Silver Alerts: A Notification System for Communities with Missing Adults.

As the U.S. population ages, the prevalence of dementia will grow and communities will face the problem of older adults wandering or becoming lost. Silver Alert systems are programs designed to locate missing older adults with dementia or other mental disabilities. Such programs have been initiated in all but five states. Data collection for these programs is often minimal or incomplete. Social workers should be involved in prevention, follow up and education with caregivers, community members and law enforcement officers. When reviewing Silver Alert policy, special attention must be given to ethical concerns and protection of older adults' civil rights.

Data to action: using environmental public health tracking to inform decision making.

CONTEXT: Public health surveillance includes dissemination of data and information to those who need it to take action to prevent or control disease. The concept of data to action is explicit in the mission of the Centers for Disease Control and Prevention's (CDC's) National Environmental Public Health Tracking Program (Tracking Program). The CDC has built a National Environmental Public Health Tracking Network (Tracking Network) to integrate health and environmental data to drive public health action (PHA) to improve communities' health. OBJECTIVE: To assess the utility of the Tracking Program and Tracking Network in environmental public health practice and policy making. DESIGN: We analyzed information on how Tracking (all program components hereafter referred to generally as "Tracking") has been used to drive PHAs within funded states and cities (grantees). Two case studies are presented to highlight Tracking's utility. SETTING: Analyses included all grantees funded between 2005 and 2013. PARTICIPANTS: Twenty-seven states, 3 cities, and the District of Columbia ever received funding. MAIN OUTCOME MEASURES: We categorized each PHA reported to determine how grantees became involved, their role, the problems addressed, and the overall action. RESULTS: Tracking grantees reported 178 PHAs from 2006 to 2013. The most common overall action was "provided information in response to concern" (n = 42), followed by "improved a public health program, intervention, or response plan" (n = 35). Tracking's role was most often either to enhance surveillance (24%) or to analyze data (23%). In 47% of PHAs, the underlying problem was a concern about possible elevated rates of a health outcome, a potential exposure, or a potential association between a hazard and a health outcome. PHAs were started by a request for assistance (48%), in response to an emergency (8%), and though routine work by Tracking programs (43%). CONCLUSION: Our review shows that the data, expertise, technical infrastructure, and other resources of the Tracking Program and Tracking Network are driving state and local PHAs.

Assessment of the contents related to screening on Portuguese language websites providing information on breast and prostate cancer.

The objective of this study was to assess the quality of the contents related to screening in a sample of websites providing information on breast and prostate cancer in the Portuguese language. The first 200 results of each cancer-specific Google search were considered. The accuracy of the screening contents was defined in accordance with the state of the art, and its readability was assessed. Most websites mentioned mammography as a method for breast cancer screening (80%), although only 28% referred to it as the only recommended method. Almost all websites mentioned PSA evaluation as a possible screening test, but correct information regarding its effectiveness was given in less than 10%. For both breast and prostate cancer screening contents, the potential for overdiagnosis and false positive results was seldom addressed, and the median readability index was approximately 70. There is ample margin for improving the quality of websites providing information on breast and prostate cancer in Portuguese.

Assessment of the contents related to screening on Portuguese language websites providing information on breast and prostate cancer / Avaliação dos conteúdos em websites sobre rastramento do câncer da mama e da próstata em língua portuguesa / Evaluación de contenidos en páginas web de lengua portuguesa sobre rastreo del cáncer de mama y próstata

The objective of this study was to assess the quality of the contents related to screening in a sample of websites providing information on breast and prostate cancer in the Portuguese language. The first 200 results of each cancer-specific Google search were considered. The accuracy of the screening contents was defined in accordance with the state of the art, and its readability was assessed. Most websites mentioned mammography as a method for breast cancer screening (80%), although only 28% referred to it as the only recommended method. Almost all websites mentioned PSA evaluation as a possible screening test, but correct information regarding its effectiveness was given in less than 10%. For both breast and prostate cancer screening contents, the potential for overdiagnosis and false positive results was seldom addressed, and the median readability index was approximately 70. There is ample margin for improving the quality of websites providing information on breast and prostate cancer in Portuguese.

O objetivo deste estudo foi avaliar a qualidade dos conteúdos sobre rastreamento, numa amostra de websites com informação sobre o câncer da próstata e/ou mama, em língua portuguesa. Consideraram-se os primeiros 200 resultados de cada busca no Google. A adequação dos conteúdos sobre rastreio foi definida de acordo com a melhor evidência científica disponível e se avaliou a sua legibilidade. Cerca de 80% dos websites referiu a mamografia como um método para rastreamento do câncer da mama, mas apenas 28% a referiram como o único método recomendado. Quase todos os websites referiram a pesquisa de PSA como um possível teste de rastreio, mas somente 10% apresentaram informação correta relativamente à efetividade dessa forma de rastreio. Para os conteúdos de ambos os cancros, o potencial para sobrediagnóstico e para um resultado falso-positivo raramente foi mencionado, e a mediana do índice de legibilidade foi de aproximadamente 70. Existe uma larga margem para melhorar a qualidade dos websites com informações sobre câncer da mama e da próstata.

