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Draft Guidance for Industry and FDA Staff: Computer-Assisted ...
... and Communications in Medicine (DICOM) Std., Joint Photographic Experts ... Computer-triage devices are ... tomography, magnetic resonance), make, model and specific ...
tracked for disease outcomes. More cutting-edge approaches involve biomarker studies in which study participants not only respond to questions but also provide blood specimens so that physiologic and biochemical factors associated with obesity and
http://eprints.qut.edu.au/9112/
This report presents the results from a survey conducted by Queensland University of Technology’s Faculty of Law as part of the Legal Framework for e-Research Project, funded by the Australian Commonwealth Department of Education, Science and Training (DEST), under the Systemic Infrastructure Initiative (SII), Research Information Infrastructure Framework for Australian Higher Education, as part of the Commonwealth Government’s Backing Australia’s Ability - An Innovation Action Plan for the Future (BAA). This report presents initial results from a national survey undertaken as part of the Legal Framework for e-Research Project. The survey was designed to explore the nature of e-Research and collaborative research in the Australian context. It should be noted that results presented are initial findings and an analysis of the legal context and the development of strategies will be included in a more detailed Project report due for release in early September 2007. The survey aims to explore the nature of research collaborations and to identify common legal and project agreement problems encountered in forming research collaborations in order to form strategies to facilitate and streamline the process of e-Research in the Australian context. Specifically, the aims of the survey were to: • Identify e-Research activities and levels of engagement; • Understand the nature of the collaborative research landscape; • Investigate characteristics of informal collaborations and agreements; and • Explore legal issues related to data and databases. Relation: Heffernan, Maree E. and David, Nikki (2007) Legal and project agreement issues in collaboration and e-Research: Survey results. Format: application/pdf Rights: Copyright 2007 Maree Heffernan, Nikki David and QUT; This work is licensed under an Australian Creative Commons Attribution Non-Commercial No Derivatives 2.5 Licence that can be viewed at http://creativecommons.org/licences/by-nc-nd/2.5/au.
Virtual problem solving for homeland security
Probing attack on the water treatment plant! The mayor and other emergency responders evacuate schools, respond to medical emergencies, and pursue the perpetrators. Fortunately for the town of Opelika, Alabama, the ...
1996-12-31
Two-phase fluid loops with capillary pumping are particularly interesting silent devices which allow energy savings and do not create any noise pollution (no mechanical vibrations). In terrestrial environment, the gravity field, when judiciously used, allows to improve their performances and thus, their use in thermal regulation of big computers, power electronic components, transformers, etc, is particularly interesting. In this study, the main results concerning the functioning of such a loop in the gravity field are presented and used to highlight the conditions that allow to take advantage of this field and the improvements obtained. (J.S.) 5 refs.
1996-12-31
The technology, dimensioning and performances of heat pipes are well known since several years. Micro-heat pipes occurred more recently with the miniaturization of systems to be cooled and the increase of surface heat fluxes to be dissipated. Publications concerning this topic are not much older than the 90`s. Using these papers, a bibliographic synthesis on micro-heat pipe performances, functioning and dimensioning is presented. Experimental studies demonstrate the efficiency of such systems but also their high sensitivity with respect to the capillary limit which leads to a progressive drying of the evaporator and a reduction of its thermal conductance. Theoretical studies are based on the same equations than heat pipes. More or less complex models have been proposed in the literature and a relatively simple model is presented in this paper. These studies have permitted to show the great influence of some parameters on micro-heat pipes functioning like: the pipe geometry, the fluid-wall contact angle, the level of pipes filling, and the bonding zone of the liquid film on the wall. (J.S.) 15 refs.
The influenza A(H1N1) epidemic in Mexico. Lessons learned
Several influenza pandemics have taken place throughout history and it was assumed that the pandemic would emerge from a new human virus resulting from the adaptation of an avian virus strain. Mexico,...Full Text Available
The influenza A(H1N1) epidemic in Mexico. Lessons learned
Full Text Available.Several influenza pandemics have taken place throughout history and it was assumed that the pandemic would emerge from a new human virus resulting from the adaptation of an avian virus strain. Mexico, since 2003 had developed a National Preparedness and Response Plan for an Influenza Pandemic focused in risk communication, health promotion, healthcare, epidemiological surveillance, strategic stockpile, research and development. This plan was challenged on April 2009, when a new influenza A(H1N1) strain of swine origen was detected in Mexico. The situation faced, the decisions and actions taken, allowed to control the first epidemic wave in the country. This document describes the critical moments faced and explicitly point out the lessons learned focused on the decided support by the government, the National Pandemic Influenza Plan, the coordination among all the government levels, the presence and solidarity of international organizations with timely and daily information, diagnosis and the positive effect on the population following the preventive hygienic measures recommended by the health authorities. The international community will be able to use the Mexican experience in the interest of global health.
2010-01-01
Objectives To evaluate current processes by which young children presenting with a febrile illness but suspected of having serious bacterial infection are diagnosed and treated, and to...Full Text Available
2010-01-01
Full Text Available.Objectives To evaluate current processes by which young children presenting with a febrile illness but suspected of having serious bacterial infection are diagnosed and treated, and to develop and test a multivariable model to distinguish serious bacterial infections from self limiting non-bacterial illnesses. Design Two year prospective cohort study.Setting The emergency department of The Children’s Hospital at Westmead, Westmead, Australia.Participants Children aged less than 5 years presenting with a febrile illness between 1 July 2004 and 30 June 2006.Intervention A standardised clinical evaluation that included mandatory entry of 40 clinical features into the hospital’s electronic record keeping system was performed by physicians. Serious bacterial infections were confirmed or excluded using standard radiological and microbiological tests and follow-up. Main outcome measures Diagnosis of one of three key types of serious bacterial infection (urinary tract infection, pneumonia, and bacteraemia), and the accuracy of both our clinical decision making model and clinician judgment in making these diagnoses.Results We had follow-up data for 93% of the 15 781 instances of febrile illnesses recorded during the study period. The combined prevalence of any of the three infections of interest (urinary tract infection, pneumonia, or bacteraemia) was 7.2% (1120/15 781, 95% confidence interval (CI) 6.7% to 7.5%), with urinary tract infection the diagnosis in 543 (3.4%) cases of febrile illness (95% CI 3.2% to 3.7%), pneumonia in 533 (3.4%) cases (95% CI 3.1% to 3.7%), and bacteraemia in 64 (0.4%) cases (95% CI 0.3% to 0.5%). Almost all (>94%) of the children with serious bacterial infections had the appropriate test (urine culture, chest radiograph, or blood culture). Antibiotics were prescribed acutely in 66% (359/543) of children with urinary tract infection, 69% (366/533) with pneumonia, and 81% (52/64) with bacteraemia. However, 20% (2686/13 557) of children without bacterial infection were also prescribed antibiotics. On the basis of the data from the clinical evaluations and the confirmed diagnosis, a diagnostic model was developed using multinomial logistic regression methods. Physicians’ diagnoses of bacterial infection had low sensitivity (10-50%) and high specificity (90-100%), whereas the clinical diagnostic model provided a broad range of values for sensitivity and specificity. Conclusions Emergency department physicians tend to underestimate the likelihood of serious bacterial infection in young children with fever, leading to undertreatment with antibiotics. A clinical diagnostic model could improve decision making by increasing sensitivity for detecting serious bacterial infection, thereby improving early treatment.
