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1
Glidden, Peter L. "Soundoff: How National Examinations Can Benefit Students and Teachers." Mathematics Teacher 85, no. 8 (November 1992): 610–11. http://dx.doi.org/10.5951/mt.85.8.0610.
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Several reform groups, including the President's Education Policy Advisory Committee and Educate America, are calling for national examinations for high school students. Examination advocates claim the following benefits: the establishment of national standards, increased accountability, and increased motivation for students. Advocates also point out that the United States is the only major industrialized country without some sort of national examination. Critics claim that examinations restrict teachers' creativity; force teachers to teach for the examination; and promote improper comparisons among states, districts, schools, teachers, and students. (See, e.g., DeWitt [1991]).
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Duncan, Pamela W. "One Grip a Little Stronger." Physical Therapy 83, no. 11 (November 1, 2003): 1014–21. http://dx.doi.org/10.1093/ptj/83.11.1014.
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Abstract Pamela W Duncan, PT, PhD, FAPTA Dr Duncan has actively participated in and contributed to physical therapist practice, physical therapist professional education, professional preparation of other health care providers, national policy development related to rehabilitation after stroke and aging, and scientific investigation. She has served several government appointments and provides leadership within several organizations. She served as co-chair of the Consensus Panel on Establishing Guidelines for Stroke Rehabilitation for the Agency for Health Care Policy, Research, and Education. She was a panel member on the National Institutes of Health's Total Hip Replacement Consensus Conference and served on the Strategic Planning Group for Stroke Research for the National Institute of Neurological Disorders and Stroke. She recently was appointed to serve on the Steering Committee of the Department of Education's National Institute on Disability and Rehabilitation Research and is currently on the Executive Leadership Council of the American Stroke Foundation and the Advisory Committee of the Canadian Stroke Network. She has served on committees and panels for the American Heart Association and was president of APTA's Neurology section. Dr Duncan's research activities focus on geriatric rehabilitation, stroke rehabilitation, and health outcomes measurement. She developed the Functional Reach Test, used to assess balance in older adults. In the past 20 years, she has received $13 million in research awards as principal investigator or co-investigator from agencies such as the National Institutes of Health, National Institute on Aging, American Heart Association, Department of Veteran's Affairs, and National Center for Medical Rehabilitation Research and from multiple private funding sources. Dr Duncan has disseminated her research findings in more than 80 peer-reviewed articles in 20 different journals, and she has written a book and 12 book chapters. Dr Duncan's work has influenced the care and rehabilitation of patients in the United States and worldwide. Physical therapy education programs across the country incorporate her findings and professional vision into the preparation of the next generation of physical therapists. APTA has awarded Dr Duncan the Marian Williams Award for Research in Physical Therapy, the Catherine Worthingham Fellowship Award, and the Mary McMillan Scholarship Award. She has also received research awards from the APTA Neurology Section, Sports Physical Therapy Section, and Section on Geriatrics, as well as a service award from the Neurology Section. She is an elected fellow of the Stroke Council of the American Heart Association and has given 8 invited lectureships at universities across the United States.
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Harris, Lauren, Daniel Gilmore, Anne Longo, and Brittany N. Hand. "Short report: Patterns of US federal autism research funding during 2017–2019." Autism 25, no. 7 (March 25, 2021): 2135–39. http://dx.doi.org/10.1177/13623613211003430.
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In 2017, the Interagency Autism Coordinating Committee, a federal advisory panel consisting of autism researchers and community members, recommended that funders of autism research prioritize research projects on: (1) treatments/interventions, (2) evidence-based services, and (3) lifespan issues. We sought to describe research funding since this recommendation was made. We searched the databases of the three largest federal funders of autism research in the United States (National Institutes of Health, Department of Education, and Centers for Disease Control and Prevention) for grants awarded during 2017–2019. We categorized grants as follows: autism screening and diagnosis, biology, risk factors, treatments and interventions, services, lifespan issues, or infrastructure and surveillance. We found that funding patterns remained largely consistent during 2017–2019. Biological research received a relative majority of funding (32.59%), followed by treatments and interventions (22.87%). While given higher funding priority by the Interagency Autism Coordinating Committee’s recent budget recommendation, fewer funds were awarded to research areas like services (5.02%) and lifespan issues (2.51%), indicating a misalignment between funding patterns and the Interagency Autism Coordinating Committee budget recommendation. These findings emphasize the need for autism research funding to align with the Interagency Autism Coordinating Committee budget recommendations to best meet the needs of the autism community, particularly autistic younger, middle-aged, and older adults. Lay abstract In 2017, an advisory board consisting of autism researchers and community members recommended that funders of autism research prioritize research projects on: (1) treatments/interventions, (2) evidence-based services, and (3) lifespan issues. To describe funding in these areas since this recommendation was made, we searched the databases of the three largest federal funders of autism research in the United States. We found that the largest portion of federal funding during 2017–2019 was awarded to research on the biology of autism (32.59%) and treatments and interventions for autism (22.87%). Less funds were awarded to research areas that are high funding priorities by the Interagency Autism Coordinating Committee budget recommendation including services (5.02%) and lifespan issues (2.51%). Our findings emphasize that autism research funding is not consistent with the Interagency Autism Coordinating Committee budget recommendation to increase funding particularly to services and lifespan issues. We recommend that funding patterns should shift to better align with these priorities so that autism research may better serve the needs of the autism community.
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Walz, Bruce J., Richard A. Bissell, Brian Maguire, and James A. Judge. "Vaccine Administration by Paramedics: A Model for Bioterrorism and Disaster ResponsePreparation." Prehospital and Disaster Medicine 18, no. 4 (December 2003): 321–26. http://dx.doi.org/10.1017/s1049023x00000558.
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AbstractThe events of 11 September 2001 have had a profound effect on disaster planning efforts in the United States. This is true especially in the area of bioter-rorism. One of the major tenets of bioterrorism response is the vaccination of at-riskpopulations. This paper investigates the efficacy of training emergency medical services paramedics to administer vaccines in public health settings as preparation for and response to bioterrorism events and other disaster events.The concept of vaccination administration by specially trained paramedics is not new. Various programs to provide immunizations for emergency services personnel and at-risk civilian populations have been reported.Vaccination programs by paramedics should follow the guidelines of the National Vaccine Advisory Committee of the Centers for Disease Control and Prevention (CDC). Thispaper compares the seven standards of the CDC guidelines to routine paramedic practice and education. It is concluded that paramedics are adequately trained to administer vaccines. However, specific training and protocols are needed in the areas of administrative paperwork and patient education. A proposed outline for a paramedic-training program is presented.
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Walz, Bruce J., Richard A. Bissell, Brian Maguire, and James A. Judge. "Vaccine Administration by Paramedics: A Model for Bioterrorism and Disaster Response Preparation." Prehospital and Disaster Medicine 18, no. 4 (December 2003): 321–26. http://dx.doi.org/10.1017/s1049023x00001278.
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AbstractThe events of 11 September 2001 have had a profound effect on disaster planning efforts in the United States. This is true especially in the area of bioter-rorism. One of the major tenets of bioterrorism response is the vaccination of at-riskpopulations. This paper investigates the efficacy of training emergency medical services paramedics to administer vaccines in public health settings as preparation for and response to bioterrorism events and other disaster events.The concept of vaccination administration by specially trained paramedics is not new. Various programs to provide immunizations for emergency services personnel and at-risk civilian populations have been reported.Vaccination programs by paramedics should follow the guidelines of the National Vaccine Advisory Committee of the Centers for Disease Control and Prevention (CDC). Thispaper compares the seven standards of the CDC guidelines to routine paramedic practice and education. It is concluded that paramedics are adequately trained to administer vaccines. However, specific training and protocols are needed in the areas of administrative paperwork and patient education. A proposed outline for a paramedic-training program is presented.
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Stennett, Amanda, Norma Ofsthun, John Larkin, Marta Reviriego-Mendoza, Len Usvyat, Franklin W. Maddux, and Jeffrey Hymes. "Treatment of a Large National Population of Anemic Hemodialysis Patients with a Long-Lasting Erythropoietin Stimulating Agent." Blood 128, no. 22 (December 2, 2016): 1268. http://dx.doi.org/10.1182/blood.v128.22.1268.1268.
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Abstract Introduction: Patients with chronic kidney disease who progress to end stage renal disease (ESRD) require renal replacement therapy to assume some functions of the diseased kidney and sustain life. Hemodialysis (HD) is the most common option for renal replacement therapy in ESRD patients and includes routine treatments 3 times per week to filter uremic toxins and remove excess fluid from the blood. The prevalence of anemia is high in the ESRD population with about 80% of HD patients being treated with an erythropoietin stimulating agent (ESA) for management of anemia (United States Renal Data System. 2015 USRDS annual data report: Epidemiology of Kidney Disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, 2015). Until recently, there had only been a few of choices for ESA therapies in the United States, epoetin alfa, which is considered short-lasting (dosing generally greater than once per week), and darbepoetin alfa, which is middle-lasting (dosing generally once per week). Methoxy polyethylene glycol-epoetin beta is a long lasting ESA (dosing once per 2-4 weeks) that has been recently approved and permitted to be used for treatment of patients with anemia in the United States. At Fresenius Medical Care North America (FMCNA), we began the conversion from use of short- or middle-lasting ESAs to Methoxy polyethylene glycol-epoetin beta in our HD facilities in December of 2014. In this analysis, we aimed to determine the profiles of hemoglobin (Hgb) levels in this large national population of anemic HD patients treated with methoxy polyethylene glycol-epoetin beta. Methods: We retrospectively studied data on HD patients treated at FMCNA facilities that converted from epoetin alfa or darbepoetin alfa to using methoxy polyethylene glycol-epoetin beta for the standard of care treatment of anemia. Data for the weekly Hgb levels that were used to conduct anemia management using the ESAs was analyzed for comparisons. The target goal for ESA treatment at FMCNA is to maintain patient Hgb levels between 10 to 11 g/dL. We computed the 3 months profiles of mean Hgb levels associated with the routine clinical use of methoxy polyethylene glycol-epoetin beta in all (n=118,681) HD patients receiving the long-lasting ESA therapy at FMCNA during May to July of 2016. Additionally, evaluations of mean Hgb levels before and after the conversion to the long-lasting ESA was performed using patient data from September 2014 to July of 2015; this analysis included 24,223, 7,494, and 1,345 anemic HD patients who received methoxy polyethylene glycol-epoetin beta for maintenance of anemia for at least 2, 4 and 6 months, respectively. Results: We found that treatment of anemia in HD patients with methoxy polyethylene glycol-epoetin beta maintained Hgb levels steady at a mean value of 10.7g/dL for the population from May to July of 2016. In an evaluation of Hgb levels before and after the conversion from epoetin alfa or darbepoetin alfa to methoxy polyethylene glycol-epoetin beta, we observed a slight increase of 0.18, 0.17, and 0.15 g/dL in mean Hgb levels after 2, 4, and 6 months of patients receiving the long-lasting ESA for maintenance of anemia (Figures 1-3). There was a slight nadir mean Hgb level of 10.2 g/dL that occurred 1 week prior to conversion to the long-lasting ESA. This was a result of anemia protocols that had patients with higher Hgb values wait until the level had decreased before converting to the long-lasting ESA. Conclusions: The findings of this retrospective investigation indicate that the long-lasting ESA methoxy polyethylene glycol-epoetin beta maintains Hgb levels in target range for HD patients. The conversion from a short- or middle-lasting ESA to the long-lasting ESA methoxy polyethylene glycol-epoetin beta may be associated with overall a minor increase in mean Hgb levels that are on average within normal limits. Disclosures Stennett: Fresenius Medical Care North America: Employment. Ofsthun:Fresenius Medical Care North America: Employment, Equity Ownership. Larkin:Fresenius Medical Care North America: Employment. Reviriego-Mendoza:Fresenius Medical Care North America: Employment. Usvyat:Fresenius Medical Care North America: Employment, Equity Ownership. Maddux:American National Bank & Trust (NASDAQ: AMNB): Membership on an entity's Board of Directors or advisory committees; Fresenius Medical Care North America: Employment, Equity Ownership, Other: Founder: Scholarships Expanding Education 501c3 non profit, Research Funding; Kidney Care Partners: Membership on an entity's Board of Directors or advisory committees; Pacific Renal Care Foundation: Membership on an entity's Board of Directors or advisory committees; Specialty Care: Membership on an entity's Board of Directors or advisory committees; Sound Physicians: Membership on an entity's Board of Directors or advisory committees; Mid Atlantic Renal Coalition: Membership on an entity's Board of Directors or advisory committees. Hymes:Nephroceuticals: Consultancy, Membership on an entity's Board of Directors or advisory committees; Fresenius Medical Care North America: Employment, Equity Ownership.
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El Rassi, Fuad, John James, Biree Andemariam, Beverley Francis-Gibson, Caterina P. Minniti, Jincy Paulose, Tom Bailey, Olivera Rajkovic-Hooley, and Ifeyinwa Osunkwo. "Children in the United States with Sickle Cell Disease Experience Greater Educational Burden Than Those Living in Low/Middle Income and Other High-Income Countries." Blood 138, Supplement 1 (November 5, 2021): 3106. http://dx.doi.org/10.1182/blood-2021-146566.
