Risk assessment of recent Egyptian H5N1 influenza viruses.

Highly pathogenic avian influenza (HPAI) viruses of the H5N1 subtype are enzootic in poultry populations in different parts of the world, and have caused numerous human infections in recent years, particularly in Egypt. However, no sustained human-to-human transmission of these viruses has yet been reported. We tested nine naturally occurring Egyptian H5N1 viruses (isolated in 2014-2015) in ferrets and found that three of them transmitted via respiratory droplets, causing a fatal infection in one of the exposed animals. All isolates were sensitive to neuraminidase inhibitors. However, these viruses were not transmitted via respiratory droplets in three additional transmission experiments in ferrets. Currently, we do not know if the efficiency of transmission is very low or if subtle differences in experimental parameters contributed to these inconsistent results. Nonetheless, our findings heighten concern regarding the pandemic potential of recent Egyptian H5N1 influenza viruses.

Evaluation of low-cost computer monitors for the detection of cervical spine injuries in the emergency room: an observer confidence-based study.

BACKGROUND: To compare the diagnostic value of low-cost computer monitors and a Picture Archiving and Communication System (PACS) workstation for the evaluation of cervical spine fractures in the emergency room. METHODS: Two groups of readers blinded to the diagnoses (2 radiologists and 3 orthopaedic surgeons) independently assessed-digital radiographs of the cervical spine (anterior-posterior, oblique and trans-oral-dens views). The radiographs of 57 patients who arrived consecutively to the emergency room in 2004 with clinical suspicion of a cervical spine injury were evaluated. The diagnostic values of these radiographs were scored on a 3-point scale (1 = diagnosis not possible/bad image quality, 2 = diagnosis uncertain, 3 = clear diagnosis of fracture or no fracture) on a PACS workstation and on two different liquid crystal display (LCD) personal computer monitors. The images were randomised to avoid memory effects. We used logistic mixed-effects models to determine the possible effects of monitor type on the evaluation of x ray images. To determine the overall effects of monitor type, this variable was used as a fixed effect, and the image number and reader group (radiologist or orthopaedic surgeon) were used as random effects on display quality. Group-specific effects were examined, with the reader group and additional fixed effects as terms. A significance level of 0.05 was established for assessing the contribution of each fixed effect to the model. RESULTS: Overall, the diagnostic score did not differ significantly between standard personal computer monitors and the PACS workstation (both p values were 0.78). CONCLUSION: Low-cost LCD personal computer monitors may be useful in establishing a diagnosis of cervical spine fractures in the emergency room.

[Expert commissions and arbitration boards. A report of current status]. / Gutachterkommissionen und Schlichtungsstellen. Ein Sachstandsbericht.

Since 1975 all German Land Medical Councils (Landesärztekammern) have launched either boards of experts or arbitration panels with the intention to settle disputes on medical malpractice by arbitration, on a voluntary base, free from commitment, and without any costs for the parties concerned. Numbers of arbitrator's awards and rates of affirmed cases of malpractice are given for the years 1988 to 1991, for all panels or boards, respectively. More details are reported from the boards of experts of the Land Medical Council of Baden-Württemberg with special reference to possible relations of affirmed awards to some demographic and professional factors. The probability of being involved in a procedure of arbitration is broken down by medical specialty and by site of employment, e.g. in hospital or in medical practice. The highest rates are found in specialties operating on and in hospital doctors. But the percentage of affirmed awards is higher for doctors working in their own office. Evaluating the consequences following the awards of two different periods shows a high degree of acceptance by the patients. Without affirmation less than ten percent of all patients involved apply to the courts but this is done by about thirty percent if the award is affirmating. In these cases the amount of the compensation wanted is contested.

[Who is (still) a cancer patient? Epidemiological aspects for the assessment of the status in diseases with a protracted course]. / Wer ist (noch) ein Krebspatient? Epidemiologische Gesichtspunkte zur Ermittlung des Bestandes bei protrahiert verlaufenden Krankheiten.

Generally it is difficult to assess the prevalence of a chronic disease or a disease with protracted course particularly without clear signs of cure. As formerly with tuberculosis, a standard period after cessation of symptoms or therapy should be defined for assessing the end of cancer disease. In view of the broad spectrum of cancer forms, more than one such period will be necessary, to be thoroughly discussed and widely accepted. The recommendations are mandatory only for epidemiologic purposes but may also be helpful under other conditions.

[Mortality and social class]. / Mortalitat und Sozialschicht.

PIP: Differential mortality by social class and occupation is analyzed using data on deaths of German men aged 30-69 who were living in the city of Stuttgart. Data are for 1976. An analysis by selected causes of death is also presented for the period 1976-1978. (summary in ENG)^ieng

[Early diagnosis of neoplasms in Baden-Württemberg]. / Zum Stand der Krebsfrüherkennung in Baden-Württemberg.

In the Federal Republic of Germany an official cancer screening program was started on July 1, 1971. The following sites are included: for males rectum and prostate, for females breast, cervix uteri, corpus uteri, ovaries, rectum. Since January 1, 1975, in addition skin, male genitalia, bladder and kidneys are screened. The official reports only deal with suspects and not with confirmed cases. The cancer registry of Baden-Württemberg is particularly involved in evaluating the results of the screening program. Of all confirmed cancers of the cervix uteri more than 50 per cent are detected by screening. Non-invasive forms represent a little more than 50 per cent of the total. Approximately one case in six of cancer of the breast or cancer of the prostate is diagnosed by screening procedures. In all other sites the percentage is 5 or less. The participation in the program varies by age and sex. Half of the women in the age group from 30 to 44 participate in the program but only about 3 per cent in the group over 75. In males, the program is aimed at the higher age groups. The total expenditure of the social health insurance in 1976 was 63 billion DM, for all screening measures 403 million DM, that is 0.6 per cent of the total amount. The contribution of the program in relation to the total cancer incidence is discussed.

[The costs of cancer screening (author's transl)]. / Die Kosten der Krebsfrüherkennung

By the cancer screening programme of the German legal health insurance 4,830,717 females were examined in 1973. The yield of cytologic "positive" cases has been 0.23 percent. The sum for finding one of these cases has been in the range from 14,388.-- DM to 16,132.--DM. As can be calculated by the available data on the incidence of cancer of the cervix uteri only about one third of these cases with "positive" findings can be a proven case of cancer (carcinoma in situ included). Thus one proven carcinoma of this site can be detected by the costs of 40,656.--DM to 80,586.--DM and this sum shows an increasing tendency. In spite of these high costs for the cancer detection programme the total expenses for early detection measures amounted only to 0.6 percent of the total expenditues of the legal health insurance in the first half-year 1974. The problem of a high rate of false-positive smears is discussed.