientific hypothesis.  You must develop a question or educated guess of how something works in order to test whether you’re correct.  That is essentially what we do in an investigation. We use information about those who are ill, in addition to knowledge about existing diseases, and some intuition to determine a plausible hypothesis. 

This is when listening and close observation comes in handy to identify the public health misadventure that led to the outbreak: lots of dead crows surrounding the West Nile Virus outbreak in NYC, rodents associated with people with Hantavirus Pulmonary syndrome, or Hepatitis C cases that went to a specific clinic that was reusing needles.

Step 4: The leap of faith (testing the hypothesis)

While the earlier steps are often about the art of epidemiologyExternal Web Site Icon., this step is all about the science.  Once we establish who is ill we need to find the factor that is causing them to become infected or poisoned. 

A common way of conducting epidemiological studies (studying the patterns and causes of disease) is through a case-control study, where identical surveys or lab data are collected from those who are ill and those who are not.  We then see if there are factors that are significantly (not due to chance) different in cases vs. controls.  For example, in a multi-state outbreak of a rare but serious parasitic eye infection, Ancathamoeba Keratitis, an interview was conducted with both cases and controls regarding a myriad of factors that scientists thought might be implicated in the occurrence of the disease mainly among contact lens wearers.  After the questionnaires were completed, an analysis was run and sure enough, certain variables were strongly associated with an increased number of cases.  One brand of contact lens solution was recalled from the market because a significantly higher number of cases used this solution.

Step 5: Take Action!
Health poster on how to prevent ebolaAccurately identifying the risk factor allows us to put in place the appropriate prevention method. This public health protection step is as old as John Snow (the so-called “father” of Epidemiology) taking the handle off the Broad Street pump in 1854External Web Site Icon. after recognizing it as the source of the cholera outbreak (and long before we had identified the cholera bacterium).  In some cases it may be an “easy” fix such as recalling a product or altering manufacturing practices, but it may require a long-term outreach and education measure to promote behavior change such as the consistent use of condoms to prevent sexually transmitted diseases or smoking cessation to prevent lung cancer.

While this five-step process may appear fairly clear and logical, many investigations will throw us curve balls in the process. For example, on many international outbreaks the logistical and security challenges can present significant hurdles. I’ve been on a monkeypox outbreak in Zaire that suddenly ended when a civil war spilled over into the area where we were working, giving us sufficient time to leave with only our specimens and data sheets.  Even on domestic outbreaks, it can take a while to get everybody working together. However, no matter what the circumstances, public health officers will persevere “until we get our man.”

For more information about CDC’s current investigations or to learn more about real-life disease detectives, please visit http://www.cdc.gov/eis/index.html.

FYI: BEMA Interest. International Sector: Caribbean Disaster Management Project (CADM)

http://www.cdema.org/index.php?option=com_content&view=article&id=110&Itemid=88

Caribbean Disaster Management Project (CADM)- Objectives PDF Print E-mail
The project has four distinct objectives as follows:
  1. Strengthen and establish a system for flood hazard mapping
  2. Enhance the capability for community Disaster Management (DM)
  3. Improve the capacity of CDERA as a disaster information warehouse/clearing house
  4. Enhance recognition of the importance and usefulness of hazard maps and Disaster Management plans among the member states.

Participating States

Thursday, September 8, 2011

FYI: Conference. MD Office of Minority Health and Health Disparities. Eighth Annual Health Dispartities Conference

www.dhmh.maryland.gov/hd

The Maryland Office of Minority Health and
Health Disparities Presents Maryland’s Eighth
Annual Health Disparities Conference

Maryland's Health Workforce: Promoting
Diversity and Strengthening the Pipeline

Tuesday, October 4, 2011, 8:30 am — 4:00 pm
The Marriott Inn & Conference Center, University of Maryland
University College
3501 University Blvd. East, Hyattsville, Maryland 20783
(*Please note that this zip code may also be identified as Adelphi in some GPS and mapping systems)



The purpose of the conference is to highlight ways to build health professions educational partnerships that reduce student barriers, strengthen the pipeline, promote diversity, and ultimately reduce minority health disparities.

