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In 2014, approximately 200,000 deaths occurred in the United States from all injuries, and 31 million sustained non-fatal injuries. In a population of 318,857,056 persons, this represents a per capita death rate from injury of 0.063% (or approximately 6 per 10,000), and a non-fatal injury rate of 9.73% (or approximately 1 in 10). Therefore, injury is common, but related death is uncommon. For injuries from fire and burns specifically, 3,194 deaths occurred (1/100,000 population) which represented 1.6% of all injury fatalities, but only 1.3% of injuries. In all, 408,945 non-fatal burns occurred in the United States in 2014, giving a rate of 0.129% of persons in the United States sustaining a burn, or about 1 per 1000. These statistics indicate that burns remains a significant problem in the United States, and by implication the world. This chapter will investigate these statistics and changes that have occurred in burn occurrence, severity, and causes, and provide some insight into potential means to improve outcomes.

Background: The acquisition of research skills by midwifery students is increasingly important especially for midwifery programmes in universities. Recently, universities in Chile have included the development of research skills in the majority of professional curricula for basic and post-basic degree programmes. The lack of research training is a limitation recognised and shared with other Latin American countries which prevents scientific and technological development. Objectives: To describe the process of implementation of a programme of research projects by midwifery students in a school in Chile and the results obtained, and the perceptions of students and teachers. Results: 31 work groups were formed (92 students), who developed and implemented research projects in gynecology, public health and neonatology. Research was conducted at six public hospitals serving high risk populations, a private clinic, and nine family health centres. The average scores earned for the projects was a 5.7 (scale of 1–7). The students and teachers positively rated the experience of undertaking research. Conclusion: The development of research projects allows students to acquire competencies and confidence in their research skills. It is an experience that can be replicated in other countries supported by the commitment of the midwifery and university faculty and the training and motivation of a group of midwifery educators.

Purpose: The aim of this study is to report the process used to validate an educational Human Papillomavirus (HPV) pamphlet and a HPV video to use in a HPV intervention study for women of color to increase HPV knowledge, health beliefs, health behaviors and intention to use the HPV vaccine for themselves or members of the family. Methods: Fifteen women enrolled in a two part, two hour methodological pilot study to validate the appearance, content and readability of the educational pamphlet and video. Quantitative data was determined women completing two 4-pont Likert type questionnaires consisting of 10 items each. The qualitative data was retrieved with the use of a semi-structure interview. Results: Greater than 86% of the participants indicated that both educational tools were acceptable in appearance, content and readability/ understanding. Participants' responses suggested a change in the pamphlet color and use of more colored illustrations as well as condensing the video narrative with bulleted summary pages after each scene. Conclusion: The tools were well received by the participants. Next steps were identified toward revision. A HPV pamphlet and an HPV video were validated for use in a future intervention study. Future Considerations: More educational pamphlets identifying validation process for use in intervention studies for targeted high risk populations.

Student cheating has always been a problem in higher education, but detection of cheating has become easier with technology (Bertram Gallant 2008). As a result, more students are being caught and reported for cheating. While reporting cheating is not a negative, the rippling effects of reported cheating (e.g., reduced time to degree) may be felt by some populations (e.g., first-generation college students, international students) more than others. Thus, preventing cheating would be a preferable option for all involved.

The purpose of this review is first, to broadly summarize the long-term commitment that began in 1965 to studying type 2 diabetes and obesity through the cooperation of the Pima Indians of Arizona, and second, to discuss the investigations with the Pima Indians of Mexico that started in 1991. The later studies emphasize gene-environment interactions in the pathogenesis of these metabolic disorders. Through the participation of both groups of Pimas, the researchers made key findings with regard to the epidemiology, physiology, clinical assessment and genetics of type 2 diabetes and obesity.