Full Text Available.BackgroundRecent healthcare policy has shifted the management of musculoskeletal conditions in the UK away from secondary care towards Clinical Assessment and Treatment Services at the primary-secondary care interface. However, little is known about the outcome of patients with musculoskeletal conditions referred from primary care to Clinical Assessment and Treatment Services or how best to identify those patients at high risk of poor outcome in this setting. We describe the protocol for a twelve-month prospective observational study which aims to describe the outcome of patients referred to musculoskeletal and back pain services at the primary-secondary care interface and to develop simple prognostic measures to guide clinical prioritisation and triage.Methods/DesignAll patients referred over a twelve-month period from primary care to musculoskeletal and back pain clinics in the primary-secondary care interface Clinical Assessment and Treatment Service in North Staffordshire will be mailed a postal questionnaire prior to their consultation. This will collect information on quality of life, general health, anxiety and depression, pain, healthcare utilisation including medication use, occupational characteristics, and socio-demographics. At the consultation in the interface clinic, the clinical diagnosis, investigations requested, and clinical interventions will be recorded. Follow-up data for the twelve-month period subsequent to recruitment will be collected via mailed follow-up questionnaires at 6 and 12 months, and review of medical records.DiscussionThis twelve-month prospective observational study of patients referred to a musculoskeletal Clinical Assessment and Treatment Service will assess the management and outcome of musculoskeletal care at the primary-secondary care interface as proposed in the Musculoskeletal Services Framework.
BackgroundRecent healthcare policy has shifted the management of musculoskeletal conditions in the UK away from secondary care towards Clinical Assessment and Treatment Services...Full Text Available
Technology Assessment and Roadmap for the Emergency Radiation Dose Assessment Program
2005-10-03
A Joint Interagency Working Group (JIWG) under the auspices of the Department of Homeland Security Office of Research and Development conducted a technology assessment of emergency radiological dose assessment capabilities as part of the overall need for rapid emergency medical response in the event of a radiological terrorist event in the United States. The goal of the evaluation is to identify gaps and recommend general research and development needs to better prepare the Country for mitigating the effects of such an event. Given the capabilities and roles for responding to a radiological event extend across many agencies, a consensus of gaps and suggested development plans was a major goal of this evaluation and road-mapping effort. The working group consisted of experts representing the Departments of Homeland Security, Health and Human Services (Centers for Disease Control and the National Institutes of Health), Food and Drug Administration, Department of Defense and the Department of Energy's National Laboratories (see appendix A for participants). The specific goals of this Technology Assessment and Roadmap were to: (1) Describe the general context for deployment of emergency radiation dose assessment tools following terrorist use of a radiological or nuclear device; (2) Assess current and emerging dose assessment technologies; and (3) Put forward a consensus high-level technology roadmap for interagency research and development in this area. This report provides a summary of the consensus of needs, gaps and recommendations for a research program in the area of radiation dosimetry for early response, followed by a summary of the technologies available and on the near-term horizon. We then present a roadmap for a research program to bring present and emerging near-term technologies to bear on the gaps in radiation dose assessment and triage. Finally we present detailed supporting discussion on the nature of the threats we considered, the status of technology today, promising emerging technologies and references for further reading.
Summary and results of the joint WMD-DAC/Alameda County bioterrorism response plan exercise.
2003-11-01
On June 12,2003, the Alameda County Public Health Department and Sandia National Laboratories/CA jointly conducted an exercise that used a Weapons of Mass Destruction-Decision Analysis Center (WMD-DAC) bioterrorism attack simulation to test the effectiveness of the county's emergency response plan. The exercise was driven by an assumed release (in the vicinity of the Berkeley Marina), and subsequent spread, of a small quantity of aerosolized, weapons-grade anthrax spores. The simulation used several key WMD-DAC capabilities, namely: (1) integration with an atmospheric dispersion model to calculate expected dose levels in the affected areas, (2) a individual-tracking capability for both infected and non-infected persons as they made decisions, sought treatment, and received prophylaxis drugs, and (3) a user interface that allows exercise participants to affect the scenario evolution and outcome. The analysis of the county's response plan included documenting and reviewing the decisions made by participants during the exercise. Twenty-six local and regional officials representing the health care system, emergency medical services and law enforcement were involved in responding to the simulated attack. The results of this joint effort include lessons learned both by the Alameda County officials regarding implementation of their bioterrorism response plan and by the Sandia representatives about conducting exercises of this type. These observations are reviewed in this report, and they form a basis for providing a better understanding of group/individual decision processes and for identifying effective communication options among decision makers.
Study of a capillary evaporator; Etude d`un evaporateur capillaire
1996-12-31
The phenomena that occur during heat and mass transfers by vaporization in porous medium can be described in various ways depending on the length-scale chosen. The most rigorous method is the one that uses the classical fluid mechanics equations to describe the phenomena at each point and in each phase of the domain considered. However, because of the geometrical complexity of the porous domain, this microscopic description is generally unusable. In order to get round this difficulty, the notion of fictive continuum is used to describe the phenomena at a macroscopic scale. In a first step, a numerical model is proposed which is based on the heat and mass transfer equations applied to a representative elementary volume. This approach allows to describe the development of a vapor pocket beneath the flange and to determine the dimensioning sizes of the capillary evaporator. In a second step, a model with a simplified geometry, called numerical network, which represents each pore of a given evaporator structure and which describes the heat and mass transfers at this scale is developed. This second approach confirms the previous results and allows to reach the mechanisms linked with the microstructure heterogeneities (percolation accidents, influence of microscopic heterogeneities..). (J.S.)
