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Public cloud platforms are vital in supporting online applications for remote learning and telecommuting during the COVID-19 pandemic. The network performance between cloud regions and access networks directly impacts application performance and users' quality of experience (QoE). However, the location and network connectivity of vantage points often limits the visibility of edge-based measurement platforms (e.g., RIPE Atlas). We designed and implemented the CLoud-based Applications Speed Platform (CLASP) to measure performance to various networks from virtual machines in cloud regions with speed test servers that have been widely deployed on the Internet. In our five-month longitudinal measurements in Google Cloud Platform (GCP), we found that 30-70% of ISPs we measured showed severe throughput degradation from the peak throughput of the day.

In recent decades there has been an extraordinary growth in and acceptance of automatic data systems that collect official and popular reports of epidemic occurrence. While different systems employ one or another proprietary algorithms to collect and parse disease reports all include, at a minimum, spatial locators, the date of a report, and the number of individual cases reported. These systems have been increasingly vital in both the study of individual epidemics and the exposition of expanding epidemics in real time. To date, however, there has been little analysis of the nature and quality of the data collected in these “big-net” programs or the degree to which redundancies and uncertainties may limit their utility. Here data on the 2009 H1N1 Type-A influenza epidemic gathered by a single system, healthmap.org, is parsed to determine where problems exist and how they might be rectified.

Public opinion surveys and polls have a long history as tools for the reportage of public sentiment. Born in the "straw polls" of nineteenth century politics, their use expanded in the last century to include a range of commercial and social subjects. In recent decades, these have included issues of medico-legal uncertainty including, in a partial list, abortion, fetal tissue research, and the propriety of medical termination. Because public opinion surveys are assumed to be "scientific," and thus unbiased, there has been little discussion of either their suitability in areas of complex, medico-legal uncertainty or the ethics of their use in these areas. This paper reviews their general history and then their use in the debate over medical termination, often called "medical aid in dying." In this review, two problems are highlighted. First, there is the ambiguous nature of polls and the manner of their construction. Second, there is the manner in which they are deployed as simple and definitive statements in areas of complex medico-legal debate. The result calls for caution in their use by ethicists and a clear duty by both academics and journalists to understand the limits of the medium in areas of medico-legal debate and discussion.

Summary On January 22, 2020, Johns Hopkins University launched its online COVID-19 dashboard to track in real time what began in December as the regional outbreak of a novel coronavirus first identified in Wuhan, China. The dashboard and its format were quickly adopted by other organizations, making global, national, and regional data on the pandemic available to all. The wealth of data freely offered in this way was collected by syndromic programs whose precise algorithms search official and popular sources for data on COVID-19 and other diseases. The dashboard signals a new phase in the maturation of the “digital revolution” from paper resources and, in their popular employ, a “democratizion” of data and their presentation. This perspective thus uses the COVID-19 experience as an example of the effect of this digital revolution on both expert and popular audiences. Understanding it permits a broader perspective on not simply the pandemic but also the cultural and socioeconomic context in which it has occurred., The bigger picture Availability of data during the current pandemic has been facilitated by open access databases summarized in dashboard maps, tables, and charts. This provided an unprecedented opportunity for not only academic research but popular reportage. Dashboard data have increasingly been joined to demographic data provided by census and other digitally stored socioeconomic data in a manner permitting journalists and researchers to analyze local and regional outbreaks and the demographics that have propelled specific outbreaks. This democratization has permitted unprecedented public exposure to the realities of the pandemic, and its propellants, at every scale. In the future, the likelihood is that the type of deep investigation of an epidemic or pandemic will be as much a matter of journalistic examination as it has been, in the past, of professional research. What once took perhaps a year for analysis and journal publication is now occurring over weeks of public analysis. The effect has been immense on the public presentation of pandemic news and the realities of local outbreaks. Its focus on socioeconomic forces encouraging intense local outbreaks—for example, in long-term facilities—are arguments for political focus on structural failures in the social safety net. This is revolutionary and … evolutionary. It is the newest phase of a “digital revolution” begun in the 1960s and a long history in public health explorations of disease events and the socioeconomic sources that propel them. For the latter, books like my Cartographies of Disease: Maps, Mapping and Medicine or Disease Maps: Epidemics on the Ground attempt to both trace the history of epidemics through their mapping and public data from yellow fever (in the 18th century) and cholera (in the 19th century) through this century’s Ebola epidemic in West Africa., Beginning in early 2020, new systems of data collection were reported as public data in a series of dashboards that have tracked the progress of COVID-19 and its variants internationally and nationally. The unprecedented presentation of disease-related data permitted academics, bureaucrats, and public reporters to not only report on the evolving pandemic at various scales but use local, regional, and national databases to consider the causes of local outbreaks. This marked both an evolution in the so-called data revolution, begun in the 1960s, and the public availability of previously hard to collect health data.