El objetivo fue evaluar la calidad de los contenidos en lengua portuguesa sobre rastreo en una muestra de páginas web con información sobre el cáncer de próstata y/o mama. Se consideraron los primeros 200 resultados de cada búsqueda en Google. La adecuación de los contenidos sobre rastreo se definió de acuerdo con la mejor evidencia científica disponible y se evaluó su legibilidad. Cerca de un 80% de las páginas web se refirieron a la mamografía como un método para el rastreo del cáncer de mama, sin embargo, solamente un 28% la mencionaron como el único método recomendado. Casi todas las páginas web señalaron el examen de Antígeno Prostático Total (APT/PSA en inglés) como un posible test de rastreo, pero solamente un 10% presentó información correcta respecto a la efectividad de esta forma de rastreo. En lo referente a los contenidos de ambos cánceres, el potencial para un sobrediagnóstico y un resultado falso positivo raramente fue mencionado, y la mediana del índice de legibilidad fue de aproximadamente 70. Existe un ancho margen para mejorar la calidad de las páginas web con información sobre cáncer de mama y de próstata.

Aspectos clínicos y epidemiológicos de pacientes con carcinoma hepatocelular en dos centros de referencia de Venezuela / Clinical and epidemiological aspects of patients with hepatocellular carcinoma in two reference centers Venezuela

El carcinoma hepatocelular (CHC) es la neoplasia primaria del hígado más frecuente, constituyendo un problema mundial de salud pública por su alta prevalencia y tasa de mortalidad. Evaluar las características clínicas y epidemiológicas de los pacientes con carcinoma hepatocelular. Estudio de casos consecutivos con revisión retrospectiva de los registros médicos de pacientes con diagnóstico de CHC que acudieron a la consulta de hepatología de dos centros caraqueños entre 1997 y 2011. Se evaluaron características clínicas, epidemiológicas y de estadiaje según Barcelona Clinic Liver Cancer, BCLC. Se incluyó 116 pacientes con diagnóstico de CHC. La edad media fue 61,34 ± 12,02 años, 75% eran hombres y 89,7% de los pacientes tenían cirrosis hepática subyacente, siendo confirmada histológicamente en 33,7%. El 70,7% de los pacientes tenían alguna complicación asociada a hipertensión portal. El virus de la hepatitis C (VHC) constituyó la principal etiología de enfermedad hepática (31%), alcohol (21,6%), virus de la hepatitis B, VHB (14,7%) y enfermedad hepática grasa no alcohólica (14,7%). El hepatocarcinoma fue diagnosticado más frecuentemente en pacientes con cirrosis por HBV 15,56%. El 56% de los casos tenían niveles de alfafetoproteína mayores de 300 ng/ml. El lóbulo derecho fue la localización más frecuente (64,7%) y 79,3% de las lesiones mostraron patrón vascular típico en los estudios radiológicos. El estadio tumoral según los criterios de Barcelona Clinic Liver Cancer (BCLC) fueron estadio C (37,9%) D (25,9%), B (24,1%), A (7,8%) y 0 (2,6%). La infección por HCV es la etiología más frecuente de cirrosis hepática en pacientes con CHC, pero la infección por VHB tiene mayor impacto en términos relativos. El diagnóstico se hace en forma tardía (estadios intermedios o avanzados), siendo necesario intensificar medidas de pesquisa en estos pacientes

The hepatocellular carcinoma (HCC) is the main primary liver neoplasia and is a public health problem in the world due to high prevalence and mortality. Evaluate clinical and epidemiological characteristics in patients with Hepatocellular carcinoma. A retrospective analysis of a prospectively maintained database of 116 patients with diagnosis of HCC in two centers of Caracas between 1997 and 2011 was conducted. We evaluated epidemiological, clinical, biochemical and tumor aspects according to Barcelona Clínic Liver Cancer in patients with HCC. Mean age was 61.34 ± 12.02 years, 75% were male and 89.7% of patients had liver cirrhosis. Portal hypertension complications (ascites, hepatic encephalopathy, esophageal varices) were present in 70.7% of patients. Hepatitis C virus (HCV) was the main etiology of hepatic disease (31%) followed by alcohol (21.6%), hepatitis B virus (14.7%) and non alcoholic steatohepatitis (14.7%). HCC was more frequent in patients with cirrhosis associated to HBV infection. The 56% of patients had alpha-fetoprotein levels higher than 300 ng/ml. The 64.7% of tumors were localized in the right lobe of liver and 79.3% of tumor lesions demonstrated typical pattern in radiologic studies. The most patients had advanced disease according to Barcelona Clinic Liver Cancer (BCLC) staging classification (Stage C, 37.9%; stage D, 25.9%; stage B, 24.1%; stage A, 7.8% and stage 0, 2.6%). HCV infection was main cause of cirrhosis in patients with HCC, but HBV infection had higher impact in these patients. Our study showed that the diagnosis of these patients undergo late and is very important intensify screening measures in patients with liver cirrhosis