NCI Community Cancer Centers Program Pilot Work Plan and Deliverables Summary Additional Program Components Including Quality of Care and Survivorship This Work Plan includes components that have not been captured in the work plans specific for the
Site scientific mission plan for the southern Great Plains CART site, January--June 1998
1998-01-01
The Southern Great Plains (SGP) Cloud and Radiation Testbed (CART) site is designed to help satisfy the data needs of the Atmospheric Radiation Measurement (ARM) Program Science Team. The primary purpose of this site scientific mission plan is to provide guidance for the development of plans for site operations. It also provides information on current plans to the ARM functional teams (Management Team, Data and Science Integration Team, Operations Team, and Instrument Team) and serves to disseminate the plans more generally within the ARM Program and among the members of the Science Team. This document includes a description of the operational status of the site and the primary site activities envisioned, together with information concerning approved and proposed intensive observation periods (IOPs). The primary users of this document are the Site operator, the Site Scientist Team (SST), the Science Team through the ARM Program science director, the ARM Program Experiment Center, and the aforementioned ARM Program functional teams. This plan is a living document that is updated and reissued every six months as the observational facilities are developed, tested, and augmented and as priorities are adjusted in response to developments in scientific planning and understanding.
Site scientific mission plan for the southern Great Plain CART site July-December 1997.
1997-08-28
The Southern Great Plains (SGP) Cloud and Radiation Testbed (CART) site is designed to help satisfy the data needs of the Atmospheric Radiation Measurement (ARM) Program Science Team. This document defines the scientific priorities for site activities during the six months beginning on July 1, 1997, and looks forward in lesser detail to subsequent six-month periods. The primary purpose of this Site Scientific Mission Plan is to provide guidance for the development of plans for site operations. It also provides information on current plans to the ARM functional teams (Management Team, Data and Science Integration Team [DSIT], Operations Team, Instrument Team [IT], and Campaign Team) and serves to disseminate the plans more generally within the ARM Program and among the members of the Science Team. This document includes a description of the operational status of the site and the primary site activities envisioned, together with information concerning approved and proposed intensive observation periods (IOPs). The primary users of this document are the site operator, the Site Scientist Team (SST), the Science Team through the ARM Program science director, the ARM Program Experiment Center, and the aforementioned ARM Program functional teams. This plan is a living document that is updated and reissued every six months as the observational facilities are developed, tested, and augmented and as priorities are adjusted in response to developments in scientific planning and understanding.
Site scientific mission plan for the Southern Great Plains CART site: July--December 1997
1997-07-01
The Southern Great Plains (SGP) Cloud and Radiation Testbed (CART) site is designed to help satisfy the data needs of the Atmospheric Radiation Measurement (ARM) Program Science Team. This document defines the scientific priorities for site activities during the six months beginning on July 1, 1997, and looks forward in lesser detail to subsequent six-month periods. The primary purpose of this Site Scientific Mission Plan is to provide guidance for the development of plans for site operations. It also provides information on current plans to the ARM functional teams and serves to disseminate the plans more generally within the ARM Program and among the members of the Science Team. This document includes a description of the operational status of the site and the primary site activities envisioned, together with information concerning approved and proposed intensive observation periods (IOPs). This plan is a living document that is updated and reissued every six months as the observational facilities are developed, tested, and augmented and as priorities are adjusted in response to developments in scientific planning and understanding.
Science and Technology for Bioterrorism Defense
2004-05-04
The Lawrence Livermore National Laboratory (LLNL) Chemical & Biological National Security Program (CBNP) provides science, technology, and integrated systems for chemical and biological security. Our approach is to develop and field systems that dramatically improve the nation's capabilities to prevent, prepare for, detect, and respond to terrorist use of chemical or biological weapons.
Science & Technology Review September/October 2008
2008-07-21
This issue has the following articles: (1) Answering Scientists Most Audacious Questions--Commentary by Dona Crawford; (2) Testing the Accuracy of the Supernova Yardstick--High-resolution simulations are advancing understanding of Type Ia supernovae to help uncover the mysteries of dark energy; (3) Developing New Drugs and Personalized Medical Treatment--Accelerator mass spectrometry is emerging as an essential tool for assessing the effects of drugs in humans; (4) Triage in a Patch--A painless skin patch and accompanying detector can quickly indicate human exposure to biological pathogens, chemicals, explosives, or radiation; and (5) Smoothing Out Defects for Extreme Ultraviolet Lithography--A process for smoothing mask defects helps move extreme ultraviolet lithography one step closer to creating smaller, more powerful computer chips.
Risk Analysis for Environmental Health Triage
2005-11-18
The Homeland Security Act mandates development of a national, risk-based system to support planning for, response to and recovery from emergency situations involving large-scale toxic exposures. To prepare for and manage consequences effectively, planners and responders need not only to identify zones of potentially elevated individual risk, but also to predict expected casualties. Emergency response support systems now define ''consequences'' by mapping areas in which toxic chemical concentrations do or may exceed Acute Exposure Guideline Levels (AEGLs) or similar guidelines. However, because AEGLs do not estimate expected risks, current unqualified claims that such maps support consequence management are misleading. Intentionally protective, AEGLs incorporate various safety/uncertainty factors depending on scope and quality of chemical-specific toxicity data. Some of these factors are irrelevant, and others need to be modified, whenever resource constraints or exposure-scenario complexities require responders to make critical trade-off (triage) decisions in order to minimize expected casualties. AEGL-exceedance zones cannot consistently be aggregated, compared, or used to calculate expected casualties, and so may seriously misguide emergency response triage decisions. Methods and tools well established and readily available to support environmental health protection are not yet developed for chemically related environmental health triage. Effective triage decisions involving chemical risks require a new assessment approach that focuses on best estimates of likely casualties, rather than on upper plausible bounds of individual risk. If risk-based consequence management is to become a reality, federal agencies tasked with supporting emergency response must actively coordinate to foster new methods that can support effective environmental health triage.