SETTING: Symptom-based screening for tuberculosis (TB) disease is limited by poor performance of symptom screening in several key populations. We tested the hypothesis that pooling sputum from multiple individuals for Xpert(®) MTB/RIF testing would reduce the number of tests required while retaining an acceptable sensitivity, thus allowing the use of Xpert for TB screening. METHODS: We compared pooling ratios that would require the least number of assays using Xpert and determined that for a population with a TB prevalence of approximately 3%, a 1:5 pooling ratio is optimal. To evaluate sensitivity, we generated pools of one specimen with known Mycobacterium tuberculosis culture positivity (smear microscopy-positive or -negative) with four culture-negative specimens. RESULTS: All 20 of the pools generated from a smear- and culture-positive sputum sample were positive using Xpert. Of the 22 pools with a smear-negative, culture-positive sample, we included 17 in the analysis, of which 13 (76%) were Xpert-positive. CONCLUSIONS: Pooling of sputum samples using Xpert achieved reasonable sensitivity and warrants further evaluation of the systematic screening of high TB prevalence populations.

Sir,We thank Dr Abadi and his colleagues for their comments on our article, ‘Factors for improving the diagnostic efficiency of the rapid urease test from the gastric corpus’ [1]. In our study, rap...

India has witnessed a substantial decline in the rate of new HIV infections in the past decade. Despite the reduction in incidence, the social determinants of health, such as poverty, gender inequality, and stigma, have made tackling the disease challenging for medical practitioners, health educators, and social workers, among other stakeholders. This article describes social determinants of HIV/AIDS and provides a brief history of shifts in the HIV/AIDS policies in India, with an overview of the current policy that is complicated by regional variations in HIV prevalence and transmission. In addition, it discusses the nature and impact of HIV in different communities vulnerable to the infection, major interventions supported by the Indian government, and the diverse roles played by social workers in combating the epidemic and providing services to people living with HIV/AIDS.

Background Resilience, or positive adaptation to challenging situations, has potential to improve health outcomes for high risk populations. Resilience may be particularly important for perinatally infected HIV positive adolescents, who are exposed to significant stigma, risks and stressors. Despite recognition that HIV positive adolescents show remarkable resilience in the face of adversity, little is known about how resilience occurs within this population. Methods The aim of this study was to identify elements of resilience in a group of perinatally infected HIV positive adolescents attending HIV clinics. In-depth interviews were conducted with 25 purposively selected HIV positive adolescents (15 female, 10 male) between the ages of 13–19 years in Johannesburg. Data were analysed in NVIVO 10 using a thematic approach to coding. Results Despite marked stressors in the lives of these adolescents, a high degree of resilience was described. Characteristics of resilience in this group included a pertinent set of beliefs, including a belief in fate and recognition of personal strength as a consequence of managing adversity. Character traits such as a pragmatic acceptance about one's life, actively taking responsibility, and a robust self-esteem were evident. Social behaviours included the ability to pursue and access adults and healthcare to meet developmental needs, having a desire to support and help others and challenging HIV related stigma. These characteristics were underscored by the capacity for self-reflection. Conclusion Perinatally infected adolescents, who face high levels of hardship and change, nevertheless exhibit strong resiliency beliefs, traits, and behaviours. Healthcare environments have the potential to be utilized as powerful resources in fostering resilience in HIV positive adolescents, if characteristics of adolescent resilience were integrated into current prevention and intervention programming. Resilience promotion could lead to improved health outcomes for HIV positive adolescents.

Objectives The objective of this study was to explore the trade-offs society and payers make when expanding treatment access to patients with chronic hepatitis C virus (HCV) infection in early stages of disease as well as to vulnerable, high-risk populations, such as people who inject drugs (PWID) and HIV-infected men who have sex with men (MSM-HIV). Methods A discrete time Markov model simulated HCV progression and treatment over 20 years. Population cohorts were defined by behaviors that influence the risk of HCV exposure: PWID, MSM-HIV, an overlap cohort of individuals who are both PWID and MSM-HIV, and all other adults. Six different treatment scenarios were modeled, with varying degrees of access to treatment at different fibrosis stages and to different risk cohorts. Benefits were measured as quality-adjusted life-years and a $150,000/quality-adjusted life-year valuation was used to assess social benefits. Results Compared with limiting treatment to METAVIR fibrosis stages F3 or F4 and excluding PWID, expanding treatment to patients in all fibrosis stages and including PWID reduces cumulative new infections by 55% over a 20-year horizon and reduces the prevalence of HCV by 93%. We find that treating all HCV-infected individuals is cost saving and net social benefits are over $500 billion greater compared with limiting treatment. Including PWID in treatment access saves 12,900 to 41,200 lives. Conclusions Increased access to treatment brings substantial value to society and over the long-term reduces costs for payers, as the benefits accrued from long-term reduction in prevalent and incident cases, mortality, and medical costs outweigh the cost of treatment.

