National Health Interview Survey, COVID-19, and Online Data Collection Platforms: Adaptations, Tradeoffs, and New Directions.

High-quality data are accurate, relevant, and timely. Large national health surveys have always balanced the implementation of these quality dimensions to meet the needs of diverse users. The COVID-19 pandemic shifted these balances, with both disrupted survey operations and a critical need for relevant and timely health data for decision-making. The National Health Interview Survey (NHIS) responded to these challenges with several operational changes to continue production in 2020. However, data files from the 2020 NHIS were not expected to be publicly available until fall 2021. To fill the gap, the National Center for Health Statistics (NCHS) turned to 2 online data collection platforms-the Census Bureau's Household Pulse Survey (HPS) and the NCHS Research and Development Survey (RANDS)-to collect COVID-19‒related data more quickly. This article describes the adaptations of NHIS and the use of HPS and RANDS during the pandemic in the context of the recently released Framework for Data Quality from the Federal Committee on Statistical Methodology. (Am J Public Health. 2021;111(12):2167-2175. https://doi.org/10.2105/AJPH.2021.306516).

The use of electronic games in therapy: a review with clinical implications.

Therapists and patients enjoy and benefit from interventions that use electronic games (EG) in health care and mental health settings, with a variety of diagnoses and therapeutic goals. We reviewed the use of electronic games designed specifically for a therapeutic purpose, electronic games for psychotherapy (EGP), also called serious games, and commercially produced games used as an adjunct to psychotherapy, electronic games for entertainment (EGE). Recent research on the benefits of EG in rehabilitation settings, EGP, and EGE indicates that electronic methods are often equivalent to more traditional treatments and may be more enjoyable or acceptable, at least to some consumers. Methodological concerns include the lack of randomized controlled trials (RCT) for many applications. Suggestions are offered for using EG in therapeutic practice.

Mitigating the risk of radiation-induced cancers: limitations and paradigms in drug development.

The United States radiation medical countermeasures (MCM) programme for radiological and nuclear incidents has been focusing on developing mitigators for the acute radiation syndrome (ARS) and delayed effects of acute radiation exposure (DEARE), and biodosimetry technologies to provide radiation dose assessments for guiding treatment. Because a nuclear accident or terrorist incident could potentially expose a large number of people to low to moderate doses of ionising radiation, and thus increase their excess lifetime cancer risk, there is an interest in developing mitigators for this purpose. This article discusses the current status, issues, and challenges regarding development of mitigators against radiation-induced cancers. The challenges of developing mitigators for ARS include: the long latency between exposure and cancer manifestation, limitations of animal models, potential side effects of the mitigator itself, potential need for long-term use, the complexity of human trials to demonstrate effectiveness, and statistical power constraints for measuring health risks (and reduction of health risks after mitigation) following relatively low radiation doses (<0.75 Gy). Nevertheless, progress in the understanding of the molecular mechanisms resulting in radiation injury, along with parallel progress in dose assessment technologies, make this an opportune, if not critical, time to invest in research strategies that result in the development of agents to lower the risk of radiation-induced cancers for populations that survive a significant radiation exposure incident.

Validating the ability of a portable shoe-floor friction testing device, NextSTEPS, to predict human slips.

Measuring shoe-floor friction is critical for assessing the safety of footwear products. Portable devices for measuring coefficient of friction (COF) are needed. This study introduces such a device and evaluates its ability to predict human slip events across shoe designs. A portable device (18 kg) was utilized to measure 66 unique shoe-floor-fluid coefficients of friction (COF). Consistent with the shoes, flooring, and fluid contaminants from the COF tests, participants (n = 66) were unexpectedly exposed to the fluid while walking. Slip predictions were made based on a separate training data set. Slip predictions were made prospectively and using logistic regression analyses. The slip predictions were valid (p < 0.001), 91% sensitive, and 64% specific. The logistic regression fit also revealed that the COF values predicted slip outcomes (p = 0.006). This device is expected to expand the capacity of researchers, product developers, forensic engineers, and safety professionals to prevent slips and enhance human safety.

Preparedness for a 'no-notice' mass-casualty incident: a nuclear detonation scenario.

