CGDIandPublicHealth Goa

7/27/2019 CGDIandPublicHealth Goa

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CANADIAN GEOSPATIALDATA INFRAST RUCTURE

GAPS AND OPPORTUNITIES IN PUBLIC HEALTH

Prepared by: New Brunswick Lung Association

Website: www.nb.lung.ca

Phone: 506!55"#6$

%ate: &arch '$( )006

*unded by: +eo,onnections( Natural -esources ,anada
http://www.nb.lung.ca/http://www.nb.lung.ca/


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ABL/ * ,N/N1

able o2 ,ontents...................................................................................................................)

/3ecuti4e 1uary............................................................................................................... Preamble.....................................................................................................................................................7

Who is This For?........................................................................................................................................7

Report Layout.............................................................................................................................................8

Literature -e4iew................................................................................................................$$ Introduction..............................................................................................................................................11

GI !pplication Potential........................................................................................................................1"

#iscussion $ Recommendations................................................................................................................1%

Needs and +aps in Public 7ealth.......................................................................................$6 In&rastructure............................................................................................................................................1'

Trainin( and )ducation...........................................................................................................................17

Research....................................................................................................................................................18

#iscussion $ Recommendations*.............................................................................................................."+8ser Needs Assessent........................................................................................................))

,ser Types.................................................................................................................................................""

,ser -eeds................................................................................................................................................""

,se ase cenarios..................................................................................................................................."/

#iscussion $ Recommendations*.............................................................................................................."'

,ase 1cenarios......................................................................................................................) hronic Respiratory ymptoms................................................................................................................"7

!ir Pollution 0orbidity0ortality Trends..............................................................................................."8

#rin2in( Water 3uality............................................................................................................................"4

Road Transport Plannin(........................................................................................................................./1

5ospital !ccessibility Patterns................................................................................................................./" #isease lusters........................................................................................................................................//

5ealthcare Plannin(................................................................................................................................/6

oine pon(i&orm )ncephalopathy......................................................................................................./%

Identi&yin( ontaminated lood Products............................................................................................../'

%isease 1ur4eillance ools and +91...................................................................................'# 9erie:..................................................................................................................................................../4

ioterrorism #etection cenarios............................................................................................................/4

ommunicable #isease #etection cenarios........................................................................................../4

;ectororne #isease #etection cenarios.............................................................................................6+

!ssessment Re


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Personnel Re


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Di(ital C$arts &) t$e 9&rld!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!0# limate han(e and 5ealth.....................................................................................................................71

9ORLDCLI-!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!0#-ete&r&l&(ical Services Canada!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!0#Nati&nal Center )&r Atm&s'$eric Researc$!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!02Nati&nal Climate Data Center!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!02 Pale&climat&l&(+!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!02

ORNL DAAC Climate C&llecti&n!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!02GEO Data P&rtal!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!02 ea Leel Rise...........................................................................................................................................7/

GSHHS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!0,NOAA:s -edi%m Res&l%ti&n Di(ital .ect&r S$&reline!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!0,Envir&nment Canada Sea7Level Rise Pr&;ect!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!0, GRID7E%r&'e!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!0"

#isease ;ectors.........................................................................................................................................7%

9est Nile .ir%s -a's!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!0" #iscussion $ Recommendations*..............................................................................................................7%

1tatistical &odules...............................................................................................................6

Introduction..............................................................................................................................................7' Timeeries 0odel....................................................................................................................................7'

Poisson 0odel...........................................................................................................................................77

ayesian 0odel.........................................................................................................................................77

ootstrap 0odel........................................................................................................................................78

ernoulli 0odel........................................................................................................................................78

paceTime Permutation 0odel..............................................................................................................74

9rdinal 0odel...........................................................................................................................................8+

)=ponential 0odel...................................................................................................................................8+

Probability 0odel omparison................................................................................................................81

Fe: ases ompared to ontrols............................................................................................................81

ernoulli ersus 9rdinal 0odel...............................................................................................................81 Temporal #ata..........................................................................................................................................81

#iscussion $ Recommendations................................................................................................................8"

;isuali +,,opliant Public 7ealth Architecture........................................."" In&ormation >0ap #eliery.....................................................................................................................88

5ealth In&ormation erice !rchitecture................................................................................................84

#atabase 0ana(ement ystems...............................................................................................................41

ecurity and !uthentication.....................................................................................................................4/ #atabase Proiders...................................................................................................................................4/

W0 and WF.........................................................................................................................................46

G#I)ndorsed tandards......................................................................................................................47

Recommendations.....................................................................................................................................47

,oplientary echnologies.............................................................................................## Introduction..............................................................................................................................................44

tatic 0appin(..........................................................................................................................................44

Interactie 0appin(...............................................................................................................................1+1

,


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Pro(rammable 0appin(.........................................................................................................................1+"

Public 5ealth !(ency o& anada...........................................................................................................1+/

-atural Resources anada....................................................................................................................1+6

,. Geolo(ical urey............................................................................................................................1+6

9pen ource o&t:are............................................................................................................................1+%

=%ant%m GIS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#6/ SAGA GIS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#63

Ge&(ra'$ic Res&%rces Anal+sis S%''&rt S+stem!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#65O'en In)rastr%ct%re )&r O%tc&mes S+stem!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!##6 SaTScan!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!###

Remote and 0obile !pplications...........................................................................................................111

Proprietary GI* o&t:are ;endors.......................................................................................................11/

CARIS >111!caris!c&m? >Canada?!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!##*PCI Ge&matics >111!'ci(e&matics!c&m? >Canada?!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!##*ESRI >111!esri!c&m?!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!##* Inter(ra'$ >111!inter(ra'$!c&m?!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!##*-a'In)& >111!ma'in)&!c&m?!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!##,Bentle+ S+stems >111!entle+!c&m?!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!##,

A%t&Des >111!a%t&des!c&m?!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!##,Sa)e S&)t1are >111!sa)e!c&m? >Canada?!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!##, #iscussion $ Recommendations..............................................................................................................11%

1uary o2 -ecoendations........................................................................................$$

,onclusion...........................................................................................................................$))

Appendi3 $: 7ealth %atabases..........................................................................................$)' linical !dministratie #atabases.........................................................................................................1"/

Disc$ar(e Astract Dataase!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#2*H&s'ital -&ridit+ Dataase!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#2*Nati&nal Am%lat&r+ Care Re'&rtin( S+stem!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#2*

5ealth 5uman Resources #atabases....................................................................................................1"6

Re(istered N%rses Dataase!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#2,Licensed Practical N%rses Dataase!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#2,Re(istered Ps+c$iatric N%rses Dataase!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#2,

5ealth pendin( #atabases...................................................................................................................1"6

Nati&nal Healt$ E4'endit%re Dataase!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#2,OECD Healt$ Dataase!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#2"Canadian -IS Dataase!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#2"Nati&nal P$+sician Dataase!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#2"Nati&nal Prescri'ti&n Dr%( Utili


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Res'irat&r+ Disease in Canada!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#**Canadian Cancer Re(istr+!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#**Canadian Patient Data Re(istr+!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#**Canadian T&acc& Use -&nit&rin( S%rve+!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#**Canadian T%erc%l&sis Re'&rtin( S+stem!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#**-&rtalit+ Dataase!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#*,Nati&nal Air P&ll%ti&n S%rveillance S+stem!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#*,

Nati&nal L&n(it%dinal S%rve+ &) C$ildren and &%t$!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#*,Nati&nal Perinatal S%rveillance S+stem!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#*,Nati&nal P&'%lati&n Healt$ S%rve+!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#*,N&ti)iale Disease Re'&rtin( S+stem!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#*"Nati&nal P&'%lati&n Healt$ S%rve+ Ast$ma S%''lement!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!#*"

anadian Institutes o& 5ealth Research................................................................................................1/%

Bibliography.......................................................................................................................$'

/


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/?/,89;/ 18&&A-@

P-/A&BL/

T$e e4'ansi&n &) t$e Canadian Ge&s'atial Data In)rastr%ct%re int& t$e '%lic $ealt$ disci'ine is deemedcritical )&r addressin( s$&rtc&min(s in '&'%lati&n $ealt$ m&nit&rin( devel&'in( e))ective interventi&nstrate(ies )&r c$r&nic and in)ecti&%s disease im'r&vin( $ealt$ care services and res'&ndin( t& $ealt$ andsa)et+ emer(encies!

T$e Ne1 Br%ns1ic L%n( Ass&ciati&n is 'leased t& 'resent t$is re'&rt assessin( (aps and opportunities&or deelopment o& G#Inested public health in&rastructure and applications!T$e re'&rt is divided int&si4 Secti&ns! Eac$ secti&n c&ntains &%r researc$ and c&ncl%des 1it$ rec&mmendati&ns! T$is re'&rt 1illassist Ge&C&nnecti&ns and P%lic Healt$ A%t$&rities acr&ss Canada )&r t$e im'r&ved a''licati&n &)ma''in( tec$n&l&(+ in s%''&rt &) '%lic $ealt$ decisi&n7main(!

T$e )&ll&1in( %esti&ns 'r&vide t$e necessar+&ocus)&r t$is st%d+

9$at (a's e4ist )&r 1e7ased ma''in( )&r '%lic $ealt$

H&1 can 1e7ased ma''in( $el' t& %ild t$e ca'acit+ &) '%lic $ealt$ 'r&)essi&nals c&mm%nities t&

%nderstand t$reats t& $%man $ealt$ sa)et+ and t$e envir&nment

9$at GIS t&&ls and data are needed )&r e'idemi&l&(ical m&delin( and res'&ndin( t& in)ecti&%s disease

H&1 can t$e CGDI s%''&rt a )%ll+7&'erati&nal '%lic $ealt$ 9-S 9FS in)rastr%ct%re incl%din(

'%lic access and disease7c&ntr&l a''licati&ns 1$ile ens%rin( data 'rivac+

H&1 '%lic $ealt$ %ser re%irements e met t$r&%($ ad&'ti&n &) 9-S tec$n&l&(+ c&m'limentar+

tec$n&l&(ies statistical t&&ls and data standards

H&1 can a distri%ted access net1&r nested in t$e CGDI e estalis$ed am&n( $ealt$ a%t$&rities )&r

envir&nmental7$ealt$ ma''in(

W7 91 791 *-

9$ile n&t limited t& t$e )&ll&1in( 1e $ave identi)ied )&%r e+ a%diences )&r t$is re'&rt! T$e

researc$ and rec&mmendati&ns are 'artic%larl+ relevant t! +eo,onnections:F&r t$e c&nvenience &) &%r )%nder Ge&C&nnecti&ns 1e 'r&vide a %ic &vervie1

&) t$e c&ntents &) t$is re'&rt ;%st el&1 incl%din( e+ rec&mmendati&ns! T$is re'&rt 1ill e &)interest t& c&r'&rate devel&'ment strate(+ tec$nical and '&lic+ 'ers&nnel and $ealt$ 'r&;ectadvis&rs! F%rt$erm&re 1e $ave determined t$at )%rt$er researc$ and stae$&lder en(a(ement isneeded t& address t$e iss%es identi)ied in t$is re'&rt!

