Strategies for Effective Improvements to the BioWatch System Proceedings of a Workshop (2018) / Chapter Skim
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2 Assessment of Current Performance
2 Assessment of Current Performance
Pages 18-31
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From page 18... ...
, reviewed work using dispersion modeling tools to optimize system architecture. Jennifer Rakeman, assistant commissioner and director of the public health laboratory in the New York City Department of Health and Mental Hygiene, then spoke about how complicated BioWatch can be at the jurisdictional level and why jurisdictions rely on the BioWatch program's work on quality assurance and dispersion modeling.
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From page 19... ...
One section of this program plan addresses the quality management system, including document control and records review, how to conduct audits and inspections, and how to take corrective action. Another section describes technical systems QA requirements, detailing training and qualification of staff, the type of facilities needed, decontamination procedures, workflow documentation, performance assessment, the procedure to follow when implementing new methods, and how to document QA performance in reports to DHS.
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From page 20... ...
Isbell explained that the latter represent instances in which there might be some ambiguity in a requirement or a contradiction between documents that are not for the field teams or laboratories to address but fall under the responsibility of the program office to fix. Any deficiencies identified require a formal corrective action report from the field or laboratory team.
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From page 21... ...
Currently, said Isbell, DHS receives separate reports for laboratory and field performance. OVERVIEW: DISPERSION MODELING TOOLS TO OPTIMIZE BIOLOGICAL DETECTION ARCHITECTURES This section draws on a paper commissioned by the Planning Committee on Strategies for Effective Biological Detection Systems, "Use of Dispersion Modeling Tools in Optimizing Biological Detection Architectures," by David Brown (see Appendix G)
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Brown noted that he and his colleagues have coupled the CONTAM model to the ANL Below Ground Model (BGM) for subway systems to look at how contamination might be exchanged between these two domains if a release occurred in one venue or the other.
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FIGURE 2-2 The QUIC urban dispersion model handles airflow around buildings. SOURCE: Brown slide 6.
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From page 24... ...
Brown hopes that, within a year, they will be able to run the models dynamically so that a single code addresses an entire city, at least to the extent that data are available to support that type of modeling. Using these models to help with siting portable sampling units requires tens of thousands of individual model runs using a library of release scenarios and performing statistical analyses of the results.
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From page 25... ...
A singlecollector BAR provides little information with which to work, so he and his colleagues have looked at collector siting strategies that would minimize the probability of a single-collector BAR. In summary, Brown said that detailed physical modeling is a cornerstone of collector siting and response in indoor, subway, and outdoor environments.
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From page 26... ...
In fact, she said, New York City's work on a second verification panel led to nationwide implementation of a second verification panel for one particular agent. She noted that DHS's transition to a critical reagents screening program led to a decrease in verification tests performed and this in conjunction with the city implementing a second verification panel led to a decrease in false-positive laboratory results.
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From page 27... ...
DISCUSSION As a prelude to the open discussion, Isbell reviewed the QA process. The elements of the QA program, she reminded the audience, are the QA program plans, laboratory and field audits, external QA samples, proficiency tests, and QA performance reviews and reports.
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From page 28... ...
This is why QA now uses positive plasmid controls, which she said is an imperfect solution because it is not representative of what would be seen operationally. She added that while DoD is working on developing better surrogates for the specific agents on the BioWatch target analyte list, it may be necessary to "step back from the current luxury of being able to characterize every single target to the Nth degree and maybe use representative targets." John Clements, the session moderator, asked Isbell what the lead time would be to get a new QA and QC program operational if the decision was made to add another agent.
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From page 29... ...
An unidentified participant asked Brown if there are any modeling activities considering dispersion of contaminated people over time after exposure as a means of improving treatment and response -- given the delays in identifying a positive sample from the time it is collected. Brown said this delay is a major concern because, while the initial attack on a subway system, for example, might be over relatively quickly, material will have already been transported to the outdoors, both through airflow and by people contaminated with the agent moving out of the subway system and dispersing through the city.
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From page 30... ...
John Vitko asked Brown if there is an adequate density of portable sampling units for a desired sensitivity, given the drive to use as few sampling units as possible because of economic concerns. Brown replied that, from a public health perspective, there are never enough detectors, particularly when trying to avoid the single-collector BAR.
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From page 31... ...
She also said that she and her colleagues go through an extensive evaluation of any new technology to understand what sample size and how many data points are needed to set performance metrics and understand the statistical confidence that a positive result should trigger an action. Shah added there needs to be an educational effort to help decision makers and the public understand the challenges of triggering an event based on a positive test result.
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