REBUILD AMERICA PROGRAM SCOPE OF WORK
2004-12-01
This report summarizes the activities carried out by Aspen Systems Corporation in support of the Department of Energy's Rebuild America program during the period from October 9, 1999 to October 31, 2004. These activities were in accordance with the Scope of Work contained in a GSA MOBIS schedule task order issued by the National Energy Technology Laboratory. This report includes descriptions of activities and results in the following areas: deployment/delivery model; program and project results; program representative support activities; technical assistance; web site development and operation; business/strategic partners; and training/workshop activities. The report includes conclusions and recommendations. Five source documents are also provided as appendices.
Proceedings of the NKS-R and NKS-B joint summary seminar
2009-08-15
Nordic Nuclear Safety Research (NKS) is a platform for Nordic cooperation and competence in nuclear safety and related radiation protection issues including emergency preparedness and protection of the environment. Its purpose is to carry out joint activities producing seminars, exercises, scientific articles, technical reports and other types of reference material, with special efforts made to engage young scientists. The region in question is the five Nordic countries, i.e., Denmark (including the Faroe Islands and Greenland), Finland, Iceland, Norway and Sweden, who share a common cultural and historic heritage. The Nordic countries have cooperated in the field of nuclear safety for approximately half a century, developing informal networks for exchange of information, strengthening the region's potential for fast, coordinated and adequate response to nuclear threats, incidents and accidents. Activities are financed and supported by Nordic authorities, research institutions, power companies, contractors and other organizations, with results used by participating organizations in their decision making processes and information efforts. The NKS-R and NKS-B Joint Summary Seminar held at the Armemuseum, Stockholm on the 26th - 27th of March 2009 showcased a range of activities supported by NKS over the previous 2 years and provided an opportunity to bring together researchers and end users from the wider NKS community. This summary seminar was the first joint venture between the NKS-R and NKS-B Programmes since the current two programme format was adopted by NKS. One of our intentions in organising the Joint Summary Seminar was to further the reciprocal awareness of ongoing research and issues under the respective NKS-R and NKS-B Programmes, with the aim of promoting new networking opportunities and generating new ideas and approaches to solving existing problems. (au)
NCIDEA: Board of Scientific Advisors Meeting Minutes of November 15-16, 2007
The first year estimated cost is $19 M for 4 U19 and 20 U01 awards. A total cost of $104 M over 5 years.
NCIDEA: Board of Scientific Advisors Meeting Minutes of March 7-8, 2005
Division of Extramural Activities Site map Contact us Home | Funding | Advisory | NCI Research Priorities | Funded Awards | Research Resources | Events | NCI News Board of Scientific Advisors Meeting Minutes March
Metropolitan area network support at Fermilab
2007-09-01
Advances in wide area network service offerings, coupled with comparable developments in local area network technology have enabled many research sites to keep their offsite network bandwidth ahead of demand. For most sites, the more difficult and costly aspect of increasing wide area network capacity is the local loop, which connects the facility LAN to the wide area service provider(s). Fermilab, in coordination with neighboring Argonne National Laboratory, has chosen to provide its own local loop access through leasing of dark fiber to nearby network exchange points, and procuring dense wave division multiplexing (DWDM) equipment to provide data channels across those fibers. Installing and managing such optical network infrastructure has broadened the Laboratory's network support responsibilities to include operating network equipment that is located off-site, and is technically much different than classic LAN network equipment. Effectively, the Laboratory has assumed the role of a local service provider. This paper will cover Fermilab's experiences with deploying and supporting a Metropolitan Area Network (MAN) infrastructure to satisfy its offsite networking needs. The benefits and drawbacks of providing and supporting such a service will be discussed.
1999-09-29
Traditional estimates of health risk are typically inflated, particularly if cancer is the dominant endpoint and there is fundamental uncertainty as to mechanism(s) of action. Risk is more realistically characterized if it accounts for joint uncertainty and interindividual variability after applying a unified probabilistic approach to the distributed parameters of all (linear as well as nonlinear) risk-extrapolation models involved. Such an approach was applied to characterize risks to potential future residents posed by trichloroethylene (TCE) in ground water at an inactive landfill site on Beale Air Force Base in California. Variability and uncertainty were addressed in exposure-route-specific estimates of applied dose, in pharmacokinetically based estimates of route-specific metabolized fractions of absorbed TCE, and in corresponding biologically effective doses estimated under a genotoxic/linear (MA{sub g}) vs. a cytotoxic/nonlinear (MA{sub c}) mechanistic assumption for TCE-induced cancer. Increased risk conditional on effective dose was estimated under MA{sub G} based on seven rodent-bioassay data sets, and under MA, based on mouse hepatotoxicity data. Mean and upper-bound estimates of combined risk calculated by the unified approach were <10{sup -6} and <10{sup -4}, respectively, while corresponding estimates based on traditional deterministic methods were >10{sup -5} and >10{sup -4}, respectively. It was estimated that no TCE-related harm is likely occur due any plausible residential exposure scenario involving the site. The unified approach illustrated is particularly suited to characterizing risks that involve uncertain and/or diverse mechanisms of action.
Medication Histories Conducted by Nurses (RNs), Pharmacy Techs (CPhTs) & Pharmacists (RPhs)
Medication Reconciliation; Emergency Department
Medical student disaster medicine education: the development of an educational resource
Full Text Available.BackgroundDisaster medicine education is an enormous challenge, but indispensable for disaster preparedness.AimsWe aimed to develop and implement a disaster medicine curriculum for medical student education that can serve as a peer-reviewed, structured educational guide and resource. Additionally, the process of designing, approving and implementing such a curriculum is presented.MethodsThe six-step approach to curriculum development for medical education was used as a formal process instrument. Recognized experts from professional and governmental bodies involved in disaster health care provided input using disaster-related physician training programs, scientific evidence if available, proposals for education by international disaster medicine organizations and their expertise as the basis for content development.ResultsThe final course consisted of 14 modules composed of 2-h units. The concepts of disaster medicine, including response, medical assistance, law, command, coordination, communication, and mass casualty management, are introduced. Hospital preparedness plans and experiences from worldwide disaster assistance are reviewed. Life-saving emergency and limited individual treatment under disaster conditions are discussed. Specifics of initial management of explosive, war-related, radiological/nuclear, chemical, and biological incidents emphasizing infectious diseases and terrorist attacks are presented. An evacuation exercise is completed, and a mass casualty triage is simulated in collaboration with local disaster response agencies. Decontamination procedures are demonstrated at a nuclear power plant or the local fire department, and personal decontamination practices are exercised. Mannequin resuscitation is practiced while personal protective equipment is utilized. An interactive review of professional ethics, stress disorders, psychosocial interventions, and quality improvement efforts complete the training.ConclusionsThe curriculum offers medical disaster education in a reasonable time frame, interdisciplinary format, and multi-experiential course. It can serve as a template for basic medical student disaster education. Because of its comprehensive but flexible structure, it should also be helpful for other health-care professional student disaster education programs.
