A qualitative analysis of health information-sharing networks in the Indonesian poultry sector.

Animal production systems are developing into increasingly complex value chains involving a large diversity of actors with multiple and dynamic linkages, concurrently creating many opportunities for disease spread. Access to timely and good-quality animal health information is vital for designing effective disease management strategies. However, several factors may hamper information flows along those chains. Understanding the structure and dynamics of information networks is essential to develop effective and acceptable health information systems. We applied a qualitative network approach to understand how information about poultry health is generated, disseminated and used for decision-making along the poultry value chain in Indonesia. Maps of the value chain and information networks were generated based on data from key informant interviews to illustrate the linkages and information-sharing patterns between stakeholders. Four types of farm business models were identified: company-owned, contract, partnership and independent. Although companies and most independent farmers collected health and production data routinely, their systems were strongly siloed and still relied on a mix of digital and paper-based methods, which impaired their analytical capacity. Technical service providers from the upstream sector and industry associations were identified as key intermediaries in the information-sharing network with the ability to create informal bridges between separate business networks and public actors. These actors can play a strategic role in the development of integrated information systems to improve stakeholders' capacity to monitor, anticipate and manage disease threats at all levels of the value chain. This study contributes to fill an important knowledge gap regarding the layer sector and may help decision-makers to design effective policies and interventions tailored to the type of business model.

Validation, certification and registration of veterinary diagnostic test kits by the World Organisation for Animal Health Secretariat for Registration of Diagnostic Kits.

In the field of diagnostic test validation, World Organisation for Animal Health (OIE) Reference Laboratories (RLs) have a pivotal role and provide the international community with impartial advice and support in the selection, development and validation of diagnostic tests, which can be applied to the specialist diseases for which they are designated. National RLs provide an invaluable function in supporting the introduction, ongoing validation and application of validated diagnostic tests in line with international standards. Experienced staff with extensive knowledge of such systems and access to specialist facilities for conducting work are available to monitor changes or advancements in technology. They consider their relevance and value to evolving diagnostic test requirements. Reference Laboratories often have a broad mandate of activity linking research or development programmes and surveillance activities to benefit the continual assessment and, if necessary, improvement of diagnostic tools. Reference Laboratories maintain or have access to unique biological archives (known positive and negative sample populations) and produce international reference standards, both of which are vital in establishing the necessary and detailed validation of any diagnostic test. Reference Laboratories act either singularly or in collaborative partnerships with other RLs or science institutes, but also, when required, and with impartiality, with the commercial sector, to ensure new tests are validated according to OIE standards. They promote and apply formal programmes of quality assurance (including proficiency testing programmes) for newly validated tests, ensuring ongoing monitoring and compliance with standards, or as required set out any limitations or uncertainties. Reference Laboratories publish information on test validation in the scientific literature and on relevant websites, as well as disseminating information at workshops and international conferences. Furthermore, they can offer training in the processes and systems underpinning test validation.

Dans le domaine de la validation des tests de diagnostic, les Laboratoires de référence de l'Organisation mondiale de la santé animale (OIE) jouent un rôle central et fournissent à la communauté internationale des conseils impartiaux ainsi qu'un soutien pour la sélection, la mise au point et la validation des tests de diagnostic utilisés pour la détection des maladies correspondant à leur domaine de spécialisation. Les Laboratoires de référence nationaux remplissent une fonction inestimable en facilitant l'introduction, la validation continue et l'application de tests de diagnostic validés conformément aux normes internationales. Ces laboratoires sont dotés de personnels expérimentés possédant une connaissance approfondie de ces systèmes et qui ont accès à des installations spécialisées pour mener à bien leurs opérations et suivre de près les changements ou les avancées technologiques. Ils peuvent ainsi examiner leur pertinence et intérêt au regard de l'évolution des exigences relatives aux tests de diagnostic. Le mandat des Laboratoires de référence recouvre souvent un large éventail d'activités reliant les programmes de recherche ou développement et les activités de surveillance, ce qui permet de réaliser une évaluation continue des outils diagnostiques et, si besoin, de procéder à leur amélioration. Les Laboratoires de référence entretiennent ou ont accès à des banques de matériels biologiques uniques (panels d'échantillons positifs et négatifs connus) et produisent des réactifs de référence internationale, deux catégories de matériels essentielles pour procéder à la validation point par point d'un test diagnostique suivant les critères requis. Les Laboratoires de référence interviennent individuellement ou en partenariat avec d'autres Laboratoires de référence ou instituts scientifiques, mais aussi, lorsque c'est nécessaire et dans le respect des règles d'impartialité, avec le secteur privé, afin de s'assurer que les nouveaux tests sont validés conformément aux normes de l'OIE. Ils soutiennent et appliquent des programmes officiels d'assurance de la qualité (y compris en participant à des programmes d'essais d'aptitude inter-laboratoires) pour les tests nouvellement validés et garantissent leur suivi continu ainsi que leur conformité avec les normes, ou, suivant les cas, définissent les limites ou le niveau d'incertitude à prendre en considération. Les Laboratoires de référence publient les données relatives à la validation des tests dans des journaux scientifique et sur les sites Web pertinents et diffusent également des informations sur le sujet lors d'ateliers et de conférences internationales. En outre, ils peuvent proposer des formations sur les procédures et les systèmes qui sous-tendent la validation des tests.

