Search

Our discussions, which were facilitated by the Task Force on MCMs and the Massachusetts Coalition for Pathogen Readiness, revealed that industry leaders and vaccine developers found the centralized leadership structure of OWS preferable to the fragmented PHEMCE structure. While changes at HHS, such as the creation of the Administration of Strategic Preparedness and Response, hint that this type of leadership structure for MCM R&D may be emerging, the scope of its mandate and authorities remains unclear.[21] Likewise, efforts to reform the PHEMCE are ongoing and subject to several reviews.[9] It remains to be seen what this group will look like in the future. Keywords: Medical countermeasures; PHEMCE; Operation Warp Speed; Pandemic preparedness; Biodefense R&D; BioShield EN Medical countermeasures PHEMCE Operation Warp Speed Pandemic preparedness Biodefense R&D BioShield 272 279 8 07/21/23 20230701 NES 230701 The rise in the incidence of emerging, reemerging, and deliberate disease outbreaks over the past 20 years highlights the threat posed by global catastrophic biological risks (GCBRs).[1] Since the inception of Project BioShield, the US government has attempted to coordinate the research and development (R&D) of medical countermeasures (MCMs) against a variety of biological, chemical, radiological, and nuclear threats. [Extracted from the article]

Global vaccine inequity is prolonging the COVID-19 pandemic. Here, we outline the scope and impact of inequitable vaccine distribution and identify challenges in vaccine development, manufacturing, and distribution as well as potential solutions to address this crisis. [ABSTRACT FROM AUTHOR]

Purpose: Ideally, a referral from a primary care physician (PCP) to a specialist results in a completed specialty appointment with results available to the PCP. This is defined as "closing the referral loop." As health systems grow more complex, regulatory bodies increase vigilance, and reimbursement shifts towards value, closing the referral loop becomes a patient safety, regulatory, and financial imperative.Objective/design: To assess the ability of a large health system to close the referral loop, we used electronic medical record (EMR)-generated data to analyze referrals from a large primary care network to 20 high-volume specialties between July 1, 2015 and June 30, 2016.Main Measures: The primary metric was documented specialist appointment completion rate. Explanatory analyses included documented appointment scheduling rate, individual clinic differences, appointment wait times, and geographic distance to appointments.Key Results: Of the 103,737 analyzed referral scheduling attempts, only 36,072 (34.8%) resulted in documented complete appointments. Low documented appointment scheduling rates (38.9% of scheduling attempts lacked appointment dates), individual clinic differences in closing the referral loop, and significant differences in wait times and distances to specialists between complete and incomplete appointments drove this gap. Other notable findings include high variation in wait times among specialties and correlation between high wait times and low documented appointment completion rates.Conclusions: The rate of closing the referral loop in this health system is low. Low appointment scheduling rates, individual clinic differences, and patient access issues of wait times and geographic proximity explain much of the gap. This problem is likely common among large health systems with complex provider networks and referral scheduling. Strategies that improve scheduling, decrease variation among clinics, and improve patient access will likely improve rates of closing the referral loop. More research is necessary to determine the impact of these changes and other potential driving factors. [ABSTRACT FROM AUTHOR]

Introduction: Health systems are seeking innovative solutions to improve specialty care access. Electronic consultations (eConsults) allow specialists to provide formal clinical recommendations to primary care providers (PCPs) based on patient chart review, without a face-to-face visit.Methods: We implemented a nephrology eConsult pilot program within a large, academic primary care practice to facilitate timely communication between nephrologists and PCPs. We used primary care referral data to compare wait times and completion rates between traditional referrals and eConsults. We surveyed PCPs to assess satisfaction with the program.Results: For traditional nephrology referrals placed during the study period (July 2016-March 2017), there was a 51-day median appointment wait time and a 40.9% referral completion rate. For eConsults, there was a median nephrologist response time of one day and a 100% completion rate; 67.5% of eConsults did not require a subsequent face-to-face specialty appointment. For eConsults that were converted to an in-person visit, the median wait time and completion rate were 40 days and 73.1%, respectively. Compared to traditional referrals placed during the study period, eConsults converted to in-person visits were more likely to be completed ( p = 0.001). Survey responses revealed that PCPs were highly satisfied with the program and consider the quick turnaround time as the greatest benefit.Discussion: Our eConsult pilot program reduced nephrology wait times and significantly increased referral completion rates. In large integrated health systems, eConsults have considerable potential to improve access to specialty care, reduce unnecessary appointments, and optimize the patient population being seen by specialists. [ABSTRACT FROM AUTHOR]