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Abstract Introduction: The Sickle Cell World Assessment Survey (SWAY) was a cross-sectional survey to assess the global impact and treatment of sickle cell disease (SCD). Complications of SCD can lead to significant negative effects on patient (pt) quality of life. Recurrent vaso-occlusive crises (VOCs) are one of the most common SCD complications and can lead to poor quality of life and chronic organ damage. SCD manifestations can start as early as the first year of life. The implications of SCD on a child's life can be far reaching and may affect education, the global impact of which has not been well described. Here, we assess data from SWAY to better understand the impact of SCD on education among pediatric pts in the US vs other high-income countries (HIC) and low/middle-income countries (LMIC). Methods: SWAY included individuals aged ≥6 years with a diagnosis of SCD. The survey was completed by proxy (parent/caregiver/guardian) for pts aged 6-11 years and could be optionally self-completed by pts aged ≥12 years. The survey consisted of 7 ratings-based (Likert scale) questions focused on education, where a score of 5, 6, or 7 indicated increasing levels of agreement. Pediatric pts were defined as those aged <18 years. Per the World Bank definition, HIC were defined as having a gross national income per capita of ≥US$12,536; LMIC represented all remaining countries. SWAY was not designed to assess treatment outcomes; all analyses are descriptive. Age groups were not matched, and pts were not followed up over time. Results: Among the 769 pediatric pts participating in SWAY, there were 77 US respondents to the educational survey (mean age, 12 y), 200 HIC respondents (mean age, 13 y), and 492 LMIC respondents (mean age, 12 y, [one respondent did not provide an age]). Pediatric pts in all groups reported that SCD adversely impacted their education. Of the US respondents, 51%, 45%, and 52% agreed that SCD negatively impacted performance on school tests, overall performance at school, and school attendance, respectively. This was a higher rate of agreement for these statements than that reported by pediatric pts from other HIC (25%, 23%, 36%) and LMIC (37%, 41%, 50%). The US respondents also agreed that SCD negatively affected performance on homework (45%), caused them to repeat a year or class (42%), lowered interest in school (36%), and limited educational progression (35%). Again, this was a higher rate of agreement than that reported by pediatric pts from other HIC (26%, 14%, 19%, 20%) and LMIC (37%, 32%, 34%, 29%). Interestingly, the largest differences in reported school impact occurred between the US and HIC, where the US respondents showed nearly two-fold higher agreement for all statements except for reduced attendance. Conversely, there were only minor differences between respondents from the US and LMIC. Full results are presented in the Figure. Conclusions: A higher proportion of pediatric pts in the US reported a negative impact of SCD on schooling compared with those in HIC and LMIC. These results were unexpected but align strongly with the emerging evidence that social determinants prevalent in the US lends itself away from the benefits of living in a resource-rich nation. Figure 1 Figure 1. Disclosures James: GBT: Honoraria; Novartis: Honoraria. Francis-Gibson: Global Alliance of SCD Organizations: Membership on an entity's Board of Directors or advisory committees; Sickle Cell Disease Association of America: Current Employment; Alliance for Regenerative Medicine Foundation for Cell and Gene Medicine: Membership on an entity's Board of Directors or advisory committees; ASH: Membership on an entity's Board of Directors or advisory committees; Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees. Minniti: GBT: Consultancy, Research Funding; Novartis: Consultancy, Honoraria; NovoNordisk: Consultancy, Honoraria; Roche: Consultancy, Honoraria. Paulose: Novartis Pharmaceuticals Corporation: Current Employment. Bailey: Novartis Pharmaceuticals: Other: I am an employee of Adelphi Real World, which received payment from Novartis Pharmaceuticals for this research. Rajkovic-Hooley: Novartis Pharmaceuticals: Other: I am an employee of Adelphi Real World, which received payment from Novartis Pharmaceuticals for this research. Osunkwo: Forma Therapeutics: Consultancy, Membership on an entity's Board of Directors or advisory committees; Health and Services Administration: Research Funding; Patient Centered Outcomes Research Instituted: Research Funding; Micella Biopharma: Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy; Novartis: Consultancy, Honoraria, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Chiesi: Consultancy; Emmaus: Consultancy; Cyclerion: Consultancy; Acceleron: Consultancy; Global Blood Therapeutics: Consultancy, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau; Terumo: Consultancy.
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Andrade-Gonzalez, Xavier, Anuhya Kommalapati, Allison M. Bock, Jacqueline Wang, Antoine Saliba, Javier Munoz, David J. Inwards, et al. "Influence of Treatment Facility Type and Annual Patient Volume on Overall Survival in Patients with Mantle Cell Lymphoma: A National Cancer Database Analysis." Blood 138, Supplement 1 (November 5, 2021): 1348. http://dx.doi.org/10.1182/blood-2021-151888.
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Abstract Introduction: Mantle cell lymphoma (MCL) is an uncommon hematological malignancy with an estimated incidence of 1 per 100,000 persons per year in the United States and represents only about 5% of all non-Hodgkin lymphomas. Several studies have shown that treatment at academic centers and a higher hospital case volume are associated with improved outcomes for uncommon hematological malignancies, probably due to increased provider expertise and access to novel therapies. Treatment of MCL can be complex given the heterogenous nature of the disease and a frequent need for autologous stem cell transplantation in eligible patients. However, the impact of treatment at an academic center and facility patient volume on the survival of patients with MCL has not been well studied in large cohorts. In this study, we utilized the National Cancer Database (NCDB) to investigate the impact of treatment at an academic center and treatment facility volume on the overall survival (OS) of patients with MCL. Methods: The NCDB was used to identify adult patients (≥ 18 years) with newly diagnosed MCL from 2004 through 2017. For facility patient volume analysis, patients were divided into groups based on the average number of new MCL patients seen annually: Tercile 1 [T1] (1-3 patients/year), Tercile 2 [T2] (4-5 patients/year) and Tercile 3 [T3] (≥6 patients/year). Treating centers were divided into Academic and Non-academic using the NCDB definitions. Academic centers were defined as centers that accessions more than 500 newly diagnosed cancer cases per year, participate in postgraduate medical education in at least four program areas including internal medicine and surgery and participates in cancer-related clinical trials. The primary endpoint was overall survival (OS). Survival analysis was performed using the Kaplan-Meier method and Cox hazards proportional model. Statistical analysis was performed using SPSS version 25. Results: We identified 22,752 patients with MCL during the study period. 9,484 (42%) patients were treated at academic centers and 13,070 (57%) were treated at non-academic centers. In terms of facility patient volume 10,948 patients (48%) were in the T1 group, 4,637 (20%) were in the T2 group and 7,166 (31%) were in the T3 group. No significant differences were found in baseline demographics (age, gender, race/ethnicity, comorbidity scores), socioeconomical variables (insurance type, median income, area of residence) and disease-related factors (B-symptoms, Ann Arbor stage) between patients treated academic vs nonacademic centers, or between patients in T1 vs T2 vs T3 groups. Notably, compared to lower volume facilities, T3 facilities were more likely to be academic centers (T3: 81% vs T2: 42% vs T1: 16%, p<0.001) . After a median follow-up of 3.4 years, the median overall survival (OS) was 5.6 years for the entire cohort. The median OS was inferior for patients treated at lower volume facilities (4.1 years for T1, 5.1 years for T2 and 9.0 years for T3, p<0.001) (Figure 1A). Similarly, the median OS was shorter for patients treated at non-academic centers vs academic centers (4.3 years vs 7.5 years respectively, p<0.001) (Figure 1B). In a multivariate analysis, treatment at a lower patient volume facility (Hazard ratio [HR] Q1= 1.26 [95%CI = 1.18-1.34]) and treatment at a non-academic center (HR = 1.1, 95%CI = 1.01-1.12) were both independent prognostic factors of inferior OS, after adjusting for demographics (age, gender, ethnicity, area of residence) and socioeconomic variables (income and insurance status). Conclusion: Patients with MCL treated at academic and higher volume facilities had a higher OS compared to patients treated at non-academic and lower volume facilities.. Additional research is needed to fully understand the mechanisms behind these differences. Patients with MCL may benefit from an early referral to academic and high-volume centers. Figure 1 Figure 1. Disclosures Munoz: Merck: Research Funding; Portola: Research Funding; Genentech: Research Funding; Incyte: Research Funding; Janssen: Research Funding; Seattle Genetics: Research Funding; Pharmacyclics/Abbvie, Bayer, Gilead/Kite Pharma, Pfizer, Janssen, Juno/Celgene, BMS, Kyowa, Alexion, Beigene, Fosunkite, Innovent, Seattle Genetics, Debiopharm, Karyopharm, Genmab, ADC Therapeutics, Epizyme, Beigene, Servier: Consultancy; Gilead/Kite Pharma, Kyowa, Bayer, Pharmacyclics/Janssen, Seattle Genetics, Acrotech/Aurobindo, Beigene, Verastem, AstraZeneca, Celgene/BMS, Genentech/Roche.: Speakers Bureau; Millennium: Research Funding; Pharmacyclics: Research Funding; Celgene: Research Funding; Physicians' Education Resource: Honoraria; Gilead/Kite Pharma: Research Funding; Kyowa: Honoraria; Bayer: Research Funding; Seattle Genetics: Honoraria; OncView: Honoraria; Targeted Oncology: Honoraria. Paludo: Karyopharm: Research Funding. Habermann: Seagen: Other: Data Monitoring Committee; Incyte: Other: Scientific Advisory Board; Tess Therapeutics: Other: Data Monitoring Committee; Morphosys: Other: Scientific Advisory Board; Loxo Oncology: Other: Scientific Advisory Board; Eli Lilly & Co.,: Other: Scientific Advisor. Nowakowski: Daiichi Sankyo: Consultancy; Zai Labolatory: Consultancy; TG Therapeutics: Consultancy; Blueprint Medicines: Consultancy; Nanostrings: Research Funding; MorphoSys: Consultancy; Kymera Therapeutics: Consultancy; Incyte: Consultancy; Ryvu Therapeutics: Consultancy; Kyte Pharma: Consultancy; Genentech: Consultancy, Research Funding; Roche: Consultancy, Research Funding; Celgene/Bristol Myers Squibb: Consultancy, Research Funding; Selvita: Consultancy; Curis: Consultancy; Karyopharm Therapeutics: Consultancy; Bantham Pharmaceutical: Consultancy. Wang: Novartis: Research Funding; LOXO Oncology: Membership on an entity's Board of Directors or advisory committees, Research Funding; TG Therapeutics: Membership on an entity's Board of Directors or advisory committees; Genentech: Research Funding; Eli Lilly: Membership on an entity's Board of Directors or advisory committees; MorphoSys: Research Funding; InnoCare: Research Funding; Incyte: Membership on an entity's Board of Directors or advisory committees, Research Funding.
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Srivastava, Amit, and Justine Alderfer. "2721. US States’ Policies for Meningococcal Vaccination vs. Disease Epidemiology." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S957—S958. http://dx.doi.org/10.1093/ofid/ofz360.2398.
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Abstract Background Serogroup B (MenB) is the leading cause of invasive meningococcal disease (IMD) cases in the United States, including 69% of cases among 16- to 23-year-olds. College students have 3.5 times greater MenB risk vs noncollege individuals, and MenB caused all college IMD outbreaks between 2011 and 2019. For healthy adolescents, the Advisory Committee on Immunization Practices (ACIP) recommends routine MenACWY vaccination at 11 and 16 years and MenB vaccination based on individual clinical decision-making, preferably at 16‒18 years (Figure 1A, B). Given the recent shift in disease epidemiology, we investigated whether current state policies also shifted to help protect adolescents against all 5 meningococcal serogroups. Methods We researched requirements for meningococcal vaccination using state public health websites and national stakeholder materials (e.g., Immunization Action Coalition and their state chapters). Data as of November 2018 were compiled by vaccine type, age, and school/college requirements. Results Forty-five states and Washington DC require either meningococcal vaccination and/or vaccine education for school attendance (grades 6–12) and for college attendance. Thirty-one states require a MenACWY primary dose (at 11 years), of which 16 states also require the booster dose at 16 years (Table 1, Figure 1C). One state requires MenB vaccination at 16–18 years. Of the 8 states that experienced college MenB outbreaks between 2013 and February 2019, all require vaccination or education for MenACWY but not MenB (Table 2). These differences in state requirements may underlie the reported adolescent vaccination coverage rates for MenACWY (85% for ≥ 1 dose, 44% for ≥ 2 doses) and MenB (14.5% for ≥ 1 dose of multidose series) vaccines, and additional reasons may be the efficiency of school-based vaccination programs, strength of the 11-year immunization platform, the more recent availability of MenB vs MenACWY vaccines, and disparate ACIP recommendations for these vaccines. Conclusion State vaccination requirements have helped catalyze MenACWY vaccine impact. Tailoring new requirements to the current epidemiology can help quell MenB disease and ensure that US adolescents are fully protected against meningococcal disease. Funding: Pfizer Disclosures All authors: No reported disclosures.
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Hood, Anna M., Heather Strong, Cara Nwankwo, Yolanda Johnson, Constance A. Mara, Lisa M. Shook, William Brinkman, et al. "Addressing Recruitment Challenges in the Engage-HU Trial in Young Children with Sickle Cell Disease." Blood 136, Supplement 1 (November 5, 2020): 26–27. http://dx.doi.org/10.1182/blood-2020-141471.
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Background: Sickle cell disease (SCD) is a genetic disorder that causes significant medical and neurologic morbidity in children. Hydroxyurea (HU) is the primary medication used to prevent these complications. National Heart, Lung, and Blood Institute (NHLBI) guidelines recommend offering HU to children as young as 9 months of age with SCD (HbSS or HbSB0 thalassemia) using a shared decision-making approach. Although HU has proven efficacious it remains underutilized and caregivers report that they are not always actively involved in the decision to initiate this therapy. Reasons for limited HU uptake likely include lack of clinician knowledge and training and negative caregiver perceptions. Thus, we developed the Engage-HU trial as a novel approach to address HU utilization barriers. A critical consideration for this trial was that SCD primarily affects individuals of African and Hispanic/Latino descent. In these minority populations, intervention trials are sometimes terminated early because of recruitment difficulties related to mistrust of research, caregiver burden, and transportation issues. As such, the Engage-HU trial design included best-practice strategies for recruiting people of color in research. This study describes these strategies, the initial recruitment plan, preliminary recruitment outcomes and strategies, and our procedural adaptations. Study Design and Methods: Engage-HU is a randomized control trial (NCT03442114) to assess how clinicians can engage caregivers in a shared discussion that considers their values and preferences and includes evidence that supports HU. Engage-HU compares two dissemination methods for clinicians to facilitate shared decision-making with caregivers of young children with SCD: 1) the American Society of Hematology Pocket Guide, and 2) the HU Shared-Decision Making (H-SDM) Toolkit. The study aims to recruit 174 caregivers and evaluate the effectiveness of the dissemination methods on patient-centered outcomes (caregiver confidence in decision-making and perceptions of experiencing shared decision-making) as well as HU uptake and child health outcomes. Eligible children are aged 0 to 5 years, candidates for HU, and their caregiver has not made a decision about HU in the past 3 months. The trial is being conducted at 9 sites in the United States and uses a stepped-wedge design. Data will be analyzed based on the intent-to-treat principle. All participants will remain in the arm of the study to which they were randomized, regardless of whether or not they receive the assigned dissemination method. The primary endpoints are caregiver decisional uncertainty and caregiver perception of shared decision-making measured using validated tools. Data will be analyzed using a linear mixed effects regression model with a robust variance estimator and maximum likelihood estimation with observations clustered within site. The Engage-HU trial includes adaptations to increase recruitment such as tailored messaging, a relational recruitment approach, streamlined data collection, and a Stakeholder Advisory Committee. However, even with these adaptations, the first 6-months of the trial yielded lower than anticipated recruitment. Rather than terminate the trial or accept low enrollment, the research team implemented a series of recruitment strategies to address barriers including helping to improve research coordinator knowledge of the study purpose and adjusting no-show and follow-up procedures (e.g., calls to families after missed appointments and reminder calls before appointments). Site clinicians and clinic staff were provided with additional training so they could give more context about Engage-HU to caregivers and the study principal investigator led monthly "all coordinator" calls to provide support by sharing updates and experiences about successful recruitment. Implementation of these strategies resulted in triple the number of enrollments over the next 7-months compared to the previous 6-months (Table 1). Our goal in sharing this information is to provide lessons learned that can be implemented in future trials with the systematically underserved SCD population. It is also anticipated that methods described here may also inform clinical approaches to better engage caregivers of young children around critical clinical conversations, such as initiating medications like HU. Disclosures King: Magenta Therapeutics: Membership on an entity's Board of Directors or advisory committees; Bioline: Consultancy; RiverVest: Consultancy; Novimmune: Research Funding; Celgene: Consultancy; Tioma Therapuetics: Consultancy; Amphivena Therapeutics: Research Funding; WUGEN: Current equity holder in private company; Cell Works: Consultancy; Incyte: Consultancy. Smith-Whitley:Prime: Other: Education material; Celgene: Membership on an entity's Board of Directors or advisory committees; Global Blood Therapeutics: Membership on an entity's Board of Directors or advisory committees; Novartis: Membership on an entity's Board of Directors or advisory committees. Neumayr:Emmaus: Consultancy; Bayer: Consultancy; CTD Holdings: Consultancy; Pfizer: Consultancy; ApoPharma: Consultancy, Membership on an entity's Board of Directors or advisory committees; Micelle: Other: Site principal investigator; GBT: Other: Site principal investigator; PCORI: Other: site principal investigator; Novartis: Other: co-investigator; Bluebird Bio: Other: co-investigator; Sangamo Therapeutics: Other; Silarus: Other; Celgene: Other; La Jolla Pharmaceuticals: Other; Forma: Other; Imara: Other; National Heart, Lung, and Blood Institute: Other; Health Resources and Services Administration: Other; Centers for Disease Control and Prevention: Other; Seattle Children's Research: Other. Yates:Novartis: Research Funding. Thompson:Novartis: Consultancy, Honoraria, Research Funding; CRISPR/Vertex: Research Funding; BMS: Consultancy, Research Funding; Baxalta: Research Funding; Biomarin: Research Funding; bluebird bio, Inc.: Consultancy, Research Funding.
