Introduction: Reimagining Epidemics.

Over the past year, historians of medicine have found our discipline invested with a new sense of relevance. In trying to make sense of epidemics past and present, many of us have been substantially influenced by Charles Rosenberg's 1989 Daedalus essay, "What Is an Epidemic? AIDS in Historical Perspective." Writing in the middle of another unfolding global pandemic, Rosenberg suggested that all epidemics possessed similar forms of social choreography, and that applying a narrative framework could help to understand their sequence, structure, and social impact. This issue of the Bulletin offers contributions from thirteen scholars working in various geographic, chronological, and thematic areas that engage with Rosenberg's fundamental historical question about what defines an epidemic, although the question takes on different forms, and different forms of urgency, in each of their works.

Notes from the Field: Teaching the History of Epidemics in the Midst of the SARS-CoV-2 Pandemic.

Teaching the history of epidemics remains a critical mission of our profession, both inside and outside of the classroom. Charles E. Rosenberg's "dramaturgical model" of epidemic response endures as a useful and flexible heuristic. Through guided discussion of the dramaturgical model, students can develop a shared vocabulary and a working theory of epidemic responses through time. Students can apply the model, then revise and refine it for themselves through writing assignments and careful comparisons of epidemics in different times, places, and populations. Special consideration must be given to teaching the history of epidemics during the present SARS-CoV-2 pandemic.

Evaluation of a Scalable Information Analytics System for Enhanced Situational Awareness in Mass Casualty Events.

We investigate the utility of DIORAMA-II system which provides enhanced situational awareness within a disaster scene by using real-time visual analytics tools and a collaboration platform between the incident commander and the emergency responders. Our trials were conducted in different geographical areas (feature-rich and featureless regions) and in different lighting conditions (daytime and nighttime). DIORAMA-II obtained considerable time gain in efficiency compared to conventional paper based systems. DIORAMA-II time gain was reflected in reduction of both average triage time per patient (up to 34.3% average triage time reduction per patient) and average transport time per patient (up to 76.3% average transport time reduction per red patient and up to 66.3% average transport time reduction per yellow patient). In addition, DIORAMA-II ensured that no patients were left behind or transported in the incorrect order compared to the conventional method which resulted in patients being left behind and transported in the incorrect order.

Spatial-temporal forensic analysis of mass casualty incidents using video sequences.

In this paper we introduce DIORAMA based forensic analysis of mass casualty incidents (MCI) using video sequences. The video sequences captured on site are automatically annotated by metadata, which includes the capture time and the camera location and viewing direction. Using a visual interface the MCI investigators can easily understand the availability of video clips in specific areas of interest, and efficiently review them. The video-based forensic analysis system will enable the MCI investigators to better understand the rescue operations and subsequently improve training procedures.

DIORAMA enhances efficiency of a mass casualty incident: System and experimentation.

In this paper we show DIORAMA efficiency in a simulated Mass Casualty Incident drill. As shown by our results DIORAMA system has achieved orderly transport of patients from site of injury to collection point, all red before the yellow were transported (no order was obeyed in the paper drills). We also show that DIORAMA system was used by responders with very short training time and by responders that are not familiar with each other. The qualitative results show that DIORAMA system was found to be user friendly and useful in tracking patients and responders in real time.

Fighting for business: the limits of professional cooperation among American doctors during the First World War.

The American medical profession participated extensively in preparedness and mobilization for the First World War, with more than one in five doctors voluntarily enlisting in various branches of the Army and Navy Medical Corps. Medical officers were widely valorized for suspending their civilian careers and for sacrificing their professional income while in service. Because of the meager commissions that medical officers received by comparison with fees many doctors earned in established private medical practices, scores of county medical societies implemented organizational solutions to this business problem, with the hopes of removing a significant disincentive to enlistment. In these "practice protection plans," a civilian doctor promised to take care of the patients of a military doctor, to forward a portion of the fees collected thereby to the family of the military doctor, and to refer these patients to the military doctor upon his return. Despite initial enthusiasm and promotion, these plans ultimately failed to achieve their objectives, leading some medical officers to accuse civilian doctors of being opportunistic, unpatriotic "slackers." This episode reveals the limits of professional cooperation in American medicine at the time and the need to explain organizational failures in the grand narrative of professionalization during the "Golden Age" of American medicine.