PURPOSE: An effective response for a mass-casualty incident requires understanding the relevant basic science and physical impact; detailed preparedness among jurisdictions; and clear, sequential response planning, including formal operational exercises, logistics, interagency, and public-private coordination, rapid activation of resilience, and continual improvement from lessons learned and new knowledge. This ConRad 2021 meeting report describes steps for civilian medical and public health response planning for a nuclear detonation; the utility of this type of planning for broader application; and extension of this planning to the international community. CONCLUSION: A nuclear detonation requires a response within minutes to what will be a large-scale disaster complicated by radiation, including some elements that are similar to a broad range of incidents. The response could be further complicated if multiple incidents occur simultaneously. Required are detailed planning, preparedness and scripting for an immediate operational response, addressing clinical manifestations of evolving radiation illness, and flexibility to adapt to a rapidly changing situation. This need translates into the use of just-in-time information; effective, credible communication; situational awareness on a global scale; and a template upon which to apply capabilities in a multi-sector response. This effort is greatly facilitated using a 'playbook' approach, the basics of which are presented.

Influence of averaging time-interval on shoe-floor-contaminant available coefficient of friction measurements.

Available coefficient of friction (ACOF) is a common metric of footwear traction performance. ACOF is the ratio of friction to normal force, often averaged over a time-interval. The time-interval needed to achieve repeatable and valid ACOF is unknown. A post-hoc analysis was performed on nine shoe-floor-contaminant combinations to assess the repeatability and bias of data averaged across 4 time-intervals (2 ms, 50 ms, 100 ms, 200 ms) after the target normal force was reached. The ability to predict human slips was assessed for ACOF across these intervals. Differences in repeatability and validity across the four intervals were small. However, statistically significant differences were observed for the shortest compared with the longest interval (lower repeatability yet modestly improved predictive ability). Given the limited impact of time-interval on the results, a shorter interval of 50 ms is recommended to enable testing of smaller floor samples.

Changes in under-shoe traction and fluid drainage for progressively worn shoe tread.

Shoe wear is known to increase slipping risk, but few studies have systematically studied this relationship. This study investigated the impact of progressive shoe wear on the available coefficient of friction (ACOF) and under-shoe fluid dynamics. Five different slip-resistant shoes were progressively worn using an accelerated, abrasive, wear protocol. The ACOF and fluid forces (the load supported by the fluid) were measured as shoes were slipped across a surface contaminated with a diluted glycerol solution. As the shoes became worn, an initial increase in ACOF was followed by a steady decrease. Low fluid forces were observed prior to wear followed by increased fluid forces as the worn region became larger. Results suggest that traction performance decreases particularly when the heel region without tread exceeds a size of 800 mm2. This study supports the concept of developing shoe replacement guidelines based upon the size of the worn region to reduce occupational slips.

UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES BIODOSIMETRY AND RADIOLOGICAL/NUCLEAR MEDICAL COUNTERMEASURE PROGRAMS.

The United States Department of Health and Human Services (HHS) is fully committed to the development of medical countermeasures to address national security threats from chemical, biological, radiological, and nuclear agents. Through the Public Health Emergency Medical Countermeasures Enterprise, HHS has launched and managed a multi-agency, comprehensive effort to develop and operationalize medical countermeasures. Within HHS, development of medical countermeasures includes the National Institutes of Health (NIH), (led by the National Institute of Allergy and Infectious Diseases), the Office of the Assistant Secretary of Preparedness and Response/Biomedical Advanced Research and Development Authority (BARDA); with the Division of Medical Countermeasure Strategy and Requirements, the Centers for Disease Control and Prevention, and the Food and Drug Administration as primary partners in this endeavor. This paper describes various programs and coordinating efforts of BARDA and NIH for the development of medical countermeasures for radiological and nuclear threats.

Imaging characteristics of a novel technetium Tc 99m-labeled platelet glycoprotein IIb/IIIa receptor antagonist in patients With acute deep vein thrombosis or a history of deep vein thrombosis.

BACKGROUND: The diagnosis of recurrent deep vein thrombosis (DVT) is challenging. Imaging with radiolabeled peptides offers a new approach for detecting acute DVT. Technetium Tc 99m ((99m)Tc)-apcitide binds with high affinity and specificity to the glycoprotein IIb/IIIa receptors expressed on activated platelets and, therefore, (99m)Tc-apcitide scintigraphy should be negative with residual abnormalities caused by old, inactive thrombi and positive with new, active thrombi. METHODS: In a prospective multicenter study, (99m)Tc-apcitide imaging was performed on 38 patients with a newly diagnosed first DVT (group 1) and 40 patients with previous DVT, symptoms of postthrombotic syndrome, and chronic intraluminal abnormalities on ultrasonography (group 2). Images were interpreted in a blinded fashion by 2 experts and by newly trained nuclear medicine physicians. The sensitivity and specificity of (99m)Tc-apcitide were determined by calculating the proportion of scans in group 1 patients that were read as "positive for acute DVT" and the proportion of scans in group 2 patients that were read as "negative for acute DVT," respectively. RESULTS: When read by 2 experts, ( 99m)Tc-apcitide had a sensitivity of 92% for both readers and specificities of 82% and 90%. Agreement between the experts was excellent. However, the accuracy and interreader agreement for newly trained nuclear medicine physicians were lower. CONCLUSIONS: Technetium Tc 99m-apcitide scintigraphy has potential utility in suspected recurrent DVT because it detects most acute thrombi and has few false-positive results in patients with previous DVT. However, the accuracy appears to depend on the training and experience of the interpreters.