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Siegel, David S., Sundar Jagannath, Roman Hajek, Meletios A. Dimopoulos, Sung-Soo Yoon, Sagar Lonial, Jacob P. Laubach, et al. "Vorinostat Combined with Bortezomib In Patients with Relapsed or Relapsed and Refractory Multiple Myeloma: Update on the Vantage Study Program." Blood 116, no. 21 (November 19, 2010): 1952. http://dx.doi.org/10.1182/blood.v116.21.1952.1952.
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Abstract Abstract 1952 Background: Initial clinical response rates have improved significantly with current treatments for multiple myeloma (MM). However, most patients eventually relapse or become refractory to approved agents, prompting the development of additional targeted agents and combination regimens. Vorinostat is a first-in-class oral histone deacetylase inhibitor that regulates the expression of genes and proteins involved in tumor growth and survival, and is approved in the United States for the treatment of patients with advanced cutaneous T-cell lymphoma in whom prior therapies have failed. Bortezomib, a reversible proteasome inhibitor, is approved for the treatment of patients with MM who have received at least 1 prior therapy. The synergistic effects of vorinostat and bortezomib have been shown in preclinical studies and confirmed in Phase I trials in patients with relapsed/refractory (RR) MM, producing objective response rates (ORRs; partial response or better) of up to 42% in all patients (including those with bortezomib-refractory disease) and overall clinical benefit of up to 90%. Methods: Vantage 088 is a global, Phase III, randomized, double-blind study to investigate the safety and efficacy of vorinostat vs placebo in combination with bortezomib in patients with relapsed MM and progressive disease after 1–3 prior antimyeloma regimens. The primary objective is to determine the duration of progression-free survival, with a planned enrollment of 742 patients. Overall survival, time to progression, ORR, tolerability, and patient-reported outcomes (PROs) will be included as secondary and exploratory outcomes. A distinctive aspect of this study design involves the evaluation of PROs using validated instruments, including quality-of-life (QoL) questionnaires for cancer patients (EORTC QLQ-C30) and myeloma patients (EORTC QLQ-MY20) and the EuroQoL-5D, presenting an opportunity to correlate PROs with efficacy and safety data. Interim analysis will take place when at least 126 events have occurred. Vantage 095 is a Phase IIB open-label study to investigate the efficacy and tolerability of vorinostat combined with bortezomib in patients with RR MM who had received ≥2 prior antimyeloma regimens; were refractory to bortezomib; and were relapsed, refractory to, intolerant of, or ineligible for other MM therapies, including immunomodulatory drugs (IMiDs). The primary objective is to determine the ORR, with a planned enrollment of 142 patients. In both studies, patients receive 21-day cycles of intravenous bortezomib (1.3 mg/m2; days 1, 4, 8, and 11) combined with oral vorinostat 400 mg (or matching placebo in Vantage 088) once daily on days 1–14. Efficacy is assessed using European Bone and Marrow Transplantation Group criteria. Adverse events (AEs; including clinical and laboratory events) are assessed and recorded using the National Cancer Institute Common Terminology Criteria for Adverse Events (version 3.0). Results: Vantage 088: As of June 11, 2010, 349 patients (range, 1–17 cycles) were randomized. Patients received a median of 2 prior regimens (range, 1–3 regimens; 25% prior bortezomib, 48% prior thalidomide, and 12% prior lenalidomide). Vantage 095: As of June 11, 2010, 108 patients were enrolled. Patients (median age, 62 y; 57% men; 67% with Eastern Cooperative Oncology Group performance status 1) were heavily pretreated (median prior regimens, 5 [range, 2–17]). Interim efficacy data were reviewed in January 2010 by an independent data monitoring committee (DMC) for the first 43 patients enrolled; the futility threshold was passed, and final results are expected to be available 2Q2011. Conclusion: 2 ongoing global, multicenter, investigational trials are evaluating the efficacy and safety of combined vorinostat and bortezomib in patients with RR MM and are rapidly accruing patients. The Vantage 088 trial has passed the initial safety evaluations by the DMC, while interim results from Vantage 095 suggest that combined vorinostat and bortezomib may have clinical activity in patients with RR MM who are refractory to bortezomib and IMiDs and ineligible for other regimens. Disclosures: Siegel: Celgene and Millennium: Advisory Board, Speakers Bureau; Merck: Advisory Board, Consultancy. Off Label Use: Vorinostat Combined with Bortezomib for treatment in Multiple Myeloma. Jagannath:Celgene: Honoraria; Millenium: Honoraria; Ortho Biotech: Honoraria; Onyx Pharma: Honoraria; Merck: Honoraria; Proteolix: Honoraria; Imedex: Speakers Bureau; Medicom World Wide: Speakers Bureau; Optum Health Education: Speakers Bureau; PER Group: Speakers Bureau. Hajek:Janssen-Cilag: Honoraria; Celgene: Honoraria; Merck, Sharp, and Dohme: Honoraria. Dimopoulos:MSD: Honoraria, Membership on an entity's Board of Directors or advisory committees; Millenium: Honoraria, Membership on an entity's Board of Directors or advisory committees; Ortho Biotech: Honoraria, Membership on an entity's Board of Directors or advisory committees. Lonial:Millennium: Consultancy, Research Funding; Celgene: Consultancy, Research Funding; BMS: Consultancy, Research Funding; Novartis: Consultancy, Research Funding; Onyx: Consultancy, Research Funding. Graef:Merck Research Laboratories: Employment. Pietrangelo:Merck Research Laboratories: Employment. Lupinacci:Merck Research Laboratories: Employment. Reiser:Merck Research Laboratories: Employment. Anderson:Millennium Pharmaceuticals: Consultancy; Celgene: Consultancy; Novartis: Consultancy; Onyx: Consultancy; Merck: Consultancy; BMS: Consultancy; Acetylon: Equity Ownership, Membership on an entity's Board of Directors or advisory committees, Speakers Bureau.
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Reedy, Jill, TusaRebecca Pannucci, Kirsten Herrick, Jennifer Lerman, Marissa Shams-White, and Meghan Zimmer. "Healthy Eating Index Protocol: Review, Update, and Development Process to Reflect Dietary Guidance Across the Lifespan." Current Developments in Nutrition 5, Supplement_2 (June 2021): 447. http://dx.doi.org/10.1093/cdn/nzab038_059.
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Abstract Objectives The Healthy Eating Index (HEI) is a measure of diet quality, independent of quantity, that can be used to assess alignment with the Dietary Guidelines for Americans (DGAs), which are the basis of nutrition policy for the United States (US) government and the foundation of all federal nutrition guidance. The recently released 2020–2025 DGAs include recommendations for infants and toddlers for the first time, and necessitate a review, update, and development process of the HEI to reflect healthy eating across the lifespan. Methods Since 2005, researchers at the HHS National Cancer Institute (NCI) and the USDA Center for Nutrition Policy and Promotion have collaborated to revise the HEI based on updates to the DGAs, and the HEI-2015 is the most recent iteration. The process includes: 1) gathering information from dietary guidelines, experts, and federal stakeholders; 2) considering substantive changes and needs for new development; and 3) completing validation analyses. Results Updates to the HEI have aimed to maintain stability, reflecting the consistency of recommendations over time. A guiding principle is to only make changes to the HEI that have a strong rationale. With no significant changes in the USDA Dietary Patterns, few changes are anticipated for the HEI for 2 years and older; instead, the emphasis for the update process is focusing on considerations for an index for infants and toddlers under 2 years. Additionally, the Scientific Report of the 2020 Dietary Guidelines Advisory Committee identified the development of a scoring system (such as the HEI) for infants and toddlers as a research recommendation, because comparisons of diet quality using the HEI have thus far only been possible for Americans 2 years and older. The HEI review, update, and development process aims to consider analyses with distributions of HEI scores across the lifespan with nationally representative data and diverse cohorts. Conclusions The HEI is a valuable tool for research that can be used in nutrition interventions, epidemiology, and consumer nutrition education programs. The timely release of a new HEI will enable application across the lifespan and support additional methodological research to examine needs specific to each life stage and how to model optimal trajectories of healthy dietary patterns. Funding Sources None.
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Bhatt, Nidhi, Cecelia Calhoun, Jason R. Hodges, Chinonyelum Nwosu, Guolian Kang, Allison A. King, Xiwen Zhao, and Jane S. Hankins. "Evaluation of Factors Influencing Health Literacy in Adolescents and Adults with Sickle Cell Disease." Blood 134, Supplement_1 (November 13, 2019): 2110. http://dx.doi.org/10.1182/blood-2019-130755.
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Introduction In the United States 36% of adults have limited health literacy, which is associated with poor health outcomes (Kutner et al. National Assessment of Adult Literacy.2006). Health literacy is defined as "the capacity to obtain, process and understand basic health information and services needed to make appropriate health decisions" (Nielsen-Bohlman et al. National Academies Press.2004). Health literacy is understudied in sickle cell disease (SCD), a genetic disease affecting a minority population in the United States. SCD Preventive treatment requires patient engagement, therefore health literacy is an important determinant of health outcomes in SCD. Previous studies reported Health literacy in adolescents with SCD is suboptimal (Perry et al. J Pediatr Nur.2017), but few studies have investigated factors influencing health literacy in this population. Health literacy can be impacted by many factors such as cognition, socioeconomic status, education level and gender. This study evaluated health literacy level and factors that influenced Health literacy in adolescents and adults with SCD. In addition, we assessed the relationship of health literacy level and Hydroxyurea therapy use, one of only two FDA-approved disease-modifying therapies for SCD. Methods This was a cross- sectional study of adolescents and adults with SCD performed at St. Jude Children's Research hospital and St. Louis Children's hospital. Adolescents and adults ages 15 to 45 years completed a health literacy assessment using the newest vital sign (NVS). NVS is a validated tool with 6 questions that tests reading, mathematics and comprehension based on a nutrition label (Weiss et al. Ann Fam Med.2005). Score of 0-1 suggests high likelihood of limited health literacy, 2-3 indicates possibility of limited health literacy and 4-6 almost always suggests adequate health literacy. Self-reported demographic information was collected such as educational level, household income, age, sex, race. Additionally, SCD genotypes and hydroxyurea utilization were confirmed through chart review. Results A random sample of 125 adolescents and adults with SCD was evaluated (Table 1): 34 (28.1%) had Hb SC or Hb Sβ+-thalassemia, 87(71.9%) had Hgb SS or Hgb Sβ0-thalassemia, and 4 participants had unknown or other genotypes. Limited health literacy was prevalent, only 40 (32%) of subjects had adequate literacy, median NVS score was 2 for all participants. Participants with Hgb SS/Hgb Sβ0-thalassemia were more likely to be on hydroxyurea (p<0.001, Chi-square test). NVS scores in subjects with less severe genotype were not significantly different compared to more severe genotypes (p=0.2, Man-Whitney-Wilcoxon test/MWW). There was no difference in health literacy scores between those on hydroxyurea and not on hydroxyurea (p=0.24, MWW test), however despite low health literacy being prevalent, 85 (68%) subjects with Hb SS or HbSβ0-thalassemia were on hydroxyurea. Income level was significantly different between patient on hydroxyurea not on hydroxyurea (p= 0.034, Fisher's exact test). In addition, patient whose income was $35000 or more were found to have a higher NVS score (p=0.012, Kruskal-Wallis test) (figure 1). Subjects with high NVS scores were significantly older (p=0.026, Analysis of variance test), over all education was significantly associated with health literacy (p=0.003, Fisher's exact). Conclusion This study shows a low prevalence of adequate health literacy amongst adolescents and adults with SCD. Our data corroborate previous literature which has reported limited health literacy in this population as well adds granularity to the factors that may influence this suboptimal outcome. There was a statistically significant association between health literacy, income level and education level in adolescents and young adults with SCD. Further, health literacy was not significantly associated with sickle cell genotype or hydroxyurea use. This study highlights the social determinants of health and specific need to address health literacy in SCD patients. To optimize the care of adolescents and young adults with SCD, targeted multimodal interventions that are tailored to low health literacy levels should be employed to reduce morbidity and mortality in this vulnerable population. Disclosures Kang: MBIO: Other: St. Jude Children's Research Hospital has an existing exclusive license and ongoing partnership with Mustang Bio for the further clinical development and commercialization of this XSCID gene therapy. King:Amphivena Therapeutics: Research Funding; Bioline: Consultancy; Celgene: Consultancy; Cell Works: Consultancy; Incyte: Consultancy; Magenta Therapeutics: Membership on an entity's Board of Directors or advisory committees; Novimmune: Research Funding; RiverVest: Consultancy; Tioma Therapeutics (formerly Vasculox, Inc.):: Consultancy; WUGEN: Equity Ownership. Zhao:MBIO: Other: St. Jude Children's Research Hospital has an existing exclusive license and ongoing partnership with Mustang Bio for the further clinical development and commercialization of this XSCID gene therapy. Hankins:NHLBI: Research Funding; National Committee for Quality Assurance: Consultancy; Global Blood Therapeutics: Research Funding; NHLBI: Honoraria; ASPHO: Honoraria; LYNKS Foundation: Research Funding; Novartis: Research Funding; Bluebird Bio: Consultancy.