Autonomous mobile platform for enhanced situational awareness in Mass Casualty Incidents.

To enhance the efficiency of the search and rescue process of a Mass Casualty Incident, we introduce a low cost autonomous mobile platform. The mobile platform motion is controlled by an Android Smartphone mounted on a robot. The pictures and video captured by the Smartphone camera can significantly enhance the situational awareness of the incident commander leading to a more efficient search and rescue process. Moreover, the active RFID readers mounted on the mobile platform can improve the localization accuracy of victims in the disaster site in areas where the paramedics are not present, reducing the triage and evacuation time.

Mobile DIORAMA-II: infrastructure less information collection system for mass casualty incidents.

In this paper we introduce DIORAMA-II system that provides real time information collection in mass casualty incidents. Using a mobile platform that includes active RFID tags and readers as well as Smartphones, the system can determine the location of victims and responders. The system provides user friendly multi dimensional user interfaces as well as collaboration tools between the responders and the incident commander. We conducted two simulated mass casualty incidents with 50 victims each and professional responders. DIORAMA-II significantly reduces the evacuation time by up to 43% when compared to paper based triage systems. All responders that participated in all trials were very satisfied. They felt in control of the incident and mentioned that the system significantly reduced their stress level during the incident. They all mentioned that they would use the system in an actual incident.

PERCEPT-II: smartphone based indoor navigation system for the blind.

In this paper we introduce PERCEPT-II, a low cost and user friendly indoor navigation system for blind and visually impaired users. Using an Android Smartphone that runs PERCEPT-II application with accessibility features, the blind user obtains navigation instructions to the chosen destination when touching specific landmarks tagged with Near Field Communication tags. The system was deployed and tested in a large building at the University of Massachusetts at Amherst.

PERCEPT Indoor Navigation System for the Blind and Visually Impaired: Architecture and Experimentation.

We introduce PERCEPT system, an indoor navigation system for the blind and visually impaired. PERCEPT will improve the quality of life and health of the visually impaired community by enabling independent living. Using PERCEPT, blind users will have independent access to public health facilities such as clinics, hospitals, and wellness centers. Access to healthcare facilities is crucial for this population due to the multiple health conditions that they face such as diabetes and its complications. PERCEPT system trials with 24 blind and visually impaired users in a multistory building show PERCEPT system effectiveness in providing appropriate navigation instructions to these users. The uniqueness of our system is that it is affordable and that its design follows orientation and mobility principles. We hope that PERCEPT will become a standard deployed in all indoor public spaces, especially in healthcare and wellness facilities.

Quantitative and qualitative evaluation of PERCEPT indoor navigation system for visually impaired users.

In this paper we introduce qualitative and quantitative evaluation of PERCEPT system, an indoor navigation system for the blind and visually impaired. PERCEPT system trials with 24 blind and visually impaired users in a multi-story building show PERCEPT system effectiveness in providing appropriate navigation instructions to these users. The uniqueness of our system is that it is affordable and that its design follows Orientation and Mobility principles. These results encourage us to generalize the solution to large indoor spaces and test it with significantly larger visually impaired population in diverse settings. We hope that PERCEPT will become a standard deployed in all indoor public spaces.

Diffusion magnetic resonance imaging in the head and neck.

Diffusion weighting (DW) represents a magnetic resonance imaging contrast distinct from T1 and T2 in terms of imaging physics and its relationship to underlying physiology and pathophysiology. DW imaging has become a sine qua non of neuroimaging because of its exquisite sensitivity to the molecular motion of water that is altered in many pathologic conditions including acute ischemia. This article reviews the physical principles of DW imaging in the head and neck and describes how it can help to solve this and several other related problems.

PERCEPT: indoor navigation for the blind and visually impaired.