Eye movements and gaze direction have been utilized to make inferences about perception and cognition since the 1800s. The driving factor behind recording overt eye movements stem from the fundamental idea that one's gaze provides tremendous insight into the information processing that takes place early on during development. One of the key deficits seen in individuals diagnosed with Autism Spectrum Disorders (ASD) involves eye gaze and social attention processing. The current chapter focuses on the use of eye-tracking technology with high-risk infants who are siblings of children diagnosed with ASD in order to highlight potential bio-behavioral markers that can inform the ascertainment of red flags and atypical behaviors associated with ASD within the first few years of development.

Peru has made significant progress in increasing access to water supply and sanitation (WS&S). It is unclear, however, if improvements have been equitable and whether certain sub-populations are making equivalent progress. This study explored trends in access to WS&S throughout Peru using data from Demographic and Health Surveys. The study focused on the worst forms of household-level WS&S access, including use of untreated surface water and the practice of open defecation (OD). The prevalence of access and the average annual percentage point change in access were analyzed by quintiles of wealth, urban and rural residence, political regions of Peru, and language for the years 2000, 2004, and 2008. The findings indicate that significant progress in access to WS&S has been made in Peru, but that several sub-populations remain underserved. Regions experiencing high levels of OD made dramatic improvements between 2000 and 2008. The poorest urban populations showed an increasing prevalence of OD, and in some cases surpassed poor, rural populations. The use of untreated surface water was reduced between 2000 and 2008, and remained below 5% for the country. An increased focus on targeting high risk populations to improve equity in access is recommended.

Objective: To summarize the endoscopic screening findings in high-risk population of esophageal and gastric carcinoma and analyze influential factors related to screening. Methods: In seven selected cities and counties with high incidences of esophageal carcinoma, people at age of 40-69 were set as the target population. Those with gastroscopy contradictions were excluded, and all who were voluntary and willing to comply with the medical requirements were subjected to endoscopic screening and histological examination for esophageal, gastric cardia and gastric carcinoma in accordance with national technical manual for early detection and treatment of cancer. Results: In three years, 36,154 people were screened, and 16,847 (46.60%) cases were found to have precancerous lesions. A total of 875 cases were found to have cancers (2.42%), and among them 739 cases had early stage with an early diagnosis rate is 84.5%. Some 715 patients underwent prompt treatment and the success rate was 81.8%. Conclusions: In a high-risk population of esophageal and gastric carcinoma, it is feasible to implement early detection and treatment by endoscopic screening. Screening can identify potential invasive carcinoma, early stage carcinoma and precancerous lesions, improving efficacy through early detection and treatment. The exploratory analysis of related influential factors will help broad implementation of early detection and treatment for esophageal and gastric carcinoma.

The aim of this study is to quantitatively analyze the influence of risk factors on the blood glucose level, and to provide theory basis for understanding the characteristics of blood glucose change and confirming the intervention index for type 2 diabetes. The quantitative method is proposed to analyze the influence of risk factors on blood glucose using back propagation (BP) neural network. Ten risk factors are screened first. Then the cohort is divided into nine groups by gender and age. According to the minimum error principle, nine BP models are trained respectively. The quantitative values of the influence of different risk factors on the blood glucose change can be obtained by sensitivity calculation. The experiment results indicate that weight is the leading cause of blood glucose change (0.2449). The second factors are cholesterol, age and triglyceride. The total ratio of these four factors reaches to 77% of the nine screened risk factors. And the sensitivity sequences can provide judgment method for individual intervention. This method can be applied to risk factors quantitative analysis of other diseases and potentially used for clinical practitioners to identify high risk populations for type 2 diabetes as well as other disease.