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Black, William H. "The Activities of the Pathways Commission and the Historical Context for Changes in Accounting Education." Issues in Accounting Education 27, no. 3 (December 1, 2011): 601–25. http://dx.doi.org/10.2308/iace-50091.
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ABSTRACT The Pathways Commission examined accounting education in the United States in response to a recommendation from the U.S. Treasury Advisory Committee on the Auditing Profession. This paper summarizes the Pathways activities and process during 2010 and 2011, and sets forth a historical context to help understand the recommendations for change in accounting education over the last several decades.
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Samaras, A. T., S. Y. Lai, B. Kim, D. P. West, J. M. McKoy, M. Henke, S. M. Silver, and C. L. Bennett. "Erythropoiesis-stimulating agents for cancer patients: Increasingly restrictive guidelines and policies in the United States and Europe." Journal of Clinical Oncology 27, no. 15_suppl (May 20, 2009): e20725-e20725. http://dx.doi.org/10.1200/jco.2009.27.15_suppl.e20725.
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e20725 Background: Erythropoiesis stimulating agents (ESAs) have transformed the treatment of cancer-associated anemia worldwide. However, recent reports of venous thromboembolism (VTE), tumor progression, and mortality risks associated with ESA administration to cancer patients have resulted in reassessments of the safety and appropriate usage of these agents. The present study investigated the disparate factors that contributed to the transformation of ESA policies. Methods: We reviewed meta-analyses, advisory committee recommendations, manufacturer label revisions, clinical guidelines, reimbursement policies from the Centers for Medicare and Medicaid Services (CMS), updated clinical guidelines, and ESA usage trends. Results: See Table . Conclusions: The risks and benefits of ESAs for cancer patients have been reassessed, resulting in increasingly restrictive guidelines and labels in the U.S. and Europe. In response to the 2008 ESA labeling change mandated by the U.S. Food and Drug Administration (FDA), the European advisory committee, Committee for Medicinal Products for Human Use (CHMP), convened to reassess the risk-benefit profile of ESAs and determined that for patients with reasonably long life expectancies, the benefits of ESAs do not outweigh the risks. Additionally, the U.S. National Comprehensive Cancer Network (NCCN) revised clinical guidelines in accordance with the FDA labeling change. Therefore, FDA actions combined with the CMS reimbursement policy have provided the impetus for increasingly restrictive use of ESAs. [Table: see text] [Table: see text]
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Choi, Y. Sammy. "Sexuality Education in Schools." Pediatrics 93, no. 5 (May 1, 1994): 871. http://dx.doi.org/10.1542/peds.93.5.871a.
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Sexuality education in the United States has been addressed recently by the official American Academy of Pediatrics (AAP) publication, "School Health: Policy and Practice" prepared by the AAP Committee on School Health.1 In the section on school and sexuality education, the AAP has endorsed the recommendations published in 1991 by the Sex Information and Education Council of the United States (SIECUS)2 which is part of the National Coalition to Support Sexuality Education, a coalition of organizations that support the goal that all children and youth receive sexuality education by the year 2000.
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Rankin, Alexander W., Sherif M. Badawy, Carolyn M. Bennett, Taylah Buissereth, Kristen Campbell, Hannah Elkus, Rachael F. Grace, Allison Remiker, Stacey Rifkin, and Taizo A. Nakano. "Standardizing the Diagnostic and Therapeutic Approach to Newly Diagnosed Children with ITP: An ITP Consortium of North America (ICON) Quality Improvement Initiative." Blood 138, Supplement 1 (November 5, 2021): 755. http://dx.doi.org/10.1182/blood-2021-146936.
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Abstract BACKGROUND Pediatric immune thrombocytopenia (ITP) is an acquired disorder of platelet destruction that is associated with an increased risk of bleeding. Despite published guidelines for the management of ITP, the available evidence is of low grade, leading to practice variation in different settings. The use of validated bleeding scores to guide clinical decision making is inconsistent. In addition, many children are initially treated with medications despite the recommendation for observation in newly diagnosed children with ITP and no or mild bleeding symptoms. This approach leads to over-utilization of healthcare resources including hospitalizations, medication administration, and medical encounters for management-related side effects. In 2020, a quality improvement (QI) project of the Pediatric ITP Consortium of North America (ICON) was initiated to improve consistency in clinical practice at ICON sites using national ITP guidelines. DESIGN/METHODS Within the ICON QI subcommittee, a standardized clinical care pathway (Figure 1) for newly diagnosed childhood ITP was developed based on the American Society of Hematology (ASH) 2019 guidelines. The goal was to unify approach to management, decrease practice variation, identify and learn from deviations in decision making, and decrease resource utilization by increasing observation rates in low-risk pediatric ITP patients. Site investigators shared the care pathway to update institutional providers on national guidelines. For Aim 1 of this project, sites completed a multi-center, retrospective analysis documenting the pre-QI pathway management of children, ages 1-16 years, diagnosed with ITP from January to December 2019. Statistical analysis was performed using R version 4.0.2. For Aim 2, after local dissemination and education of the clinical care pathway, clinicians at all participating sites will review the pathway at the time of managing newly diagnosed children and then complete a short survey documenting a bleeding score and management decisions. RESULTS Current data from the retrospective review is summarized in Figure 1. 98 patients across four ICON institutions are included in this analysis. The median age at diagnosis was 6 years (IQR 2.7, 9.2) with 61% being male. 43 (44%) patients had their first hematology encounter in the inpatient setting, 40 (41%) in the outpatient clinic, and 14 (14%) in the emergency room. Buchanan and Adix bleeding scores were obtained from only one patient (1%) at diagnosis. Treatment strategies varied including observation in 47 (48%) patients, IVIG in 40 (41%), corticosteroids in 9 (9%), and anti-D globulin in 3 (3%). 53 (54%) patients were admitted at the time of diagnosis. The prospective QI pathway is being utilized by six ICON institutions and 20 patients have been followed on the pathway since November 2020. An additional seven sites are in various phases of study activation. DISCUSSION Evidence-based ITP guidelines and an expert consensus report have been recently published. For children with newly diagnosed ITP and a platelet count <20 x 10 9/L who have no or mild bleeding, ASH guidelines suggest against admission to the hospital and suggest observation rather than treatment with corticosteroids. Retrospective analysis of the management at four ICON centers demonstrates the variation in approach to treatment. However, although guidelines suggest initial management based on objective assessment of bleeding symptoms, only one patient (1%) had a documented bleeding score at presentation, suggesting a lack of a standard approach to management and practice variation. These data support the need for this quality initiative, which involves clinicians reviewing the pathway while managing patients and answering a survey at the time of clinical visits to report on bleeding symptoms and management. This initiative will be expanded to include a total of 13 institutions across the United States. Data will be analyzed every 1-2 years and changes will be made to the pathway with the goal of improving care. Further quality initiatives may help to standardize the management approach of pediatric ITP patients and optimize health outcomes in this patient population. Figure 1 Figure 1. Disclosures Badawy: Bluebird Bio Inc: Consultancy; Sanofi Genzyme: Consultancy; Vertex Pharmaceuticals Inc: Consultancy. Grace: Novartis: Research Funding; Dova: Membership on an entity's Board of Directors or advisory committees, Research Funding; Agios: Research Funding; Principia: Membership on an entity's Board of Directors or advisory committees. Nakano: Novartis: Consultancy.
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Orenstein, Walter A., Bruce G. Gellin, Richard H. Beigi, Sarah Despres, Ruth Lynfield, Yvonne Maldonado, Charles Mouton, et al. "Overcoming Barriers to Low HPV Vaccine Uptake in the United States: Recommendations from the National Vaccine Advisory Committee: Approved by the National Vaccine Advisory Committee on June 9, 2015." Public Health Reports 131, no. 1 (January 2016): 17–25. http://dx.doi.org/10.1177/003335491613100106.
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Committee, National Vaccine Advisory. "Assessing the State of Vaccine Confidence in the United States: Recommendations from the National Vaccine Advisory Committee." Public Health Reports 130, no. 6 (November 2015): 573–95. http://dx.doi.org/10.1177/003335491513000606.
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Meddin, Barbara J. "The Future of Decision Making in Child Welfare Practice: The Development of an Explicit Criteria Model for Decision Making." Children Australia 9, no. 4 (1985): 3–6. http://dx.doi.org/10.1017/s0312897000007451.
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AbstractThe paper examines the impact that a decision making model can have on child placement decisions. Using a pre and post test design with three different conditions, the research investigated the ability to increase the consistency of the placement decision by the use of a decision making model that includes explicit criteria.The study found that consistency of decision making was enhanced by the provision of the decision making model and that consistency could be further enhanced by the provision of training in the model. Implications for training of new workers and reduction of worker stress and burnout are discussed.The incident of child abuse and neglect continues to rise. The National Centre on Child Abuse and Neglect estimates that approximately one million children will be abused or neglected this year in the United States. In the State of Illinois alone, during fiscal year 1981 nearly 80,000 reports of abuse or neglect were received. Almost 50% of those reports were found to be actual cases of abuse or neglect.Whether the incident in Australia of child abuse and neglect is increasing or not is difficult to assess, since currently there is no standardised way of collecting data. However, from all indicators a similar increase is indeed occurring. Boss in his book, “On the Side of the Child”, reports that the number of cases seen by the Western Australian Department of Community Welfare has steadily increased. This is corroborated by statistics compiled by that State’s Advisory and Consultative Committee in Child Abuse (ACCCA). Their Statistical Information Report for July-December 1983 indicates an 86% increase in reports of sexual abuse and 12.5% increase in physical abuse. In Queensland the number of child abuse and/or neglect case investigations went from 1 095 in 1981 to 1 631 in 1982 – an increase of more than one third. In Tasmania between 1980 to 1982 the number of reports increased by nearly one-third, from 228-302. The Montrose Child Protection and Family Crisis Unit of the Department of Youth and Community Services in New South Wales report similar increases.On almost a daily basis, social workers are called upon to make far reaching decisions that have the potential to be a life consequential both for the child who is the victim of abuse and/or neglect and that child’s family. Because these decisions, especially the placement decision, have such great ramifications, social workers should be expected to make decisions with great care, consideration and consistency. This may be due, in part because agencies have been slow to explicate, empirically validate, and systematically apply decision making criteria that assist workers in making case decisions.While research indicates that criteria do exist and are used by child welfare workers, the research also indicates that they are not used in any systematic fashion. The result is that idiosyncratic decisions are invited and the potential spectre of gross inequities in the delivery of social services exists. Unless asystematic, consensually based decision making model is used that explicates both the decisions that need to be made along with a specific set of criteria for making these decisions, it is impossible for the child welfare agency to guarantee a minimum level of service delivery.
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Rosen, Michael, Jim McCready, and Tony Bull. "Raising the profile of Canada's 9th forest region: Urban forests." Forestry Chronicle 82, no. 1 (January 1, 2006): 54–56. http://dx.doi.org/10.5558/tfc82054-1.
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A recent CIF Ottawa Valley section meeting in Carleton Place, Ontario was cause for reflection on the important role of urban forests. In spite of their well-known benefits, Canadian urban forests are under great pressure. However, recent developments in municipal planning and the creation of the Canadian Urban Forest Network show some progress — developments encouraged for the first time by the most recent National Forest Strategy. This contrasts to a historic denial by forestry organizations to include urban forests as part of "Canada's Forests" in spite of their economic and environmental significance. It also contrasts with urban forest programs initiated by the USDA Forest Service in the United States. For smaller communities like Carleton Place, urban forests are very important. They are being recognized by the community through its Official Plan, in operational guidelines and through an R.P.F.-led volunteer Urban Forest Advisory Committee. Key words: urban forests, strategic urban forest plans, Canadian Urban Forest Network, Urban Forest Advisory Committee
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Bednarczyk, Robert A., Mallory K. Ellingson, and Saad B. Omer. "Human Papillomavirus Vaccination Before 13 and 15 Years of Age: Analysis of National Immunization Survey Teen Data." Journal of Infectious Diseases 220, no. 5 (January 17, 2019): 730–34. http://dx.doi.org/10.1093/infdis/jiy682.
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Abstract Human papillomavirus (HPV) vaccination is suboptimally used in the United States. Vaccination before the 13th birthday is recommended by the Advisory Committee on Immunization Practices and vaccination before the 15th birthday requires only 2 doses. We estimated the proportion of adolescents up to date for HPV vaccine using provider-verified vaccination data from the 2016 National Immunization Survey-Teen. Only 16% of US adolescents completed HPV vaccination before turning 13, and 35% completed HPV vaccination before turning 15. With sexual activity initiation increasing throughout adolescence and higher immunogenicity for younger vaccinees, vaccination before the 13th birthday can provide better protection against HPV-related cancers.
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Zhao, Linlu, Kelsey Young, Althea House, Rob Stirling, and Matthew Tunis. "Demonstrating the capacity of the National Advisory Committee on Immunization for timely responses to post-market vaccine monitoring signals: Canada’s experience with the live-attenuated influenza vaccine." Canada Communicable Disease Report 47, no. 56 (June 9, 2021): 279–84. http://dx.doi.org/10.14745/ccdr.v47i56a06.
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Over the last several years, the recommended use of the live-attenuated influenza vaccine (LAIV) for children has evolved in the United States (US) in response to evidence of a potential decrease in LAIV effectiveness based on post-market monitoring. These issues were not observed in Canada or elsewhere; consequently, recommendations from Canada’s National Advisory Committee on Immunization (NACI) and the US Advisory Committee on Immunization Practices (ACIP) on whether to use LAIV differed for two influenza seasons (2016–2017 and 2017–2018). This retrospective describes how NACI arrived at its recommendations in response to post-market signals of reduced LAIV performance from the US in 2013–2014 and again in 2015–2016. NACI’s experience with LAIV marks the first time in Canada where a preferential recommendation on the use of an influenza vaccine in a routine immunization program was reversed. This experience highlights the importance of ongoing post-market monitoring of vaccines, international collaboration and careful consideration of local context to inform vaccine recommendations. NACI’s capacity for timely responses to post-market vaccine performance signals will facilitate responsiveness to similar post-market monitoring signals from the coronavirus disease 2019 (COVID-19) vaccines.
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Johnson, David Alan. "Prospects for a National Clearinghouse on International Medical Schools." Journal of Medical Regulation 94, no. 3 (September 1, 2008): 7–11. http://dx.doi.org/10.30770/2572-1852-94.3.7.
