The National Strategy for Biosurveillance, July 2012, is formulated around four core functions: 1) Scan and discern the environment; 2) Identify and integrate essential information; 3) Alert and inform decision makers; and 4) Forecast and advise Impacts. This workshop will focus on the second core function – Identify and Integrate Essential Information. This function is focused to expedite incident detection and assessment. “Although all incidents have unique aspects, there are common elements of any national public health emergency. As with a health care provider and a new patient, there are certain key questions asked to identify symptoms and narrow probable causes to assist with patient treatment.” In order to fulfill this requirement the community must improve diagnostic capability, especially at point-of-care to enable accurate and timely collection of information for early detection and throughout an incident or outbreak.
A point-of-care (POC) system is a hospital or outpatient information system that includes bedside terminals, instrumentation, sensors, or other devices for capturing and entering data at the location where the patients receive their care. Doctors and clinicians use POC systems to record directly the details of patient encounters, to review medical information, and to order tests, referrals, prescriptions, and other services related to the patient’s ailments. Modern POC systems are being designed to replace many of the functions previously associated with paper documents.
POC systems are part of the future of biosurveillance. A POC system facilitates the electronic capture of key diagnostic data that is directly or readily translated to computer-interpretable form. POC systems typically include decision support tools like drug interactions and to even suggest diagnoses. Ideally doctors and clinicians will have sensors that use naturally bodily fluids for initial diagnosis and then the information is transmitted directly into the POC system where further analysis is conducted and feedback provided to doctor or clinician in real time.
Topics to be addressed will include:
· Improve point of care (POC) diagnostics capabilities
· Accurate and real time collection for physicians and clinicians
· POC decision support capabilities – i.e. diagnoses and drug interactions
· POC DNA sequencing
· Link POC results to public health databases and near real time feedback mechanisms
· Data standards for interoperability of POC system, the electronic health record, and biosurveillance-related databases
· Data analysis and modeling supporting POC-generated data – i.e. determining relationship between the completeness of sampling of a population and the size of outbreaks of diseases that can be detected
Conveniently Timed With:
Monday, June 17, 2013
9:00 Welcome and Opening RemarksRichard Stouder
, Director Technology Development and Deployment, Global Security Directorate, Oak Ridge National Laboratory (ORNL)
9:15 KEYNOTE ADDRESS: National Biosurveillance Science & Technology RoadmapFranca R. Jones, PhD, Assistant Director-Chemical and Biological Countermeasures, White House Office of Science and Technology Policy
Abstract is forthcoming.
9:45 National Biosurveillance Integration SystemSteve Bennett, PhD, Director, National Biosurveillance Integration Center, U.S. Department of Homeland Security
Abstract is forthcoming.
10:15 Innovative Strategies for Point-of-Care DiagnosticsHarshini Mukundan, PhD, Principal Investigator, Chemistry Division, Los Alamos National Laboratory
Effective point-of-care diagnosis relies not only on reliable, sensitive and specific detection devices but also on effective assays, ligands, functional surfaces, sampling, and data analysis. This presentation is an overview of the varied developments at LANL that address the above requirements, while highlighting the major challenges to effective application of such platforms.10:45 Networking Break, Exhibit and Poster Viewing
11:15 Global Surveillance and Response to Disease Outbreaks Global Surveillance and Response to Disease OutbreaksPenny Hitchcock, PhD, Chief Scientist, BioWatch Program, Tauri Group
Management of disease outbreaks with potential for international impact is a daunting challenge. In this diverse, yet collective world, disease threats are skyrocketing while health care resources are dwindling. Strategic use of existing infrastructure and resources; improved concepts of operation; and development of more effective trade and travel policies are essential. Best practices from 14 international surveillance and response programs are provided to demonstrate how response to disease outbreaks of public health significance might be improved. Strategic use of effective vaccines, early (environmental) detection, personal practices of infection control, home-based diagnostic tests, and single-dose treatments are highlighted.