Hepatitis is among the world's most prevalent and life threatening diseases. High risk populations like sanitary workers dealing with all sorts of infective materials are easy targets for transmission of this killer disease. The primary objective of our study is to determine the burden of hepatitis B and C among people belonging to this occupation. The secondary objective is to compare the efficacy of ELISA with ICT for screening of both the maladies. 107 subjects who gave informed consent were included in this study. Blood samples were drawn and screening performed with both ELISA and ICT. 26 subjects were found to be sero positive with ICT while 39 were positive with ELISA. 20 subjects were found sero positive with ICT and 36 with ELISA. Our study found that there is a high burden of HBV and HCV among sanitary workers and therefore, there is a great need to devise preventive regimens for protection of this high risk group against viral hepatitis. Objectives: To evaluate the burden of Hepatitis B & C among Sanitary Workers in Pakistan, To compare the sensitivity of ICT and ELISA for screening of HBV and HCV

Cigarette smoking has been identified as the primary causal risk factor in developing lung cancer [1], which is a leading cause of cancer death among both men and women in the United States (U.S.) ...

Author(s): Dinesha, Thongadi Ramesh; Boobalan, Jayaseelan; Sivamalar, Sathasivam; Solomon, Sunil S; Poongulali, Selvamuthu; Pradeep, Ambrose; Murugavel, Kailapuri G; Balakrishnan, Pachamuthu; Smith, Davey M; Saravanan, Shanmugam

Background Demographic and epidemiologic characteristics of Hepatitis E virus (HEV) infected patients in the United States are not well-described. HEV infection may result in severe complications and lead to chronic infection and cirrhosis, especially in immunocompromised patients. There are no widely accepted guidelines for HEV screening and testing in the United States. Identifying traits of known seropositive patients and comorbidities may inform better screening and prevention strategies. In this study, we describe rates of liver disease, transplant status, chronic kidney diseases, and diabetes mellitus among patients serologically tested for HEV at our institution. Methods We retrospectively reviewed all patients for whom HEV IgM or IgG serologic testing was performed across the Mayo Clinic enterprise using the Advanced Cohort Explorer tool. For patients with any documented HEV serologic test, we abstracted baseline patient characteristics and underlying comorbidities at the time of testing. We then grouped subjects according to serologic testing results by antibody type. Survival at one year from date of testing was also assessed. Results A total of 979 unique subjects were identified. The preponderance of subjects was Caucasian (781, 79.8%). Of subjects tested for HEV with serology, 123 (12.6%) had any positive serology. Breakdown of baseline characteristics and selected comorbidities are summarized in Table 1. The largest proportion of subjects, 458 (46.8%), were both IgG and IgM negative and 432 subjects received only IgM or IgG testing. Liver disease was more prevalent in patients with positive vs. negative testing (5.8% vs. 2.1%) as was higher age (average 55.1 years vs. 52.2). One-year survival was similar in all groups. Conclusion HEV serology is not commonly tested. Among those tested, seropositivity is uncommon. Our data show higher HEV seropositivity in older adults, which may represent increase risk of exposure over time. Higher percentage of positive testing was also observed in subjects with liver disease, which may indicate a possible etiologic association. Further population-based studies are needed to estimate prevalence of HEV infection and associated liver disease, outcomes in infected patients, and indications for testing in at-risk populations. Disclosures All authors: No reported disclosures.

69 Background: Lung cancer screening for high risk populations has a major impact in reducing mortality.In our population, HIV patients are younger (mean age 68.0 vs 56.8, p= 0.014) and have a higher percentage of advanced disease at diagnosis (49% vs 68%, p< 0.001),when compared to non-HIV lung cancer patients.Due to this increased risk and aggressiveness, we embarked on a quality improvement initiative to increase screening in our HIV smoking population. Methods: Data was collected retrospectively from 10/18 to 1/19 in the HIV clinic. A multidisciplinary team was created involving thoracic oncologists, radiologists and HIV physicians to discuss methods to improve screening. We identified areas to be improved and utilized performance improvement tools such as a Pareto chart and PICK chart. Data was then collected prospectively. Results: In the initial 4 month period,among HIV positive patients 55–77 years old with significant smoking history, 13% (total n=54) of patients had a chest CT done for lung cancer screening and only 3.7% were referred for lung cancer screening during that specific period. Main barriers were lack of proper identification of screening candidates, discrepancies in smoking history within the EMR and lack of a consistent system for referral. An algorithm was created in the referral workflow, in which providers would need only to identify patients in the age group of 55-77 years old with any history of smoking and refer to a lung cancer screening program. The screening program would contact the patient and screen as per CMS guidelines. 17 Patients were referred from the HIV clinic from 4/8/19 to 5/2/19. Of these patients, 29% had a lung cancer screening CT scan done or scheduled, 18% of patients did not qualify for screening,and the remaining 53% of referrals are pending to be screened by telephone call. Further data on subsequent PDSAs and results of screening scans will be presented at the meeting. Conclusions: Modifying the screening algorithm for lung cancer in our HIV clinic by adding support from a dedicated screening program increased screening rates by 25% in the first month of intervention. Subsequent interventions include: patient education to reduce the stigma of lung cancer and EMR alerts when a patient meets criteria for screening.