Target Audience: Academic representatives, health providers, students, community advocates, health departments, other governmental agencies, legislators, non-profit & for-profit entities, and the business community.

The conference is free of charge.
Lunch and refreshments will be provided.


Conference Co-Sponsors
University of Maryland School of Public Health
Hopkins Center for Health Disparities Solutions


Wednesday, September 7, 2011

FYI: Youth Opportunity ! State Farm Youth Advisory Board Opportunity

http://statefarmyab.com/apply/the-board/


Become a Board Member

Become a Board Member From this page you can apply to be a part of the State Farm Youth Advisory Board. The YAB is one of the nation’s most exciting opportunities for youth empowerment and development. The board is comprised of 30 youth from around the country who serve as equal members on the board. The board is given responsibility over the resources of $5 million dollars to grant signature service-learning projects that seek to solve important domestic issues. Please read all of the information carefully.



Commitment expected of the Board Members

The Board’s work is handled through four in-person meetings at State Farm’s Corporate headquarters in Bloomington, Illinois or at other locations within the U.S. Primary commitment to the board and time working is through electronic communications between meetings. The expectation is that all associate and board members will commit 15 hours per month to board activities.

All Youth Advisory Board meetings are mandatory for all board and associate board members.

Previous boards felt that the first board meeting is critical to understanding the mission, helping develop processes and to get to know fellow board members before working online to develop the grant proposals.

The funding meeting is where the board makes all its decisions on grants to be funded.

IF you cannot make these meetings, your candidacy as an applicant will be affected. Extenuating circumstances will be taken into account.

Youth Advisory Board meetings beginning with the term that begins January 4, 2012 and ends January 2, 2013 will take place on:
  • January 4-8, 2012 - Bloomington, IL
    • Key Events
      • Orientation of associate board members
      • Associate board members move to board status
      • Board members rotate to alumni status
      • Development of new board’s mission, goals and issue areas
  • April 10-14, 2012 – at the National Service-Learning Conference – Minneapolis, MN
    • Key Events
      • Presentations at conference
      • Board meeting
  • August 2-7, 2012 - Bloomington, IL
    • Key Events
      • Funding meeting for grants
  • January 2-6, 2013 – Bloomington, IL
    • Key Events
      • Orientation of associate board members
      • Associate board members move to board status
      • Board members rotate to alumni status
      • Development of new board’s mission, goals and issue areas

Youth Advisory Board Members’ Expenses

All travel, lodging and meal expenses of Board and Associate Board members are covered for all meetings initiated by State Farm relative to Board activities. Board and Associate Board members will not be compensated for their time other than through expense reimbursement.

There is no personal financial cost associated with board and associate board membership.

All applications must be submitted online by October 3, 2011 or they will not be considered. There are no exceptions.

FYI: Cairn Energy's Respone Plan it own disaster

Op-Ed: Cairn Energy’s Arctic oil spill response plan its own disaster
Read more: http://www.digitaljournal.com/article/311179#ixzz1XGiOWRvW

Edinburgh - As the oil and gas industry plows into the Arctic's frigid and inhospitable waters, a member's oil spill response plan has found the light of day, despite best efforts to keep it secret, and gives credence to concerns over the next great catastrophe.
With ExxonMobile and Russia’s Rosneft reaching a multi-billion dollar oil and gas deal over Arctic Ocean hydrocarbon reserves, the industry has been able to throw words around in attempts to assure the general public another BP Gulf disaster is not likely, but Cairn Energy’s recently published oil spill response plan (pdf), thanks to Greenpeace, shows how ill-equipped the industry is in dealing with such a disaster.


