Strategies to improve global influenza surveillance: a decision tool for policymakers.

BACKGROUND: Global pandemic influenza preparedness relies heavily on public health surveillance, but it is unclear that current surveillance fully meets pandemic preparedness needs. METHODS: We first developed a conceptual framework to help systematically identify strategies to improve the detection of an early case or cluster of novel human influenza disease during the pre-pandemic period. We then developed a process model (flow diagram) depicting nine major pathways through which a case in the community could be detected and confirmed, and mapped the improvement strategies onto this model. Finally, we developed an interactive decision tool by building quantitative measures of probability and time into each step of the process model and programming it to calculate the net probability and time required for case detection through each detection pathway. Input values for each step can be varied by users to assess the effects of different improvement strategies, alone or in combination. We illustrate application of the tool using hypothetical input data reflecting baseline and 12-month follow-up scenarios, following concurrent implementation of multiple improvement strategies. RESULTS: We compared outputs from the tool across detection pathways and across time, at baseline and 12-month follow up. The process model and outputs from the tool suggest that traditional efforts to build epidemiology and laboratory capacity are efficient strategies, as are more focused strategies within these, such as targeted laboratory testing; expedited specimen transport; use of technologies to streamline data flow; and improved reporting compliance. Other promising strategies stem from community detection - better harnessing of electronic data mining and establishment of community-based monitoring. CONCLUSION: Our practical tool allows policymakers to use their own realistic baseline values and program projections to assess the relative impact of different interventions to improve the probability and timeliness of detecting early human cases or clusters caused by a novel influenza virus, a possible harbinger of a new pandemic. Policymakers can use results to target investments to improve their surveillance infrastructure. Multi-national planners can also use the tool to help guide directions in surveillance system improvements more globally. Finally, our systematic approach can also be tailored to help improve surveillance for other diseases

The role of transnational non-governmental organizations in the disposition of chemical and nuclear weapons in the United States: A comparative analysis

This dissertation furthers our understanding of transnational NGOs by comparing the participation of eight NGOs involved in the technological debates surrounding chemical and nuclear weapons disposal in the United States. It examines four areas of inquiry: (1) what types of NGOs are involved; (2) what types of challenges NGOs face in establishing credibility in highly technical issue areas; (3) how NGOs mobilize their constituents around abstruse technical issues; and (4) why NGOs decide to forge transnational ties. The dissertation finds that while grassroots advocacy NGOs in the two cases now play a pivotal role in determining the pace and manner in which international arms control treaties are implemented domestically, they have also faced difficulties. In particular, they have had difficulty mobilizing their constituencies around such technical issues, and have had difficulty establishing scientific and political credibility. In addition, scientific NGOs have had difficulty mobilizing large masses of people because they lack the infrastructure to do so and often convey their goals using technical language that does not resonate with the public. As a result, in these two cases, a symbiotic relationship has developed between advocacy NGOs and scientific NGOs to both augment credibility and mobilize more people. Most importantly, the dissertation identifies a new form of political strategy used by some NGOs. This new strategy is termed translational politics, or the distillation of highly scientific information into language that can be understood by the general public. This strategy has been used by advocacy organizations when they cannot rely on traditional symbolic politics, and by scientific organizations when they need to simplify their message. These translational NGOs occupy the understudied political space between scientific elites and advocates. The dissertation adds to our understanding of the strategies used by NGOs to mobilize constituencies around highly technical issues, the tensions between scientific expertise and participatory decision-making processes, and how differing perceptions of risk become incorporated into the policy-making process

Support for the 21st-Century Reserve Force: Insights to Facilitate Successful Reintegration for Citizen Warriors and Their Families, Summary

Many studies have examined the impact of deployment on military families, but few have assessed either the challenges that guard and reserve families face following deployment or how they manage the reintegration phase of the deployment cycle. This report aims to facilitate the successful reintegration of guard and reserve personnel as they return to civilian life after deployment. Using surveys and interviews with guard and reserve families, along with interviews with resource providers, this report examines how these families fare after deployment, the challenges they confront during that time frame, and the strategies and resources they use to navigate the reintegration phase. Factors associated with reintegration success include the adequacy of communication between families and the service member's unit or Service and between service members and their families, initial readiness for deployment, family finances, and whether the service member returns with a psychological issue or physical injury. Successful reintegration from the families' perspective was related to measures of military readiness, such as the service members' plans to continue guard or reserve service. In addition, there is a wide-ranging and complex "web of support" available to assist families with reintegration, including U.S. Department of Defense (DoD) programs, state and local government agencies, private nonprofit and for-profit resource providers, faith-based organizations, and informal resources (such as family, friends, and social networks). Opportunities for collaboration among providers abound. DoD does not have to "do it all," but the report suggests steps it can take to ensure that reintegration proceeds as smoothly as possible

Illustrative example of the decision tool: Input values for the likelihood (probability) and timeliness (in days) of each step in the process model, for baseline and one-year follow up

<p><b>Copyright information:</b></p><p>Taken from "Strategies to improve global influenza surveillance: A decision tool for policymakers"</p><p>http://www.biomedcentral.com/1471-2458/8/186</p><p>BMC Public Health 2008;8():186-186.</p><p>Published online 28 May 2008</p><p>PMCID:PMC2430963.</p><p></p

Process model: Pathways and steps toward detection and confirmation of a novel case or cluster of human influenza in the community

<p><b>Copyright information:</b></p><p>Taken from "Strategies to improve global influenza surveillance: A decision tool for policymakers"</p><p>http://www.biomedcentral.com/1471-2458/8/186</p><p>BMC Public Health 2008;8():186-186.</p><p>Published online 28 May 2008</p><p>PMCID:PMC2430963.</p><p></p