Medical student disaster medicine education: the development of an educational resource
BackgroundDisaster medicine education is an enormous challenge, but indispensable for disaster preparedness.AimsWe aimed to develop and implement...Full Text Available
MRI follow-up of conservatively treated meniscal knee lesions in general practice
2010-05-01
Full Text Available.
L:\Group\FMB\3 Presentation to Congress\2004\Congressional Justification Web Version\cj web.PDF
Justification narrative........................................................................................................5 Budget mechanism table.................................................................................................32 Budget authority by activity............................................................................................33 Summary of changes.......................................................................................................34 Budget authority by object..............................................................................................36 Salaries and expenses......................................................................................................37 Significant items in Senate Appropriation Committee Report.......................................38 Authorizing legislation...................................................................................................99 Appropriation history...................................................................................................100 Detail of full-time equivalent employment (FTE).......................................................101 Detail of positions.
Impact of HIV Infection on Diastolic Function and Left Ventricular Mass
2010-01-01
Full Text Available.BackgroundHIV patients have increased risk for cardiovascular disease, but the underlying mechanisms remain unknown. The purpose of this study was to determine the prevalence of echocardiographic abnormalities among asymptomatic HIV-infected individuals compared to HIV-uninfected individuals.Methods/ResultsWe performed echocardiography in 196 HIV-infected adults and 52 controls. Left ventricular ejection fraction (LVEF), left ventricular mass indexed to the body surface area (LVMI), and diastolic function were assessed according to American Society of Echocardiography standards. LVMI was higher in HIV-infected patients (77.2g/m2 in HIV patients vs. 66.5g/m2 in controls, p<0.0001). LVEF was similar in both groups. Eight(4%) of the HIV patients had evidence of LV systolic dysfunction (defined as an EF<50%) versus none of the controls; 97(50%) had mild diastolic dysfunction compared to 29% of the HIV-uninfected subjects (p=0.008). After adjustment for hypertension and race, HIV-infected participants had a mean 8g/m2 larger LVMI compared to controls (p=0.001). Higher LVMI was independently associated with lower nadir CD4 T cell count, suggesting that immunodeficiency may play a role in this process. After adjustment for age and traditional risk factors, HIV patients had a 2.4 greater odds of having diastolic dysfunction as compared to controls (p=0.019).ConclusionsHIV-infected patients had a higher prevalence of diastolic dysfunction and higher LVMI compared to controls. These differences were not readily explained by differences in traditional risk factors and were independently associated with HIV infection. These results suggest that contemporary asymptomatic HIV patients manifest mild functional and morphological cardiac abnormalities which are independently associated with HIV infection.
Impact of HIV Infection on Diastolic Function and Left Ventricular Mass
2010-01-01
BackgroundHIV patients have increased risk for cardiovascular disease, but the underlying mechanisms remain unknown. The purpose of this study was to determine the...Full Text Available
Full Text Available.BackgroundRecently published results from a large randomized trial (Canadian Cervical Cancer Screening Trial study group) suggest that human papillomavirus testing followed by Pap smear-based triage for human papillomavirus positive women may be an effective way to screen women for cervical cancer. We determined the potential cost-effectiveness of including human papillomavirus tests for cervical cancer screening for Canada and three provinces: Alberta, Newfoundland and Ontario.MethodsWe developed four Markov decision models using data from relevant Canadian and provincial studies and databases. The models were used to determine the number of false positive test results, cancers, lifetime costs and life-expectancy for 27 different screening strategies that varied by age to begin screening (18 or 25 years), screening interval (one, two, three, or five years) and whether the currently recommended strategy (screening every year from age 18 until 21 and then every three years afterwards with conventional Paps) was conducted prior to age 25. Strategies were compared using incremental cost-effectiveness ratios.ResultsScreening strategies beginning at age 18 were associated with a substantial increase in the number of false-positive test results but only small differences in the number of cancers compared to the same strategy conducted beginning at age 25. Strategies of human papillomavirus testing first, followed by triage with Pap smears were associated with lower costs and greater increases in life-expectancy than the currently recommended screening strategy in Canada.ConclusionA strategy of human papillomavirus testing beginning at age 25, with Pap triage for women with positive human papillomavirus results may be more effective at reducing cervical cancer at a lower cost than the current recommended strategy for screening in Canada.
BackgroundRecently published results from a large randomized trial (Canadian Cervical Cancer Screening Trial study group) suggest that human papillomavirus testing followed by Pap...Full Text Available
High definition ultrasound imaging for battlefield medical applications
1996-06-23
A team has developed an improved resolution ultrasound system for low cost diagnostics. This paper describes the development of an ultrasound based imaging system capable of generating 3D images showing surface and subsurface tissue and bone structures. We include results of a comparative study between images obtained from X-Ray Computed Tomography (CT) and ultrasound. We found that the quality of ultrasound images compares favorably with those from CT. Volumetric and surface data extracted from these images were within 7% of the range between ultrasound and CT scans. We also include images of porcine abdominal scans from two different sets of animal trials.
TITLE I?DEPARTMENT OF LABOR TRAINING AND EMPLOYMENT SERVICES Language prohibiting the use of funds from any other appropria-tion to provide meal services at or for Job Corps centers.