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ABSTRACT In 2006, a special committee appointed by the Federation of State Medical Boards (FSMB) issued its report on the “Evaluation of Undergraduate Medical Education” in the United States and abroad. Satisfied with accreditation systems already providing reasonable and adequate assurance for the quality of medical education in this country, the committee turned its focus toward international medical schools. Because international medical graduates (IMGs) comprise 25 percent of the physician workforce, U.S. medical licensing boards continue to seek meaningful information on the medical schools of their licensees. The report's recommendations included a call for close monitoring of efforts to provide international accreditation systems. One of the current initiatives being closely watched is that of the Caribbean Authority for Accreditation in Medicine and Other Health Professions (CAAM). Under the auspices of the Caribbean Community, CAAM has established an accreditation system for medical schools in the region, carried out site visits and rendered decisions for a number of Caribbean schools. A complementary initiative currently underway by FSMB and ECFMG staff involves the development of a primer on IMGs and international medical education. This web-based resource is scheduled for completion in late fall 2008. The major recommendation of the special committee report called for the FSMB to work with state medical boards and the ECFMG to establish an information and data clearinghouse on international medical schools. A clearinghouse workgroup has already begun meeting and considering various quality indicators suggested by the special committee report such as admission requirements, policies relative to advanced standing and aggregate performance data on USMLE. The challenges facing the clearinghouse are significant. One approach being considered is to focus data collection efforts primarily on the eight to 10 schools currently supplying the largest number of IMGs seeking medical licensure in the United States.
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TAUXE, R., H. KRUSE, C. HEDBERG, M. POTTER, J. MADDEN, and K. WACHSMUTH. "Microbial Hazards and Emerging Issues Associated with Produce† A Preliminary Report to the National Advisory Committee on Microbiologic Criteria for Foods." Journal of Food Protection 60, no. 11 (November 1, 1997): 1400–1408. http://dx.doi.org/10.4315/0362-028x-60.11.1400.
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In the past two decades, the consumption of fresh fruits and vegetables in the United States has increased, and the geographic sources and distribution of fresh produce have expanded greatly. Concomitantly, public health officials have documented an increase in the number of reported produce-associated foodborne disease outbreaks in the United States. The Centers for Disease Control and Prevention (CDC) reports that the number of these outbreaks doubled between 1973 and 1987, and 1988 and 1991, and that the number of cases of illness associated with these outbreaks more than doubled. A variety of produce items have been affected. During 1995 alone, major outbreak investigations linked infections with Salmonella serotype Stanley to alfalfa sprouts, Salmonella Hartford to unpasteurized orange juice, Shigella spp. to lettuce and green onions, Escherichia coli O157:H7 to lettuce, and hepatitis A virus to tomatoes. In response to this apparent increase, the U.S. Food and Drug Administration asked the National Advisory Committee on Microbiological Criteria for Foods to address and better define the association of foodborne disease and microbial pathogens with fresh produce. A subcommittee formed in June 1995 is documenting relevant epidemiologic data, current industry practices, and laboratory data to identify potential hazards and related control strategies. This report presents the preliminary findings of that subcommittee.
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Clay, E. Leila Jerome, Carrie Gann, Kyle Jordan, Ashley Howard, Dawn Gates, and Lorilyn Wilson. "Transitioning from Pediatric to Adult Care: The Role of an Education Curriculum for Adolescents and Young Adults with Sickle Cell Disease." Blood 138, Supplement 1 (November 5, 2021): 2994. http://dx.doi.org/10.1182/blood-2021-153824.
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Abstract Introduction: Sickle Cell Disease (SCD) is the most common inherited blood disorder, affecting over 100,000 people in the United States. The latest medical managements have yielded better outcomes in mortality and morbidity among people with SCD. Despite these advancements, emerging young adults have complications transitioning from pediatric care to adult care and remain with the highest mortality rate in the population. Got Transition is a federally funded national resource center that aims to support youth and young adults moving from pediatric to adult care by implementing the Six Core Elements of Transition. At our institution, we established a transition program aimed at improving clinical care, medical management, and improvement in the transition from pediatric to adult medical care. Our goal was to develop a standardized, age appropriate sickle cell education curriculum to implement at clinic visits for our patients aged 13 and older. Hypothesis: We hypothesize that with a structured transition curriculum, we would be able to improve patient knowledge in medical aspect of the disease, academic resources and a better understanding of their complex psychosocial needs. Methods: We developed a transition program called Adolescent and Young Adult Sickle Cell Uplift and Learn Program for Transition (AYA SCULPT) that would focus on patients starting at 13 years old with a multidisciplinary approach of care. We adopted the Got Transition model implementing the Six Core Elements of Transition. Our team not only wanted to address educational topics related to their medical care, but also psychosocial and academic topics. A transition education curriculum was created spanning three age groups on the three major topics and further broken up into three smaller sections for clinic use to accommodate for time restraints (Table 1). A pilot of the medical curriculum was started August 2019 addressing medical topics relating to better understanding of sickle cell disease. We then introduced our psychosocial curriculum in January 2021. A member of our comprehensive sickle cell team provides the four-question pre-test to the patient at the beginning of their regularly scheduled clinic appointment. At the end of the appointment the nurse or provider will grade the pre-test and provide verbal education as well as printed material on the topics for the day. Scoring and topics are tracked in the patient's note as well as in a transition education database. At the patient's next visit, the same test is administered as a post-test in order to determine knowledge acquired and retention of the materials. Post-test scores are also recorded in the patient note and transition education database. Once the patient finishes a module, we move to the next topic at the next regularly scheduled visit. Depending on the patient's genotype and medication management, post-tests can be given between two to six months after the pre-test. Results: Scores from pre-test were compared to those of post-test for patients that had the opportunity to complete the medical curriculum quizzes. One hundred and fifty six patients range from age 13-21 were included in this pilot study. Of patients aged 19-21, 69% have taken at least one pre-test and post-test for the medical education (63 total pre- and post-tests). Forty-three (78%) patients aged 16-18 have taken at least one pre-test and post-test (75 total pre- and post-tests). Thirty-three (67%) patients aged 13-15 have taken at least one pre-test and post-test (53 total pre- and post-tests). Results were categorized as score increased, score unchanged (pre-test score was not 100%), maintained 100% (unable to increase in score), and score decreased. In every age group, the category with the most results was "score increased." Shown in Table 2. Conclusion: Further extrapolation suggests that the medical curriculum provided in clinic improves the sickle cell knowledge in this adolescent and young adult population. Though all age groups improved, the biggest improvement was noted in knowledge with our 13-15 year olds. These results suggest that early transition education can be impactful even if started at the early phases of adolescence. Studies are still ongoing with our medical curriculum and early psychosocial data is beginning to support our previous findings. As part of transition health care, focusing on disease education can provide better knowledge and hopefully improve patient outcomes. Figure 1 Figure 1. Disclosures Clay: Novartis: Honoraria; GBT: Membership on an entity's Board of Directors or advisory committees.
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Reinhardt, Sarah L., Rebecca Boehm, Nicole Tichenor Blackstone, Naglaa H. El-Abbadi, Joy S. McNally Brandow, Salima F. Taylor, and Marcia S. DeLonge. "Systematic Review of Dietary Patterns and Sustainability in the United States." Advances in Nutrition 11, no. 4 (March 13, 2020): 1016–31. http://dx.doi.org/10.1093/advances/nmaa026.
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ABSTRACT Improving awareness and accessibility of healthy diets are key challenges for health professionals and policymakers alike. While the US government has been assessing and encouraging nutritious diets via the Dietary Guidelines for Americans (DGA) since 1980, the long-term sustainability, and thus availability, of those diets has received less attention. The 2015 Dietary Guidelines Advisory Committee (DGAC) examined the evidence on sustainable diets for the first time, but this topic was not included within the scope of work for the 2020 DGAC. The objective of this study was to systematically review the evidence on US dietary patterns and sustainability outcomes published from 2015 to 2019 replicating the 2015 DGAC methodology. The 22 studies meeting inclusion criteria reveal a rapid expansion of research on US dietary patterns and sustainability, including 8 studies comparing the sustainability of DGA-compliant dietary patterns with current US diets. Our results challenge prior findings that diets adhering to national dietary guidelines are more sustainable than current average diets and indicate that the Healthy US-style dietary pattern recommended by the DGA may lead to similar or increased greenhouse gas emissions, energy use, and water use compared with the current US diet. However, consistent with previous research, studies meeting inclusion criteria generally support the conclusion that, among healthy dietary patterns, those higher in plant-based foods and lower in animal-based foods would be beneficial for environmental sustainability. Additional research is needed to further evaluate ways to improve food system sustainability through both dietary shifts and agricultural practices in the United States.
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Feldman, Douglas. "PA Comments." Practicing Anthropology 11, no. 4 (September 1, 1989): 2–12. http://dx.doi.org/10.17730/praa.11.4.274558297522178t.
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During August, 1988, I was asked by the United States Information Agency to go to Bangladesh to share information about AIDS with the Bangladesh National AIDS Committee and others. In the course of my stay in Dhaka, I met with the Deputy Prime Minister and Minister of Home Affairs, the Minister of Health, the Director of the American Cultural Center of the U. S. Information Service, the Dean of the University of Dhaka Medical School, the Director of the National Health Card Service (an organization administering hundreds of rural health clinics in Bangladesh), and the Chief of the Bureau of Health Education. I gave presentations before the Bangladesh National AIDS Committee, the faculty and student body of the University of Dhaka Medical School, and during a reception given by the National Health Card Service.
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Capwell, Ellen M., Carol Cox, Alyson Taub, M. Elaine Auld, and Elias Berhanu. "Quality Assurance in Professional Preparation of Community/Public Health Education Specialists: Contributions of SABPAC." Pedagogy in Health Promotion 5, no. 1 (January 31, 2018): 62–69. http://dx.doi.org/10.1177/2373379918756426.
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The Society for Public Health Education and American Association for Health Education Baccalaureate Program Approval Committee (SABPAC) provided a valuable service to the health education profession in the United States for 27 years. From 1987 to its sunset in 2014, SABPAC offered a voluntary process whereby undergraduate community/public health education professional preparation programs could seek review and evaluation of their programs against published national health education criteria. Those programs meeting SABPAC criteria were granted “Approval.” SABPAC approval was instituted as one way by which the health education profession could strive to promote consistent professional preparation in the field and ensure that health education graduates were prepared for contemporary workforce demands. Over the years, SABPAC chairs, committee members, and volunteers devoted countless hours reviewing self-studies and conducting on-site visits of professional preparation programs and documenting how they met SABPAC criteria and/or could enhance compliance with guidelines. Seeking SABPAC approval provided many program benefits. Recognizing that accreditation is the “gold standard” in education, the health education profession applied a thoughtful and researched process beginning in 2001 to transition from SABPAC approval to undergraduate accreditation through the Council on Education for Public Health. Three national task forces developed recommendations, conducted events to foster communication about the change, and assisted professional preparation programs to prepare for and seek the Council on Education for Public Health accreditation. This brief article documents the genesis, organization, and processes of SABPAC in the United States, until its sunset as a major contributor to quality assurance in health education for more than a quarter of a century.
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Pirozhkova, Irina, and Aleksey Popov. "The right to self-government: an international fixation of the definition." Vestnik of the St. Petersburg University of the Ministry of Internal Affairs of Russia 2021, no. 3 (October 1, 2021): 37–43. http://dx.doi.org/10.35750/2071-8284-2021-3-37-43.
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The article summarizes and analyzes the basic standards of local self-government, reflected in international normative legal acts, including those developed within the framework of the CIS, which are framework in relation to Russian national standards. The theoretical problem of the definition of «the right to local self-government» is updated, the structure and features of related rights are analyzed. The main sources were international documents of the United Nations Organization, Union of independent states, as well as reports and strategic declarations of international public associations that carry out consultative and analytical work with local self-government systems around the world.
The authors classify international sources of law that set the standards for local self-government, dividing them into three groups. It is concluded that, in general, when the aforementioned standards are reflected in the national normative material, they are most fully contained in the international framework normative acts of the Union of independent states. The authors note, along with the role of the UN Advisory Committee on Local Self-Government Issues, the special importance of international non-governmental associations in the formation of standards of local self-government (United Cities and Local Governments, UCLG). The sum of international standards in the area under consideration consists in declarative acts of strategic development of the local self-government system.
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Hanlon, Cathleen A., James G. Olson, Cathy J. Clark, and _. _. "Article I: Prevention and education regarding rabies in human beings." Journal of the American Veterinary Medical Association 215, no. 9 (November 1, 1999): 1276–80. http://dx.doi.org/10.2460/javma.1999.215.09.1276.
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Summary Substantial changes in the epizootic characteristics of rabies have transpired in the United States during the past 50 years. Traditional veterinary practices and public health recommendations have effectively controlled rabies in dogs and prevented associated human fatalities; however, they have been unable to adequately address the problem of rabies in wildlife. Attributable in part to a renewed focus on emerging infectious diseases, a conference was held at the Centers for Disease Control and Prevention in 1993 to begin discussion focused on the reemergence of rabies and to formulate new suggestions for prevention and control of rabies in the United States. Three major working groups were formed from a national committee of professionals representing a broad array of biomedical disciplines. These groups concentrated on prevention of rabies in human beings, education, laboratory diagnosis of rabies, and rabies control in animals. The groups described the perceived minimum requirements to promote prevention and control of rabies in the United States into the next century. The following article describes the needs and recommendations identified by the prevention and education working group. Two other articles, scheduled for the Nov 15 and Dec 1, 1999 issues of JAVMA, will relay the needs and recommendations of the working groups on laboratory diagnosis of rabies and rabies in wildlife.
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Hash, Phillip M. "The National School Orchestra Contests." Journal of Research in Music Education 63, no. 4 (December 30, 2015): 397–420. http://dx.doi.org/10.1177/0022429415618373.
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The purpose of this study was to examine the National School Orchestra Contests sponsored by the National Bureau for the Advancement of Music and the Committee on Instrumental Affairs (CIA) of Music Supervisors National Conference from 1929 to 1937. Research questions examined contest (a) organization and operation, (b) rules and procedures, (c) participants, and (d) repertoire, as well as (e) the influence of early school orchestra competitions on subsequent large-group assessment. I also made recommendations for the development of these events today based on their counterparts of the 1920s and 1930s. The first national school orchestra contest convened at the State University of Iowa in May 1929 and in other cities throughout the mid United States until 1937. Judges ranked ensembles based on their ability to perform two prepared selections and sight-read unfamiliar music until 1933, when the CIA implemented a rating system to improve the validity of adjudication, emphasize educational values, and reduce competitiveness. Although the number of participants increased substantially with the rating system, the contests never achieved a national scope due to prohibitive expenses for orchestras traveling long distances.
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Brown, Lisa, Anna Fisher, David Dosa, and Sue Anne Bell. "NACSD RECOMMENDATIONS FOR OLDER ADULT DISASTER PREPAREDNESS, RESPONSE, AND RECOVERY." Innovation in Aging 7, Supplement_1 (December 1, 2023): 208. http://dx.doi.org/10.1093/geroni/igad104.0687.