The Pathogen-annotated Tracking Resource Network (PATRN) system: a web-based resource to aid food safety, regulatory science, and investigations of foodborne pathogens and disease.

Investigation of foodborne diseases requires the capture and analysis of time-sensitive information on microbial pathogens that is derived from multiple analytical methods and sources. The web-based Pathogen-annotated Tracking Resource Network (PATRN) system (www.patrn.net) was developed to address the data aggregation, analysis, and communication needs important to the global food safety community for the investigation of foodborne disease. PATRN incorporates a standard vocabulary for describing isolate metadata and provides a representational schema for a prototypic data exchange standard using a novel data loading wizard for aggregation of assay and attribution information. PATRN currently houses expert-curated, high-quality "foundational datasets" consisting of published experimental results from conventional assays and next generation analysis platforms for isolates of Escherichia coli, Listeria monocytogenes, and Salmonella, Shigella, Vibrio and Cronobacter species. A suite of computational tools for data mining, clustering, and graphical representation is available. Within PATRN, the public curated data repository is complemented by a secure private workspace for user-driven analyses, and for sharing data among collaborators. To demonstrate the data curation, loading wizard features, and analytical capabilities of PATRN, three use-case scenarios are presented. Use-case scenario one is a comparison of the distribution and prevalence of plasmid-encoded virulence factor genes among 249 Cronobacter strains with similar attributes to that of nine Cronobacter isolates from recent cases obtained between March and October, 2010-2011. To highlight PATRN's data management and trend finding tools, analysis of datasets, stored in PATRN as part of an ongoing surveillance project to identify the predominant molecular serogroups among Cronobacter sakazakii isolates observed in the USA is shown. Use-case scenario two demonstrates the secure workspace available for private users to upload and analyze sensitive data, and for collating cross-platform datasets to identify and validate congruent datapoints. SNP datasets from WGS assemblies and pan-genome microarrays are analyzed in a combinatorial fashion to determine relatedness of 33 Salmonella enterica strains to six strains collected as part of an outbreak investigation. Use-case scenario three utilizes published surveillance results that describe the incidence and sources of O157:H7 E. coli isolates associated with a produce pre-harvest surveillance study that occurred during 2002-2006. In summary, PATRN is a web-based integrated platform containing tools for the management, analysis and visualization of data about foodborne pathogens.

Establishment of resource portal of assistive technology in Taiwan.

PURPOSE: To establish an Assistive Technology (AT) resource portal for users, professionals and policy-makers in Taiwan to provide a new and versatile information network for AT popularization. METHOD: The Centre for AT Resources and Popularization (CATR@P), integrated the resources primarily from five AT Resource Centres of the Ministry of Interior in Taiwan. CATR@P invited representatives of organizations for people with disabilities, AT specialists and policy-makers to join the task force. A web company was responsible for website software design and collaboration with CATR@P, which included planning portal functions, all user-friendly interfaces and pilot testing. RESULTS: The Resource Portal of AT was officially online in October 2006. The portal was structured with 19 main functions and the contents of this new portal are versatile and multifunctional. It contains vast amounts of national and international resources such as archives of AT centres, AT products, a professionals directory, websites linkage, full text of the AT Companion Journal, E-paper, on-line consultation services, frequently asked questions, and on-line questionnaires. CONCLUSIONS: Integration of Taiwan AT resources in conjunction with the internet technology has made resources more available for people with disabilities and society.

An Eclipse-based development approach to health information technology.

The rapid proliferation of applications--electronic health record and clinical decision support systems among them--cannot keep up with the growing needs of healthcare delivery organisations. The absence of uniform standards and interoperability has hindered the successful deployment and acceptance of these applications. Eclipse and other open source applications have the potential to fill some of these gaps. The benefits include acceptance of open standards, enabling interoperability and scalability, prevention of vendor lock-in and lower costs. In this paper, we describe an Eclipse-based open source electronic health record application, a prototype. We contrast the Eclipse approach to other development approaches. Implementation is feasible and provides customization, although there are challenges to overcome. We envision organisations adopting open source development tools as alternatives to vendor-driven, proprietary systems.