2009-09-17
SummaryAcute respiratory infections (ARI) are a common reason for seeking medical attention and the threat of pandemic influenza will likely add to these numbers. Using human...Full Text Available
2009-09-17
Full Text Available.SummaryAcute respiratory infections (ARI) are a common reason for seeking medical attention and the threat of pandemic influenza will likely add to these numbers. Using human viral challenge studies with live rhinovirus, respiratory syncytial virus, and influenza A, we developed peripheral blood gene expression signatures that distinguish individuals with symptomatic ARI from uninfected individuals with > 95% accuracy. We validated this “acute respiratory viral” signature - encompassing genes with a known role in host defense against viral infections - across each viral challenge. We also validated the signature in an independently acquired dataset for influenza A and classified infected individuals from healthy controls with 100% accuracy. In the same dataset, we could also distinguish viral from bacterial ARIs (93% accuracy). These results demonstrate that ARIs induce changes in human peripheral blood gene expression that can be used to diagnose a viral etiology of respiratory infection and triage symptomatic individuals.
2010-03-01
Full Text Available.European Guidelines for Quality Assurance in Cervical Cancer Screening have been initiated in the Europe Against Cancer Programme. The first edition established the principles of organised population-based screening and stimulated numerous pilot projects. The second multidisciplinary edition was published in 2008 and comprises ∼250 pages divided into seven chapters prepared by 48 authors and contributors. Considerable attention has been devoted to organised, population-based programme policies which minimise adverse effects and maximise benefits of screening. It is hoped that this expanded guidelines edition will have a greater impact on countries in which screening programmes are still lacking and in which opportunistic screening has been preferred in the past. Other methodological aspects such as future prospects of human papillomavirus testing and vaccination in cervical cancer control have also been examined in the second edition; recommendations for integration of the latter technologies into European guidelines are currently under development in a related project supported by the European Union Health Programme. An overview of the fundamental points and principles that should support any quality-assured screening programme and key performance indicators are presented here in a summary document of the second guidelines edition in order to make these principles and standards known to a wider scientific community.
2010-03-01
European Guidelines for Quality Assurance in Cervical Cancer Screening have been initiated in the Europe Against Cancer Programme. The first edition established the principles of organised population-based...Full Text Available
Diagnostic errors: The new focus of patient safety experts
Johns Hopkins patient safety experts say it's high time for diagnostic errors to get the same attention from medical institutions and caregivers as drug-prescribing errors, wrong-site surgeries and hospital-acquired ...
1996-12-31
This paper presents the research program for the development of a prototype of high performances heat pipe (HPHP) intended to be installed on the STENTOR telecommunication satellite. A trade-off study was performed and led to the selection of a reliable and simple concept with axial grooves, ammonia and a minimum heat transport capacity of 500 W.m. A first model with a 17 mm diameter, a 2.8 m length and a mass lower than 500 g/m has been manufactured and tested. First results indicate a 600 W.m heat transport capacity at 20 deg. C (horizontal position) and a 400 W.m capacity with a 5 mm tilt, and allow to validate this concept. (J.S.) 6 refs.
Full Text Available.BackgroundImplementing quality improvement programs that require behavior change on the part of health care professionals and patients has proven difficult in routine care. Significant randomized trial evidence supports creating fall prevention programs for community-dwelling older adults, but adoption in routine care has been limited. Nationally-collected data indicated that our local facility could improve its performance on fall prevention in community-dwelling older people. We sought to develop a sustainable local fall prevention program, using theory to guide program development.MethodsWe planned program development to include important stakeholders within our organization. The theory-derived plan consisted of 1) an initial leadership meeting to agree on whether creating a fall prevention program was a priority for the organization, 2) focus groups with patients and health care professionals to develop ideas for the program, 3) monthly workgroup meetings with representatives from key departments to develop a blueprint for the program, 4) a second leadership meeting to confirm that the blueprint developed by the workgroup was satisfactory, and also to solicit feedback on ideas for program refinement.ResultsThe leadership and workgroup meetings occurred as planned and led to the development of a functional program. The focus groups did not occur as planned, mainly due to the complexity of obtaining research approval for focus groups. The fall prevention program uses an existing telephonic nurse advice line to 1) place outgoing calls to patients at high fall risk, 2) assess these patients' risk factors for falls, and 3) triage these patients to the appropriate services. The workgroup continues to meet monthly to monitor the progress of the program and improve it.ConclusionA theory-driven program development process has resulted in the successful initial implementation of a fall prevention program.
BackgroundImplementing quality improvement programs that require behavior change on the part of health care professionals and patients has proven difficult in routine care. Significant...Full Text Available
DEA_2005_Annual Report_Cov_FINAL REVS.qxp
Suzich JA, Ghim S, Palmer-Hill FJ, White WI, Tamura JK, Bell J, Newsome JA, Jenson AB, and Schlegel R. Systemic immuniza-tion with papillomavirus L1 protein completely prevents the development of viral mucosal papillomas.
Controlling a sea of information
Curators at one of the world's most widely used biological databases, The Arabidopsis Information Resource, or TAIR, have joined forces with the journal Plant Physiology, to solve the "flood of information" dilemma. It ...
Full Text Available.BackgroundSince the last decade there has been a gradual change of boundaries of health professions in providing arthritis care. In Canada, some facilities have begun to adopt new arthritis care models, some of which involve physiotherapists (PT) working in extended roles. However, little is known about PTs' interests in these new roles. The primary objective of this survey was to determine the interests among orthopaedic physiotherapists (PTs) in being a certified arthritis therapist, a PT specialized in arthritis, or an extended scope practitioner in rheumatology, and to explore the associated factors, including the coverage of arthritis content in the entry-level physiotherapy training.MethodsSix hundred PTs practicing in orthopaedics in Canada were randomly selected to receive a postal survey. The questionnaire covered areas related to clinical practice, perceptions of rheumatology training received, and attitudes toward PT roles in arthritis care. Logistic regression models were developed to explore the associations between PTs' interests in pursuing each of the three extended scope practice designations and the personal/professional/attitudinal variables.ResultsWe received 286 questionnaires (response rate = 47.7%); 258 contained usable data. The average length of time in practice was 15.4 years (SD = 10.4). About 1 in 4 PTs agreed that they were interested in assuming advanced practice roles (being a certified arthritis therapist = 28.9%, being a PT specialized in rheumatology = 23.3%, being a PT practitioner = 20.9%). Having a caseload of ≥ 40% in arthritis, having a positive attitude toward advanced practice roles in arthritis care and toward the formal credentialing process, and recognizing the difference between certification and specialisation were associated with an interest in pursing advanced practice roles.ConclusionOrthopaedic PTs in Canada indicated a fair level of interest in pursuing certification, specialisation and extended scope practice roles in arthritis care. Future research should focus on the effectiveness and cost-effectiveness of the emerging health service delivery models involving certified, specialized or extended scope practice PTs in the management of arthritis.