11:45 Guiding Epidemiological Models by Integrating Point-of-Care Diagnostics with Disease-Surveillance InformationArvind Ramanathan, PhD, Researcher, Computational Science and Engineering Division, Oak Ridge National Laboratory
A significant challenge in bio-surveillance is the lack of tools to identify and integrate essential information from point-of-care (POC) diagnostics with broader level disease surveillance information from Centers for Disease Control (CDC) and other state and federal agencies. Even if such information becomes available, it is still difficult to analyze this information and present information to decision makers that can ultimately guide their action. To overcome these challenges, we present a novel data analytics platform that will integrate POC diagnostic information with disease surveillance information from state and federal agencies and augment them with widely used disease spread models to predict (1) how diseases may spread, (2) identify vulnerable populations and (3) present scenarios to decision makers on what effective strategies of intervention might best work. We present our initial results on integrating the POC information collected from the Texas Department of State Health Services with the CDC influenza surveillance network and show how both data integration and analytics can improve predictions of disease spread and in addition, provide quantitative insights to decision makers regarding intervention strategies.
12:15 Q&A and Concluding Discussion for the Morning Session12:30 Lunch
2:00 KEYNOTE ADDRESS: Diagnostic Challenges for BiosurveillanceBob Kadlec, Vice President Biodefense & Public Health Practice, PRTM Management Consultants (formerly Staff Director, U.S. Senate Subcommittee on Bioterrorism, Homeland Security Council & Office of Secretary of Defense)
Abstract is forthcoming.
2:30 Parallel Nucleic Acid and Protein Detection for Improved Biosurveillance Richard Allen, PhD, Senior Scientist, Biodefense and Food Safety, Luminex Corporation
Accurate assessment of complex disease states presents a unique instrumentation and assay challenge. As doctors and clinicians increasingly rely on multiple data streams from the location where patients receive care, the importance of continuity between the systems generating these data streams increases. To provide a more comprehensive snapshot of an evolving infection, efforts at Luminex Corporation include development of an automated, field portable diagnostic system based on the open architecture xMAP technology. A key aspect of this technology is the ability to test for both the pathogen itself, through molecular techniques, and also host biomarkers that signal the course of infection via affinity capture reagents. Taken together, these data will yield a more accurate and timely treatment, leading to better clinical outcomes than either test alone. Luminex will provide an update on integration of nucleic acid and protein biomarker assays and provide data from initial testing.
3:00 Development of a Sample to Answer PCR InstrumentWilliam M. Nelson, MD, President and CEO, Tetracore, Inc.
Tetracore has designed the T-COR 8 to provide its customers with a portable solution for real-time PCR identification of both clinical and environmental biothreat agents. The instrument has a small footprint, is battery operated and rechargeable through a 12 volt source. Tetracore has also developed sample-to-answer protocols for the direct-analysis of both clinical and environmental material. Operating modes include stand-alone (via touch screen) or remote (via Ethernet or computer).
3:30 Ambient Temperature Assays for Point of Care SystemsRolf Müller, PhD, President and CSO, Biomatrica, Inc.
Result of a molecular diagnostic assay is highly dependent on the quality of the biological sample and the quality of the reagent used. Molecular analytes such as DNA, RNA and proteins in patient samples, reagents and molecular standards require cold chain management that is difficult to manage, costly and increases failure rates for diagnostic assays. Reagent stabilization through lyophilization can be used in certain cases, but it is difficult to develop and implement at production scale. Biomatrica has developed biostabilization methods for patient samples and assay reagents that allow a complete ambient diagnostic workflow for point of care systems. Thermo-stabilized patient samples and diagnostic assays can be transported globally at ambient temperature.4:00 Networking Break, Exhibit and Poster Viewing
4:30 PANEL DISCUSSION:Challenges for Point-of-Care BiosurveillanceModerator:
, Director Technology Development and Deployment, Global Security Directorate, Oak Ridge National Laboratory (ORNL)Panelists:Franca R. Jones
, PhD, Assistant Director-Chemical and Biological Countermeasures, White House Office of Science and Technology PolicyBob Kadlec
, Vice President Biodefense & Public Health Practice, PRTM Management Consultants (formerly Staff Director, U.S. Senate Subcommittee on Bioterrorism, Homeland Security Council & Office of Secretary of Defense)Steve Bennett
, PhD, Director, National Biosurveillance Integration Center, U.S. Department of Homeland Security5:30 Concluding Remarks, End of Symposium
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