En el terreno de la validación de pruebas de diagnóstico, los Laboratorios de Referencia de la Organización Mundial de Sanidad Animal (OIE) cumplen una función central y proporcionan a la comunidad internacional servicios de apoyo y asesoramiento imparcial para la selección, el desarrollo y la validación de pruebas de diagnóstico, que pueden aplicarse a la enfermedad para la que cada laboratorio esté designado. Los laboratorios de referencia nacionales cumplen una inestimable función de apoyo a la implantación, la continua validación y la utilización de pruebas de diagnóstico validadas con arreglo a las normas internacionales. Disponen de personal experimentado y muy buen conocedor de estos sistemas y de acceso a instalaciones especializadas de trabajo, lo que les permite seguir de cerca los cambios o adelantos tecnológicos y estudiar su utilidad o interés en relación con la evolución de los requisitos de las pruebas de diagnóstico. Los Laboratorios de Referencia suelen tener un mandato amplio, que a los programas de investigación y desarrollo aúna actividades de vigilancia, en aras de la continua evaluación y, en caso necesario, mejora de las herramientas de diagnóstico. Estos laboratorios poseen (o tienen acceso a) archivos biológicos únicos (conjuntos de muestras probadamente positivas y negativas) y elaboran patrones de referencia internacional, elementos ambos indispensables para llevar a buen fin la necesaria validación detallada de toda prueba de diagnóstico. Los Laboratorios de Referencia pueden trabajar en solitario o en colaboración con otros Laboratorios de Referencia, con institutos científicos e incluso, cuando hace falta, y procediendo con imparcialidad, con entidades del sector privado, a fin de garantizar que toda nueva prueba sea validada con arreglo a las normas de la OIE. También promueven y llevan adelante programas oficiales de garantía de la calidad de pruebas recién validadas (incluidos programas de pruebas de competencia), lo que asegura un seguimiento continuo y el cumplimiento de la normativa en todo momento, o fijan, cuando es necesario, limitaciones o niveles de incertidumbre. Asimismo, estos laboratorios publican datos sobre la validación de pruebas en revistas científicas y sitios web conexos y difunden información al respecto en talleres y conferencias internacionales. Además, pueden impartir formación sobre los procesos y sistemas que fundamentan la validación de pruebas de diagnóstico.

The Crystal Backlighter Imager: A spherically bent crystal imager for radiography on the National Ignition Facility.

The Crystal Backlighter Imager (CBI) is a quasi-monochromatic, near-normal incidence, spherically bent crystal imager developed for the National Ignition Facility (NIF), which will allow inertial confinement fusion capsule implosions to be radiographed close to stagnation. This is not possible using the standard pinhole-based area-backlighter configuration, as the self-emission from the capsule hotspot overwhelms the backlighter signal in the final stages of the implosion. The CBI mitigates the broadband self-emission from the capsule hot spot by using the extremely narrow bandwidth inherent to near-normal-incidence Bragg diffraction. Implementing a backlighter system based on near-normal reflection in the NIF chamber presents unique challenges, requiring the CBI to adopt novel engineering and operational strategies. The CBI currently operates with an 11.6 keV backlighter, making it the highest energy radiography diagnostic based on spherically bent crystals to date. For a given velocity, Doppler shift is proportional to the emitted photon energy. At 11.6 keV, the ablation velocity of the backlighter plasma results in a Doppler shift that is significant compared to the bandwidth of the instrument and the width of the atomic line, requiring that the shift be measured to high accuracy and the optics aligned accordingly to compensate. Experiments will be presented that used the CBI itself to measure the backlighter Doppler shift to an accuracy of better than 1 eV. These experiments also measured the spatial resolution of CBI radiographs at 7.0 µm, close to theoretical predictions. Finally, results will be presented from an experiment in which the CBI radiographed a capsule implosion driven by a 1 MJ NIF laser pulse, demonstrating a significant (>100) improvement in the backlighter to self-emission ratio compared to the pinhole-based area-backlighter configuration.