Identifying the transition from mostly aerobic to mostly anaerobic is critical for predicting physical performance and prescribing exercise programs. The ventilatory threshold (VT) is a common gas exchange variable linked to this transition, but its determination requires sophisticated equipment, tester expertise, and money. In contrast, the respiratory rate (RRB) breakpoint has been highly correlated with VT and is easier to establish than VT. The purpose of this study was to examine whether the relationship between VT and RRB holds true in sedentary untrained individuals as it does in trained participants. Seventeen healthy college-aged participants (7 males, 9 females) completed a graded treadmill protocol to exhaustion to establish VO2 max. Ventilatory threshold and RRB were determined during the maximal and a subsequent submaximal test. A 6th degree polynomial regression identified the RRB for both exercise bouts. Dependent t-tests and Pearson's correlations were calculated between VT and RRB. Ventilatory threshold and RRB from the submaximal exercise were highly correlated (r=.84, P<0.001) and not statistically different (P=.182). The VT and RRB from the maximal exercise were not statistically different (P=0.706), but were not correlated (r=.04, P=0.882). The RRB from both tests were statistically different (P=0.047). Considering the difference in relationship between the two tests, future studies should consider th e testing protocol when examining VT. The results indicate that the RRB can estimate the VT in untrained individuals during submaximal exercise. [ABSTRACT FROM AUTHOR]

Background: Risk of normal tissue toxicity limits the amount of thoracic radiation therapy (RT) that can be routinely prescribed to treat non-small cell lung cancer (NSCLC). An early biomarker of response to thoracic RT may provide a way to predict eventual toxicities—such as radiation pneumonitis—during treatment, thereby enabling dose adjustment before the symptomatic onset of late effects. MicroRNAs (miRNAs) were studied as potential serological biomarkers for thoracic RT. As a first step, we sought to identify miRNAs that correlate with delivered dose and standard dosimetric factors. Methods: We performed miRNA profiling of plasma samples obtained from five patients with Stage IIIA NSCLC at five dose-points each during radical thoracic RT. Candidate miRNAs were then assessed in samples from a separate cohort of 21 NSCLC patients receiving radical thoracic RT. To identify a cellular source of circulating miRNAs, we quantified in vitro miRNA expression intracellularly and within secreted exosomes in five NSCLC and stromal cell lines. Results: miRNA profiling of the discovery cohort identified ten circulating miRNAs that correlated with delivered RT dose as well as other dosimetric parameters such as lung V20. In the validation cohort, miR-29a-3p and miR-150-5p were reproducibly shown to decrease with increasing radiation dose. Expression of miR-29a-3p and miR-150-5p in secreted exosomes decreased with radiation. This was concomitant with an increase in intracellular levels, suggesting that exosomal export of these miRNAs may be downregulated in both NSCLC and stromal cells in response to radiation. Conclusions: miR-29a-3p and miR-150-5p were identified as circulating biomarkers that correlated with delivered RT dose. miR-150 has been reported to decrease in the circulation of mammals exposed to radiation while miR-29a has been associated with fibrosis in the human heart, lungs, and kidneys. One may therefore hypothesize that outlier levels of circulating miR-29a-3p and miR-150-5p may eventually help predict unexpected responses to radiation therapy, such as toxicity. Electronic supplementary material The online version of this article (doi:10.1186/s13014-016-0636-4) contains supplementary material, which is available to authorized users., Version of Record

Anti-GM1 and anti-GQ1b ganglioside antibodies are found in association with acute and chronic peripheral neuropathies, including Guillain-Barré syndrome. They are believed to arise as a result of molecular mimicry with immunogenic microbial polysaccharides. Although anti-ganglioside antibodies are suspected to play a causal role in neuropathy pathogenesis, the details of this have yet to be proven. The approach in this laboratory to solving this issue has been to generate anti-GM1 and anti-GQ1b monoclonal antibodies from peripheral blood lymphocytes of affected patients and to study their immunolocalization in peripheral nerve and their electrophysiologic effects in animal models in which peripheral nerve sites are exposed to anti-ganglioside antibodies. These data show that anti-ganglioside antibody-reactive epitopes are widely distributed in peripheral nerve and can cause electrophysiologic abnormalities in a variety of model systems; thus, these data support the view that anti-ganglioside antibody-reactive epitopes may directly contribute to neuropathy pathogenesis. [ABSTRACT FROM PUBLISHER]