428 Background: Avelumab is a human anti‒PD-L1 IgG1 antibody approved in the US, Canada, and Israel for the treatment of locally advanced or metastatic urothelial carcinoma (mUC) progressed after platinum chemotherapy. In the JAVELIN Solid Tumor study, patients (pts) in various subgroups had a favorable objective response rate (ORR) with avelumab. Here, we report further post hoc analyses of safety and efficacy outcomes with avelumab in high-risk mUC subgroups. Methods: Pts with mUC that had progressed after platinum-based therapy in the JAVELIN Solid Tumor study were analyzed. Best overall response (per RECIST 1.1) was adjudicated by an independent review committee. ORR, disease control rate (DCR), progression-free survival (PFS), and adverse event (AE) profiles for pre-specified subgroups of high-risk pts were compared. Results: 242 pts with mUC received avelumab and were followed up for ≥2 years (data cutoff, Apr 2018). No difference was found in ORR between pts with renal insufficiency (creatine clearance [CrCl]

Cardiac amyloidosis is an underdiagnosed cause of heart failure. It occurs secondary to the deposition of amyloid protein in the myocardium. The main types of cardiac amyloidosis include light chain cardiac amyloidosis (AL), hereditary (hATTR) amyloidosis, and wild type (wtATTR) amyloidosis. Prognosis is poor when diagnosis is delayed. Early recognition and diagnosis are critical for improved outcomes. Cardiac amyloidosis, previously with limited treatment options, now has multiple pharmaceutical therapeutic options available. Increasing awareness of amyloidosis among patients and clinicians alike may lead to increased screening and diagnosis with institution of medical therapy early in the disease course. Particular attention needs to be focused on high risk populations, the elderly and patients of African ancestry.

Transcatheter aortic valve replacement (TAVR) constitutes a relatively new treatment option for the patients with severe symptomatic aortic stenosis. Evidence from registries and randomized control trials has underscored the value of this treatment in inoperable and high risk populations, while new developments in valve technology and TAVR enabling devices have reduced the risk of complications, simplified the procedure, and broadened the applications of this therapy. The initial promising clinical results and the potential of an effective less invasive treatment of aortic stenosis has not only created high expectations but also the need to address the pitfalls of TAVR technology. The evolving knowledge concerning the groups of patients who would benefit from this treatment, the limited long term follow-up data, the concerns about devices' long term durability, and the severity of complications remain important caveats which restrict the widespread clinical adoption of TAVR. The aim of this review article is to present the recent advances, highlight the limitations of TAVR technology, and discuss the future perspectives in this rapidly evolving field.

Blood pressure surveillance, monitoring, and evaluation of programs to prevent and control hypertension are critical because increased blood pressure is a leading risk for premature death and disability. Since 2003, the Hypertension Outcomes Research Task Force has existed in Canada, with members who assist in the development and revision of surveys and conduct analyses that help guide hypertension programs. Although the Task Force has tracked a 5-fold increase in the control of hypertension (from 13% in 1985-1992 to 65% in 2007-2009), surveillance data also indicate that many "care gaps" remain. Fifty-four percent of people with diabetes and 34% of those without diabetes have blood pressure readings greater than their target. Treatment rates are high in those who are diagnosed (95%), but 17% of people with hypertension remain undiagnosed. Younger men (more so than women) are too often unaware of having hypertension. Although they are more likely to be aware of their diagnosis, older women are 2 times more likely to have uncontrolled hypertension than men; systolic blood pressure is high in over 80% of those with uncontrolled blood pressure (90% in women); and often people with hypertension are not provided comprehensive advice on healthy behaviours, or assisted in developing plans to control their blood pressure. Many current surveys do not have adequate statistical power to assess vulnerable populations; surveys of Aboriginal populations do not usually assess blood pressure, such that the burden of hypertension in these high risk populations cannot be assessed.