Aperture design for the third neutron and first gamma-ray imaging systems for the National Ignition Facility.

The current construction of a new nuclear-imaging view at the National Ignition Facility will provide a third line of sight for hotspot and cold fuel imaging and the first dedicated line of sight for 4.4-MeV γ-ray imaging of the remaining carbon ablator. To minimize the effort required to hold and align apertures inside the vacuum chamber, the apertures for the two lines of sight will be contained in the same array. In this work, we discuss the system requirements for neutron and γ-ray imaging and the resulting aperture array design.

Diagnostic Performance of Ultrafast Brain MRI for Evaluation of Abusive Head Trauma.

BACKGROUND AND PURPOSE: MR imaging with sedation is commonly used to detect intracranial traumatic pathology in the pediatric population. Our purpose was to compare nonsedated ultrafast MR imaging, noncontrast head CT, and standard MR imaging for the detection of intracranial trauma in patients with potential abusive head trauma. MATERIALS AND METHODS: A prospective study was performed in 24 pediatric patients who were evaluated for potential abusive head trauma. All patients received noncontrast head CT, ultrafast brain MR imaging without sedation, and standard MR imaging with general anesthesia or an immobilizer, sequentially. Two pediatric neuroradiologists independently reviewed each technique blinded to other modalities for intracranial trauma. We performed interreader agreement and consensus interpretation for standard MR imaging as the criterion standard. Diagnostic accuracy was calculated for ultrafast MR imaging, noncontrast head CT, and combined ultrafast MR imaging and noncontrast head CT. RESULTS: Interreader agreement was moderate for ultrafast MR imaging (κ = 0.42), substantial for noncontrast head CT (κ = 0.63), and nearly perfect for standard MR imaging (κ = 0.86). Forty-two percent of patients had discrepancies between ultrafast MR imaging and standard MR imaging, which included detection of subarachnoid hemorrhage and subdural hemorrhage. Sensitivity, specificity, and positive and negative predictive values were obtained for any traumatic pathology for each examination: ultrafast MR imaging (50%, 100%, 100%, 31%), noncontrast head CT (25%, 100%, 100%, 21%), and a combination of ultrafast MR imaging and noncontrast head CT (60%, 100%, 100%, 33%). Ultrafast MR imaging was more sensitive than noncontrast head CT for the detection of intraparenchymal hemorrhage (P = .03), and the combination of ultrafast MR imaging and noncontrast head CT was more sensitive than noncontrast head CT alone for intracranial trauma (P = .02). CONCLUSIONS: In abusive head trauma, ultrafast MR imaging, even combined with noncontrast head CT, demonstrated low sensitivity compared with standard MR imaging for intracranial traumatic pathology, which may limit its utility in this patient population.

Design of the polar neutron-imaging aperture for use at the National Ignition Facility.

The installation of a neutron imaging diagnostic with a polar view at the National Ignition Facility (NIF) required design of a new aperture, an extended pinhole array (PHA). This PHA is different from the pinhole array for the existing equatorial system due to significant changes in the alignment and recording systems. The complex set of component requirements, as well as significant space constraints in its intended location, makes the design of this aperture challenging. In addition, lessons learned from development of prior apertures mandate careful aperture metrology prior to first use. This paper discusses the PHA requirements, constraints, and the final design. The PHA design is complex due to size constraints, machining precision, assembly tolerances, and design requirements. When fully assembled, the aperture is a 15 mm × 15 mm × 200 mm tungsten and gold assembly. The PHA body is made from 2 layers of tungsten and 11 layers of gold. The gold layers include 4 layers containing penumbral openings, 4 layers containing pinholes and 3 spacer layers. In total, there are 64 individual, triangular pinholes with a field of view (FOV) of 200 µm and 6 penumbral apertures. Each pinhole is pointed to a slightly different location in the target plane, making the effective FOV of this PHA a 700 µm square in the target plane. The large FOV of the PHA reduces the alignment requirements both for the PHA and the target, allowing for alignment with a laser tracking system at NIF.

