Identification and Assessment of Public Health Surveillance Gaps under the IHR (2005)

Objective

To conceive and develop a model to identify gaps in public health surveillance performance and provide a toolset to assess interventions, cost, and return on investment (ROI).

Introduction

Under the revised International Health Regulations (IHR [2005]) one of the eight core capacities is public health surveillance. In May 2012, despite a concerted effort by the global community, the World Health Organization (WHO) reported out that a significant number of member states would not achieve targeted capacity in the IHR (2005) surveillance core capacity.Currently, there is no model to identify and measure these gaps in surveillance performance. Likewise, there is no toolset to assess interventions by cost and estimate the ROI.We developed a new conceptual framework that: (1) described the work practices to achieve effective and efficient public health surveillance; (2) could identify impediments or gaps in performance; and (3) will assist program managers in decision making.

Methods

Published articles and grey-literature reports, manuals and logic model examples were gathered through a literature review of PubMed, Web of Science, Google Scholar, and other databases. Logic models were conceived by categorizing discrete surveillance inputs, activities, outputs, and outcomes. Indicators were selected from authoritative sources or developed and then mapped to the logic model elements. These indicators will be weighted using the principle component analysis (PCA), a method for enhanced precision of statistical analysis. Finally, on the front end of the tool, indicators will graphically measure the surveillance gap expressed through the tool’s architecture and provide information using an integrated cost-impact analysis.

Results

We developed five public health surveillance logic models: for IHR (2005) compliance; event-based; indicator-based; syndromic; and predictive surveillance domains. The IHR (2005) domain focused on national-level functionality, and the others described the complexities of their specific surveillance work practices. Indicators were then mapped and linked to all logic model elements.

Conclusions

This new framework, intended for self-administration at the national and subnational levels, measured public health surveillance gaps in performance and provided cost and ROI information by intervention. The logic model framework and PCA methodology are tools that both describe work processes and define appropriate variables used for evaluation. However, both require real-world data. We recommend pilot testing and validation of this new framework. Once piloted, the framework could be adapted for the other IHR (2005) core capacities.     

Comparative study of retreatment of Thermafil and lateral condensation endodontic fillings

The aim of the present study was to evaluate the possibility of retreating teeth obturated with: (i) Thermafil with plastic carrier, (ii) Thermafil with metallic carrier and (iii) laterally condensed gutta-percha. The following aspects were analysed: removal of obturation, time required for removal, remaining filling material and apical extrusion during reinstrumentation. Thirty human teeth with a single canal were instrumented up to a size 45 K-type file, divided into three groups of 10 teeth each and obturated with Thermafil with plastic carrier (group 1), Thermafil with metallic carrier (group 2), and laterally condensed gutta-percha (group 3) with AH26 as the sealer. Reinstrumentation was performed manually after 30 days storage using Hedstroem files and xylene as a solvent. The average time needed to remove the obturation was 12 min 1 s for group 1, 14 min 36 s for group 2 and 11 min 26 s for group 3. Although no statistically significant differences were observed between groups 1 and 2, and 1 and 3 ( P > 0.05), the differences between groups 2 and 3 were significant ( P < 0.05). The amount of remaining filling material was significantly higher in group 2 when compared with groups 1 and 2 ( P < 0.01). Although the lowest incidence of apical extrusion during reinstrumentation was found in group 3, the differences among groups were not statistically significant.     

双黄连滴丸的主要药效学研究

目的：评价双黄连滴丸的主要药效,为临床合理使用提供参考。方法：解热试验、抗炎试验、抗菌试验。结果：双黄连滴丸口服灌胃给药剂量在10和3g/kg（含生药）时,对细菌内毒素引起的家兔体温升高具有良好的降解作用;口服灌胃给药剂量在20和6g/kg（含生药）时,能显著抑制腹腔注射醋酸（HAC）所致小鼠腹腔毛细血管通透性的增高和二甲苯所致的小鼠耳肿胀（P＜0．01）;能保护由腹腔射金黄色葡萄球菌引起的动物死亡;体外抗菌试验表明对金黄色葡萄球菌、流感杆菌、B型链球菌具有较好的抑菌作用（最低抑制菌浓度分别为40,40和160mg/ml含生药）。结论：双黄连滴丸具有解热、抗炎、抗菌作用。     

MR fluoroscopy: initial clinical studies

Magnetic resonance (MR) fluoroscopy is a method for high-speed MR image acquisition with the goals of short acquisition time per image (500 msec or less), high image rate (10 images or more per second), and high-speed image reconstruction (150 msec or less from data acquisition to image display). The authors present their results with the first two goals in volunteers. MR fluoroscopic image data were acquired with a limited flip angle pulse sequence with reduced repetition times (TRs) and fewer phase encodings used per image. The sequence was applied continuously, and images were formed by updating one set of data with data from the most recently taken measurements. Sample head images were generated with TR/echo times as small as 11/5.5 msec and 48 phase encodings for a total acquisition time of about 500 msec. Images were acquired while the volunteer flexed his head. Artifacts from the motion became less evident on images as progressively shorter acquisition times were used.     

Complications of automatic implantable cardioverter defibrillators: radiographic, CT, and echocardiographic evaluation

Automatic implantable cardioverter defibrillators (AICDs) were studied in three groups: (a) Serial radiographs were reviewed in 51 clinic patients. Twenty of 96 (21%) AICD patches distorted with time. (b) Thirty-six postoperative computed tomographic (CT) scans of asymptomatic patients revealed that pericardial fluid collections were frequent during the month after surgery but rare beyond that. Echocardiography was insensitive for these collections. CT also demonstrated dense fibrosis around some distorted patches, months after surgery. (c) Five other patients with pericardial infection had distorted patches, and the four studied with CT had fluid beneath their patches. (d) A case of constrictive pericarditis had distorted patches but was not diagnosed with CT. The authors conclude that distorted patches may indicate postoperative complications and that CT is the imaging modality of choice.