2! 7ealth Authorities:T$e researc$ and rec&mmendati&ns in t$is re'&rt c&ncentrate &n '%lic $ealt$a''licati&ns (a's needs disease s%rveillance and ma''in( tec$n&l&(ies met$&d&l&(ies datastandards 'rivac+ '&lic+ 'ers&nnel and trainin( re%irements and m&re!

0


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*! -esearch +roups:T$is re'&rt &%tlines t$e c$allen(es t& medical researc$ (r&%'s 1$en accessin('%lic $ealt$ data %t als& 'r&vides s%stantial insi($t &n t$e tec$n&l&(ies met$&d&l&(ies andstandards t$at can )acilitate access t& data )&r medical researc$ and m&delin( '%r'&ses! T$e re'&rtals& identi)ies 'ri&rities )&r researc$ and GIS ma''in( ased &n a t$&r&%($ literat%re revie1 and%ser c&ns%ltati&n!

,! +eoatics 9ndustry:GIS is emer(in( as a critical t&&l )&r s'atial e'idemi&l&(ical anal+sis &)

c$r&nic and in)ecti&%s diseases! Ge&matics Ind%str+ interested in reain( int& t$e '%lic $ealt$maret m%st )irst %nderstand '%lic $ealt$ %ser re%irements! T$is re'&rt 'r&vides a s&lid)&%ndati&n incl%din( s%((ested minim%m standards )&r 9-S9FS a''licati&ns t& meet '%lic$ealt$ needs!

-/P- LA@8

9e $ave divided t$e re'&rt int& si4 secti&ns! ! summary o& recommendations can be &ound on Pa(e 11'.Here is an &%tline &) t$e re'&rt incl%din( (&als )&r eac$ secti&n!

1ection ne:

+oal:T& 'r&vide a rie) intr&d%cti&n t& t$e (r&1in( need )&r e7$ealt$ disease s%rveillance and1e7ma''in( a''licati&ns in s%''&rt &) '%lic $ealt$ decisi&n7main(! T$is secti&n als& identi)ies(a's 1it$in '%lic $ealt$ and t$e CGDI )&r devel&'ment &) 1e7ma''in( a''licati&ns in)rastr%ct%re trainin( and researc$!,hapter $:Literat%re Revie1,hapter ):Needs and Ga's in P%lic Healt$

1ection wo:

+oal:c&ntains a $i($7level disc%ssi&n &) GIS a''licati&ns in '%lic $ealt$ incl%din( case scenari&s!,hapter ':User Needs Assessment,hapter !:Case7Scenari&s

1ection hree:

+oal:(iven (r&1in( c&ncerns &ver 'andemics and in)ecti&%s disease 1&rld1ide t$is secti&ndisc%sses t$e re%irements )&r disease s%rveillance met$&d&l&(ies and tec$n&l&(ies incl%din(disease detecti&n data c&llecti&n st&ra(e and anal+sis in)rastr%ct%re and s&)t1are and m&re!,hapter 5:Disease S%rveillance T&&ls and GIS

1ection *our:

+oal:t$e )&%ndati&n )&r t$e e4'ansi&n &) CGDI int& '%lic $ealt$ incl%des 'a+in( cl&se attenti&n t&$ealt$ data inte(rati&n and standards 'rivac+ iss%es data setss&%rces statistical m&delin( andvis%ali


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1ection *i4e:

+oal:in c&nsiderati&n &) t$e )irst )&%r secti&ns 1e $ave devel&'ed an &vervie1 &) CGDI7nestedOGC7c&m'liant '%lic $ealt$ arc$itect%re incl%din( rec&mmendati&ns )&r a''licati&ns dataasesdeliver+ c$annels net1&r sec%rit+ minim%m standards and m&re!,hapter $):CGDI7Nested OGC7C&m'liant P%lic Healt$ Arc$itect%re,hapter $':C&m'limentar+ Tec$n&l&(ies

1ection 1i3

+oal:t& 'r&vide a )%ll s%mmar+ &) rec&mmendati&ns c&ntained 1it$in t$is re'&rt! Cl&sin( t$&%($tsand directi&n is 'r&vided in t$e c&ncl%si&n!,hapter $!:S%mmar+ &) Rec&mmendati&ns,hapter $5:C&ncl%si&n

At t$e end &) t$is re'&rt +&% 1ill )ind A''endi4 # and Bili&(ra'$+!T$e Ne1 Br%ns1ic L%n( Ass&ciati&n'r&'&ses t$at $ealt$ a%t$&rities acr&ss Canada c&nsider t$e rec&mmendati&ns in t$is re'&rt as 'art &)devel&'in( e7$ealt$ s+stems and t&1ard ad&'ti&n &) CGDI7nested GIS a''licati&ns data and services!

It is essential t$at m&re researc$ and devel&'ment e c&nd%cted in &rder t& address t$e (a's and&''&rt%nities identi)ied in t$is re'&rt! T& t$at end 1e rec&mmend t& Ge&C&nnecti&ns t& s%''&rt $ealt$researc$ (r&%'s t& enale t$e e4'ansi&n &) t$e CGDI int& '%lic $ealt$!

T$is 'r&;ect 1as c&nd%cted in -arc$ 266/ and 1as 're'ared + sta)) &) t$e Ne1 Br%ns1ic L%n(Ass&ciati&n incl%din( -a%rice Lantei(ne Jia&l%n i and Eddie Old)ield! Dr! Bar -acKinn&n andm+sel) 'r&vided &versi($t (%idance in t$e devel&'ment &) t$is re'&rt! S$&%ld +&% e interested inc&ntactin( %s re(ardin( t$is re'&rt &r a&%t an+ &) t$e t&'ics addressed $erein 'lease d& n&t $esitate t&c&ntact me! And rememer

When @ou ,anCt Breathe( Nothing /lse &attersD

Kennet$ -a+eePresident and CEONe1 Br%ns1ic L%n( Ass&ciati&nP$&ne >"6/? ,""735/# e4t #62Email en!ma+een!l%n(!ca

5
mailto:[email protected]:[email protected]


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SECTION ONE

CHAPTER # Literat%re Revie1

CHAPTER 2 Needs and Ga's in P%lic Healt$

#6


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L9/-A8-/ -/;9/W

9N-%8,9N

Res'irat&r+ disease e4erts a ma;&r im'act &n t$e Canadian $ealt$care s+stem acc&%ntin( )&r m&re t$an M,illi&n d&llars &) direct e4'endit%re 'er ann%m! Indirect c&sts related t& disailit+ and m&rtalit+ is estimatedt& e4ceed direct $ealt$ c&sts + t1&7)&ld! T$e Centre )&r C$r&nic Disease Preventi&n and C&ntr&l identi)iesres'irat&r+ disease as t$e m&st 'revalent c$r&nic c&nditi&n in c$ildren #! It a))ects nearl+ 2!" milli&nCanadians 3 &) ad%lts and #2 &) c$ildren! Res'irat&r+ disease in Canada res%lts in #"6666 emer(enc+de'artment visits "6666 $&s'itali111!in)&1a+7in)&r&%te!ca?!It 'r&m&tesinter&'erailit+ and standards am&n( $ealt$ in)&rmati&n s+stems and incl%des a standards revie1 'r&cess1it$in 1$ic$ t$e OGC CGDI standards ma+ e c&nsidered! T$e Canada Healt$ In)&1a+ 1&rs in'artners$i' 1it$ t$e Pr&vinces and 'rivate sect&r t& devel&' t$e necessar+ in)rastr%ct%re )&r e7$ealt$!

Nearl+ a decade $as 'assed since t$e )irst call t& inte(rate GIS tec$n&l&(+ int& t$e Canadian $ealt$7care'lannin( 'r&cess/! Since t$at time &nl+ t$ree researc$ (r&%'s in Canada $ave )&ll&1ed %' &n t$e initial'r&'&sal0 3 5! C&nversel+ GIS a''licati&ns $ave ec&me a sta'le in E%r&'ean $ealt$ '&lic+ eval%ati&n t&&ls7 devel&'in( $ealt$ data mana(ement t&&ls in Ital+#6 a nati&nal '%lic $ealt$ atlas in T$e Net$erlands ##

##
http://www.infoway-inforoute.ca/http://www.infoway-inforoute.ca/


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$ealt$care 'lannin( t&&ls in S1it


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,hronic bstructi4e Pulonary %isease

relati&ns$i' et1een m&t&r ve$icle emissi&ns and res'irat&r+ $ealt$ %sin( a (e&(ra'$ic

in)&rmati&n s+stem t& estimate t$e avera(e dail+ e4'&s%re t& P->2!"? /6!

'&'%lati&n ris assessment &) s$&rt7term e4'&s%re t& l&1 levels &) (ase&%s '&ll%tants in an %ran

envir&nment/#

cr&ss7secti&nal im'act anal+sis &) n%rsin( c$aracteristics &n m&rtalit+ trends in ac%te care

$&s'itals )&r 'atients 1it$ c$r&nic &str%ctive '%lm&nar+ disease/2

s'ir&metric anal+sis &) im'aired l%n( )%ncti&n am&n( First Nati&ns c$ildren/* time7series anal+sis &) elderl+ 'e&'le $&s'italiac%te and c$r&nic r&nc$itis

'%lm&nar+ )%ncti&n? and acc%lt%rati&n indices )&r Native American '&'%lati&n sam'les3#!

an eval%ati&n &) $ealt$care data 'r&)iles t& identi)+ 1$ee


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(e&(ra'$ic s%rve+ &n t$e %se &) 'r&'$+la4is a(ainst Pne%m&c+stis carinii 'ne%m&nia5,

'ediatric m&ridit+ trend anal+sis t& identi)+ 'ne%m&nia7ind%ced res'irat&r+ tract in)ecti&ns

am&n( First Nati&ns c$ildren5"!9n2luen


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emer(ence &) t$e 9est Nile .ir%s in Canada res%ltin( )r&m c$an(in( ec&s+stem 'r&cesses and

its '&tential im'act &n '&'%lati&n $ealt$ interventi&n strate(ies#2"!

s'atial m&delin( &) landsca'e sensitivit+ t& climate c$an(e#2/!

ther

-ana(in( S%r(e Demand >e!(! res%ltin( )r&m Nat%ral Disasters Pandemics?

C&&rdinatin( Healt$ and Sa)et+ a%t$&rities >D&mestic Emer(enc+ Res'&nse?