Disaster medicine is characterized by shortages of everything but patients. There are never enough beds, equipment, personnel, or supplies. In the 2014 Ebola epidemic, another scarcity was maps. The need for maps of the affected areas, and the ways the maps were used, serve to emphasize the way maps have always served in both disaster medicine and public health preparedness. Those lessons are reviewed here in the context of the Ebola epidemic. (Disaster Med Public Health Preparedness. 2015;0:1-8)

Today we take for granted the idea of global health, of disease as an international event. Increasingly, we assume as well that the international spread of disease can be traced to human travel patterns as well as to recurring environmental conditions. Perversely, the idea of ‘global health’ and its inverse, global disease, owes little to the three-dimensional imaging of the planet and almost everything to the two-dimensional plane of the map. Here the idea of global disease is traced from its beginnings in the 18th century to its 19th-century introduction in maps of the first cholera pandemic. This global perspective, and the responsibilities it promoted among civil officials, can be seen in modern studies of cancer, influenza and other conditions with both environmental foundations and international presence.

Bioethicists have typically disdained where they did not simply ignore the Hippocratic tradition in medicine. Its exclusivity--an oath of and for physicians--seemed contrary to the perspective that bioethicists have attempted to invoke. Robert M. Veatch recently articulated this rejection of the Hippocratic tradition, and of a professional ethic of medicine in general, in a volume based on his Gifford lectures. Here that argument is critiqued. The strengths of the Hippocratic tradition as a flexible and ethical social doctrine are offered in its stead.

There is something very traditional about Nancy Krieger’s decidedly modern work. She advances a social epidemiology that is multidisciplinary, advancing a “quantitative population science” that is also spatial in its approach and method of analysis. Many geographers see their work as affirming the potential of medical cartography and geography as disciplines critical to public health studies of disease incidence. This article argues that the history of epidemiology and public health are historically spatial and geographic, a link lost in the research of many twentieth century health researchers. A review of the history of medical geography, and of public health, insists upon the spatiality of disease studies as a critical groundwork not simply for contemporary disease studies but for the history of disease studies as they have slowly developed over for more than 200 years.

Teaching GIS is relatively simple, a matter of helping students develop familiarity with the software. Mapping as an aid to thinking is harder to instruct. This article presents a laboratory and lecture package developed to teach the utility of mapping in a course on spatial data analysis. Following a historical review of the use of surface mapping in medicine, it investigates a recent outbreak of salmonella. The lab teaches two different analytic techniques, hierarchical buffers and a surface kerneling approach. The result is a historically grounded program in which different means of address are compared and considered by students.

The acceptance of military directives violating medical ethics and international covenants encouraged by the demonisation of the enemy by the US president in 2002 has effectively removed the right of medical personnel to refuse participation in internationally proscribed actions Medicine and its traditional ethic of care is today a victim of the current conflict in Iraq and Afghanistan, its uniquely humanising mission rejected by US President George W Bush and his advisors. In denying the applicability of international agreements guaranteeing medicine’s ecumenical role in this conflict they have transformed medicine into just another weapon of tactical significance. The result, predictable in retrospect, has been to make military physicians and nurses complicit—actively or passively—in what Litton calls an “atrocity-producing situation”, resulting in detainee or prisoner abuse.1 From the first revelations of detainee torture in US detention camps (2004) to recent allegations of continued abuse (2006), the focus of international attention has shifted from the US prosecution of low ranking, non-commissioned military personnel to the context in which the atrocities they committed occurred. “No one up the chain of command has ever been held accountable for what is in these horrifying images,” Center for Constitutional Rights Director Bill Goodman said of recently published photographs of 2004 prisoner torture and abuse.2 “The situation in several areas violates international law and conventions on human rights and torture,” said the UN Special Rapporteur on Torture following a 2006 investigation.3 The denial of international law and convention involved the overt disavowal of covenants and conventions that for almost 150 years required medical personnel in the US military to act within the guidelines of a Hippocratic vision of medicine. To understand how fundamental this change has been requires a brief review of the history of medicine’s previously protected status and then a description of …

Organizational change in education, as manifested by school reform, is indeed complex. In this article, we describe our experience with organizational change and analyse it using organizational change theories common in education. An evaluation of the reform initiative yielded unexpected problems related to sustainability. As a result, this article revisits the assumptions from the organizational change literature that guided our change strategy. This reflection led to the discovery of key theoretical ideas that, although less familiar, may have more practical utility for those engaged in organizational change within schools.

