A model for sustainable short-term international medical trips.

The health status of many people in developing countries is often dismal compared with the norms in industrialized countries. Increasingly, medical practitioners in the United States and other industrialized countries have become interested in global health issues, an interest that often takes the form of short-term international medical trips. We discuss several ethical issues associated with participation in such trips and use our experiences in developing the Children's Health International Medical Project of Seattle (CHIMPS) to outline and illustrate a set of 7 guiding principles for making these trips. CHIMPS is a resident-run, faculty-supported international medical program founded in 2002 by pediatric residents at the University of Washington in Seattle. Members of CHIMPS work with a rural community in El Salvador to support ongoing public health interventions there and provide sustainable medical care in collaboration with the community and a local nongovernmental organization. The 7 principles developed as a result of this work-mission, collaboration, education, service, teamwork, sustainability, and evaluation-can be used as a model for health practitioners as they develop or select international medical trips. The importance of partnering with the community and working within the existing medical and public health infrastructure is emphasized. Many of the challenges of doing international medical work can be overcome when efforts are guided by a few specific principles, such as those we have outlined.     

DNA replication and late protein synthesis during SP82 infection of Bacillus subtilis

During infection of Bacillus subtilis by bacteriophage SP82, substantial quantities of at least two different late proteins were synthesized, even in the absence of detectable phage DNA replication. The two proteins were the lytic enzyme (which is possibly a host specific enzyme) and the protein(s) responsible for serum blocking power (which is presumably phage specific). The absence of replication was assured by the use of an SP82 double mutant carrying a mutation in each of two cistrons required for replication, and was verified by density transfer and isotope incorporation experiments. Thus, it appears that phage DNA replication is not required for late protein synthesis during SP82 infection.     

Remote Echography between a Ground Control Center and the International Space Station Using a Tele-operated Echograph with Motorized Probe

Echography is the most appropriate imaging modality for investigating astronauts. Unfortunately, it requires a great deal of training to perform ultrasound examinations, which can be difficult and time consuming, especially if the astronaut does not have a medical background. We designed a new echography system with motorized probes that allows for the majority of exam functions to be controlled by a ground-based sonographer. Using tele-operation, the sonographer controls the orientation of the transducer (tilt, rotation) and echograph settings (gain, depth, freeze) and triggers ultrasound functions (pulsed wave color Doppler, 3-D capture, radiofrequency data collection, elastography). With this system, astronauts are required to hold the motorized probe only at the locations indicated, with the remainder of the exam being conducted by the ground-based sonographer. During spaceflight, ultrasound imaging of the carotid artery, jugular vein, thyroid, liver, gallbladder, biliary tract and portal vein (2-D, 3-D, color, pulsed wave, radiofrequency) were successfully performed.     

Development and validation of the Workplace Interruptions Measure

In 3 studies, we developed and tested the first comprehensive, self‐report measure of workplace interruptions. The Workplace Interruptions Measure (WIM) is based on a typology of interruptions that included intrusions, distractions, discrepancy detections, and breaks. The four‐factor structure was reduced to a 12‐item measure in Study 1 (N = 317) and confirmed in a diverse sample of employees in Study 2 (N = 160). Study 3 (N = 323) further examined the psychometric properties of the WIM in a sample of university faculty and staff. Studies 2 and 3 demonstrated that both effort‐enhancing interruptions (intrusions, distractions, and discrepancy detections) and recovery‐enhancing interruptions (breaks) were associated with stressors and strains. Distractions, discrepancy detections, and breaks uniquely predicted strain outcomes beyond other workplace stressors (i.e., quantitative workload, interpersonal conflict, and role conflict). We discuss implications of the WIM for the theory and practice of interruptions research.     

Understanding Population-Based Site-Specific Cancer Incidence Rates in the USA

As compared with conventionally reported national population-based incidence rates, incidence rates better represent the ??burden?? of disease if they remove prevalent cases from the denominator. In order to reflect the ??risk?? in a disease-free population, rates should both exclude prevalent cases from the denominator and second or later diagnosed cases at the same site from the numerator. Five common cancers were evaluated through a correction method using 2005?C2007 Surveillance, Epidemiology, and End Results Program data to determine the extent of difference between conventional and corrected incidence rates. These corrections lowered the incidence rates 4.0?C5.8% for female breast cancer, 4.6?C7.6% for melanoma, 3.0?C4.0% for colorectal cancer, and 2.1?C2.5% for lung and bronchus cancer. Corrected incidence rates for prostate cancer were 9.9?C13.7% higher. In cancers with either high prevalence and/or high occurrence of multiple primaries at the same site, corrected population-based incidence rates are warranted.     

Dermoscopy to Identify Dermal Thinning

Biopsying of children is often difficult to accomplish and traumatic. Consequently, techniques that avert biopsy are welcome in children. We describe the use of handheld dermoscopy for confirmation of the diagnosis of lesions with dermal thinning, including focal dermal hypoplasia, aplasia cutis, and striae. The major advantage of this technique is rapid diagnosis in the absence of a surgical procedure.     

Role of the vulnerable elders survey-13 screening tool in predicting treatment plan modification for older adults with cancer

Background: The Vulnerable Elders Survey (VES-13) is commonly used to identify older patients who may benefit from Comprehensive Geriatric Assessment (CGA) prior to cancer treatment. The optimal cut point of the VES-13 to identify those whose final oncologic treatment plan would change after CGA is unclear. We hypothesized that patients with high positive VES-13 scores (7–10)have a higher likelihood of a change in treatment compared to low positive scores (3–6).Methods: Retrospective review of a customized database of all patients seen for pre-treatment assessment in an academic geriatric oncology clinic from June 2015 to June 2019. Various VES-13 cut points were analyzed to identify those individuals whose treatment was modified after CGA. Area under the curve (AUC) was calculated and subgroups of patients treated locally or systemically were also examined to determine if performance varied by treatment modality.Results: We included 386 patients with mean age 81, 58% males. Gastrointestinal cancer was the most common site (31%) and 60% were planned to receive curative treatment. The final treatment plan was modified in 59% overall, with 52.7% modified with VES-13 scores 7–10, 50.8% with scores 3–6 and 28.1% with scores <3 (P = 0.002). VES-13 performance in predicting treatment modification was similar for cut points 3 (AUC 0.58), 4 (0.59), 5 (0.59), and 6 (0.59) and in those considering local treatment vs. chemotherapy.Conclusions: A positive VES-13 score was associated with final oncologic treatment plan modification. A high positive score was not superior to the conventional cut point of ≥3.