Read more: http://www.digitaljournal.com/article/311179#ixzz1XGjLdECA


Despite oil and gas propaganda claiming oil dispersed “naturally” in Shell’s recent North Sea spill and the determination a tar sands oil pipeline poses “no significant impacts” to one of the world’s largest aquifers, Cairn “dramatically understates the potential size and impacts of a blow out ... and dramatically overstates the potential effectiveness of any spill response,” said Richard Steiner, a professor formerly at the University of Alaska, the Guardian reports.
For instance, on page 78 of the plan , anyone with an operational brain can see Shell spokeswoman Kelly op de Weegh hasn’t got a clue when she claims in the Wall Street Journal, “We could respond to any incident within an hour.” Maybe she could share her company’s expertise with Cairn, because the Scottish company notes
Even in the most ideal conditions recovery rates will never be 100% and are actually more likely to be around 10 - 20 percent.
In a duh moment, Cairn notes the faster a response time, the better chance there is for recovery, as the oil will have had less time “to spread and fragment." However, the dismal nature of the report doesn’t stop there, as Cairn also notes if ice is present (think Arctic) on the water’s surface
it is likely that oil will become remobilised once there is a thaw.
Each line of the report gets better than the one before.
Operations are unlikely to be possible in wave heights exceeding 2m (failure of boom with oil being washed over) or in winds of more than 35 km/hr.
Maybe someone could send a video of Discovery Channel’s Deadliest Catch to Cairn executives. Just sayin’.
Page 70 of the oil spill response plan is a lulu as well, with Cairn stating if ice is “entrained within the oil,” a secondary response would occur upon thaw. One can easily imagine an oil spill heading into the winter months. But don’t fear, Cairn has an answer for any problems associated with ice over.
Ice can be located by augering and recovered using ice slots. Sections of oiled ice can be cut out and allow the ice to thaw in a heated warehouse and then separating the oil from the water.
Okay, let’s just transport ice cubes, or ice blocks, contaminated with oil, to the nearest warehouse, if we can just get through the ice. Except winter’s coming on, and the Arctic is known for its darkness at that time of year. So, also on page 70, Cairn states
During the winter months there are very few hours of daylight which can cause serious operational complications.
Cairn’s answer is “limited portable lights.” Want more of this? How about the stresses associated with metal in extreme cold conditions? Or how about massive ice floes and ice chunks and ice bergs hitting oil platforms. Then there’s the matter of Greenland’s geography, with Cairn admitting on page 89
the coastal environment in Greenland does not facilitate containment, recover or protection due to the uneven rocky substrate that prevails in the region.
Sadly, or would that be honestly, Cairn adds on page 90
in some circumstances oiled shorelines are best left to recover naturally.
There’s that word again. Sorry about that, Greenland. Naturally.
One could go on, summarizing Cairn just thinks we’re all stupid, that no one will say anything, that no one will question this, that we need oil.
The fact Cairn’s oil spill response plan even surfaced is a story in itself. Increasing its pressure on the oil company, in July, around 60 Greenpeace activists entered Cairn’s offices near Scotland’s Edinburgh Castle, dressed in polar bear suits and searching for the oil spill response plan.
“More than 50,000 people have written to Cairn bosses demanding that they come clean over their oil spill response plan and our volunteers braved freezing Arctic seas to board Cairn's rig and look for these secret documents,” said Paul Morrozzo, a Greenpeace campaigner, according to the Guardian.
“In response, the rig master told the volunteers that if they wanted the plans they should go to Cairn's HQ. That's why today we've come to look inside their international headquarters and we won't leave until these oil spill papers are in the public domain,” Morrozzo added.
Long story short, Greenpeace didn’t publish the documents. Greenland’s government did, saying it “decided to publish the oil spill contingency plan in Greenland after having heard the wish of the public for such publication,” Greenpeace UK reports.
A Cairn spokeswoman told the Guardian its oil spill response plan “is robust and appropriately designed to deal with an incident in this area.”
Still, it would be wise to heed the words of Greenpeace on this issue. Campaigner Vicky Wyatt said: “It's no wonder Cairn Energy didn't want the public to see their secret spill plan. The company offers only giant assumptions and pie-in-the-sky solutions. This cowboy company are playing roulette with one of the most important and fragile environments on the planet, and must be stopped,” the Guardian notes.
This opinion article was written by an independent writer. The opinions and views expressed herein are those of the author and are not necessarily intended to reflect those of DigitalJournal.com


Read more: http://www.digitaljournal.com/article/311179#ixzz1XGjBpudR

FYI: National Child Traumatic Stress Network.

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