Students often ask whether the examples we give as instructors have any relevance to their worlds, to their lives. Too often the answer is no. This paper describes a case that is obviously pertinent to both secondary and university students and their instructors. The legal battle over equality and racial discrimination in the New York City School system presents not simply a rich field for geographical consideration but also a pertinent one. It brings to students and their instructors a complex of economic, legal, and social issues played across a discrete spatial surface. As importantly, it offers a case study exploring the difficulties of both defining and then achieving distributive justice in post-modern environments in a context students and their instructors will recognize as relevant and timely. The discussion that results may be useful in economic, legal, locational, and social geographic instruction.

For most Canadians, the arguments that began on Oct. 14, 2014, at the Supreme Court in Ottawa are about medical aid in dying. But what is really at stake in Carter et al. v. Attorney General of Canada et al. is Canadian law itself, the meaning of its guarantees, promises and injunctions. Lawyers

The 2014 Ebola outbreak has been seen by many as a “perfect storm” and an “unprecedented” public health calamity. This article attempts to place this most current of epidemics, one currently struggling for pandemic status, in an historical frame. At least since the 1600s protocols and programs for the containment of epidemic disease have been known, and mapped. And yet it was almost six months after warnings about this epidemic were first sounded that incomplete programs of control and surveillance were instituted. In effect, we have forgotten the basics of what was once common knowledge in public health. Having placed our faith in bacteriology, virology, and pharmacology, we have forgotten the lessons learned, long ago. (Disaster Med Public Health Preparedness. 2014;0:1-6)

This commentary considers issues raised in a recent article on GIS-based approaches to modeling disease clusters. ‘Modeling exposure opportunities’ (Sabel, Gatrell & Loytonen et al., 2000. Social Science and Medicine , 50 , 1121–37) and the general problem of mapping disease clusters. It notes that the authors’ advocate a fundamentally statistical approach, Kerneling estimation, to map the occurrence of a specific illness whose etiology is unknown. Epidemiologists, ironically, have advocated a fundamentally cartographic solution, the cartogram, in addressing the general problem of disease clusters. The advantages and limits of both approaches are reviewed and the potential for their comparison in a single study suggested. Most importantly, perhaps, the commentary seeks to join the epidemiological and medical geographic literatures as they pertain to this analytic problem and medical cartography's potential (GIS-based or traditional) to understand disease etiology.

Quality of Life is a broad construct used in health planning, health economics, and medical decision-making. It is also a term that has a long currency in social and sociological literatures. This paper considers the assumptions underlying prospective QL instruments in an historical and contemporary context. It argues that as a tool in health planning and in clinical decision making life quality as a measurement has its origins in the early eugenics literature and the social policies that derived from it in first North America, the primary focus of this paper, and later in Europe. Reference to narrative and social literatures, as well as those involving coping and adaptation, are then used to critique the assumptions underlying this class of QL instruments. It concludes that to the degree now current prospective instruments reflect a purely physical perspective of "disease burden" irrespective of social conditions they create a context that works against life quality, and in some cases, the continuance of persons with physical differences.

Healthcare Providers advising patient surrogates on the appropriateness of continued care for comatose patients have often been sharply criticized for coercive behavior toward patient surrogates; with failing to provide them with adequate information; and for a general failure to adequately cinsider the cimplex needs and hopes of patients, their surrogates, and caregivers. Because decisions on the continuation or withdrawal of care (for example where tube feeding or respiratory assistance are required for nonresponsive patients) often need the legal approval of surrogates the failure of both medical personnel and patient families to understand each other's priorities may lead to ethical and interpersonal conflict.

In theory, physicians subscribe to and in their actions personify a set of virtues whose performance demands personal engagement. At the same time, they are instructed in their professional roles to remain emotionally and personally distant from those they are called to treat. The result, the authors argue, is an ethical conflict whose nature is described through an analysis of two narratives drawn from an online blog for young physicians. Confusion over professional responsibilities and personal roles were found to affect physicians' perceptions of their clinical duties and their social roles. In addition, it sets in sharp relief contemporary debates on physician training and the ethical nature of medical professionalism. Practically, the authors suggest, the confusion may contribute to early physician burnout. Methodologically, this paper promotes the use of online discussion sites as rich repositories providing an insight into real dilemmas and the actual perception of physicians' attempts to address them. It thus promotes use of such sites as a resource in which assumptions about physicians' own perceptions about the nature of their role in contemporary society can be tested.