Neisseria gonorrhoeae, the causative agent of gonococcal infection, is known to frequently change their characteristics to evade host immune mechanism. Characterization of the clinical isolates of the organism can lead to identification of the circulating strains and often a sexual network in a community to help in designing the control strategy. Keeping in mind the above consideration, a total of 239 N. gonorrhoeae, isolated from high-risk populations, were characterized for serotypes and serovars by monoclonal antibodies against protein I of the organism. Majority of the serotypes were serotype B (142, 59.4%). Majority of the isolates showing resistance to at least one of the antibiotics tested were also serotype B (139, 59.2%), whereas, majority of the isolates showing resistance to any three of the antibiotics (multidrug resistant, MDR) (63%) was serotype A. A total of 41 different serovars were also identified and five of which (Arst, Bropt, Bopt, Arost, and Brop) included the highest percent (49.3%) of the isolates. Many serovars (23/41, 56.1%) were new emergent and included 58 (24.3%) of the isolates investigated. All of the new serovars were resistant to at least one of the antibiotics tested and the highest rate (40/102, 39.2%) was MDR. Serotyping and serovar determination was found contributory to understand the microepidemics of the N. gonorrhoeae isolates. Further studies including antibiogram and contact tracing can efficiently help in control of the disease. DOI: http://dx.doi.org/10.3329/bmrcb.v38i3.14339 Bangladesh Med Res Counc Bull 2012; 38(3): 114-118 (December)

Monica Robotin,1,2 Yumi Patton,3 Jacob George1,4 1School of Medicine, University of Sydney, Sydney, Australia; 2Cancer Council New South Wales, Sydney, Australia; 3Faculty of Engineering, University of New South Wales, Sydney, Australia; 4Storr Liver Unit, Westmead Millennium Institute, Westmead Hospital, Sydney, Australia Introduction: In Australia, chronic hepatitis B (CHB) disproportionately affects migrants born in hepatitis B endemic countries, but its detection and management in high risk populations remains suboptimal. We piloted a primary care based program for CHB detection and management in an area of high disease prevalence in Sydney, Australia. Prior to its launch, all local general practitioners were invited to take part in a continuing medical education (CME) program on hepatitis B diagnosis and management. Material and methods: Preceding each CME activity, participants completed an anonymous survey recording demographic data and hepatitis B knowledge, confidence in CHB management, and preferred CME modalities. We compared knowledge scores of first-time and repeat attendees. Results: Most participants (75%) were males, spoke more than one language with their patients (91%), self-identified as Asian-Australians (91%), and had graduated over 20 years previously (69%). The majority (97%) knew what patient groups require CHB and hepatocellular cancer screening, but fewer (42%–75%) answered hepatitis B management and vaccination questions correctly. Knowledge scores were not significantly improved by seminar attendance and the provision of hepatitis B resources. At baseline, participants were fairly confident about their ability to screen for CHB, provide vaccinations, and manage CHB. This did not change with repeat attendances, and did not correlate with survey outcomes. Large group CMEs were the preferred learning modality. Discussion: Knowledge gaps in hepatitis B diagnosis and management translate into missed opportunities to screen for CHB, to vaccinate those susceptible, and to prevent disease complications. The results suggest that a range of innovative CME programs are required to update general practitioners on the modern management of CHB infection. Keywords: hepatocellular cancer, vaccination, screening, continuing medical education, hepatitis B screening, vaccination