%91,8119N > -/,&&/N%A9N1

It is clear t$at man+ '&tential a''licati&ns e4ist )&r GIS in '%lic $ealt$ in Canada! In &rder t& de'l&+ t$esea''licati&ns in a c&nsistent and e))ective manner acr&ss t$e CGDI Ge&C&nnecti&ns needs t& 'r&vide '%lic$ealt$ &r(ani


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N//%1 AN% +AP1 9N P8BL9, 7/AL7

T$e Ne1 Br%ns1ic L%n( Ass&ciati&n $eld a 1&rs$&' &n N&vemer 22 266" entitled P%lic Healt$and 9e7ased -a''in(!T$is 1&rs$&' aimed t& rin( t&(et$er 'r&)essi&nals acr&ss '%lic $ealt$ '%licsa)et+ and envir&nment disci'lines t& e4'l&re c$allen(es and &''&rt%nities )&r en$ancin( evidence7ased

decisi&n7main( t$r&%($ 1e7ased ma''in( tec$n&l&(+! Over 06 'r&)essi&nals attended re'resentin( arelativel+ even distri%ti&n &) t$e a&ve * disci'lines! T$ere 1ere als& re'resentatives )r&m * levels &)(&vernment ind%str+ academia and n&n7(&vernment &r(anidatatec$n&l&(+ standards etc?!A 1esite c&ntainin( all t$e 'resentati&ns made t$e )inal re'&rt and lins t&relevant sites is availale HREF$tt'111!n!l%n(!cama''in( -ACROBUTTON HtmlResAnc$&r111!n!l%n(!cama''in(!T$e 1&rs$&' 1as )%nded + Ge&C&nnecti&ns Nat%ral Res&%rces Canada!

A)ter a revie1 &) 'artici'ant )eedac at &%r recent 1&rs$&' 1e $ave devel&'ed a disc%ssi&n &) e+ needsand (a's in '%lic $ealt$ 1it$ res'ect t& ad&'ti&n &) 1e7ased GIS tec$n&l&(+! T$e disc%ssi&n is&r(ani


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Healt$ a(encies and '%lic sa)et+ a%t$&rities s$are c&mm&n res'&nsiilities 1it$ res'ect t& c&mm%nit+interventi&n and illnessin;%r+ 'reventi&n! Healt$ and sa)et+ a%t$&rities s$&%ld 1&r in c&lla&rati&n t&devel&' t$e GIS t&&ls and in)rastr%ct%re t& s%''&rt c&mm&n (&als >e!(! res'&ndin( t& $ealt$ emer(encies?!Terms &) re)erence s$&%ld e devel&'ed + a''r&'riate a%t$&rities )&r dealin( 1it$ $ealt$ emer(enciesincl%din( inte(rati&n &) 1e7ma''in( t&&ls s$arin( &) s'atial data and ali(nment &) strate(ic 'ri&rities in'%lic $ealt$ and sa)et+!

T$e P%lic Healt$ A(enc+ &) Canada identi)ied " e+ re%irements )&r t$e ad&'ti&n &) GIS + '%lic $ealt$'r&)essi&nals

N&7c&st access t& data

Int%itive and eas+7t&7%se t&&ls

S%''&rt and Trainin(

-&re researc$ and a''lied met$&d&l&(ies

Cr&ss7sect&ral a''r&ac$

CGDI '%lic $ealt$ in)rastr%ct%re m%st e %ilt in c&nsiderati&n &) t$ese " re%irements in &rder t& 'r&videe))ective s%''&rt t& '%lic $ealt$ decisi&n7maers! F%rt$erm&re ased &n 'artici'ant7)eedac a''licati&nsnested 1it$in t$e CGDI s$&%ld c&nsider t$e )&ll&1in( %ser re%irements

Have a %ser )riendl+ int%itive inter)ace

Pr&vide access t& metadata catal&(%e services

Pr&vide m%lti'le levels &) access >'ermissi&ns?

O))er t&&ls )%ncti&nalit+ ased &n %ser 'r&)iles 'ermissi&ns

Enale m%ltimedia e4tensi&ns

All&1 %sers t& lin vis%alil&cal 'r&vincial and )ederal? in &rder t& (arner t$e necessar+ s%''&rt )&r investin( int$is t+'e &) in)rastr%ct%re! In &rder t& im'lement 1e7ma''in( in)rastr%ct%re )&r '%lic $ealt$'r&vincialterrit&rial de'artments &) $ealt$ m%st $ave a c$am'i&n t&'7level c&mmitment and a %sinesscase t$at rec&(ni&r intan(iles?!T& )&ster (reater ad&'ti&n&) GIS tec$n&l&(+ in '%lic $ealt$ Ge&C&nnecti&ns m%st 1&r 1it$ '%lic $ealt$ a%t$&rities t& ens%resec%rit+ &) t$eir dataases and &'erati&ns 1ill n&t e c&m'r&mised + t$e im'lementati&n &) 1e ma''in(tec$n&l&(ies and t$e s$arin( &) data!

-A9N9N+ AN% /%8,A9NT$ere are *"66 '%lic $ealt$ 'r&)essi&nals in Ne1 Br%ns1ic t$at re%ire trainin( &n e7$ealt$ t&&ls andtec$n&l&(ies!Acr&ss Canada t$e n%mer &) $ealt$ 'r&)essi&nals re%irin( trainin( in e7$ealt$ 'resents ada%ntin( c$allen(e!In &rder )&r 1e7ma''in( tec$n&l&(ies t& e e))ective '%lic $ealt$ 'r&)essi&nals m%ste trained t& %se t$e tec$n&l&(+ in dail+ 'ractice!Healt$ a%t$&rities s$&%ld 'r&vide &''&rt%nities t& d&ct&rsn%rses and '%lic $ealt$ &))icials )&r in7service learnin( &n GIS-a''in( )&r disease 'reventi&n and $ealt$'r&m&ti&n! Universities can e en(a(ed t& intr&d%ce GIS -a''in( 1it$in t$e N%rsin( Fac%lt+ S&cialSciences and &t$er disci'lines as a''r&'riate tain( it e+&nd t$e traditi&nal realm &) s&)t1are

#0


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en(ineerin(! Private Sect&r can &))er &''&rt%nities and s'&ns&rs$i's )&r 'r&)essi&nal devel&'ment %sin(GIS -a''in( in 'artic%lar )&r a''licati&ns in '%lic $ealt$!

Ge&C&nnecti&ns in c&lla&rati&n 1it$ 'artners s$&%ld &r(anis%c$ as Avian Fl%? as 1ell as c&nd%ctin( e'idemi&l&(ical s'atial anal+sis! T& enale$ealt$ 'r&)essi&nals t& %tilideterminants &)$ealt$? and '&'%lati&n v%lnerailities!E'idemi&l&(ists s$&%ld 'la+ a (reater r&le in decidin( re%irements)&r vis%ali


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incl%de $ealt$ data standards >e!(! Healt$ Level 0 HL0? OGC inter&'erailit+ standards ISO s&)t1arestandards -etadata standards IT standards >)&r net1&r sec%rit+? and m&re!

A n%mer &) arriers remain t& enale GIS7ased researc$ in t$e '%lic $ealt$ c&mm%nit+! T$ese can es%mmariin)l%ene!(!

mi(rat&r+ ird r&%tes T%erc%l&sis Diaetes etc?

-&nit&r c$r&nic diseases >incl%din( &esit+?

-&nit&r 1ater >incl%din( 1ell71ater? and )&&d %alit+

Cr&ss7disci'linar+ researc$ >s%c$ as linin( air %alit+ climate c$an(e and $%man $ealt$?

P&'%lati&n dem&(ra'$ics >)&r assessin( '&'%lati&n v%lnerailities?

@&int $ealt$ and sa)et+ emer(enc+ mana(ement

Hi($1a+ sa)et+ 9eat$er7related incidents

P%lic Healt$ In)rastr%ct%re )acilities

Am%lance ve$icle r&%tin(

All res'irat&r+ diseases

Gl&al 9armin( $ealt$ im'acts m&delin( >'ast c%rrent )%t%re scenari&s?

Fl&&d


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%91,8119N > -/,&&/N%A9N1:

In additi&n t& t$e rec&mmendati&ns a&ve >s%mmari


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SECTION T9O

CHAPTER * User Needs Assessment

CHAPTER , Case Scenari&s

2#


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81/- N//%1 A11/11&/N

81/- @P/1

Users can e classi)ied r&adl+ int& t$ree levels &) access! Users are de)ined + t$eir decisi&n7main(re%irements t$eir re%ired s'eci)icit+ &) data >i!e! 'atient identi)iers $ealt$ &%tc&mes etc? data 'rivac+limitati&ns and %ser stat%s!T$ese %ser t+'es are re)erred t& in s%se%ent c$a'ters!

*irst Le4el D&ct&rs N%rses -edical O))icers H&s'ital -ana(ers Pr&vincial E'idemi&l&(ists

Healt$ Emer(enc+ C&&rdinat&rs Am%lat&r+ Services and m&re!

1econd Le4el Researc$ Gr&%'s Healt$ A%t$&rities in &t$er ;%risdicti&ns

hird Le4el General P%lic

T$e 1&rs$&' $eld &n N&vemer 22nd 266" 'r&vided t$e Ne1 Br%ns1ic L%n( Ass&ciati&n 1it$ a variet+&) 'artici'ant7in'%ts c&llected )r&m rea7a1a+ 1&rin( (r&%'s and individ%al eval%ati&n )&rms! In &rder

t& de)ine s'eci)ic %ser re%irements in a 'r&;ect health authorities are encouraged t& %se a n%mer &)met$&ds 1$ic$ s$&%ld e 'r&m&ted + Ge&C&nnecti&ns 1it$in ne1 calls )&r 'r&'&sals!

T$e )&ll&1in( met$&ds can e %sed t& determine %ser needs

Surveys:t& &tain a statistical sam'le &) %ser needs )r&m acr&ss '%lic $ealt$ de'artments!

Focus Groups:t& &tain s'eci)ic )eedac and rec&mmendati&ns )r&m '%lic $ealt$ 'r&)essi&nals &n'r&'&sed s+stems a''licati&ns met$&d&l&(ies etc!

eb!"am:t& rec&rd %ser interacti&n 1it$ a''licati&ns >in eta7testin( '$ase?

"lient Forums:Ge&matics Ind%str+ s$&%ld en(a(e '%lic $ealt$ 'r&)essi&nals t& determine s'eci)ic%ser needs in terms &) )%ncti&nalit+ a''licati&n inter)ace deliver+ c$annels 9-S9FS standardsand additi&nal 1edata services!

#dentify $merging %athogens:1$ic$ diseases s$&%ld a GIS s+stem e ca'ale &) m&delin( t&im'r&ve decisi&n main( >es'eciall+ 1$ere t$ere is c&ncern &ver $%man e4'&s%re t& envir&nmentaldeterminants ris )act&rs? t$is c&%ld $ave l&cal re(i&nal &r nati&nal )&c%s!

#dentify %riority &usiness 'eeds:1$ic$ needs(a's in $ealt$ care c&%ld e addressed 1it$ GISma''in( >e!(! l&cati&n selecti&n )&r clinics?