In October 2008, former US Federal Reserve Chairman and “federal market cheerleader” Allan Greenspan told a US congressional committee he made a “mistake” in assuming the self-interest of organisations would not endanger their clients.1 In his words, his years of policy stewardship erred, “in presuming that the self-interests of organisations, specifically banks and others, were such that they were best capable of protecting their own shareholders and their equity in the firms”. It has been that belief in corporate efficacy and stewardship that has powered the last two decades of policy analysis in healthcare. Over this period the increasingly accepted goal has been to shift the responsibility for healthcare from public agencies to private contractors and insurers. In some cases the result has been a remaking of the “public-private mix” in healthcare, with an emphasis on ever greater corporate involvement.2 Reflexively, the assumption has been that the private sector always does better what governmental agencies do badly: “the market predictably leads to better long-term outcomes overall”.3 It is this assumption, and the libertarian economics Greenspan and others have espoused for 40 years that are now in question, if not wholly in disrepute. The obvious first lesson of the current crisis is that the unfettered market is not necessarily superior. Without real and stringent public supervision, private corporations may do very badly indeed in providing necessary service. It may be that not only government supervision but also government participation—and here the nationalised banks are an example—is necessary for the common good of corporate and private citizens alike. The primary goal of any business is to maximise profit and market position, not the welfare …

The problem of urban accessibility for persons with mobility restrictions has been for some years a subject of discussion both within academic communities and communities of physically restricted transit users. Some have argued the issue lies within the spaces created by those whose experience of the city is dependent on transit rather than automobile use, or who use wheelchairs rather than walk. This paper attempts to advance what has been a largely experiential literature into a more sustained argument that develops a program to describe the altered spaces created by different transit modalities for users with different abilities. With a review of the literature it begins with the author's own experience and the means by which it led to a new transit initiative focused upon surface analytics in transit analysis rather than a more traditional mode of consideration.

Autopsy is a curious practice, at once resolutely anonymous and irrepressibly intimate. The person who was, is no more, his or her personality swiped away by death. And yet, as the physical parts are separated and studied in dissection, a personal history and life are revealed. See the healed

When Mahatma Gandhi was asked about American democracy, he said he thought it a grand idea and hoped, someday, Americans might try it. A devastating critique, gently delivered, it is how I think of bioethics, a good idea we await rather than one we have instituted. Beginning in the 1960s, a group

Sub-project 6 of the European Integrated Project APROSYS, implemented within the 6th Framework Programme, has developed an integrated safety system for side impact protection. For this, two different innovative technologies have been applied for the first time as a technology showcase in a car: shape memory alloy based actuators and a pre-crash sensing subsystem using radar and stereo-vision observing the side of a vehicle. Several technical challenges had to be met during development work. The sensing subsystem detects an imminent collision and decides about the probability of a collision. It activates the actuator before the crash occurs in order to reduce intrusion into the passenger compartment. This article describes the sensing subsystem, the actuator subsystem and finally the testing programme that was executed to evaluate the complete system.

Recent advances in silicon photonics will be discussed, along with key technical challenges that could significantly impact or enable new applications. This includes a brief summary of a NSF-Sponsored Workshop: Very Large Scale Photonic Integration. Article not available.

A bioethicist argues that two journal articles about quality of life-adjusted years research oversimplifies the issue and do not take into consideration people's abilities to adapt to disability and disease. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.

There has been no informed or honest debate in North America over the issue of liberalized euthanasia. Despite thousands of newspaper stories, scores of learned academic articles, a handful of closely analyzed legal decisions, and hours of broadcast news and talk show imagery, a full discussion is yet to begin.

Tallis states that it is a fundamental principle of medicine “that you should be allowed to determine what is in your own best interest when you are of sound mind.”1 This is the consumerist view and not fundamental. The fundamental principles …

My brief Salon piece, “End of life, year after year after year,” [1][1] obviously touched a nerve with Dr. Wohlgemut. [2][2] However, his reply insists on a host of views that I do not hold. I do not suggest that Fred’s doctors should have been smarter, or that because physicians are indeed

After Fred (as we’ll call him) was diagnosed with an inoperable tumour the doctors told him he had perhaps six months to live. A merchant seaman, Fred decided to spend his savings enjoying himself while waiting for the end. More than eight months later, Fred showed up at a hospice still dying

Why has longevity become a source of dismay rather than a cause for celebration? How did we turn the greatest triumph of 20th century public health and medicine into a problem for the 21st century? ![Figure][1] Photo by: Stuart Kinmond The nation's health bureaucrats and provincial

Dr. John Snow is not the first man to be honoured for valorous acts he never accomplished, nor is he the first to have honest, partially successful work transformed into a miraculous success. On the 200th anniversary of Snow's death it is time to acknowledge the glorious failure to accept that Snow'

What would we do, today, were polio to return? For those too young to remember or old enough to have forgotten, in the early 1950s the last polio pandemic swept the world. From Copenhagen, Denmark, to Vancouver, Canada, to Hong Kong, local medical teams mounted an unprecedented effort to sustain the