BackgroundSince the last decade there has been a gradual change of boundaries of health professions in providing arthritis care. In Canada, some facilities have begun to adopt new...Full Text Available
Full Text Available.BackgroundThe aims of this study were to estimate the prevalence of left ventricular systolic (LVSD) and diastolic (LVDD) dysfunction, and to test if BNP and urinary albumin excretion rate (AER) are related to LVSD, LVD and left ventricular mass (LVM) in asymptomatic type 2 diabetes patients.MethodsPresence of LVSD, LVDD and LVM, determined with echocardiography, was related to levels of BNP and AER in 153 consecutive asymptomatic patients with type 2 diabetes.ResultsLVSD was present in 6.1% of patients whereas 49% (29% mild, 19% moderate and 0.7% severe) had LVDD and 9.4% had left ventricular hypertrophy. Increasing age (P < 0.0001) was the only independent variable related to mild LVDD whereas increasing BNP (P = 0.01), systolic blood pressure (P = 0.01), age (P = 0.003) and female gender (P = 0.04) were independent determinants of moderate to severe LVDD. AER (P = 0.003), age (P = 0.01) and male gender (P = 0.006) were directly and independently related to LVM.ConclusionAbout half of asymptomatic type 2 diabetes patients have LVDD. Of those, more than one third display moderate LVDD pattern paralleled by increases in BNP, suggesting markedly increased risk of heart failure, especially in females, whereas AER and male sex are related to LVM.
BackgroundThe aims of this study were to estimate the prevalence of left ventricular systolic (LVSD) and diastolic (LVDD) dysfunction, and to test if BNP and urinary albumin excretion...Full Text Available
2009-11-16
Exposure to ionizing radiation produces few immediate outwardly-visible clinical signs, yet, depending on dose, can severely damage vital physiological functions within days to weeks and produce long-lasting health consequences among survivors. In the event of a radiological accident, the rapid evaluation of the individual absorbed dose is paramount to discriminate the worried but unharmed from those individuals who must receive medical attention. Physical, clinical and biological dosimetry are usually combined for the best dose assessment. However, because of the practical limits of physical and clinical dosimetry, many attempts have been made to develop a dosimetry system based on changes in biological parameters, including techniques for hematology, biochemistry, immunology, cytogenetics, etc. Lymphocyte counts and chromosome aberrations analyses are among the methods that have been routinely used for estimating radiation dose. However, these assays require several days to a week to be completed and therefore cannot be used to obtain a fast estimate of the dose during the first few days after exposure when the information would be most critical for identifying victims of radiation accidents who could benefit the most by medical intervention. The steadily increasing sophistication in our understanding of the early biochemical responses of irradiated cells and tissues provides the opportunity for developing mechanism-based biosignatures of exposure. Compelling breakthroughs have been made in the technologies for genome-scale analysis of cellular transcriptional and proteomic profiles. There have also been major strides in the mechanistic understanding of the early events in DNA damage and radiation damage products, as well as in the cellular pathways that lead to radiation injury. New research with genomic- and proteomic-wide tools is showing that within minutes to hours after exposure to ionizing radiation protein machines are modified and activated, and large-scale changes occur in the gene expression profile involving a broad variety of cell-process pathways after a wide range of both low (10 cGy) exposures. Evaluation of these potential gene and protein biomarkers for early and late diagnostic information will be critical for determining the efficacy of the signatures to both low and high dose IR exposures. Also needed are approaches that enable rapid handling and processing for mass-casualty and population triage scenarios. Development of in vivo model system will be crucial for validating both the biological and the instrumentation for biodosimetry. Such studies will also help further understanding of the molecular mechanisms of the biological effects of radiation and the differences of responses due to individual genetic variation.
Full Text Available.Background:The reliability of patient history and clinical information on Pap test requisitions has been questioned but not previously objectively determined. The effect of incomplete/inaccurate information on quality of patient care has not been previously quantified. Our objectives were (1) to find out how clinicians and their assistants viewed the requisition slip, and whether they understood the reasons for supplying the information requested, (2) to measure the completeness and accuracy of information on the requisition slips, and (3) to determine whether the clinical information and patient history provided on Pap test requisitions could be relied upon to accurately assign a Pap test to the laboratory's “high-risk rescreen” pool.Methods:Clinicians and their assistants were surveyed. A total of 899 consecutive Pap test requisition slips were reviewed. Patient history and clinical information from the slips were compared to data from our laboratory information system and/or electronic patient medical records.Results:Most survey respondents felt that proper completion of requisitions was important, but only 17% of clinicians and less staff realized that negative high-risk Pap tests underwent a quality assurance rescreen. Clinicians and/or staff recorded the last menstrual period, specimen source, and clinical information on the requisition slips 96%, 97%, and 88% of the time, respectively. Of 695 Pap tests with applicable computerized records, 172 (25%) qualified for high-risk rescreen based upon information provided on the requisition slip alone. An additional 52 Pap tests (7%), or 23% of the total high-risk Pap tests were discovered to be of high risk only after review of the electronic records.Conclusions:Clinicians and staff were receptive to discussions concerning the completion of requisition slips, but laboratory expectations could be better communicated. Requisition slips were properly completed with a high frequency, but the check boxes did not elicit all the information expected, so revision was necessary. The high accuracy of the completion of requisition slips permitted 77% of high-risk Pap tests to be identified via the requisition slip alone. Our findings challenge the conventional anecdotal impressions of “notoriously unreliable” information on Pap test requisition slips, but our experience may not be applicable to other settings.