Background: Detection of hepatocellular carcinoma (HCC) in high risk populations has traditionally involved the use of ultrasound (US), followed by computed tomography (CT) or magnetic resonance imaging (MRI) for confirmation of suspected lesions. The aim of our study was to determine, retrospecttively, in an unselected population of patients with cirrhosis, if an initial US could be as accurate as a subsequent CT or MRI in detecting HCC. Methods: 1600 consecutive cases from 2004-2007 in which US was performed for HCC screening were evaluated. 160 were identified which had an initial US followed by CT or MRI within 6 months. This group included 34 cases of HCC and 126 controls without HCC. Results: 26 cases of HCC were correctly identified by US, representing a sensitivity of 76.5%; the mean alpha-fetoprotein (AFP) level was 440.4 ng/dL. The other 8 cases had a false negative US; the mean AFP was 212.4 ng/dL. In 125 controls the mean AFP was 17.14 ng/dL. This group had only 12 patients, or 9.6%, with an AFP greater than 20 ng/dL, and only 1 who had an AFP greater than 400 ng/mL. In this study, the positive predictive value of US for detecting HCC was 96.3%, while the negative predictive value was 94.0%. Combining US with the AFP level, and using a cutoff of 20 ng/dL, the sensitivity was increased to 87.5%. In this series of 160 patients, only 2 patients with HCC had a negative US and normal serum AFP. Conclusion: In combination with regular monitoring of AFP levels, US can eliminate more expensive imaging studies until further investigation by CT or MRI of questionable US results or elevated AFP is necessary, thus reducing the overall cost of monitoring these populations.

Osteoporosis is an age related disorder manifested by skeletal fractures. This has been recognized as an important health issue mainly in women. Low bone mineral density is the major cause for osteoporosis. Detection and prediction of osteoporosis is a major challenge. Detection of osteoporosis helps in determining the density of the bone and also in the prevention of osteoporotic fractures in the high risk populations. In this study an easy first line method has been proposed to detect and predict osteoporosis. Impulse response test was carried out on the tibial bone for the detection of osteoporosis with the help of LabVIEW. The vibrations which were generated by the periodic impact of surgical hammer were captured by the accelerometer. The recorded analog signal was examined in frequency domain. The natural frequency of the vibration was significantly decreased in osteoporosis subjects which in turn indicate the loss in mechanical strength of the bone and bone mineral density. Prediction of osteoporosis was performed using a decision making system such as ANN in Matlab where factors other than bone mineral density was considered.

Risk of sudden cardiac death (SCD) varies greatly by ethnicity, and is particularly high in African Americans as compared to Caucasians. The reasons for these racial differences are unclear but are likely multifactorial. Possible differences in coronary and non-coronary risk factors, socioeconomic factors, and genetic factors should all be considered when investigating this observed racial disproportionality in SCD risk. Furthermore, there is a relative paucity of data on the risk of SCD in non-African American minorities, including Asian Americans and Latinos. In this paper, we will review traditional and contemporary data describing these racial differences and potential explanations for them. A careful examination of the racial differences in SCD risk can not only assist in identifying high risk populations and those who may be targeted for early intervention, but can also provide insight into the pathophysiologic mechanisms of SCD.

Infectious Diseases and Tropical Medicine Research Center, Zahedan University of Medical Sciences, Zahedan, IR Iran Department of Histology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, IR Iran Corresponding author: Bita Moudi, Department of Histology, School of Medicine, Zahedan University of Medical Sciences, Zahedan, IR Iran. Tel/Fax: +98-5433295794, E-mail: bita.moodi@yahoo.com

Hemostasis is essential during endoscopic sinus and skull base surgery. Patients must be adequately assessed for bleeding risk to appropriately consent to surgery. The patient and the surgeon must be aware of the individual bleeding risk for a given procedure. A thorough history and physical examination is the best screening methodology available to determine whether a patient requires further hematologic work-up. Included in this assessment should be any medications and herbals that the patient consumes. This ensures a safe evaluation of the patient, streamlines appropriate consultation and testing when necessary, and confers accurate surgical risk assessment.

Gall bladder cancer is generally fatal. The high morbidity and mortality due to gall bladder cancer exerts a significant impact on efforts towards cancer control in high risk populations of the World and a rationale program for control of gall bladder cancer mortality has remained as an unmet need in these populations. Currently there are no effective strategies for controlling gall bladder cancer mortality. This mini review is to highlight the need and feasibility for secondary prevention of gall bladder cancer by screening in high risk populations. A way forward is to assess the role of secondary prevention of gall bladder cancers by conducting randomized- controlled screening trials in high risk populations.