()* (se "ase )odeling:Once s'eci)ic a''licati&ns are identi)ied U-L Use Case -&delin( cane %sed t& de)ine t$e tass'r&ced%res &) a $ealt$ 'r&)essi&nal t$eir interacti&ns 1it$ t$e GIS s+stem dataase and t$e desired &%tc&mes >incl%din( an+ de'endencies in t$e 1&r)l&1?!

81/- N//%1

As s%mmari


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s%''&rt &) GISIT 'r&)essi&nals &r t$e services c&%ld e a%t&mated &r &%ts&%rced! Trainin( and ed%cati&nare seen as essential c&m'&nents t& t$e s%ccess)%l intr&d%cti&n &) GIS in an+ '%lic $ealt$ ;%risdicti&n! Datam%st e acc%rate relevant and timel+ an+ 1e7ma''in( s+stem s$&%ld e acc&m'anied + a dataase%sin( a''r&'riate $ealt$ data standards 1it$ s'atial and tem'&ral stam's &n $ealt$ data )%rt$er descried int$e )&ll&1in( Secti&ns!

All '%lic $ealt$ re%irements c&%ld e streamlined in a 1&r)l&1 mana(ement 'lan 1$ere t$e deliver+ &)s'eci)ic end7%ser 'r&d%cts ma's data 1&%ld meet re%irements in terms &) level &) detail timeliness)&rmat and a''licailit+!T& desi(n 1&r)l&1s )&r t$e %se &) GIS in '%lic $ealt$ a U-L s+stem ma+ e%sed >Uni)ied -&delin( Lan(%a(e?!U-L Use Case Be$avi&r Dia(rams and Interacti&n Dia(rams 1&%lde m&st %se)%l! T$ese dia(rams can $el' '%lic $ealt$ a%t$&rities t& m&del t$e 1&r)l&1 &) individ%al$ealt$ 'r&)essi&nals and de'artments t$eir in)&rmati&n needs access '&ints)re%enc+ interacti&n 1it$ dataand eac$ &t$er and decisi&n7main( re%irements and de'endencies! U-L can als& e %sed t& desi(na''licati&n )eat%res )%ncti&nalit+ in res'ect t& %ser re%irements

T$e (eneral '%lic interested in '%lic $ealt$ in)&rmati&n 1&%ld re%ire access t& a((re(ate datadistri%ted &n &'en 1e )&rmats $tml and s$&%ld e (iven t&'ical in)&rmati&n and disclaimers a&%t t$e%se &) datama's! In t$e Secti&n entitled CGDI7nested OGC7c&m'liant P%lic Healt$ Arc$itect%re 1e$ave 'r&vided a detailed descri'ti&n &) t$e t+'e &) in)rastr%ct%re re%ired t& meet t$e needs &) %sers in all

t$ree levels!

81/ ,A1/ 1,/NA-91

Since relativel+ little GIS7ased researc$ in '%lic $ealt$ $as een d&ne in Canada little is n&1n a&%ts'eci)ic %se cases &r c&nventi&nal met$&d&l&(ies! H&1ever %se7cases can e devel&'ed n&1in( t$ec$r&nic and c&mm%nicale diseases are a 'ri&rit+ )&r Canadian $ealt$ 'r&)essi&nals and 1$atmet$&d&l&(ies $ave een em'l&+ed in s'eci)ic cases )r&m ar&%nd t$e 1&rld! T$ere)&re a n%mer &) %secases $ave een )&rm%lated t& eval%ate t$e a''licati&n '&tential &) GIS t& '%lic $ealt$ its e))ectiveness )&ren$ancin( $ealt$care decisi&n7main( via (e&s'atial anal+sis and t$e res%ltin( medical s&cial ec&n&micand envir&nmental ene)its! S%mmariP-2!"? t&tal s%s'ended 'artic%lates &


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-rin.ing ater /uality Eval%ate t$e im'act a(ric%lt%ral c&mmercial and residential devel&'ment activities&n t$e %alit+ &) 1ater disc$ar(ed int& streams laes and 1etlands and %ltimatel+ rec+cled )&r '&tale %set$r&%($ a%i)er 1ells! Res%lts ma+ (%ide researc$ers and '&lic+maers in t$e devel&'ment &) tar(etedsensin( and m&nit&rin( tec$n&l&(ies tail&r c&ntr&l meas%res )&r ris miti(ati&n &) '&tale 1ater )r&mmicr&ial and c$emical envir&nmental c&ntaminati&n! Devel&'ment &) accessile dataases t& identi)+)act&rs t$at increase t$e 'r&ailit+ &) (r&%nd1ater '&ll%ti&n 1&%ld lead t& m&re e))ective 'r&(rams )&rl&catin( residential 1ells s%sce'tile t& c&ntaminati&n! Active m&nit&rin( &) residential 1ells is essential t&

red%ce '&tential $%man e4'&s%re t& c&ntaminated drinin( 1ater!

+oad Transport %lanning Eval%ate envir&nmental c&nse%ences &) r&ad tra))ic in %ran areas d%rin( t$etrans'&rt 'lannin( sta(e &) r&ad net1&r c&nstr%cti&n! Uran 'lanners 1&%ld e ale t& inte(rate GIS7m&dels 1it$in traditi&nal travel demand m&dels )&r r&ad net1&r 'lannin(! Inte(rati&n 1&%ld all&1 land%se trans'&rt and envir&nmental 'lanners t& m&del t$e envir&nmental e))ects &) vari&%s r&ad net1&rscenari&s aid in t$e selecti&n &) envir&nmentall+ 're)erred r&ad net1&rs $i($li($t '&ll%ti&n levelmana(ement re%irements )&r )%t%re r&ad net1&rs enc&m'ass air '&ll%ti&n and )%el c&ns%m'ti&n m&d%les1it$in t$e s+stem and ill%strate t$e s+stem:s %tilit+ t$r&%($ case st%dies at trans7&%ndar+ metr&'&litan andl&cal7area scales!F%rt$erm&re researc$ (r&%'s and )leet mana(ers interested in &t$ red%cin( air '&ll%ti&nand im'r&vin( )%el e))icienc+ &) )leets can c&mine GIS 1it$ GPS A%t&matic .e$icle L&cat&r

tec$n&l&(+ as 'r&vided + c&m'anies lie Netisti4 >111!netisti4!c&m?!

0ospital ccessibility %atterns Identi)+ '&'%lati&n se(ments v%lnerale t& di))erential (e&(ra'$ic access t&critical medical treatment )&r a variet+ &) medical c&nditi&ns incl%din( str&e m+&cardial in)arcti&n andres'irat&r+ distress! A GIS m&del c&%ld identi)+ t$e 'r&ailit+ &) c&m'licati&ns )r&m medical c&nditi&nt$e r&le &) trans'&rtati&n m&de and relative distance t& $&s'ital access identi)+ t$e '&'%lati&n se(ments1it$ limited (e&(ra'$ic access t& a $&s'ital ca'ale &) 'er)&rmin( medical 'r&ced%res identi)+ dela+s in&tainin( medical treatment 1aitin( times trans'&rt times medical sta))in( identi)+ '&'%lati&n se(mentse4cl%ded )r&m 'ri&rit+ access + a(e inc&me distance medical c&nditi&n trans'&rt m&de etc! O%tc&mesc&%ld e disc%ssed 1it$in t$e c&nte4t &) c&mm%nit+ $ealt$ care clinics vers%s traditi&nal centrali


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&ovine Spongiform $ncephalopathy C&nd%ct a tem'&ral7s'atial anal+sis &) '&tential &vine s'&n(i)&rmence'$al&'at$+ am&n( cattle $erds 'ri&r t& t$e intr&d%cti&n &) active s%rveillance meas%res! Tem'&ralm&del c&%ld identi)+ '&'%lati&n ris cl%sters 'ri&r t& t$e intr&d%cti&n &) e))ective c&%nter7meas%res as ac&nc%rrent time7la( vect&r e4ists )&r all ris7)act&r vis%ali


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%91,8119N > -/,&&/N%A9N1:

T$e case scenari&s descried a&ve are disc%ssed in m&re detail in t$e ne4t c$a'ter! T$e+ d& n&t re'resentan e4$a%stive list &) case scenari&s %t d& 'r&vide a r&ad ran(e &) '&tential GIS a''licati&ns t$at 1&%ld(reatl+ ene)it t$e Canadian '%lic $ealt$ care s+stem! D%e t& t$e lac &) c&nsistent GIS7ased researc$ inCanada e'idemi&l&(ists 1ill $ave a di))ic%lt time l&catin( in)&rmati&n &n disease7s'eci)ic a''licati&ns &)GIS and ma+ e deterred + t$is )act! T$ere)&re it is im'&rtant )&r Ge&C&nnecti&ns t& )&ster ne1 researc$

and a''licati&ns t$at can $el' t& 'r&d%ce case7st%dies 1$ic$ can e trans)erred t& $ealt$ re(i&ns acr&ssCanada!

In additi&n t& t$e '&int a&ve Ge&C&nnecti&ns s$&%ld enc&%ra(e t$e devel&'ment &) case7st%dies in &rdert& 'r&vide Canadian $ealt$ a%t$&rities 1it$ dem&nstrale ene)its &) GIS a''licati&ns and in)rastr%ct%re )&r'%lic $ealt$!

It is critical t$at '%lic $ealt$ a''licati&ns 1it$in t$e CGDI c&nsider t$e di))erent re%irements &) %sers!P%lic $ealt$ a%t$&rities re%ire access t& s'eci)ic data m&delin( met$&d&l&(ies s'atial anal+sis t&&ls etc!T$e (eneral '%lic re%ires access t& a((re(ate level data 1it$&%t access t& ac(r&%nd m&delin(met$&d&l&(ies &r s'atial anal+sis t&&ls! T$e Ne1 Br%ns1ic L%n( Ass&ciati&n rec&mmends t$at

a''licati&ns $ave t$ree access m&d%les &ne )&r '%lic access &ne )&r '%lic $ealt$ a%t$&rities and &ne )&rGIS 'ers&nnel >i!e! administrat&rs?!

In &rder t& tae )%ll advanta(e &) GIS tec$n&l&(ies t$e CGDI m%st 1&r 1it$ $ealt$ a%t$&rities t& render'%lic $ealt$ data availale >1$ile ens%rin( 'rivac+ sa)e(%ards? &n a near real7time asis! In additi&n datam%st c&n)&rm t& ri(&r&%s standards incl%din( $ealt$ c&des >e!(! HL0? times'atial stam's etc! -&rerec&mmendati&ns &n data standards are c&ntained in Secti&n ,! H&1ever it is clear t$at '%lic $ealt$a%t$&rities researc$ (r&%'s and t$e '%lic re%ire access t& near real7time data &n '&'%lati&n $ealt$disease distri%ti&n $ealt$ care and m&re!