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Abstract This presentation shares the recommendations drafted by the National Advisory Committee on Seniors and Disasters (NACSD). This federal advisory committee provides advice and guidance to the Assistant Secretary for Preparedness and Response within the U.S. Department of Health and Human Services (HHS) and the HHS Secretary. The NACSD is comprised of seven non-federal members with expertise in geriatric disaster planning, preparedness, response, or recovery and ten federal (non-voting) members who are ex officio representatives from agencies within HHS and other Executive Branch departments. The voting members drafted recommendations intended to address the immediate and persistent challenges in public health emergency preparedness, response, and recovery affecting older adults in the United States. Numerous meetings with federal and non-federal subject matter experts from various disciplines were held to develop the recommendations. The NACSD was also tasked with evaluating issues and programs and providing findings, advice, and recommendations to the Secretary of Health and Human Services to support and enhance all-hazards public health and medical preparedness, response, and recovery activities related to meeting the unique needs of older adults and their families across the entire spectrum of their wellbeing. The NACSD evaluated and provided input concerning the medical and public health needs of older adults related to preparation for, response to, and recovery from all-hazards emergencies; and may provide advice and consultation with respect to State emergency preparedness and response activities relating to older adults.
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Burton, Deron C., Jonathan R. Edwards, Arjun Srinivasan, Scott K. Fridkin, and Carolyn V. Gould. "Trends in Catheter-Associated Urinary Tract Infections in Adult Intensive Care Units—United States, 1990–2007." Infection Control & Hospital Epidemiology 32, no. 8 (August 2011): 748–56. http://dx.doi.org/10.1086/660872.
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Background.Over the past 2 decades, multiple interventions have been developed to prevent catheter-associated urinary tract infections (CAUTIs). The CAUTI prevention guidelines of the Healthcare Infection Control Practices Advisory Committee were recently revised.Objective.To examine changes in rates of CAUTI events in adult intensive care units (ICUs) in the United States from 1990 through 2007.Methods.Data were reported to the Centers for Disease Control and Prevention (CDC) through the National Nosocomial Infections Surveillance System from 1990 through 2004 and the National Healthcare Safety Network from 2006 through 2007. Infection preventionists in participating hospitals used standard methods to identify all CAUTI events (categorized as symptomatic urinary tract infection [SUTI] or asymptomatic bacteriuria [ASB]) and urinary catheter–days (UC-days) in months selected for surveillance. Data from all facilities were aggregated to calculate pooled mean annual SUTI and ASB rates (in events per 1,000 UC-days) by ICU type. Poisson regression was used to estimate percent changes in rates over time.Results.Overall, 36,282 SUTIs and 22,973 ASB episodes were reported from 367 facilities representing 1,223 adult ICUs, including combined medical/surgical (505), medical (212), surgical (224), coronary (173), and cardiothoracic (109) ICUs. All ICU types experienced significant declines of 19%–67% in SUTI rates and 29%–72% in ASB rates from 1990 through 2007. Between 2000 and 2007, significant reductions in SUTI rates occurred in all ICU types except cardiothoracic ICUs.Conclusions.Since 1990, CAUTI rates have declined significantly in all major adult ICU types in facilities reporting to the CDC. Further efforts are needed to assess prevention strategies that might have led to these decreases and to implement new CAUTI prevention guidelines.
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Howe, Sondra Wieland. "Elsie Shawe, Music Supervisor in St. Paul, Minnesota (1898–1933)." Journal of Research in Music Education 52, no. 4 (December 2004): 328–42. http://dx.doi.org/10.1177/002242940405200405.
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Elsie Shawe (1866–1962), supervisor of music in St. Paul, Minnesota, for thirty-five years, is an example of a music supervisor in the United States who was active in the formative years of the Music Supervisors National Conference (MSNC). Although she is cited only briefly in national accounts, there is a substantial amount of material on her career in local archives. In the St. Paul Public Schools, Shawe supervised classroom teachers, organized the school music curriculum, and conducted performances in the community. She served as a church organist and choir director in St. Paul and was president of the Minnesota Music Teachers Association. At the national level, Shawe was an officer of the NEA Department of Music Education and a member of the board of directors of the MSNC. Through her committee work, Shawe promoted the standardization of patriotic national songs.May 5, 2004November 10, 2004.
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La, Elizabeth M., Diana Garbinsky, Shannon Hunter, Sara Poston, Patricia Novy, and Parinaz Ghaswalla. "179. Individual and State-level Factors Associated with Receipt of Multiple Recommended Adolescent Vaccines in the United States." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S218—S219. http://dx.doi.org/10.1093/ofid/ofaa439.489.
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Abstract Background The Advisory Committee on Immunization Practices (ACIP) routinely recommends several adolescent vaccines, including human papillomavirus (HPV); quadrivalent meningococcal conjugate (MenACWY); and tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccines. Limited data are available on the percentage of adolescents receiving this complement of ACIP-recommended vaccines and factors that may increase likelihood of completion. Methods This study used 2015–18 pooled National Immunization Survey-Teen (NIS-Teen) data to estimate national and state-level completion rates by age 17 of a two-dose MenACWY series, two- or three- dose HPV series (depending on age at first vaccination), and a Tdap vaccine, using multivariable logistic regression modeling to adjust for individual characteristics. NIS-Teen data were then combined with public state-level data to construct a multilevel model evaluating effects of both individual- and state-level factors on completion. Results After adjusting for individual-level factors, the national completion rate for these ACIP-recommended vaccines by age 17 was 30.6% (95% confidence interval [CI]: 30.1–31.0%). However, rates for individual states varied substantially, from 11.3% in Idaho (CI: 6.9–18.0%) to 56.4% in Rhode Island (CI: 49.8–62.8%) (Figure 1). In the multilevel model, individual characteristics associated with increased likelihood of receiving the recommended vaccines by age 17 included female gender, black or Hispanic race, Medicaid coverage (vs. private/other), last provider visit at age 16 or 17, generally having ≥1 provider visit in last year, and receiving a provider recommendation for HPV vaccination. Residing in a state with a MenACWY vaccination mandate for elementary and secondary schools was the only state-level variable that significantly increased the likelihood of completion (odds ratio: 1.6; CI: 1.2–2.3) (Figure 2). Figure 1: Model-Adjusted Completion Rates of ACIP-Recommended HPV, MenACWY, and Tdap Vaccines by Age 17 Years in the United States, 2015–18. ACIP, Advisory Committee on Immunization Practices; HPV, human papillomavirus; MenACWY, quadrivalent meningococcal conjugate; Tdap, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis. Note: Vaccination completion is based on completion of the HPV series (i.e., receipt of 2 doses for individuals aged 9–14 years at first vaccination or receipt of 3 doses for individuals aged 15 years or older at first vaccination), completion of the MenACWY series (i.e., receipt of 2 doses), and receipt of a Tdap vaccine. Note: Model-adjusted composite vaccination completion is adjusted for sex, race/ethnicity, mother’s educational attainment, health insurance status, continuity of health insurance coverage since age 11, whether the individual was 16 or 17 years old at their last checkup, number of physician or other healthcare professional visits in past 12 months, whether a doctor or other healthcare professional ever recommended that the individual receive HPV vaccination, and state. The model-adjusted estimate is generated by taking the average of the predicted probability of vaccination for each individual as if they were all from the same state (while retaining all other characteristics). Figure 2: Individual-Level and State-Level Characteristics Associated with an Individual’s Completion of ACIP-Recommended HPV, MenACWY, and Tdap Vaccines by Age 17 Years in the United States, 2015–18. ACIP, Advisory Committee on Immunization Practices; CI, confidence interval; HCP, healthcare professional; HPV, human papillomavirus; MenACWY, quadrivalent meningococcal conjugate; ref, referent category; Tdap, tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis. Note: Bold characters and darker circles indicate significant results. Note: Vaccination completion is based on completion of the HPV series (i.e., receipt of 2 doses for individuals aged 9–14 years at first vaccination or receipt of 3 doses for individuals aged 15 years or older at first vaccination), completion of the MenACWY series (i.e., receipt of 2 doses), and receipt of a Tdap vaccine. Conclusion Recommended adolescent vaccine completion rates are suboptimal and highly variable across states. Provider recommendations, visits at 16–17 years of age, and state mandates for MenACWY are implementable strategies associated with completion of recommended adolescent vaccines. Funding GlaxoSmithKline Biologicals SA (study identifier: HO-19-19991) Disclosures Elizabeth M. La, PhD, RTI Health Solutions (Employee) Diana Garbinsky, MS, GSK (Other Financial or Material Support, The study was conducted by RTI Health Solutions, which received consultancy fees from GSK. I am a salaried employee at RTI Health Solutions and received no direct compensation from GSK for the conduct of this study..) Shannon Hunter, MS, GSK (Other Financial or Material Support, Ms. Hunter is an employee of RTI Health Solutions, who received consultancy fees from GSK for conduct of the study. Ms. Hunter received no direct compensation from the Sponsor.) Sara Poston, PharmD, The GlaxoSmithKline group of companies (Employee, Shareholder) Patricia Novy, PhD, GSK (Employee, Shareholder) Parinaz Ghaswalla, PhD, ORCID: 0000-0002-2883-5590, GlaxoSmithKline (Employee, Shareholder)
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Koffman, Brian, Betsy Dennison, Kaitlin Kennard, John C. Byrd, Richard R. Furman, John M. Pagel, Matthew S. Davids, et al. "Factors That Influence Treatment Decision-Making: Perspectives of 1147 Chronic Lymphocytic Leukemia (CLL) Patients in the United States." Blood 132, Supplement 1 (November 29, 2018): 4414. http://dx.doi.org/10.1182/blood-2018-99-112971.
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Abstract Introduction: Given the availability of several active treatment (tx) options for CLL, providers frequently make tx recommendations based on their interpretation of objective data from consensus criteria and clinical trials. There are limited data describing patient (pt) experience, values, and insights when encountering multiple tx choices. The CLL Society, a pt-driven, physician-curated nonprofit organization focused on the unmet needs of the CLL community, sought to explore how CLL pts make tx decisions. Methods: A 64 question survey was distributed online and in paper to CLL pts from Oct-Dec 2017. The survey was developed by CLL experts. The research was IRB-approved. Chi square was used for statistical comparison; all other analyses are descriptive in nature. Results: 1147 pts from 48 states completed the survey. Median age was 65 (range 28-86), 46% male, 96% Caucasian. Who Influences Tx: Of the 79% of pts who have seen a CLL expert, defined as a provider focused on CLL at an academic/research center, 95% rated their provider as very/extremely influential. 83% of pts rated their own opinions as influential, and 59% rated the opinion of a general hematologist/oncologist (gen heme/onc), a provider who sees a variety of cancer types, as influential. Only 27% let their provider unilaterally decide on tx. Of these pts, 19% trusted their provider to select the best tx and 5% didn't have enough understanding to be involved in the decision. 64% were influenced by outside sources of information, such as family members, live CLL support groups, or online sources including pt experts and forums. Factors in Deciding Tx: Of the 67% pts surveyed who have been treated, 73% were offered > 1 tx choice by their provider. In deciding on a specific tx, 94% of respondents stated that it was very/extremely important to know there were tx options beyond their current regimen. The most important factors in selecting tx were response rate (91%), overall survival (88%), progression-free survival (86%), long-term side effects (82%), ability to achieve undetectable MRD (80%), cost/insurance coverage (66%), and location of tx (50%) with significant differences between subgroups (Table 1). Tx was impacted by cost or insurance issues for 16% (n=104). Of these 104 pts, cost/insurance issues resulted in tx delay for 34 and change in tx plan for 24 pts. 16 pts reported that an appeal led to coverage and 16 pts received financial assistance. Pts' willingness to accept potentially curable but high-risk tx was heavily influenced by availability of alternate options. For example, 18% of pts would be willing to consider cytotoxic chemotherapy if alternate options were available vs. 72% if no options were available. Similar patterns were seen with CAR-T tx (28% vs. 79%) and bone marrow transplantation (BMT) (15% vs. 66%) with significant differences between subgroups (Table 2). 82% were willing to take a life-long tx for long-term control without potential for cure. Willingness to accept long-term tx was significantly higher in treated vs. untreated pts (84% vs. 77%, p=.006) and men vs. women (84% vs. 78%, p=.008). Clinical Trial Education: Of those treated by a gen heme/onc, 31% received no education on clinical trials. Only 15% reported good understanding of trial opportunities vs. 52% treated by a CLL expert (p<.001). 9% of pts treated by gen heme/onc were offered clinical trial participation vs. 47% treated by a CLL expert (p<0.001). Pts who declined or would have declined participation cited reasons including preference for "proven" tx (38%), distance from trial site (29%), fear (20%), frequent imaging (20%), overall lack of understanding about trials (15%), and lack of information (14%). Summary: Most respondents want to be and are involved in tx decisions. While providers are influential in decision making, CLL pts also rely on outside sources. Gender, age, and tx status influence which factors drive decision making. Pts select tx based on response rate, survival, side effects, and ability to achieve deep response and want a plan in place for sequencing tx. The majority are willing to consider long-term tx without cure. Few want chemotherapy, CAR-T, or BMT unless they have no other options. A significant opportunity for improvement in education on clinical trial opportunities was identified. This description of pt experience, values, and preferences enriches the informed consent process and may lead to more tailored and patient-centered care. Disclosures Kennard: AbbVie, Gilead, Verastem: Consultancy. Furman:TG Therapeutics: Consultancy; Loxo Oncology: Consultancy; Sunesis: Consultancy; Verastem: Consultancy; Incyte: Consultancy, Other: DSMB; Genentech: Consultancy; Acerta: Consultancy, Research Funding; Gilead: Consultancy; Janssen: Consultancy; Pharmacyclics LLC, an AbbVie Company: Consultancy; AbbVie: Consultancy. Pagel:Pharmacyclics, an AbbVie Company: Consultancy; Gilead: Consultancy. Davids:Sunesis: Membership on an entity's Board of Directors or advisory committees; Roche: Consultancy; Astra-Zeneca: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; BMS: Research Funding; Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Astra-Zeneca: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; MEI Pharma: Consultancy, Research Funding; Surface Oncology: Research Funding; Gilead: Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy; Merck: Consultancy; Merck: Consultancy; MEI Pharma: Consultancy, Research Funding; TG Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Astra-Zeneca: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; MEI Pharma: Consultancy, Research Funding; Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy; Sunesis: Membership on an entity's Board of Directors or advisory committees; Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees; TG Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Pharmacyclics: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Gilead: Membership on an entity's Board of Directors or advisory committees; Verastem: Consultancy, Research Funding; Surface Oncology: Research Funding; Gilead: Membership on an entity's Board of Directors or advisory committees; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pharmacyclics: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Abbvie: Consultancy, Membership on an entity's Board of Directors or advisory committees; Celgene: Consultancy; Roche: Consultancy; Pharmacyclics: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees; BMS: Research Funding; Verastem: Consultancy, Research Funding; BMS: Research Funding; Genentech: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Surface Oncology: Research Funding; Verastem: Consultancy, Research Funding; TG Therapeutics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Consultancy, Membership on an entity's Board of Directors or advisory committees; Sunesis: Membership on an entity's Board of Directors or advisory committees; Merck: Consultancy; Roche: Consultancy. Nabhan:Cardinal Health: Employment, Equity Ownership. Kay:Acerta: Research Funding; Tolero Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees, Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees; Morpho-sys: Membership on an entity's Board of Directors or advisory committees; Pharmacyclics: Membership on an entity's Board of Directors or advisory committees, Research Funding; Agios Pharm: Membership on an entity's Board of Directors or advisory committees; Celgene: Membership on an entity's Board of Directors or advisory committees; Gilead: Membership on an entity's Board of Directors or advisory committees; Infinity Pharm: Membership on an entity's Board of Directors or advisory committees; Cytomx Therapeutics: Membership on an entity's Board of Directors or advisory committees. Siddiqi:Juno Therapeutics: Other: Steering committee. Brander:Genentech: Consultancy, Honoraria, Other: Institutional research funding for non investigator initiated clinical trial, Research Funding; Pharmacyclics, an AbbVie Company: Consultancy, Honoraria, Research Funding; AbbVie: Consultancy, Honoraria, Other: Institutional research funding for non investigator initiated clinical trial, Research Funding; Teva: Consultancy, Honoraria; Novartis: Consultancy, Other: DSMB; TG Therapeutics: Consultancy, Honoraria, Other: Institutional research funding for non investigator initiated clinical trial, Research Funding; BeiGene: Other: Institutional research funding for non investigator initiated clinical trial, Research Funding; Acerta: Other: Institutional research funding for non investigator initiated clinical trial, Research Funding; DTRM: Other: Institutional research funding for non investigator initiated clinical trial, Research Funding. Wierda:AbbVie, Inc: Research Funding; Genentech: Research Funding. Hill:Abbvie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Genentech: Honoraria, Membership on an entity's Board of Directors or advisory committees, Research Funding; Pfizer: Honoraria, Membership on an entity's Board of Directors or advisory committees; Seattle Genetics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Novartis: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pharmacyclics: Honoraria, Membership on an entity's Board of Directors or advisory committees; Amgen: Research Funding; Abbvie: Honoraria, Membership on an entity's Board of Directors or advisory committees; Pharmacyclics: Honoraria, Membership on an entity's Board of Directors or advisory committees. Cheson:AbbVie, Roche/Genentech, Pharmacyclics, Acerta, TG Therapeutics: Consultancy. Choi:Pharmacyclics: Consultancy, Research Funding, Speakers Bureau; Gilead: Speakers Bureau; Rigel: Consultancy; Genentech: Speakers Bureau; AbbVie, Inc: Consultancy, Speakers Bureau. Mato:AstraZeneca: Consultancy; Prime Oncology: Honoraria; Portola: Research Funding; Johnson & Johnson: Consultancy; Medscape: Honoraria; Celgene: Consultancy; TG Therapeutics: Consultancy, Research Funding; Acerta: Research Funding; Pharmacyclics, an AbbVie Company: Consultancy, Research Funding; AbbVie: Consultancy, Research Funding; Regeneron: Research Funding.