Au nanoparticle network-type thin films formed via mixed assembling and cross-linking route for biosensor application: quartz crystal microbalance study.

We have investigated a means of producing Au nanoparticle network-type thin films that are derived by a one-step mixed-assembly cross-linking route, can avoid nonspecific interactions, and provide maximum binding to a specific target. Although a stepwise layer-by-layer construction method exists, our goal is to seek an alternative and simpler pathway for preparing thin films such as electrode nanomaterials. The model system consisting of Au nanoparticles, 1,6-hexananedithiol (HDT) cross-linkers, and 3-mercaptopropionic acid (MPA) captures was studied. The mixing of these three components in solutions allowed sequential assembly, cross-linking, and eventual precipitation of the network-type thin films on a Au substrate. Characterization of the films was carried out using UV-visible spectroscopy, cyclic voltammetry, and a quartz crystal microbalance. Such a thin film can be useful in biosensing and surface-coating applications. By controlling the ratio of HDT and MPA, we made Au nanoparticle network-type thin films on which goat-anti-human IgG antibodies that were immobilized can bind specifically to IgG with negligible nonspecific binding.

Using the Internet? The experiences of parents of disabled children.

BACKGROUND: Research has offered consistent evidence that the provision of crucial information to parents of disabled children, at a time when they need it and in a form that they can use, is an intractable problem. This makes it important to develop new and effective approaches to information presentation, distribution and delivery. The Internet has been put forward as a medium through which families' needs for information and services can be met. This paper looks at parents of disabled children's experience of using it. METHODS: A cross-sectional survey of 3014 adult carers, of which 788 were carers of disabled children aged 0-17. Data were collected using a postal questionnaire. RESULTS: A high proportion (75%) had previously used the Internet. Of these, 63% were frequent users and 91% were using it at home. Popular uses were emailing, obtaining information about caring, ordering equipment and shopping online. Despite positive benefits, users experienced problems relating to technical issues and equipment and system design. Lack of time owing to caring and other circumstances was an issue for over half of all users. Never users were more likely to be living in rented accommodation, be unemployed and not have a PC at home. Reasons for not using the Internet included lack of access to equipment, cost and lack of skill. CONCLUSIONS: For some parents the Internet is a viable and flexible medium for accessing useful information and services. However, caution about the extent to which it becomes the primary means for delivering information is needed. Technical problems and lack of time can make it difficult to search for complex information. The 'digital divide' between users and non-users makes it crucial that issues of cost, lack of equipment and skill be addressed. Information needs to be made available in other forms to ensure that those who cannot or do not wish to use the Internet are not socially excluded.

Development and evaluation of a hand held computer based on-call pack for health protection out of hours duty: a pilot study.

BACKGROUND: The on call service for health protection in most parts of the UK is provided by general public health consultants, registrars and nurses as the first tier of response backed up by medical consultants in health protection. The first tier responder usually carries a large bag of papers containing both local and national guidance on the management of common cases/incidents. An electronic on call pack may provide a suitable practical alternative to large paper based systems and help professionals deliver out of hours health protection advice and response to incidents. METHODS: We developed and piloted an electronic on call pack in Hertfordshire for use at the health protection unit level containing key local and national guidelines, contact information and useful references. The on-call pack was initially piloted using a laptop and more recently using a personal digital assistant (PDA). The use of the on-call pack was evaluated. RESULTS: Key advantages of the electronic system include reduced size, faster access to information that is clearly indexed and the relative ease of updating information. As part of the pilot, the electronic on call pack was presented to a local and regional training meeting with good response from participants using qualitative and quantitative methods. CONCLUSION: It is anticipated that with suitable evaluation this system can be adapted and utilised by other health protection practitioners. This system provides a fast, reliable and easily maintained source of information for the public health on-call team.

Development of a web-based database to manage American College of Emergency Physicians/American Academy of Pediatrics Emergency Information Forms.

Children with special health care needs require special advanced planning for their unique emergencies. A Web site has been developed to allow secure Internet access to a database of Emergency Information Forms developed using the American College of Emergency Physicians/American Academy of Pediatrics format. The content and organization of the Web site, found at http://www.memscis.org, are described. A tour of the site is available. A set of XML data elements has been defined. Additional disaster preparedness elements have been added to the American College of Emergency Physicians/American Academy of Pediatrics Emergency Information Forms. The organization, security, and relationship of the site to electronic health records are described.