In &rder t& desi(n e))ective ma''in( a''licati&ns 1it$in t$e CGDI '%lic $ealt$ a%t$&rities are enc&%ra(ed

t& %se U-L t& identi)+ %se cases 1&r)l&1 de'endencies and decisi&n7main( re%irements >data GISt&&ls s'atial anal+sis?! S%c$ U-L dia(rams can e %se)%l t& a''licati&n devel&'ers t$e CGDI data andservice 'r&viders and end7%sers!

As %ser needs are identi)ied t$e CGDI s$&%ld c&m'ile a list &) %se7cases met$&d&l&(ies and U-Ldia(rams t$at can assist ne1 a''licati&n devel&'ers in t$eir desi(n main( t$e devel&'ment 'r&cess )&rne1 a''licati&ns services and data m&re e))icient and less c&stl+ t& t$e devel&'er!

2/


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,A1/ 1,/NA-91

T$ese case scenari&s ill%strate t$e advanta(es &) GIS tec$n&l&(+ )&r res'&ndin( t& t$e (r&1in( demand )&r(e&s'atial in)&rmati&n deemed essential t& t$e $ealt$care decisi&n7main( 'r&cess acr&ss a m%ltit%de &)s%7sect&rs!

,7-N9, -/1P9-A-@ 1@&P&1

7ypothesis Determine t$e ass&ciati&n et1een c$r&nic res'irat&r+ s+m't&ms and l&n(7termamient c&ncentrati&ns &) )ine 'artic%lates >P-2!"? t&tal s%s'ended 'artic%lates &2!"?P->#6? t&tal s%s'ended 'artic%lates >TSP? &SO2? etc! in e4cess &) s%((estedlevels!

1elected -e2erences

Ae+ D!E! B!E! Ostr& F! Petersen and R!@! B%rc$ette #55" C$r&nic res'irat&r+ s+m't&ms ass&ciated 1it$ estimatedl&n(7term amient c&ncentrati&ns &) )ine 'artic%lates less t$an 2!" micr&ns in aer&d+namic diameter >P-2!"? and&t$er air '&ll%tants!@ournal o& )=posure !nalysis and )nironmental )pidemiolo(y">2?#*07#"5!

Ae+ D!E! F! Petersen P!K! -ills and 9!L! Bees&n #55* L&n(7term amient c&ncentrati&ns &) t&tal s%s'ended'artic%lates ?**7,/!

Ae+ D!E! P!K! -ills F!F! Petersen and 9!L! Bees&n #55# L&n(7term amient c&ncentrati&ns &) t&tal s%s'ended'artic%lates and &4idants as related t& incidence &) c$r&nic disease in Cali)&rnia Sevent$7Da+ Adventists!)nironmental 5ealth Perspecties5,>A%(?,*7"6!

Gars$ic Eric F! Laden @!E! Hart and A! Car&n 266* Residence near a ma;&r r&ad and res'irat&r+ s+m't&ms in U!S!.eterans!)pidemiolo(y#,>/?02370*/!

20


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Gilm&%r -!I! #55" Interacti&n &) air '&ll%tants and '%lm&nar+ aller(ic res'&nses in e4'erimental animals! To=icolo(y#6">27*?**"7*,2!

Hr%a F! E! Faian&va K! K&''&va and @!@! .andener( 266# C$ild$&&d res'irat&r+ s+m't&ms $&s'ital admissi&nsand l&n(7term e4'&s%re t& air&rne 'artic%late matter! @ournal o& )=posure !nalysis and )nironmental

)pidemiolo(y##>#?**7,6!Nic&lai T! #555 Air '&ll%ti&n and res'irat&r+ disease in c$ildren 1$at is t$e clinicall+ relevant im'act Pediatric

Pulmonolo(y upplement#357#*!Nic&lai T! #555 Envir&nmental air '&ll%ti&n and l%n( disease in c$ildren! 0onaldi !rchies &or hest #isease

",>/?,0"7,03!

Ostr& B!D! #55* E4aminin( ac%te $ealt$ &%tc&mes d%e t& &S%''l ,?2#*72#/!

Sc$1art,?32/73*#!

Sc$1ela D! 2666 Air '&ll%ti&n and $ealt$ in %ran areas!Reie:s on )nironmental 5ealth#">#72?#*7,2!van Bree L! -! -arra H!@! van Sc$eindelen P!H! Fisc$er S! de L&&s E! B%rin($ and P!@! R&m&%t #55" D&se7e))ect

m&dels )&r ?#26,7#2#"!

A9- PLL89N &-B9%9@&-AL9@ -/N%1

7ypothesis Assessed t$e relati&ns$i' et1een air '&ll%ti&n mete&r&l&(ical variales and dail+m&rtalit+ trends!

%ata 1ource H&s'ital and emer(enc+ r&&m admissi&ns )&r res'irat&r+ c&nditi&ns!

+91 &odel Identi)+ 'atient e4'&s%re levels )r&m amient air&rne emissi&n! C&nstr%ct anatm&s'$eric dis'ersi&n m&del! Lin 'atient:s residential address via a GIS dataase! Fit a c&nditi&nall&(istic re(ressi&n m&del incl%de a(e inc&me (r&%' e4'&s%re levels as cate(&rical variales!

1tatistical &ethods Estimate relati&ns$i' %sin( l&(istic re(ressi&n m&dels! Identi)+ resid%als! I)c&variates n&t time de'endent a''l+ a (eneralitem'erat%re and relative$%midit+? and relative distance )r&m emissi&n s&%rces and $&s'ital access!

1elected -e2erencesAnders&n H!R! C! S'i4 S! -edina @!P! Sc$&%ten @! Castellsa(%e G! R&ssi D! Vmir&% G! T&%l&%mi B! 9&;t+nia A!

P&na L! Bac$ar&va @! Sc$1art< and K! Kats&%+anni #550 Air '&ll%ti&n and dail+ admissi&ns )&r c$r&nic&str%ctive '%lm&nar+ disease in / E%r&'ean cities res%lts )r&m t$e APHEA 'r&;ect! The )uropean Respiratory

@ournal* 9&&icial @ournal o& the )uropean ociety &or linical Respiratory Physiolo(y#6>"?#6/,7#60#Atins&n R!9! H!R! Anders&n @! S%n+er @! A+res -! Baccini @!-! .&n A! B&%m($ar F! F&rastiere B! F&rser(

G! T&%l&%mi @! Sc$1art< and K! Kats&%+anni 266# Ac%te e))ects &) 'artic%late air '&ll%ti&n &n res'irat&r+admissi&ns res%lts )r&m APHEA 2 'r&;ect!!merican @ournal o& Respiratory and ritical are 0edicine#/,>#6 Pt

#?#3/67#3//!Ballester F! @!-! Tenias and S! Pere*?57#"!Eras B! A!-! Kell+ B! P$+sic C! C&de and -! Ed1ards 266" Air '&ll%ti&n and c$ild$&&d ast$ma emer(enc+

$&s'ital admissi&ns estimatin( intra7cit+ re(i&nal variati&ns! International @ournal o& )nironmental 5ealthResearch#">#?##726!

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F%sc& D! F! F&rastiere P! -ic$el&"?,207,*,!

-ann @!K! I!B! Ta(er F! L%rmann -! Se(al C!P! =%esenerr+ @r! -!-! L%(( @! S$an and S!K! .an den Eeden 2662Air '&ll%ti&n and $&s'ital admissi&ns )&r isc$emic $eart disease in 'ers&ns 1it$ c&n(estive $eart )ail%re &rarr$+t$mia!)nironmental 5ealth Perspecties##6>#2?#2,07#2"2!

-ic$el&S%''l ,?0"756!

R&sales7Castill& @!A! .!-! T&rres7-e#?/0700!

%-9NE9N+ WA/- F8AL9@

7ypothesis T& eval%ate t$e im'act a(ric%lt%ral c&mmercial and residential devel&'ment activities$ave &n t$e %alit+ &) 1ater disc$ar(in( int& streams laes and 1etlands and %ltimatel+ rec+cled)&r '&tale %se t$r&%($ a%i)er 1ells!

-e=uireents: n interactive framewor. for quantitative analysis between human and natural

systems1

%ata 1ources: G#S!based remote sensing imagery analysis, groundwater!surface water hydrologic

flu2es and water quality data to assess the vulnerability of potable water supplies1

&ethod: Spatially referenced data derived from dynamic models can be used to ran. watershed!specific stressors and receptors3 volatile organic compounds and nitrate!nitrogen analyzed using

gas chromatography4mass spectrometry and the cadmium reduction method, respectively1

;ariables: Soil permeability, depth to water, aquifer hydraulic conductivity, and topography1

ssign numerical weightings according to variable5s importance in regional groundwater quality16ariable weights comprise a G#S map layer1 These map layers may be combined to formulate a

groundwater pollution potential map1

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+91 &odel: G#S techniques to quantify e2planatory variables that affect well susceptibility to

nitrate: population density, land cover, local relief 7percent slope8, and soil te2ture1

1tatistical &ethods: *ogistic regression may identify forest 4 grassland 4 cultivated land cover

variables that significantly impact probability of '9!' contamination1 )atlab may be employed asa scientific programming tool for numerical analysis, coupled with a -ynamic -ata $2change

solution in order to develop a water quality model from within the G#S application1

%iscussion: +esults may guide researchers and policyma.ers in the development of targeted sensingand monitoring technologies3 tailor control measures for ris. mitigation of potable water frommicrobial and chemical environmental contamination1 -evelopment of accessible databases to

identify factors that increase the probability of groundwater pollution would lead to more effective

programs for locating residential wells susceptible to contamination1 ctive monitoring of

residential wells is essential to reduce potential human e2posure to contaminated drin.ing water1

echnologies enabled:i! distributed sensing approaches for microbial and chemical contamination 7eg! 'at$&(ens end&crine

disr%'t&rs?ii! distri%ted a''licati&n7s'eci)ic and in)rastr%ct%re7ada'tive 1ater treatment s+stemsiii! (e&statistical inte(rati&n &) m&nit&rin( data and GIS la+ers

iv! s+stems anal+sis &) micr&ial and c$emical 'r&li)erati&n in distri%ti&n s+stems!

utcoes:

i! technology implementation needed to ma2imize economic and public health benefits3ii! information technology!based monitoring infrastructure development3iii! integration of processes and spatial analysis3iv! educational and training platforms for students, practitioners and regulators3v! technology diffusion potential to rural ; remote regions in "anada with limited financial

resources 7including First 'ations8

,onclusion: #ntegration of spatial data, G#S, water modeling ma.es it possible to organize and

analyze data spatially, and view results on interactive maps as well as tables and distribution charts1

The integration allows scientists and managers in different locations to coordinate and share theirestimations for environmental e2posure and ris. assessments1 )odel can subsequently be applied to

other pollutant source sectors1

1elected -e2erences:Adriaens P! P! G&&vaerts S! Serl&s E! Ed1ards and T! E(li 266* Intelli(ent in)rastr%ct%re )&r s%stainale '&tale

1ater a r&%ndtale )&r emer(in( transnati&nal researc$ and tec$n&l&(+ devel&'ment needs! Bi&tec$n&l&(+ Advances22>#72?##57#*,!