Background:The reliability of patient history and clinical information on Pap test requisitions has been questioned but not previously objectively determined. The effect...Full Text Available
IntroductionLesotho has the third highest HIV prevalence in the world (an adult prevalence of 23.2%). Despite a lack of resources for health, the country has implemented state-of-the-art...Full Text Available
Full Text Available.IntroductionLesotho has the third highest HIV prevalence in the world (an adult prevalence of 23.2%). Despite a lack of resources for health, the country has implemented state-of-the-art antiretroviral treatment guidelines, including early initiation of treatment (<350 cells/mm3), tenofovir in first line, and nurse-initiated and managed HIV care, including antiretroviral therapy (ART), at primary health care level.Programme approachWe describe two-year outcomes of a decentralized HIV/AIDS care programme run by Doctors Without Borders/Médecins Sans Frontières, the Ministry of Health and Social Welfare, and the Christian Health Association of Lesotho in Scott catchment area, a rural health zone covering 14 clinics and one district hospital. Outcome data are described through a retrospective cohort analysis of adults and children initiated on ART between 2006 and 2008.Discussion and EvaluationOverall, 13,243 people have been enrolled in HIV care (5% children), and 5376 initiated on ART (6.5% children), 80% at primary care level. Between 2006 and 2008, annual enrolment more than doubled for adults and children, with no major external increase in human resources. The proportion of adults arriving sick (CD4 <50 cells/mm3) decreased from 22.2% in 2006 to 11.9% in 2008. Twelve-month outcomes are satisfactory in terms of mortality (11% for adults; 9% for children) and loss to follow up (8.8%). At 12 months, 80% of adults and 89% of children were alive and in care, meaning they were still taking their treatment; at 24 months, 77% of adults remained in care.ConclusionDespite major resource constraints, Lesotho is comparing favourably with its better resourced neighbour, using the latest international ART recommendations. The successful two-year outcomes are further evidence that HIV/AIDS care and treatment can be provided effectively at the primary care level. The programme highlights how improving HIV care strengthened the primary health care system, and validates several critical areas for task shifting that are being considered by other countries in the region, including nurse-driven ART for adults and children, and lay counsellor-supported testing and counselling, adherence and case management.
Addressing Competencies for the Future in the Professional Curriculum
2009-12-17
This paper reviews the literature, analyzes current and future practice, develops a list of competencies necessary for future pharmacists, and provides recommendations to pharmacy's academic enterprise...Full Text Available
Addressing Competencies for the Future in the Professional Curriculum
2009-12-17
Full Text Available.This paper reviews the literature, analyzes current and future practice, develops a list of competencies necessary for future pharmacists, and provides recommendations to pharmacy's academic enterprise regarding curricula of the future. Curricula of the future will center around 3 functional roles for pharmacists: patient-centered care, population-based care, and systems management; and must also foster the development of 5 cross-cutting abilities in student pharmacists: professionalism, self-directed learning, leadership and advocacy, interprofessional collaboration, and cultural competency. Future curricula must be developed in an evidence-based manner, focus less on information storage and retrieval, engage student pharmacists in a variety of highly interactive learning experiences, and expand experiential learning opportunities throughout all years.
A systematic review of task- shifting for HIV treatment and care in Africa
Full Text Available.BackgroundShortages of human resources for health (HRH) have severely hampered the rollout of antiretroviral therapy (ART) in sub-Saharan Africa. Current rollout models are hospital- and physician-intensive. Task shifting, or delegating tasks performed by physicians to staff with lower-level qualifications, is considered a means of expanding rollout in resource-poor or HRH-limited settings.MethodsWe conducted a systematic literature review. Medline, the Cochrane library, the Social Science Citation Index, and the South African National Health Research Database were searched with the following terms: task shift*, balance of care, non-physician clinicians, substitute health care worker, community care givers, primary healthcare teams, cadres, and nurs* HIV. We mined bibliographies and corresponded with authors for further results. Grey literature was searched online, and conference proceedings searched for abstracts.ResultsWe found 2960 articles, of which 84 were included in the core review. 51 reported outcomes, including research from 10 countries in sub-Saharan Africa. The most common intervention studied was the delegation of tasks (especially initiating and monitoring HAART) from doctors to nurses and other non-physician clinicians. Five studies showed increased access to HAART through expanded clinical capacity; two concluded task shifting is cost effective; 9 showed staff equal or better quality of care; studies on non-physician clinician agreement with physician decisions was mixed, with the majority showing good agreement.ConclusionsTask shifting is an effective strategy for addressing shortages of HRH in HIV treatment and care. Task shifting offers high-quality, cost-effective care to more patients than a physician-centered model. The main challenges to implementation include adequate and sustainable training, support and pay for staff in new roles, the integration of new members into healthcare teams, and the compliance of regulatory bodies. Task shifting should be considered for careful implementation where HRH shortages threaten rollout programmes.
A systematic review of task- shifting for HIV treatment and care in Africa
BackgroundShortages of human resources for health (HRH) have severely hampered the rollout of antiretroviral therapy (ART) in sub-Saharan Africa. Current rollout models are hospital-...Full Text Available
2010-01-01
Within 2 months of its discovery last spring, a novel influenza A (H1N1) virus, currently referred to as 2009 H1N1, caused the first influenza pandemic in decades. The virus has caused disproportionate...Full Text Available
2010-01-01
Full Text Available.Within 2 months of its discovery last spring, a novel influenza A (H1N1) virus, currently referred to as 2009 H1N1, caused the first influenza pandemic in decades. The virus has caused disproportionate disease among young people with early reports of virulence similar to that of seasonal influenza. This clinical review provides an update encompassing the virology, epidemiology, clinical manifestations, diagnosis, treatment, and prevention of the 2009 H1N1 virus. Because information about this virus, its prevention, and treatment are rapidly evolving, readers are advised to seek additional information. We performed a literature search of PubMed using the following keywords: H1N1, influenza, vaccine, pregnancy, children, treatment, epidemiology, and review. Studies were selected for inclusion in this review on the basis of their relevance. Recent studies and articles were preferred.
Tr avis worked with investigators in Europe and Canada to compile a cohort of over 32,000 HD patients from 16 registries in Europe and North America.
Modeling Requirements for Simulating the Effects of Extreme Acts of Terrorism: A White Paper
1998-10-01
This white paper presents the initial requirements for developing a new computer model for simulating the effects of extreme acts of terrorism in the United States. General characteristics of the model are proposed and the level of effort to prepare a complete written description of the model, prior to coding, is detailed. The model would simulate the decision processes and interactions of complex U. S. systems engaged in responding to and recovering from four types of terrorist incidents. The incident scenarios span the space of extreme acts of terrorism that have the potential to affect not only the impacted area, but also the entire nation. The model would be useful to decision-makers in assessing and analyzing the vulnerability of the nation's complex infrastructures, in prioritizing resources to reduce risk, and in planning strategies for immediate response and for subsequent recovery from terrorist incidents.
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