Good oral health is necessary to overall health and well-being. Most oral diseases, and in particular dental caries, are entirely preventable. However, in 2010, 3.9 billion people were globally affected by oral conditions, and the global prevalence of untreated caries in permanent teeth was 35.3%. The contemporary thinking is that dental caries starts as an infectious disease which then becomes a chronic disease. Public health measures and other caries-preventive approaches have resulted in dramatic reductions in dental caries across populations. However, in a given population, not all individuals have experienced these successes uniformly. High-risk populations, defined as those with a ‘higher-than-expected risk', exist for most diseases and conditions including caries. The global scientific literature suggests that these are the following: (1) minorities, (2) individuals with low-socioeconomic status and (3) other vulnerable populations such as the very young and elderly who continue to battle with oral health disparities by experiencing higher oral disease levels including dental caries. As the science and resources exist to prevent caries, it is essential to identify and target these high-risk individuals and populations.

The American College of Chest Physicians (ACCP) has established guidelines for the treatment of VTE, but the generalizability to all populations is unclear. In this review we analyzed the rate of reporting and enrollment of blacks and women in clinical trials cited in the ACCP guidelines for treatment of unprovoked VTE. We extracted data from clinical trials cited by the ACCP that compared durations of anticoagulation therapy for the treatment of unprovoked VTE. We excluded trials that treated surgical or cancer patients. For trials that did not report race/ethnicity we contacted the primary investigators via email for enrollment data. The final analysis included 17 randomized clinical trials with a total patient population of N = 13,693. All trials reported data on sex; conversely, 2 trials (11.8 %) reported race/ethnicity within the primary manuscript. We ultimately acquired data on race/ethnicity from the primary investigator in 5 additional trials for a total race/ethnicity data from 7 trials. There were 7573 males (55.3 %) and 6120 females (44.7 %) enrolled in these studies. Among trials that reported race and ethnicity the total patient population was N = 5368; 5171 (96.3 %) white, 115 (2.1 %) black, 65 (1.4 %) Asian and 7 (0.25 %) Hispanic. Racial/ethnic minorities are underreported and under represented in clinical trials forming the cornerstone of ACCP guidelines for the optimal duration for VTE treatment. Conversely, the reporting and inclusion of women was substantive. The guidelines for unprovoked VTE treatment may not be generalizable to racially and ethnically diverse patient populations.

Many economists and policy makers believe that United States healthcare costs are rising at an unsustainable rate. In response, newer payment systems such as bundled payments, accountable care organizations, and population health management have been proposed. These new paradigms all aim to encourage collaboration between health care providers to conserve costs and increase quality. To succeed in this evolving environment, radiologists should consider embracing change by working to standardize radiology practice, participating in radiology utilization management, working with vendors to increase storage of radiology imaging data to improve access and interconnectivity, and exploring targeted screening in high risk populations.

The TOB-G project is funded under the EU 3rd Health Programme which is the main instrument that the Commission uses to implement the EU Health Strategy. The project started in June 2014 and will be completed in September 2017. The project consortium consists of 5 partners from 4 European countries (Belgium, Greece, Ireland and Romania). The TOB-G project aims to develop and implement an innovative and cost effective approach to prevent chronic diseases related to tobacco dependence by focusing on creating specialized tobacco cessation guidelines for populations of high risk including adolescents, pregnant women, adults with COPD, Cardiovascular disease and diabetes. The specialized guidelines for high risks groups will be developed according to ENSP’s evidence based and good practices in tobacco cessation. The smoking cessation guidelines contain strategies and recommendations designed to assist clinicians/ doctors in delivering and supporting effective treatments for tobacco use and dependence and will also be available within the context of an e-learning platform for European clinicians. Overall, the TOB-G project will enhance the overall European capacity in the treatment of tobacco dependence, through offering smoking cessation tools, appropriately assessed and fitted to the specific needs of high risk groups.

The epidemic of human immunodeficiency virus (HIV) infection in the United States has changed dramatically since its initial recognition in 1981.[1][1] Early in the epidemic, the incidence of HIV reached over 130,000 new cases per year, and death as a result of acquired immunodeficiency syndrome (