Aeli&n C!-! and B!C! C&nte 266, S%sce'tiilit+ &) residential 1ells t& .OC and nitrate c&ntaminati&n! Envir&nmentalScience W Tec$n&l&(+ *3>/?#/,37#/"*!

B$ad%ri B! @! Har&r B! En(el and -! Gr&ve 2666 Assessin( 1aters$ed7scale l&n(7term $+dr&l&(ic im'acts &) land7%se c$an(e %sin( a GIS7NPS m&del! Envir&nmental -ana(ement 2/>/?/,*7/"3!

C$& @!H! K! Se& S%n( and S! R+&n( Ha 266, A river 1ater %alit+ mana(ement m&del )&r &'timisin( re(i&nal

1aste1ater treatment %sin( a (enetic al(&rit$m! @&%rnal &) Envir&nmental -ana(ement 0*>*?22572,2!Fritc$ T!G! C!L! -cKni($t @!C! elderman @r! and @!G! Arn&ld 2666 An a%i)er v%lnerailit+ assessment &) t$e Pal%4+

a%i)er central Te4as USA %sin( GIS and a m&di)ied DRASTIC a''r&ac$! Envir&nmental -ana(ement 2">*?**07*,"!

Harman 9!A! C!@! Allan and R!D! F&rs+t$e 266# Assessment &) '&tential (r&%nd1ater c&ntaminati&n s&%rces in a1ell$ead 'r&tecti&n area! @&%rnal &) Envir&nmental -ana(ement /2>*?20#7232!

Li !R! G!H! H%an( !F! Li @! Str%(er and @!D! Fisc$er 266* A 'esticide r%n&)) m&del )&r sim%latin( r%n&)) l&sses &)'esticides )r&m a(ric%lt%ral lands! 9ater Science and Tec$n&l&(+ @&%rnal &) t$e Internati&nal Ass&ciati&n &n 9aterP&ll%ti&n Researc$ ,0>#?**7,6!

-an&s B! T! B&%rnaris N! Sille&s .! Ant&n&'&%l&s and @! Pa'at$anasi&% 266, A decisi&n s%''&rt s+stem a''r&ac$ )&rrivers m&nit&rin( and s%stainale mana(ement! Envir&nmental -&nit&rin( and Assessment 5/>#7*?3"753!

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-arsili7Lielli S! E! Ca'&rali S! Arri($i and C! Becattelli 266# A (e&re)erenced river %alit+ m&del! 9ater Scienceand Tec$n&l&(+ @&%rnal &) t$e Internati&nal Ass&ciati&n &n 9ater P&ll%ti&n Researc$ ,*>0?22*72*6!

-iller C! P! C$%de and S! Bac&c 266* A c&m'aris&n &) 1ell$ead 'r&tecti&n area delineati&n met$&ds )&r '%licdrinin( 1ater s+stems in 9$atc&m C&%nt+ 9as$in(t&n! @&%rnal &) Envir&nmental Healt$ //>2?#072/ ,,!

Pa+ra%dea% S! -!G! T&%rn&%d F! Cerness&n and B! Pic&t 266# Ann%al n%trients e4'&rt m&dellin( + anal+sis &)land%se and t&'&(ra'$ic in)&rmati&n case &) a small -editerranean catc$ment! 9ater Science and Tec$n&l&(+@&%rnal &) t$e Internati&nal Ass&ciati&n &n 9ater P&ll%ti&n Researc$ ,,>27*?*2#7*20!

Sanc$e#7*?2"*72/3!

9an( Jin$a& -! H&mer S!D! D+er C! 9$ite7H%ll and C! D% 266" A river 1ater %alit+ m&del inte(rated 1it$ a 1e7ased (e&(ra'$ic in)&rmati&n s+stem! @&%rnal &) Envir&nmental -ana(ement 0">*?2#57223!

-A% -AN1P- PLANN9N+

7ypothesis GIS7ased m&delin( t& eval%ate envir&nmental c&nse%ences &) r&ad tra))ic in %ranareas d%rin( t$e trans'&rt 'lannin( sta(e &) r&ad net1&r c&nstr%cti&n %ran desi(n and 'lannin(!

Bene2its Ale t& inte(rate m&del 1it$in traditi&nal travel demand m&dels )&r r&ad net1&r'lannin(! Inte(rati&n all&1s land %se trans'&rt and envir&nmental 'lanners t& m&del t$eenvir&nmental e))ects &) vari&%s r&ad net1&r scenari&s aid in t$e selecti&n &) envir&nmentall+'re)erred r&ad net1&rs $i($li($t '&ll%ti&n level mana(ement re%irements )&r )%t%re r&adnet1&rs enc&m'ass air '&ll%ti&n and )%el c&ns%m'ti&n m&d%les 1it$in t$e s+stem and ill%stratet$e s+stem:s %tilit+ t$r&%($ case st%dies at trans7&%ndar+ metr&'&litan and l&cal7area scales!

1elected -e2erencesA))%m @!K! A!L! Br&1n and !C! C$an 266* Inte(ratin( air '&ll%ti&n m&dellin( 1it$ scenari& testin( in r&ad trans'&rt

'lannin( t$e TRAE-S a''r&ac$! The cience o& the Total )nironment*#2>#7*?#7#,!Andre -ic$el and A! .illan&va 266, C$aracterisati&n &) an %ran %s net1&r )&r envir&nmental '%r'&ses! The

cience o& the Total )nironment**,**">Dec #?3"755!Bra%er -! G! H&e P! van .liet K! -elie)ste P! Fisc$er U! Ge$rin( @! Heinric$ @! C+r+s T! Bellander -! Le1ne

and B! Br%neree) 266* Estimatin( l&n(7term avera(e 'artic%late air '&ll%ti&n c&ncentrati&ns a''licati&n &) tra))icindicat&rs and (e&(ra'$ic in)&rmati&n s+stems!)pidemiolo(y#,>2?22372*5!

Bri((s D!@! C! de H&&($ @! G%lliver @! 9ills P! Elli&tt S! Kin($am and K! Small&ne 2666 A re(ressi&n7asedmet$&d )&r ma''in( tra))ic7related air '&ll%ti&n a''licati&n and testin( in )&%r c&ntrastin( %ran envir&nments! The

cience o& the Total )nironment2"*>#7*?#"#7#/0!Bri((s D!@! C! de H&&($ @! G%lliver @! 9ills P! Elli&tt S! Kin($am and K! Small&ne 2666 A re(ressi&n7ased

met$&d )&r ma''in( tra))ic7related air '&ll%ti&n a''licati&n and testin( in )&%r c&ntrastin( %ran envir&nments! Thecience o& the Total )nironment2"*>#7*?#"#7#/0!

En(lis$ P! R! Ne%tra R! Scal) -! S%llivan L! 9aller and L! V$% #555 E4aminin( ass&ciati&ns et1een c$ild$&&d

ast$ma and tra))ic )l&1 %sin( a (e&(ra'$ic in)&rmati&n s+stem!)nironmental 5ealth Perspecties#60>5?0/#70/0!Giann&%li -! V! Samaras -! Keller P! De$aan -! Kalliv&da S! S&rens&n and A! Ge&r(aai 266" Devel&'ment &) a

dataase s+stem )&r t$e calc%lati&n &) indicat&rs &) envir&nmental 'ress%re ca%sed + trans'&rt! The cience o& theTotal )nironment>@%n 2# E'% a$ead &) 'rint?!

Girvet2?2#372**!

G&rdian -!E! S! Hane%se and @! 9ae)ield 266" An investi(ati&n &) t$e ass&ciati&n et1een tra))ic e4'&s%re and t$edia(n&sis &) ast$ma in c$ildren! @ournal o& )=posure !nalysis and )nironmental )pidemiolo(y>@%n 25 E'%a$ead &) 'rint?

Green R!S! S! Sm&r&dins+ @!@! Kim R! -cLa%($lin and B! Ostr& 266, Pr&4imit+ &) Cali)&rnia '%lic sc$&&ls t& %s+r&ads!)nironmental 5ealth Perspecties##2>#?/#7//!

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G%nier R!B! A! Hert*?2,672,/!

L&vett A!A! @!P! Par)itt and @!S! Brainard #550 Usin( GIS in ris anal+sis a case st%d+ &) $a#?27#"!Avr%sin G!A! G!-! @ac%e*?*627*#2!

G%a(liard& -ar F! 266, S'atial accessiilit+ &) 'rimar+ care c&nce'ts met$&ds and c$allen(es! International@ournal o& 5ealth Geo(raphics*>#?*!

L&ve D! and P! Lind%ist #55" T$e (e&(ra'$ical accessiilit+ &) $&s'itals t& t$e a(ed a (e&(ra'$ic in)&rmati&ns+stems anal+sis 1it$in Illin&is!5ealth erices Research25>/?/257/"#!

Na%ener( E! and K! Bas% #555 E))ect &) ins%rance c&vera(e &n t$e relati&ns$i' et1een ast$ma $&s'itali2?#*"7#,3!

O:Neill L! 266* Estimatin( &%t7&)7$&s'ital m&rtalit+ d%e t& m+&cardial in)arcti&n! 5ealth are 0ana(ement cience/>*?#,07#",!

R&ser&7Bi4+ L! 266, S'atial access t& $ealt$ care in C&sta Rica and its e%it+ a GIS7ased st%d+!ocial cience B0edicine"3>0?#20#7#23,!

Sc&tt P$illi' A! C!@! Tem&vs+ K! La1rence E! G%daitis and -!@! L&1ell #553 Anal+sis &) Canadian '&'%lati&n 1it$'&tential (e&(ra'$ic access t& intraven&%s t$r&m&l+sis )&r ac%te isc$emic str&e!tro2e25>##?2*6,72*#6!

Tanser F! and D! 9ilins&n #555 S'atial im'licati&ns &) t$e t%erc%l&sis DOTS strate(+ in r%ral S&%t$ A)rica a n&vela''licati&n &) (e&(ra'$ical in)&rmati&n s+stem and (l&al '&siti&nin( s+stem tec$n&l&(ies! Tropical 0edicine B

International 5ealth,>#6?/*,7/*3!

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V1arenstein -! D! Kri(e and B! 9&l)) #55# T$e %se &) a (e&(ra'$ical in)&rmati&n s+stem )&r $&s'ital catc$ment arearesearc$ in NatalK1aV%l%!outh !&rican 0edical @ournal36>#6?,507"66!

%91/A1/ ,L81/-1

7ypothesis Identi)+ t$e (e&(ra'$ical distri%ti&n and variati&n in disease c&rrelate s'atial andtem'&ral trends in disease vect&rs ma' '&'%lati&ns at ris assess res&%rce all&cati&ns m&nit&rinterventi&n strate(ies!