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Javitt, Gail, Deena Berkowitz, and Lawrence O. Gostin. "Assessing Mandatory HPV Vaccination: Who Should Call the Shots?" Journal of Law, Medicine & Ethics 36, no. 2 (2008): 384–95. http://dx.doi.org/10.1111/j.1748-720x.2008.00282.x.
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The human papillomavirus (HPV) is the most common sexually transmitted infection worldwide. In the United States, more than six million people are infected each year. Although most HPV infections are benign, two strains of HPV cause 70 percent of cervical cancer cases. Two other strains of HPV are associated with 90 percent of genital warts cases.In June 2006, the Food and Drug Administration (FDA) approved the first vaccine against HPV. Sold as Gardasil, the quadrivalent vaccine is intended to prevent four strains of HPV associated with cervical cancer, precancerous genital lesions, and genital warts. Following FDA approval, the national Advisory Committee on Immunization Practices (ACIP) recommended routine vaccination for girls ages 11-12 with three doses of quadrivalent HPV vaccine. Thereafter, state legislatures around the country engaged in an intense effort to pass laws mandating vaccination of young girls against HPV. This activity was spurred in part by an intense lobbying campaign by Merck, the manufacturer of the vaccine.
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Walker, Frances J., James A. Singleton, Pengjun Lu, Karen G. Wooten, and Raymond A. Strikas. "Influenza Vaccination of Healthcare Workers in the United States, 1989-2002." Infection Control & Hospital Epidemiology 27, no. 3 (March 2006): 257–65. http://dx.doi.org/10.1086/501538.
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Objectives.We sought to estimate influenza vaccination coverage among healthcare workers (HCWs) in the United States during 1989-2002 and to identify factors associated with vaccination in this group. The Advisory Committee on Immunization Practices (ACIP) recommends annual influenza vaccination for HCWs to reduce transmission of influenza to patients at high risk for serious complications of influenza.Design.Analysis of cross-sectional data from 1989-2002 surveys conducted by the National Health Interview Survey (NHIS). The outcome measure was self-reported influenza vaccination in the past 12 months. Bivariate and multivariate analysis of 2002 NHIS data.Setting.Household interviews conducted during 1989-2002, weighted to reflect the noninstitutionalized, civilian US population.Participants.Adults aged 18 years or older participated in the study. A total of 2,089 were employed in healthcare occupations or settings in 2002, and 17,160 were employed in nonhealthcare occupations or settings.Results.The influenza vaccination rate among US HCWs increased from 10.0% in 1989 to 38.4% in 2002, with no significant change since 1997. In a multivariate model that included data from the 2002 NHIS, factors associated with a higher rate of influenza vaccination among HCWs aged 18-64 years included age of 50 years or older (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.1-2.1), hospital employee status (OR, 1.5; 95% CI, 1.2-1.9), 1 or more visits to the office of a healthcare professional in the past 12 months (OR, 1.5; 95% CI, 1.1-2.2), receipt of employer-provided health insurance (OR, 1.5; 95% CI, 1.1-2.1), a history of pneumococcal vaccination (OR, 3.9; 95% CI, 2.5-6.1), and history of hepatitis B vaccination (OR, 1.9; 95% CI, 1.4-2.4). Non-Hispanic black persons were less likely to be vaccinated (OR, 0.6; 95% CI, 0.5-0.9) than non-Hispanic white persons. There were no significant differences in vaccination levels according to HCW occupation category.Conclusions.Influenza immunization among HCWs reached a plateau during 1997-2002. New strategies are needed to encourage US HCWs to receive influenza vaccination to prevent influenza illness in themselves and transmission of influenza to vulnerable patients.
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Colakoglu, Salih, Seth Tebockhorst, and David Woodbridge Mathes. "Is Vascularized Composite Allograft Transplantation Experimental or an Accepted Surgical Procedure: Results from a National Survey." Journal of Reconstructive Microsurgery 36, no. 04 (January 27, 2020): 276–80. http://dx.doi.org/10.1055/s-0039-1701029.
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Abstract Background More than 85 patients have received over 100 hand/arm transplants and more than 35 patients have received full or partial face transplants at institutions around the world. Given over two decades of experience in the field and in the light of successful outcomes with up to 17 years follow up time, should we still consider vascularized composite allograft (VCA) as a research/clinical investigation? We present the results of a nationwide electronic survey whose intent was to gather institutional bias with regard to this question. Methods An 11 question survey that was developed by VCA advisory committee of American Society of Transplantation was sent to all identified Internal Review Board chairs or directors in the United States. Results We received a total of 54 responses (25.3%) to the survey. The majority (78%) of responses came from either the chairperson, director, or someone who is administratively responsible for an IRB. Conclusion Though certainly not an exhaustive investigation into each institution's preference, we present a representative sampling. The results of which favor VCA as an accepted clinical procedure given the appropriate setting. Further research is needed to fully ascertain practices at each individual institution.
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Rifkin, Robert M., and Susan R. Peck. "Biosimilars: Implications for Clinical Practice." Journal of Oncology Practice 13, no. 9_suppl (September 2017): 24s—31s. http://dx.doi.org/10.1200/jop.2017.025734.
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In 2015, the United States Food and Drug Administration (FDA) approved the first biosimilar, filgrastim-sndz, a biosimilar of the granulocyte colony-stimulating factor filgrastim. Since that time, the FDA has approved four additional biosimilar tumor necrosis factor α inhibitors, and, in May 2017, the Oncology Drug Advisory Committee voted in favor of approval of an epoetin alfa biosimilar. The patents of several widely used biologic cancer therapies (including trastuzumab, rituximab, bevacizumab, cetuximab, and pegfilgrastim) are recently expired or due to expire in the near future, so the introduction of biosimilars into the oncology treatment armamentarium is imminent. However, their arrival also will introduce challenges, including pharmacy and supply chain management and the need for education of clinicians and patients about the efficacy and safety of these agents. These considerations, along with an overview of biosimilars in the oncology pipeline, will be discussed in this review.
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Battistoni, Richard M. "Should Political Scientists Care about Civic Education?" Perspectives on Politics 11, no. 4 (December 2013): 1135–38. http://dx.doi.org/10.1017/s1537592713002867.
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For the past decade, concern about a crisis in civic education and engagement, especially among young people, has been rampant. In 2003, The Civic Mission of Schools report sounded a clarion call for greater attention to citizenship education in K–12 schools and touched off a national campaign, joined by such luminaries as Justice Sandra Day O'Connor, advocating improvements in the way we educate American youth for participation in democracy. Two years later, the work of the American Political Science Association's Committee on Civic Education and Engagement culminated in the publication of Democracy at Risk, which examined growing trends toward civic disengagement and proposed reforms to reinvigorate political participation in the United States. Just last year, a joint effort by the US Department of Education and the Association of American Colleges and Universities produced A Crucible Moment: College Learning and Democracy's Future, once again chronicling a “civic recession” across the land and issuing a “National Call to Action” for higher education to do more to educate young citizens for democracy.
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Thorman, Jan C., and Pamela Bergmann. "Development and Implementation of Guidelines for Federal On-Scene Coordinators for Protecting Historic Properties." International Oil Spill Conference Proceedings 1999, no. 1 (March 1, 1999): 363–66. http://dx.doi.org/10.7901/2169-3358-1999-1-363.
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ABSTRACT In 1997, the National Response Team completed a Programmatic Agreement on Protection of Historic Properties during Emergency Response under the National Oil and Hazardous Substances Pollution Contingency Plan. This agreement, which was drafted by a National Response Team ad hoc committee consisting of representatives of National Response Team member agencies, the Advisory Council on Historic Preservation, and the National Conference of State Historic Preservation Officers, has important ramifications for federal On-Scene Coordinators and responsible parties conducting spill response in the United States. The purpose of the Programmatic Agreement is to ensure that historic properties are appropriately taken into account in planning for and conducting emergency response to oil spills and hazardous substance releases under the National Oil and Hazardous Substances Pollution Contingency Plan. The agreement provides a uniform, nationwide approach to considering and protecting historic properties before and during an emergency response. Signatories, which include the U.S. Coast Guard and the Environmental Protection Agency, agree to implement this Programmatic Agreement or to develop and then implement regional Programmatic Agreements that are consistent with the nationwide Programmatic Agreement and the National Historic Preservation Act. As of September 1998, implementation of the nationwide Programmatic Agreement and development of regional Programmatic Agreements were just beginning by Regional Response Teams and federal On-Scene Coordinators throughout the United States. The Alaska Regional Response Team, whose development of regional cultural resources guidelines in the early 1990s led to the development of the nationwide Programmatic Agreement, had begun preparing a document on implementation of the nationwide Programmatic Agreement in Alaska. The emergency response provisions of the nationwide Programmatic Agreement were implemented for the first time in the November 1997, M/V Kuroshima spill near Dutch Harbor, Alaska. The major lesson learned from this incident with regard to the nationwide Programmatic Agreement is that its provisions are workable and can contribute to the overall success of the response.
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Schmidt, Judit. "Hogy minden falat számítson: étrendi ajánlás az amerikaiaknak." Egészségfejlesztés 62, no. 3 (July 17, 2021): 37–41. http://dx.doi.org/10.24365/ef.v62i3.6587.
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Az 1980-ban megjelent első kiadás óta az Amerikaiaknak szóló étrendi ajánlások (Dietary Guidelines for Americans) tudományosan megalapozott tanácsokat adnak arra vonatkozóan, hogy mit kell enni és inni az egészség megőrzése, a krónikus betegségek kockázatának csökkentése és a tápanyagszükséglet kielégítése érdekében. Az étrendi ajánlások közzétételét az 1990. évi Nemzeti Táplálkozásfigyelő és Kapcsolódó Kutatási Törvény (National Nutrition Monitoring and Related Research Act) írja elő, amely kimondja, hogy az Egyesült Államok Mezőgazdasági Minisztériuma (U. S. Departments of Agriculture, USDA) és az Egészségügyi és Humán Szolgáltatások Minisztériuma (Health and Human Services, HHS) legalább öt évente közösen tegyen közzé egy jelentést, amely táplálkozási és étrendi információkat, ajánlásokat tartalmaz a lakosság számára. A törvény (Public Law 101-445, 7 United States Code 5341 et seq.) előírja, hogy az étrendi ajánlásoknak a jelenlegi tudományos és orvosi ismereteken kell alapulniuk. Az étrendi ajánlások 2020-2025-ös kiadása a 2015-ös kiadásra épül, a 2020-as étrendi ajánlások tanácsadó bizottságának tudományos jelentésén (Scientific Report of the 2020 Dietary Guidelines Advisory Committee) alapuló felülvizsgálatokkal, valamint a szövetségi ügynökségek és a lakossági észrevételek figyelembevételével.
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Bhatti, Alexandra, Cristina Carias, and Ya-Ting Chen. "1380. Current status of the legal landscape regarding Rotavirus Vaccination in the United States." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S699—S700. http://dx.doi.org/10.1093/ofid/ofaa439.1562.