In order to enhance the perception of indoor and unfamiliar environments for the blind and visually-impaired, we introduce the PERCEPT system that supports a number of unique features such as: a) Low deployment and maintenance cost; b) Scalability, i.e. we can deploy the system in very large buildings; c) An on-demand system that does not overwhelm the user, as it offers small amounts of information on demand; and d) Portability and ease-of-use, i.e., the custom handheld device carried by the user is compact and instructions are received audibly.

RiBOMS: RFID-based object management system for home environments.

In this paper we introduce a RFID-based object management system, RiBOMS, for home environments. The system has an easy to use pictorial user interface aimed at older adults with associative memory impairments. The system technical correctness was successfully tested in a lab environment.

DIORAMA: dynamic information collection and resource tracking architecture.

DIORAMA is a real-time scalable decision support framework built on rapid information collection and accurate resource tracking functionalities. Using RFID technology the proposed system tracks emergency responders and victims at the disaster scene. DIORAMA improves the accuracy and decreases the time it takes rescuers to triage, treat and evacuate victims from a disaster scene, as compared to the traditional methods and process that involves using paper triage tags. The information can then be viewed from a website that shows a satellite image of the disaster area with icons representing the paramedics and victims.

Radiology resource utilization during an H1N1 influenza outbreak.

PURPOSE: This study was conducted to evaluate the radiology resources utilized by patients infected with novel influenza A (H1N1) during the 2009 summer outbreak to aid in pandemic planning for the 2010 influenza season. MATERIALS AND METHODS: Of the 222 patients diagnosed or presumed to have H1N1 infection in the authors' health system from May 1 to July 18, 2009, 66 received imaging, including at least one chest imaging study directly related to the infection. Fourteen of these patients required advanced mechanical ventilation and were admitted to the intensive care unit (ICU; group 1); the remainder were managed as outpatients (27 of 52) or required brief hospitalizations (25 of 52) without mechanical ventilation (group 2; n = 52). The imaging histories of all 66 patients were reviewed for the period of hospitalization for group 1 patients and from 10 days before to 30 days after the diagnosis of influenza infection for group 2 patients to determine the number, types, and temporal distribution of radiology procedures performed during the flu outbreak. RESULTS: Thirty percent of all patients with known or presumed influenza (H1N1) underwent radiologic imaging. The 14 patients in the ICU received a total of 469 chest radiographic studies (mean, 33.5), 15 thoracic CT examinations, and 170 additional imaging studies, the most common of which were 72 abdominal radiographic studies and 16 abdominal CT examinations. Seventy-one percent (334 of 469) of all the radiographic examinations in ICU patients were obtained during a single month. In contrast, group 2 patients received a total of 71 chest radiographic studies (mean, 1.4), 6 thoracic CT examinations, and 28 additional imaging studies, spread roughly evenly over the study period, with a subtle peak in early June. CONCLUSIONS: The majority of patients with H1N1 infection (70%) received no imaging studies. Patients sufficiently ill to require some level of imaging had, on average, just over one chest radiographic study. The 6% of patients who required ICU stays received an average of 33.5 chest radiographic studies and one thoracic CT examination. This information should be useful for health care organizations in planning their radiology resource needs during an H1N1 flu pandemic.

Endogenous ATP release inhibits electrogenic Na⁺ absorption and stimulates Cl⁻ secretion in MDCK cells.