&ethods Devel&' test statistics t& detect tem'&ral7s'atial cl%sterin( 'atterns )&r in)ecti&%s and n&n7in)ecti&%s disease! Derive c&nditi&nal 'r&ailities )&r P&iss&n distri%ted rand&m variales! A''l+Ba+esian statistics t& sm&&t$ disease ris estimates! C&mine s'atial and tem'&ral vect&rs t&c&nstr%ct a t$ree7dimensi&nal (rid! C&ntr&l c&m'&nents + 1ei($tin( meas%res t& identi)+ diseasetem'&ral7s'atial cl%ster tendencies! Sim%late di))erent distri%ti&n 'atterns )&r t$e '&'%lati&n! A''l+test t& s'eci)ic disease vect&rs l&cali*?#"07#/,!C$a'%t E!K! @!I! -ee and R! Heimer 2662 S'atial anal+sis &) $%man (ran%l&c+tic e$rlic$i&sis near L+me C&nnectic%t!)mer(in( In&ectious #iseases3>5?5,*75,3!

Elli&tt P! and D! 9artener( 266, S'atial e'idemi&l&(+ c%rrent a''r&ac$es and )%t%re c$allen(es! )nironmental5ealth Perspecties##2>5?5537#66/!

Gesler 9! #53/ T$e %ses &) s'atial anal+sis in medical (e&(ra'$+ a revie1! ocial cience B 0edicine2*>#6?5/*750*!

Hall H!I! C!.! Lee and 9!E! Ka+e #55/ Cl%ster a s&)t1are s+stem )&r e'idemi&l&(ic cl%ster anal+sis! tatistics in0edicine#">075?5,*75"6!

Hassan A!N! S! Dister and L! Bec #553 S'atial anal+sis &) l+m'$atic )ilariasis distri%ti&n in t$e Nile Delta in relati&nt& s&me envir&nmental variales %sin( (e&(ra'$ic in)&rmati&n s+stem tec$n&l&(+!@ournal o& the )(yptian ocietyo& Parasitolo(y23>#?##57#*#!

H;almars U! -! K%lld&r)) G! G%sta)ss&n and N! Na(ar1alla #55/ C$ild$&&d le%aemia in S1eden %sin( GIS and as'atial scan statistic )&r cl%ster detecti&n!tatistics in 0edicine#">075?06070#"!

@&n Vdene 266# -et$&ds &) m&rtalit+ >incidence? rates inter'retati&n assessment in small '&'%lati&ns! entral)uropean @ournal o& Public 5ealth5>#?#,72#!

N&rstr&m -! 266# Ge&(ra'$ical In)&rmati&n S+stem >GIS? as a t&&l in s%rveillance and m&nit&rin( &) animal diseases!!cta ;eterinaria candinaica* upplementum5,0573"!

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t%erc%l&sis is&lates in a $i($ incidence re(i&n! International @ournal o& Tuberculosis and Lun( #isease/>##?#66#7#6##!

9arin( Ste'$en C! A! Va&s7Felierti R! 9&&d -! St&ne P! Pad(ett and R! Ara)at 266" T$e %tilit+ &) (e&(ra'$icin)&rmati&n s+stems >GIS? in ra'id e'idemi&l&(ical assessments )&ll&1in( 1eat$er7related disasters met$&d&l&(icaliss%es ased &n t$e Tr&'ical St&rm Allis&n e4'erience! International @ournal o& 5y(iene and )nironmental

5ealth263>#72?#657##/!ianna&%lias N! B!H! R&1e L!9! Svens&n D!P! Sc$&')l&c$er K! Kell+ and D!C! .&alander 266* V&nes &)

'reventi&n t$e (e&(ra'$+ &) )all in;%ries in t$e elderl+!ocial cience B 0edicine"0>##?26/"7260*!

7/AL7,A-/ PLANN9N+

7ypothesis Assess t$e a''licailit+ &) GIS tec$n&l&(+ in $ealt$care 'lannin(! E4amine t$e'&tential &) GIS a''licati&ns t& mana(e $ealt$care 'lannin(!

&ethods =%esti&nnaire and intervie1 a''r&ac$ $&s'ital admissi&n and sta))in( data!

+91 &odel Anal+#?0575/!Hi((s G! and -! G&%ld 266# Is t$ere a r&le )&r GIS in t$e :ne1 NHS:5ealth Place0>*?2,072"5!@%areHGIS? a t&&l )&r $ealt$ 'lannin( and

e'idemi&l&(+ in Here1!5are&uah#,#>#2?#6067#60" #635!Kla%ss G%nnar L! Sta% -! 9idmer and A! B%sat& 266" H&s'ital service areas a ne1 t&&l )&r $ealt$ care 'lannin( in

S1it*?2*572"#!

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Peters @erem+ and G!B! Hall #555 Assessment &) am%lance res'&nse 'er)&rmance %sin( a (e&(ra'$ic in)&rmati&ns+stem!ocial cience B 0edicine,5>##?#""#7#"//!

Sie(el C! A! Davids&n K! Ka)adar @!-! N&rris @! T&dd and @! Steiner #550 Ge&(ra'$ic anal+sis &) 'ert%ssis in)ecti&nin an %ran area a t&&l )&r $ealt$ services 'lannin(!!merican @ournal o& Public 5ealth30>#2?26227262/!

B;9N/ 1PN+9*-& /N,/P7ALPA7@

7ypothesis C&nd%ct a tem'&ral7s'atial anal+sis &) '&tential &vine s'&n(i)&rm ence'$al&'at$+am&n( cattle $erds 'ri&r t& t$e intr&d%cti&n &) active s%rveillance meas%res!

&ethods Generate ma' inde4 )&r $erds $erd densit+ and standardila+ered +dia(n&sis? + e%al (e&(ra'$ic (rids t& vis%aliBSE? t$e end &) t$e e(innin( &r t$e e(innin(&) t$e end Folia -europatholo(ica,2>S%''l A?""7/3!

Cassa C!A! S!@! Grannis @!-! Over$a(e and K!D! -andl 266" A N&vel C&nte4t7Sensitive A''r&ac$ t& An&n+miDec #" E'% a$ead &) 'rint?!D&nnan P!T! @!D! Parratt S!.! 9ils&n R!B! F&res @!I! O:Ri&rdan and R!@! S1in(ler 266" -%lti'le scler&sis in

Ta+side Sc&tland detecti&n &) cl%sters %sin( a s'atial scan statistic!0ultiple clerosis##>,?,6*7,63!D%cr&t C! D! Arial D! Calavas and T! Car'enter 266" A s'ati&7tem'&ral anal+sis &) BSE cases &rn e)&re and a)ter

t$e rein)&rced )eed an in France! ;eterinary Research*/>"7/?3*573"*!Evans B! and F! -%nr&e 266, T$e r&le &) t$e veterinar+ c&mm%nit+ in t$e &vine s'&n(i)&rm ence'$al&'at$+ rec&ver+

'$ase in Canada! anadian ;eterinary @ournal,">*?2##72#0!Graven&r -!B! and R!R! Ka& 266* Ris assessments &n BSE! ;eterinary Record#"2>2/?3#/!Green L!E! and S!@! C&rnell 266" Investi(ati&ns &) cattle $erd read&1ns 1it$ &vine t%erc%l&sis in )&%r c&%nties &)

En(land and 9ales %sin( .ETNET data!Preentie ;eterinary 0edicine06>*7,?25*7*##!-acNa !C! 266* Hierarc$ical Ba+esian s'atial m&dellin( &) small7area rates &) n&n7rare disease! tatistics in

0edicine22>#6?#0/#7#00*!-&&re G!E! -!P! 9ard -! K%lld&r)) R!@! Caldanar& L!F! G%'till H!B! Le1is and L!T! Glicman 266" A s'ace7time

cl%ster &) adverse events ass&ciated 1it$ canine raies vaccine! ;accine2*>,37,5?"""07""/2!-&rle+ R!S! S! C$en and N! R$ea%lt 266* Assessment &) t$e ris )act&rs related t& &vine s'&n(i)&rm ence'$al&'at$+!

Reue cienti&i#?##!Od&i A! S!9! -artin P! -ic$el @! H&lt D! -iddlet&n and @! 9ils&n 266* Ge&(ra'$ical and tem'&ral distri%ti&n &)

$%man (iardiasis in Ontari& Canada!International @ournal o& 5ealth Geo(raphics2>#?"!

*"


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Ols&n K!L! -! B&netti -! Pa(an& and K!D! -andl 266" Real time s'atial cl%ster detecti&n %sin( inter'&int distancesam&n( 'recise 'atient l&cati&ns!0 0edical In&ormatics and #ecision 0a2in(">@%n 2#?#5!

PereCli)t&n N@?! 2/3"#07",6

Ricetts -!N! 266, P%lic $ealt$ and t$e BSE e'idemic! urrent Topics in 0icrobiolo(y and Immunolo(y23,557##5!

Sc$%del A!A! B!@! Carrill& E!@! Gimen& E!L! 9eer @! Blanc& .iera C! van Gelderen E! Ull&a A! Nader and B!G!

Cane #55, B&vine s'&n(i)&rm ence'$al&'at$+ s%rveillance in Ar(entina! Reue cienti&i#?#572"!

Tan(& T! and K! Taa$as$i 266" A )le4il+ s$a'ed s'atial scan statistic )&r detectin( cl%sters!International @ournal o&5ealth Geo(raphics,>-a+ #3?##!

.i(re H! P! Bae& S!E! @&rsal .! Bille7Hansen A!G! Hassin( C! En&e and A! B&tner 266" S'atial and tem'&ral'atterns &) 'i( $erds dia(n&sed 1it$ P&st1eanin( -%ltis+stemic 9astin( S+ndr&me >P-9S? d%rin( t$e )irst t1&+ears &) its &cc%rrence in Denmar! ;eterinary 0icrobiolo(y##6>#72?#072/!

9%/N9*@9N+ ,NA&9NA/% BL% P-%8,1

7ypothesis C&nd%ct a tem'&ral7s'atial anal+sis '&tential )&r c&ntaminated l&ts &) l&&d 'r&d%ctres%ltin( )r&m $e'atitis7C HI. &r &t$er l&&d7'r&d%ct ass&ciated7c&mm%nicale disease in t$e'r&vince &) Ne1 Br%ns1ic!