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Abstract Background In the US, the Advisory Committee on Immunization Practices recommended routine rotavirus vaccination for all infants in 2006. Since then, rotavirus (RV) vaccination coverage (VC) has increased; however, RV VC is still below that of other routine childhood vaccines. All states require children to be vaccinated against certain communicable diseases as a condition for childcare attendance; other states require that children with diarrhea are excluded from childcare. Given the potential impact of these policies on VC, we sought to understand the legal landscape affecting rotavirus (RV) vaccination. Methods Legal epidemiological methods using Westlaw NEXT database were used to complete a systematic assessment of RV vaccination requirements for childcare entry and evaluate the ease at which non-medical exemptions are attained. These methods were also used to evaluate state diarrhea childcare exclusion policies. Results Six states require RV vaccination for childcare attendance: Wyoming (2018); Ohio and Rhode Island (2015); Idaho (2011); North Dakota (2008); and Pennsylvania (2002) (Figure 1). All 6 states permit non-medical exemption that allow children to be exempt from vaccination. Ohio, North Dakota, and Pennsylvania are the most lenient, only requiring parental signature to withdraw from vaccination; while Wyoming is the least lenient, requiring a signed notarized official document. Childcare diarrhea exclusion policies were found in 28 states. Rotavirus Vaccination Requirements for Childcare Entry by State as of 2019. Conclusion To date, a minority of states have implemented RV vaccination policies while more states have diarrhea exclusion policies. However, vaccination policies may play a role in increasing VC and consequently lower acute gastroenteritis and diarrhea burden. In 2017, the VC for the full series of RV vaccination was 73.2%. Four of the states that have RV state vaccination policies had higher state-wide vaccination coverages than the national average. Given the concern in reducing diarrhea transmission, as evidenced by the large number of diarrhea exclusion policies, and the potential impact of policies on higher VC which may result in greater protection and reduction in RV disease, considerations should be given to implementing such policies in more states. Disclosures Alexandra Bhatti, JD, MPH, Merck (Employee) Cristina Carias, PhD, Merck (Employee, Shareholder) Ya-Ting Chen, PhD, Merck & Co., Inc. (Employee, Shareholder)
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ALAM, AHM Zahirul. "EDITORIAL." IIUM Engineering Journal 22, no. 1 (January 4, 2021): i. http://dx.doi.org/10.31436/iiumej.v22i1.1719.
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CHIEF EDITOR Ahmad Faris Ismail, IIUM, Malaysia TECHNICAL EDITOR Sany Izan Ihsan, IIUM, Malaysia EXECUTIVE EDITOR AHM Zahirul Alam, IIUM, Malaysia ASSOCIATE EDITOR Nor Farahidah Za’bah, IIUM, Malaysia LANGUAGE EDITOR Lynn Mason, Malaysia COPY EDITOR Hamzah Mohd. Salleh, IIUM, Malaysia EDITORIAL BOARD MEMBERS Abdullah Al-Mamun, IIUM, Malaysia Abdumalik Rakhimov, IIUM, Malaysia Ali Sophian, IIUM, Malaysia Erwin Sulaeman, IIUM, Malaysia Hanafy Omar, Saudi Arabia Hazleen Anuar, IIUM, Malaysia Konstantin Khanin, University of Toronto, Canada Ma'an Al-Khatib, IIUM, Malaysia Md Zahangir Alam, IIUM, Malaysia Meftah Hrairi, IIUM, Malaysia Mohamed B. Trabia, United States Mohammad S. Alam, Texas A&M University-Kingsville, United States Mustafizur Rahman, National University Singapore, Singapore Ossama Abdulkhalik, Michigan Technological University, United States Othman O Khalifa, IIUM, Malaysia Razi Nalim, IUPUI, Indianapolis, Indiana, United States Rosminazuin AB. Rahim, IIUM, Malaysia Waqar Asrar, IIUM, Malaysia INTERNATIONAL ADVISORY COMMITTEE Anwar, United States Abdul Latif Bin Ahmad, Malaysia Farzad Ismail, USM, Pulau Pinang, Malaysia Hanafy Omar, Saudi Arabia Hany Ammar, United States Idris Mohammed Bugaje, Nigeria K.B. Ramachandran, India Kunzu Abdella, Canada Luis Le Moyne, ISAT, University of Burgundy, France M Mujtaba, United Kingdom Mohamed AI-Rubei, Ireland Mohamed B Trabia, United States Syed Kamrul Islam, United States Tibor Czigany, Budapest University of Technology and Economics, Hungary Yiu-Wing Mai, The University of Sydney, Australia. AIMS & SCOPE OF IIUM ENGINEERING JOURNAL The IIUM Engineering Journal, published biannually (January and July), is a carefully refereed international publication of International Islamic University Malaysia (IIUM). Contributions of high technical merit within the span of engineering disciplines; covering the main areas of engineering: Electrical and Computer Engineering; Mechanical and Manufacturing Engineering; Automation and Mechatronics Engineering; Material and Chemical Engineering; Environmental and Civil Engineering; Biotechnology and Bioengineering; Engineering Mathematics and Physics; and Computer Science and Information Technology are considered for publication in this journal. Contributions from other areas of Engineering and Applied Science are also welcomed. The IIUM Engineering Journal publishes contributions under Regular papers and Invited review papers. It also welcomes contributions that address solutions to the specific challenges of the developing world, and address science and technology issues from an Islamic and multidisciplinary perspective. REFEREES’ NETWORK All papers submitted to IIUM Engineering Journal will be subjected to a rigorous reviewing process through a worldwide network of specialized and competent referees. Each accepted paper should have at least two positive referees’ assessments. SUBMISSION OF A MANUSCRIPT A manuscript should be submitted online to the IIUM-Engineering Journal website at http://journals.iium.edu.my/ejournal. Further correspondence on the status of the paper could be done through the journal website. Whilst every effort is made by the publisher and editorial board to see that no inaccurate or misleading data, opinion or statement appears in this Journal, they wish to make it clear that the data and opinions appearing in the articles and advertisement herein are the responsibility of the contributor or advertiser concerned. Accordingly, the publisher and the editorial committee accept no liability whatsoever for the consequence of any such inaccurate or misleading data, opinion or statement. IIUM Engineering Journal ISSN: 1511-788X E-ISSN: 2289-7860 Published by: IIUM Press, International Islamic University Malaysia Jalan Gombak, 53100 Kuala Lumpur, Malaysia Phone (+603) 6421-5014, Fax: (+603) 6421-6298
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Potts-Datema, William, Becky J. Smith, Howard Taras, Theresa C. Lewallen, James F. Bogden, and Sharon Murray. "Successful strategies and lessons learned from development of large-scale partnerships of national non-gowernmental organisations." Promotion & Education 12, no. 3-4 (September 2005): 131–37. http://dx.doi.org/10.1177/10253823050120030107.
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National governments worldwide work to improve education and health outcomes for children and youth and influence their behaviours. Also heavily engaged are national non-governmental organisations (NGOs) in the voluntary and non-profit sector. While individual agencies and non-profit organisations are often concerned with specific issues of interest related to their charge, constituency or membership, they often develop allegiances with like-minded groups to accomplish broader goals. Two such collaborations in the United States are the focus of this discussion, the National Co-ordinating Committee on School Health and Safety (NCCSHS) and the Friends of School Health (hereafter, "the Friends"). This article reviews these two significant partnerships of public health and education NGOs and outlines successful strategies and lessons learned from the development of these large-scale partnerships. NCCSHS is a collaboration of 64 NGOs and six U.S. government departments representing both the fields of public health and education. Nearly all major NGOs working in fields related to school health are represented, and the six primary governmental agencies all have at least some responsibility for students' health and safety. The group is the primary intersection of NGOs and the Federal government related to school health at the national level. The Friends of School Health ("the Friends") is the primary school health advocacy coalition at the national level in the United States. Sixty-one education and public health NGOs participate. The coalition serves as a communication mechanism and venue for collaborative action on issues before the U.S. Congress and state legislatures that relate to school health. Since the coalition advocates to legislators and other decision makers, no government agencies participate. The paper describes the strategies relating to the initial development of the collaboratives and their ongoing operation. A common theme in development of both of these examples of large-scale partnerships is trust. Like any partnership, the ability to work and grow is dependent on the level of trust among the partners. Both the National Coordinating Committee on School Health and Safety and the Friends of School Health work together successfully within and across their collaborations, to improve health and educational outcomes for children and youth. While both experience challenges, and neither would indicate that its work is near completion, they provide important insight into how these collaboratives can initially develop and subsequently operate productively while providing important contributions to the promotion of healthy schools, and ultimately, healthy nations.
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Flamm, Robert K., Michael A. Pfaller, Paul G. Ambrose, David Andes, John S. Bradley, Sujata M. Bhavnani, and Ronald N. Jones. "1591. Updated Fluoroquinolone MIC Breakpoints: Impact on Susceptibility Rates in the United States." Open Forum Infectious Diseases 6, Supplement_2 (October 2019): S580—S581. http://dx.doi.org/10.1093/ofid/ofz360.1455.
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Abstract Background In 2015 USCAST, the National Advisory Committee for the United States (US) to EUCAST, produced a report (Version 1.0) on their website (www.uscast.org) re-evaluating fluoroquinolone (FQ) breakpoint interpretive criteria (IC) based on analysis of current microbiology and pharmacokinetic/pharmacodynamic (PK/PD) data. EUCAST initiated a consultative process using USCAST analyses in an effort to update FQ IC, released in 2017. CLSI formed an ad-hoc working group in late 2015 to review the USCAST FQ document and formulate questions about content. In 2018, USCAST released V1.3 of the FQ document and CLSI subsequently published updated FQ MIC IC in the M100-S29 (2019) document. This study evaluated the impact on susceptibility (S) rates for US surveillance data that these IC changes created. Methods Clinical isolates (reference broth microdilution MIC) from 2016–2018 US SENTRY Program were analyzed for S based on current and previous IC. FQ results for ciprofloxacin (CIP), levofloxacin (LEV), and moxifloxacin (MOX) were evaluated. Benchmark S comparison data for meropenem, cefepime, piperacillin–tazobactam and delafloxacin (new FQ) were also included. Results S rates for Enterobacteriaceae (ENT;Figure) were reduced by 3.8/3.7% for CIP/LEV (CLSI) and 2.3/2.5% (EUCAST). MOX-S rate vs. ENT declined 5.7% (EUCAST). Although reductions in S occurred for most organism groups, K. pneumoniae (6.0/5.5% for CIP/LEV [CLSI] and 4.0/4.2% [EUCAST]) and S. marcescens (7.4/4.1% for CIP/LEV [CLSI] and 4.1/5.0% [EUCAST]) reductions were among the largest changes. For Pseudomonas aeruginosa (PSA), CIP-S decreased 6.8% and LEV-S 10.1% (CLSI); but potential for false-S results remain using CLSI IC (5 pathogens). Conclusion USCAST’s comprehensive analyses of FQ IC in 2015 led to revised breakpoints for most organism/drug combinations among ENT and PSA compared with those being used before. USCAST analysis was most influenced by PK/PD in vivo data as current clinical outcomes data by MIC was limited. Awareness and interactions (both formal and informal) among breakpoint setting organizations has modified FQ ICs which are lower than previously recommended, and although not perfectly harmonized in time and detail, this represents a successful model. Disclosures All authors: No reported disclosures.
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Rubinstein, Judith, Boaz Adler, Jake Blumenthal, Ruth Chang, S. Yin Ho, Ashley Jaksa, Briana Lurie, Anson Pontynen, Emily Rubinstein, and Rachel Sliman. "VP157 What Is The Response To Immuno-Oncology By Health Technology Assessment Agencies?" International Journal of Technology Assessment in Health Care 33, S1 (2017): 220–21. http://dx.doi.org/10.1017/s0266462317003968.
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INTRODUCTION:Immunotherapies are a relatively new innovative class of drug that have garnered excitement in the fight against cancer. In 2011, the immunotherapy drug, ipilimumab, was approved. Since then, four additional drugs have gained approval. This analysis evaluates the initial reception of immunotherapies by Health Technology Assessment (HTA) agencies.METHODS:The Context Matters Data Model was used to evaluate the regulatory and HTA agency decisions surrounding the five approved immunotherapies through November 2016: atezolizumab, elotuzumab, ipilimumab, nivolumab, and pembrolizumab. Thirty-three labels from Australia, Canada, Europe, and the United States, and ninety-two assessments from Agenzia Italiana del Farmaco (AIFA), Gemeinsamer Bundesausschuss (Federal Joint Committee; G-BA), Haute Autorité de Santé (French National Authority for Health; HAS), Institute for Clinical and Economic Review (ICER), Institute for Quality and Efficiency in Health Care (IQWiG), National Institute for Health and Care Excellence (NICE), Pharmaceutical Benefits Advisory Committee (PBAC), pan-Canadian Oncology Drug Review (pCODR), and Scottish Medicines Consortium (SMC) were found. Using a sample t-test and a chi-squared test, reimbursement agencies’ decisions were evaluated, and the clinical and economic factors that went into these decisions were examined.RESULTS:Of the evaluated reviews: sixty-four were for melanoma indications, fourteen were for non-small-cell lung cancer (NSCLC) indications, and seven were for kidney cancer indications. Many of the reviews did not reach any decision, but 75 percent of HTA decisions (n = 72; p = .0000) reached were positive. Elotuzumab, approved for multiple myeloma, received a positive decision from G-BA and a negative one from SMC. There was an association between different disease conditions or drugs and the rate of positive decisions.For reviews that had clinical reasons for their decisions, 72.9 percent (n = 59; p = .0000) had positive clinical rationales that were associated with positive decisions (p = .000). Economic rationales for decisions were more mixed, with only 48.4 percent (n = 31; p = .0000) receiving positive decisions. Positive economic evaluations were also associated with positive decisions (p = .000). Atezolizumab, approved only in the United States at the time of this writing, has yet to be reviewed by any of the HTA agencies.CONCLUSIONS:Immunotherapies are promising new options for the treatment of cancer. Thus far, reception by HTA agencies has generally been positive.
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Peden, Amy E., Dennis Alonzo, Faye McMillan, Tich Phuoc Tran, Catherine Hawke, Rebecca Ivers, and Richard C. Franklin. "Co-Designing a Farm Safety Gamified Educational Resource With Secondary School Students and Their Teachers: Qualitative Study Protocol." International Journal of Qualitative Methods 22 (January 2023): 160940692311563. http://dx.doi.org/10.1177/16094069231156345.
Full textAbstract:
Unintentional injuries are a leading cause of preventable harm among adolescents. Adolescents also experience an increased risk of farm injury, and in Australia, injury-related farm fatalities among adolescents have remained largely unchanged over the past two decades. A third of all incidents involve farm visitors, indicating the need for population-level safety information. This project uses qualitative data to inform a co-design process with adolescents, and their teachers, to develop a game-based farm injury prevention online educational resource. This protocol describes the multi-phase co-design project. Focus group discussions regarding farm injury prevention will be held with students (Year 7 & 8; ∼12–14 years of age) and teachers at high schools with an agricultural focus across two Australian states. Inductive thematic analysis of discussion transcripts, and analysis of farm injury data, will inform the development of the modules and content of the game. User experience testing of the prototype will form the final phase of the project. This process is supported by a Stakeholder Advisory Group, which includes representatives of youth farming organisations, agricultural educators, and national child safety organisations. This group will assist in interpretation and dissemination of findings and promoting the resultant educational resource in schools. Ethical approval has been granted by the University of New South Wales Human Research Ethics Committee. Results will be disseminated through peer-reviewed publications, mass media releases, academic conferences, and the agricultural education sector in Australia via the stakeholder advisory group. This study will provide useful insights into co-designing injury prevention resources for adolescents using gamification and result in a co-designed farm injury prevention educational resource for schools and the general community via mobile and web-based applications.