Our previous studies with a line of Madin-Darby canine kidney (MDCK) cells (FL-MDCK) transfected with FLAG-labeled alpha, beta, and gamma subunits of epithelial Na(+) channel (ENaC) showed that, although most of the short-circuit current (I (sc)) was amiloride sensitive (AS-I (sc)), there was also an amiloride-insensitive component (NS-I (sc)) due to Cl(-) secretion (Morris and Schafer, J Gen Physiol 120:71-85, 2002). In the present studies, we observed a progressive increase in NS-I (sc) and a corresponding decrease in AS-I (sc) during experiments. There was a significant negative correlation between AS-I (sc) and NS-I (sc) both in the presence and absence of treatment with cyclic adenosine monophosphate (cAMP). NS-I (sc) could be attributed to both cystic fibrosis transmembrane conductance regulator (CFTR) and a 4, 4'-diisothiocyano-2, 2'-disulfonic acid stilbene (DIDS)-sensitive Ca(2+)-activated Cl(-) channel (CaCC). Continuous perfusion of both sides of the Ussing chamber with fresh rather than recirculated bathing solutions, or addition of hexokinase (6 U/ml), prevented the time-dependent changes and increased AS-I (sc) by 40-60%, with a proportional decrease in NS-I (sc). Addition of 100 muM adenosine triphosphate (ATP) in the presence of luminal amiloride produced a transient four-fold increase in NS-I (sc) that was followed by a sustained increase of 50-60% above the basal level. ATP release from the monolayers, measured by bioluminescence, was found to occur across the apical but not the basolateral membrane, and the apical release was tripled by cAMP treatment. These data show that constitutive apical ATP release, which occurs under both basal and cAMP-stimulated conditions, underlies the time-dependent rise in Cl(-) secretion and the proportional fall in ENaC-mediated Na(+) absorption in FL-MDCK cells. Thus, endogenous ATP release can introduce a significant confounding variable in experiments with this and similar epithelial cells, and it may underlie at least some of the observed interaction between Cl(-) secretion and Na(+) absorption.

Reproducibility of odor maps by fMRI in rodents.

The interactions of volatile odorants with the approximately 1000 types of olfactory receptor neurons in the olfactory mucosa are represented in the olfactory bulb by glomerular spatial activity maps. If these spatial maps underlie the perceptual identification of odorants then, for a given organism, they must be both specific and reproducible. However, this intra-organism reproducibility need not be present between organisms because genetic and developmental studies of olfactory bulb wiring suggest that there is substantial variation between the glomerular arrangements of closely related organisms and even between the two bulbs in a given animal. The ability of functional MRI (fMRI) to record responses of the entire rodent olfactory bulb repeatedly within the same subject has made it possible to assess the reproducibility of odor-induced spatial activity maps both within and between subjects exposed to equivalent stimuli. For a range of odorants, representing multiple chemical classes, a level of fMRI reproducibility (at 7.0 T and 9.4 T) comparable or superior to other cortical regions was demonstrated. While the responses of different bulbs to the same odorant could be localized within the same broad regions of the glomerular sheet, the precise magnitude and topology of the response within those regions were both often highly variable. These results demonstrate the robustness of high-field fMRI as a tool for assaying olfactory bulb function and provide evidence that equivalent perceptual outcomes may arise from divergent neural substrates.

Adaptation in the rodent olfactory bulb measured by fMRI.

Effective evaluation of the odor environment necessitates the ability to attenuate responses to potent background odors in favor of novel and less robust stimuli. Olfactory receptor neuron studies suggest that some of this adaptation takes place in the primary sensory neurons, but the more extensive adaptation seen in higher cortical areas implies the involvement of additional neural mechanisms. At 7.0 T, high-resolution fMRI was used to assess the response of the rodent olfactory bulb, the most peripheral cortical structure involved in olfactory processing, to a variety of odor stimuli. The results suggest that there are additional regulatory mechanisms in the olfactory bulb that result in greater adaptation in deeper areas than that seen in sensory receptors alone and that the resultant adaptation is positively affected by increasing stimulus duration and concentration and decreasing recovery time. The implications of these findings for the integration of peripheral input with perception are discussed.

Simultaneous activation of mouse main and accessory olfactory bulbs by odors or pheromones.

It is generally believed that the main olfactory system processes common odors and the accessory olfactory system is specifically for pheromones. The potential for these two systems to respond simultaneously to the same stimuli has not been fully explored due to methodological limitations. Here we examine this phenomenon using high-resolution functional magnetic resonance imaging (fMRI) to reveal simultaneously the responses in the main (MOB) and accessory olfactory bulbs (AOB) to odors and pheromones. Common odorants elicited strong signals in the MOB and weak signals in the AOB. 2-Heptanone, a known mouse pheromone, elicited strong signals in both the MOB and AOB. Urine odor, a complicated mixture of pheromones and odorants, elicited significant signals in limited regions of the MOB and large regions of the AOB. The fMRI results demonstrate that both the main and the accessory olfactory systems may respond to volatile compounds but with different selectivity, suggesting a greater integration of the two olfactory pathways than traditionally believed.