&ethods Devel&' an anti&d+ testin( met$&d t& estimate t$e ris &) in)ecti&n at eac$ e4'&s%re time)r&m m%lti'le e4'&s%re data! -et$&d ma+ als& e em'l&+ed t& estimate transmissi&n rates and rissass&ciated 1it$ di))erent s&%rces &) in)ecti&n )r&m a ran(e &) in)ecti&%s disease a''licati&ns

+91 &odel An+ e4'&s%re t& c&ntaminated l&&d 'r&d%cts 'r&vides an &''&rt%nit+ )&r in)ecti&n %tt$e in)ecti&n stat%s at eac$ e4'&s%re time is n&t &served! Instead t$e availale data )r&m anti&d+testin( &nl+ indicate 1$et$er at least &ne &) t$e e4'&s%res res%lted in in)ecti&n! Usin( a sim'le

Bern&%lli m&del t& descrie t$e ris &) in)ecti&n in eac$ +ear t$e asence &) in)&rmati&n re(ardin(1$ic$ e4'&s%re led t& in)ecti&n ma+ e )itted int& a )rame1&r &) inc&m'lete data inter'&lati&n! T$ee4'ectati&n7ma4imi2#?2/6"72/#6!

de Carli G! .! P%r& and G! I''&lit& 266* Ris &) $e'atitis C vir%s transmissi&n )&ll&1in( 'erc%tane&%s e4'&s%re in$ealt$care 1&rers!In&ection*#>Dec S%''l 2?22720!

el7Sada1+ -! H! Ra(a H! el7T&%$+ L! el7-&r Ael A!-! -an(&%d -!H! Eissa A!F! A)e)+ E! el7S$&ra(+ I!A!Ira$em S! -a$r&%s A! Adel7-&nem E!I! Saee and A! Ismail T!A! -&rs+ S! Ete1a E! N&r Edin ! -&sta)a! A&%el7-a(d -!I! Hassan K! La&%


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at S$aria G&vern&rate E(+'t ser&'revalence and ass&ciated ris )act&rs! @ournal o& the )(yptian ociety o&Parasitolo(y*,># S%''l?*/07*3,!

Fan( C!T! S!P! Field -!P! B%sc$ and P! He+ns Ad% 266* H%man imm%n&de)icienc+ vir%s7# and $e'atitis C vir%s RNAam&n( S&%t$ A)rican l&&d d&n&rs estimati&n &) resid%al trans)%si&n ris and +ield &) n%cleic acid testin(! ;o=

an(uinis3">#?57#5!Gi&rdan& H!-! A!.! Franca L! -eirelles C!A! Escan$&ela N!F! Nis$im%ra R!L! Sant&s K!R! =%adr&s -! -a2?20"723#!

Reill+ -! A! Salim E! La1l&r O! Smit$ I! Tem'erle+ and ! Pa1itan 266, -&dellin( in)ecti&%s disease transmissi&n1it$ c&m'le4 e4'&s%re 'attern and s'arse &%tc&me data!tatistics in 0edicine2*>#5?*6#*7*6*2!

Reill+ -! and E! La1l&r #555 A lieli$&&d7ased met$&d &) identi)+in( c&ntaminated l&ts &) l&&d 'r&d%ct!International @ournal o& )pidemiolo(y23>,?0307052!

R&+ K!-! D! G&lder( A! Ta+l&r and P! -ills 266* Investi(atin( t$e s&%rce &) $e'atitis C vir%s in)ecti&n am&n(individ%als 1$&se r&%te &) in)ecti&n is %nde)ined a st%d+ &) ten cases! candinaian @ournal o& In&ectious #iseases

*">"?*2/7*23!.&(t -! F! -%$la%er S!L! Bra%n T! Lan( R! B%sc$ R! Lan(e G! Fr&sner and @! Hess 266, Prevalence and ris

)act&rs &) $e'atitis C in)ecti&n a)ter cardiac s%r(er+ in c$ild$&&d e)&re and a)ter l&&d d&n&r screenin(! In&ection*2>*?#*,7#*0!

in N! S! -ei L! Li F!L! 9ei L!=! V$an( and !V! Ca& 266* St%d+ &n t$e e'idemi&l&(+ and distri%ti&n &) $%manimm%n&de)icienc+ vir%s7# and $e'atitis C vir%s in)ecti&n am&n( intraven&%s dr%( %sers and ille(al l&&d d&n&rs inC$ina in C$inese!Chon(hua Liu Din( in( Due Ca Chi2,>##?5/275/"!

*0


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SECTION THREE

CHAPTER " Disease S%rveillance T&&ls and GIS

*3


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%91/A1/ 18-;/9LLAN,/ L1 AN% +91

;/-;9/W

Earl+ detecti&n &) c&$&rt e4'&s%re d%e t& an &%trea &) c&mm%nicale disease is essential )&r avertin(catastr&'$ic &%tc&mes!#*3 #*5T$e 'rimar+ c$aracteristic &) an+ emer(enc+ 'lannin( t&&l is its ailit+ t&ens%re earl+ detecti&n and s%se%entl+ en(a(e a''r&'riate res'&nse meas%res! Real time s%rveillance datais an essential in(redient!#,6Data s&%rces s$&%ld incl%de a m%ltit%de &) disease activit+ indicat&rs andi&sens&rs sc$&&l &r 1&r asenteeism rates 'atient re)errals 1al7in clinics emer(enc+ de'artments andd&ct&rQs &))ices m&nit&rin( &ver7t$e7c&%nter sales &) medicati&n and mete&r&l&(ical data! Anal+sis &)t$ese data s&%rces m%st als& &cc%r in real time! Emer(enc+ res'&nse meas%res m%st e 'rec&m'iled trainedand tested s& t$at emer(enc+ res'&nse 1ill &cc%r 1it$&%t dela+ irres'ective &) an+ ass&ciated 1eat$er &rl&(istic c&nditi&ns!#,# #,2

B9/---91& %//,9N 1,/NA-91

9$ile m&st acterial &r(anisms c&ntaminatin( air )&&d &r 1ater are nat%ral &cc%rrences and ver+ s'eci)icin t$eir transmissi&n7m&de man+ t&4ins can e 1ea'&ni= Fever?#"* #",Francisellatularensis>T%laremia 7 rait )ever?#""Hem&rr$a(ic )ever#"/)ycoto2in>T2?#"0+icinus communis >Ricin?#"3 #"5 #/6 Staph enteroto2in B#/# 6ariola virus >small'&4?#/2 and'la(%e?!#/* 9$ile &r(anisms var+ in inc%ati&n '$ases and e'idemi&l&(ical im'act'lannin( and assessment 'r&t&c&ls s$&%ld 'r&ceed + 1a+ &) 1&rse7case scenari&s! &acillus anthracisin)ecti&n is a viale Class A t$reat m&del )&r devel&'in( critical 'lannin( and assessment t&&ls! It entails a

narr&1 res'&nse &''&rt%nit+#/,

and '&ses e4treme demands &n an+ detecti&n s+stem!#/"

9$ile i&sens&rtec$n&l&(ies are c%rrentl+ availale e4'&s%re treatment re(imens are di))ic%lt! #//T$e e'idemi&l&(ical casedistri%ti&n c%rve res%ltin( )r&m an ant$ra4 &%trea is s%dden stee' and e4tremel+ let$al! T$e s'atialdistri%ti&n &) aer&s&li


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n&ti)icati&n $ave e4tremel+ l&1 sensitivit+ )&r ne1 s+ndr&mes %ntil several +ears a)ter t$e e4istence &) t$es+ndr&me is identi)ied! P%lic $ealt$ de'artments s$&%ld devel&' and disseminate s+ndr&me de)initi&ns! T&date $&1ever t$e re'&rtin( sensitivit+ and s'eci)icit+ &) ne1 s+ndr&mes remains m&derate at est! Dataanal+sis 1$et$er man%al &r a%t&matic d&es n&t %s%all+ &cc%r in real time! C%rrent '%lic $ealt$ decisi&n7main( and res'&nse strate(ies ma+ e inade%ate >as stated in t$e Learnin( )r&m SARS re'&rt? $&1evert$e stat%s %& is &)ten c&nsidered acce'tale! Eval%ati&n &) t$ese strate(ies are c&nsidered t& e c&nc%rrent1it$ t$e devel&'ment &) an+ c&nta(i&%s disease detecti&n and s%rveillance s+stem!

T$e e'idemi&l&(ical c%rve &) a c&nta(i&%s 'ers&n7t&7'ers&n &%trea &) man+ c&mm%nicale diseases is%s%all+ c$aracteri"orynebacterium diphtheriaes'!?#/3 #/5German measles >+ubella viruss'!?#06Le'r&s+ >)ycobacteriumleprae s'!?#0# #02-easles >)orbillivirus (en!)easles virus s'! r%e&la?#0*-enin(&c&cc%s >'eisseriameningitidis s'!?#0, #0" #0/ -%m's >+ubulavirus (en! )umps virus s'!?#00 #03 P)ei))er:s acill%s>0aemophilus influenzaes'!?#05 #36R$e%matic )ever#3#Severe Ac%te Res'irat&r+ S+ndr&me >SARS? #32#3*Small'&4 >6ariola viruss'!?#3,Stre't&c&cc%s A >Streptococcus pyogeness'!?#3" #3/and T%erc%l&sis>)ycobacterium(en)ycobacterium tuberculosiss'!?!#30 #33

;/,-B-N/ %91/A1/ %//,9N 1,/NA-91.ect&r7 and $&st7&rne disease detecti&n scenari&s incl%de &%treas inv&lvin( t$e transmissi&n &) an a(entvia an insect vect&r &r animal $&st t& $%mans! T$e e'idemic 'attern &) &%trea diseases c$aracteristic )&rt$is cate(&r+ is m&deled in Fi(%re #!

*igure $: ;ector and 7ostBorne /pideiological ransission Patterns

As t$e m&del im'lies disc&ver+ &) &%treas in t$is cate(&r+ re%ires t$at detecti&n s+stems m&nit&r n&t

&nl+ $%man disease mani)estati&ns %t als& c&ntri%tin( vect&rs and $&sts &) t$e i&l&(ical a(ents! S%c$s+stems need t& inc&r'&rate data )r&m veterinar+ s&%rces! Beca%se &) t$eir recent &cc%rrence and ra'ids'read 9est Nile ence'$alitis SARS and t$e H"N# Bird Fl% vir%ses are si(ni)icant re'resentative t$reats int$is cate(&r+! 9$ile &t$er diseases in t$is cate(&r+ ma+ reveal mared vect&r $eter&(eneit+ an+ anal+sis &)(eneral ca'acit+ 1&%ld need t& em'l&+ ad;%nct (e&(ra'$ic vect&r c$eclists )&r 'arasites insects 1ild andd&mestic animals! T$e ailit+ t& 'r&cess envir&nmental data re'resents an additi&nal re%irement )&r vect&r7&rne disease detecti&n s+stems s%c$ as rem&te sens&r+ satellite ima(er+ anal+sis em'l&+ed as an earl+1arnin( t&&l )&r Ri)t .alle+ Fever!#35 T$e ailit+ t& m&nit&r )&r ne1 vect&r7&rne diseases >i1e1 H"N#? is are%irement! 9e n&te t$at t$e c%rrent s+stem &) re'&rtale disease n&ti)icati&n $as e4tremel+ l&1 se

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