Improving malaria control in West Africa: interruption of transmission as a paradigm shift.

With the paradigm shift from the reduction of morbidity and mortality to the interruption of transmission, the focus of malaria control broadens from symptomatic infections in children ≤5 years of age to include asymptomatic infections in older children and adults. In addition, as control efforts intensify and the number of interventions increases, there will be decreases in prevalence, incidence and transmission with additional decreases in morbidity and mortality. Expected secondary consequences of these changes include upward shifts in the peak ages for infection (parasitemia) and disease, increases in the ages for acquisition of antiparasite humoral and cellular immune responses and increases in false-negative blood smears and rapid diagnostic tests. Strategies to monitor these changes must include: (1) studies of the entire population (that are not restricted to children ≤5 or ≤10 years of age), (2) study sites in both cities and rural areas (because of increasing urbanization across sub-Saharan Africa) and (3) innovative strategies for surveillance as the prevalence of infection decreases and the frequency of false-negative smears and rapid diagnostic tests increases.

The U.S. government's medical countermeasure portfolio management for nuclear and radiological emergencies: synergy from interagency cooperation.

Following the attacks of 11 September 2001, emergency preparedness within the U.S. Department of Health and Human Services, as well as at the Department of Defense and other federal agencies, received higher visibility, new mandates and increased funding. Emergency deployment teams increased the frequency of drills to enable better response to the health consequences of mass-casualty incidents. Interagency coordination has also continued to increase to more efficiently and effectively leverage federal resources toward emergency medical preparedness for both civilian and military populations.

Rapid radiation dose assessment for radiological public health emergencies: roles of NIAID and BARDA.

A large-scale radiological incident would result in an immediate critical need to assess the radiation doses received by thousands of individuals to allow for prompt triage and appropriate medical treatment. Measuring absorbed doses of ionizing radiation will require a system architecture or a system of platforms that contains diverse, integrated diagnostic and dosimetric tools that are accurate and precise. For large-scale incidents, rapidity and ease of screening are essential. The National Institute of Allergy and Infectious Diseases of the National Institutes of Health is the focal point within the Department of Health and Human Services (HHS) for basic research and development of medical countermeasures for radiation injuries. The Biomedical Advanced Research and Development Authority within the HHS Office of the Assistant Secretary for Preparedness and Response coordinates and administers programs for the advanced development and acquisition of emergency medical countermeasures for the Strategic National Stockpile. Using a combination of funding mechanisms, including funds authorized by the Project BioShield Act of 2004 and those authorized by the Pandemic and All-Hazards Preparedness Act of 2006, HHS is enhancing the nation's preparedness by supporting the radiation dose assessment capabilities that will ensure effective and appropriate use of medical countermeasures in the aftermath of a radiological or nuclear incident.

Biomarkers and imaging: physics and chemistry for noninvasive analyses.

The era of 'modern medicine' has changed its name to 'molecular medicine', and reflects a new age based on personalized medicine utilizing molecular biomarkers in the diagnosis, staging and monitoring of therapy. Alzheimer's disease has a classical biomarker determined at autopsy with the histologic staining of amyloid accumulation in the brain. Today we can diagnose Alzheimer's disease using the same classical pathologic biomarker, but now using a noninvasive imaging probe to image the amyloid deposition in a patient and potentially provide treatment strategies and measure their effectiveness. Molecular medicine is the exploitation of biomarkers to detect disease before overt expression of pathology. Physicians can now find, fight and follow disease using imaging, and the need for other disease biomarkers is in high demand. This review will discuss the innovative physical and molecular biomarker probes now being developed for imaging systems and we will introduce the concepts needed for validation and regulatory acceptance of surrogate biomarkers in the detection and treatment of disease.