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Objective To describe the latest revisions and modifications to the “HL7 2.5.1 Implementation Guide for Syndromic Surveillance” (formerly the PHIN Message Guide for Syndromic Surveillance) that were made based on community commentary and resolution of feedback from the HL7 balloting process. In addition, the next steps and future activities as the IG becomes an “HL7 Standard for Trial Use” will be highlighted. Introduction In 2011, the Centers for Disease Control and Prevention (CDC) released the PHIN Messaging Guide for Syndromic Surveillance v. 1. In the intervening years, new technological advancements including Electronic Health Record capabilities, as well as new epidemiological and Meaningful Use requirements have led to the periodic updating and revision of the Message Guide. These updates occurred through informal and semi-structured solicitation and in response to comments from across public health, governmental, academic, and EHR vendor stakeholders. Following the Message Guide v.2.0 release in 2015, CDC initiated a multi-year endeavor to update the Message Guide in a more systematic manner and released further updates via an Erratum and a technical document developed with the National Institute of Standards and Technology (NIST) to clarify validation policies and certification parameters. This trio of documents were consolidated into the Message Guide v.2.1 release and used to inform the development of the NIST Syndromic Surveillance Test Suite (http://hl7v2-ss-r2-testing.nist.gov/ss-r2/#/home), validate test cases, and develop a new rules-based IG built using NIST’s Implementation Guide Authoring and Management Tool (IGAMT). As part of a Cooperative Agreement (CoAg) initiated in 2017, CDC partnered with ISDS to build upon prior activities and renew efforts in engaging the Syndromic Surveillance Community of Practice for comment on the Message Guide. The goal of this CoAg is have the final product become an “HL7 Standard for Trial Use” following the second phase of formal HL7 balloting p in Fall 2018. Methods ISDS coordinated a multi-stakeholder working group to revisit the consolidated Message Guide, v.2.1 and collect structured comments via an online portal, which facilitated the documentation, tracking, and prioritization of comments for developing consensus and reconciliation and resolution when there were errors, conflicts, or differing perspectives for select specifications. Over 220 comments were received during the most recent review period via the HL& balloting process (April – June 2018) with sixteen elements captured for each comment, which included: Subject, Request Type, Clinical Venue Application, Submitter Name, IG Section #, Priority, Working and Final Resolution (Figure 1). The online portal was used to communicate with members of the Message Guide Workgroup to provide feedback directly to one another through a ‘conversation tab’. This became an important feature in teasing out underlying concerns and issues with a given comment across different local, state, and private sector partners (Figure 2). Some comments were able to be fully described and resolved using this feature. Following the HL7 balloting period, ISDS continued the weekly webinar-based review process to delve into specific issues in detail. Each week ISDS staff would lead the webinars structured around similar comment types (e.g. values sets, DG1 Segments, IN1 Segments, Conformance Statements, etc.). This leveraged the expertise of individuals and institutions with concerns revolving around a specific domain, messages segment, or specification described within the Message Guide. Comments for which consensus and resolution was achieved were “closed-out’ on the portal inventory and new assignments for review would be disseminated across the Message Guide Workgroup for consideration and discussion during the subsequent webinar. Results To date this review process has identified and updated a wide-range of specification and requirements described within the Message Guide v.2.0. These include: specifications for persistent patient ID across venues of service, inclusion of the ICD-10-CM value set for diagnosis, removal of the ICD-9-CM requirement for testing and messages, modification of values such as pregnancy status, travel history, and medication list from “O” to “RE”, and the update of value sets and PHIN VADS references for FIPS, SNOmed, ICD-10-CM, Acuity, Patient Class, and Discharge Disposition. Conclusions The results of this multi-agency comment and review process will be synthesized and compiled by ISDS. The updated version of the Message Guide (re-branded to the HL7 V 2.5.1 Implementation Guide for Syndromic Surveillance) will go through a second round of review and commentary thru HL7 in Fall 2018. This systematic and structured review and documentation process has allowed for the synthetization and reconciliation of a wide range of disparate specifications, historical hold-overs, and requirements via the perspectives of a diverse range of public health partners. As this review process continues it is anticipated that the final HL7 balloted “Standard for Trial Use” IG 2.5 will represent a more refined and extensible product that can support syndromic surveillance activities across a wider and more diverse range of clinical venues, EHR implementations, and public health authorities. ISDS and CDC have recommended that future modifications to the Promoting Interoperability (PI) Programs (formerly Meaningful Use) reference and require the utilization of the revised Implication Guide for Certification. The HL7 2.5.1 Implementation Guide can be found: https://cdn.ymaws.com/www.healthsurveillance.org/resource/resmgr/docs/Group_Files/Message_Guide/IG_SyS_Release_1.pdf

ISIS, the spallation neutron source at the Rutherford Appleton Laboratory in the UK, uses a 50 Hz, 800 MeV proton RCS to provide a beam power of 0.2 MW, delivered in 0.4 us long pulses. Detailed studies are now under way for a major upgrade. Accelerator designs using FFAs, conventional accumulator and synchrotron rings are being considered for the required MW beam power. This paper summarises the scope of the different research incorporating results from recent target studies and user consultations. Preliminary results for Fixed Field Alternating gradient (FFA) rings and conventional rings located in the existing ISIS synchrotron hall are presented., Proceedings of the 10th Int. Particle Accelerator Conf., IPAC2019, Melbourne, Australia

ISIS is the pulsed spallation neutron source located at the Rutherford Appleton Laboratory in the UK. Operation is based on a 50 Hz, 800 MeV proton synchrotron, accelerating up to 3·10¹³ protons per pulse (ppp), which provides beam to two target stations. ISIS is beam loss limited, so to achieve greater beam intensity and optimal operation, losses must be reduced. Some beam loss may be attributed to resonance lines found in betatron tune space. These could be driven by higher order magnet field components, errors or misalignment. This paper describes work measuring losses against tune space around the ISIS working point. Experiments have been carried out to measure beam loss against tune in the ISIS synchrotron. The experiments were done at low intensity to minimise space charge and intensity effects. Resonance lines that cause beam loss can be clearly identified and provide new information about the machine. The experimental process has been automated in order to decrease experiment duration and to reduce systematic human error. MAD-X models that compare the beam envelope at different points in tune space to the beam pipe aperture are used to distinguish between losses caused by increased envelope size and losses induced by driven resonances., Proceedings of the 9th Int. Particle Accelerator Conf., IPAC2018, Vancouver, BC, Canada

Objective To describe data management and analytic processes undertaken to rapidly acquire and use previously unavailable data during a public health emergency response. Introduction Accurately gauging the health status of a population during an event of public health significance (e.g. hurricanes, H1N1 2009 pandemic) in support of emergency response and situation awareness efforts can be a challenge for established public health surveillance systems in terms of geographic and population coverage as well as the appropriateness of health indicators. The demand for timely, accurate, and event-specific data can require the rapid development of new data assets to “fill-in” existing information gaps to better characterize the scope, scale, magnitude, and population health impact of a given event within a very narrow time-window. Such new data assets may be concurrently under development and evaluation while being used to support response efforts. Recent examples include the “drop-in” surveillance processes deployed at evacuation centers following Hurricane Katrina1 and the illness and injury surveillance systems established for response workers during the Deepwater Horizon Oil spill response. During the 2009 H1N1 pandemic response, CDC acquired access to data from several national-level health information systems that previously had been un-vetted as public health information sources. These sources provided data extracts from massive administrative or electronic medical records (EMR) based in hospital and primary care settings. It was hoped that such data could supplement existing influenza surveillance systems and aid in the characterization of the pandemic. Few of these new data sources had formal documentation or concise information on the underlying populations and geographies represented. Methods Throughout CDC’s H1N1 response; epidemiologists, data managers, and IT specialists collaborated to develop standardized methods to rapidly characterize, process, store, and provision these new data for analysis and reporting by subject matter experts.These new data were not part of a formally designed sample so each data source needed to undergo extensive empirical review to understand, representativeness, unique nuances, and facilitate the interpretation of analytic results and accurate reporting to public health decision makers. Results Such work requires a multi-disciplinary approach that cyclically reviews incoming data iteratively while concurrently documenting findings, modifying initial business rules (e.g. extraction, binning, or coding logic), and analytic techniques to produce the most interpretable and informative results. To elucidate the underlying complexity for these sequential and contingent activities occurring across information technology, informatics, and epidemiology domains, we retrospectively described the intersection of the discrete tangible tasks and workforce roles via a TaskFlow diagram (Figure 1). Vertical “swim lanes” represent discrete tasks: On-boarding/Documentation, Analysis/Visualization, and Visualization/Reporting. Workforce roles such as Data management, Epidemiological Analysis, and Communications are broken into three horizontal “swim lanes” as each requires dramatically different skillsets and are accomplished by different individuals. Each of the steps (1–9) in the diagram were leveraged to produce supplemental artifacts (e.g. code books, extraction guides, defined analytic methods, etc.) to support ongoing analysis, interpretation, reporting, and over process improvement. The totality of all of these interrelated activities have an a priori purpose of characterizing population health during an event of public health significance to support disease prevention and control efforts in a timely fashion. Conclusions This presentation describes the underlying business processes, activities, and roles used in transforming novel data sources, during the H1N1 response, into informative assets to support public health surveillance. By formally articulating and describing each of these steps, in a structured manner, we hope to contribute to the dialogue of developing useful practices for leveraging electronic health data to meet public health surveillance challenges.