Two-color spatial and temporal temperature measurements using a streaked soft x-ray imager.

A dual-channel streaked soft x-ray imager has been designed and used on high energy-density physics experiments at the National Ignition Facility. This streaked imager creates two images of the same x-ray source using two slit apertures and a single shallow angle reflection from a nickel mirror. Thin filters are used to create narrow band pass images at 510 eV and 360 eV. When measuring a Planckian spectrum, the brightness ratio of the two images can be translated into a color-temperature, provided that the spectral sensitivity of the two images is well known. To reduce uncertainty and remove spectral features in the streak camera photocathode from this photon energy range, a thin 100 nm CsI on 50 nm Al streak camera photocathode was implemented. Provided that the spectral shape is well-known, then uncertainties on the spectral sensitivity limits the accuracy of the temperature measurement to approximately 4.5% at 100 eV.

Combined neutron and x-ray imaging at the National Ignition Facility (invited).

X-ray and neutrons are commonly used to image inertial confinement fusion implosions, providing key diagnostic information on the fuel assembly of burning deuterium-tritium (DT) fuel. The x-ray and neutron data provided are complementary as the production of neutrons and x-rays occurs from different physical processes, but typically these two images are collected from different views with no opportunity for co-registration of the two images. Neutrons are produced where the DT fusion fuel is burning; X-rays are produced in regions corresponding to high temperatures. Processes such as mix of ablator material into the hotspot can result in increased x-ray production and decreased neutron production but can only be confidently observed if the two images are collected along the same line of sight and co-registered. To allow direct comparison of x-ray and neutron data, a combined neutron x-ray imaging system has been tested at Omega and installed at the National Ignition Facility to collect an x-ray image along the currently installed neutron imaging line of sight. This system is described, and initial results are presented along with prospects for definitive coregistration of the images.

A new streaked soft x-ray imager for the National Ignition Facility.

A new streaked soft x-ray imager has been designed for use on high energy-density (HED) physics experiments at the National Ignition Facility based at the Lawrence Livermore National Laboratory. This streaked imager uses a slit aperture, single shallow angle reflection from a nickel mirror, and soft x-ray filtering to, when coupled to one of the NIF's x-ray streak cameras, record a 4× magnification, one-dimensional image of an x-ray source with a spatial resolution of less than 90 µm. The energy band pass produced depends upon the filter material used; for the first qualification shots, vanadium and silver-on-titanium filters were used to gate on photon energy ranges of approximately 300-510 eV and 200-400 eV, respectively. A two-channel version of the snout is available for x-ray sources up to 1 mm and a single-channel is available for larger sources up to 3 mm. Both the one and two-channel variants have been qualified on quartz wire and HED physics target shots.

Backscatter measurements for NIF ignition targets (invited).

Backscattered light via laser-plasma instabilities has been measured in early NIF hohlraum experiments on two beam quads using a suite of detectors. A full aperture backscatter system and near backscatter imager (NBI) instrument separately measure the stimulated Brillouin and stimulated Raman scattered light. Both instruments work in conjunction to determine the total backscattered power to an accuracy of ∼15%. In order to achieve the power accuracy we have added time-resolution to the NBI for the first time. This capability provides a temporally resolved spatial image of the backscatter which can be viewed as a movie.

Demonstration of the density dependence of x-ray flux in a laser-driven hohlraum.

Experiments have been conducted using laser-driven cylindrical hohlraums whose walls are machined from Ta2O5 foams of 100 mg/cc and 4 g/cc densities. Measurements of the radiation temperature demonstrate that the lower density walls produce higher radiation temperatures than the high density walls. This is the first experimental demonstration of the prediction that this would occur [M. D. Rosen and J. H. Hammer, Phys. Rev. E 72, 056403 (2005)10.1103/PhysRevE.72.056403]. For high density walls, the radiation front propagates subsonically, and part of the absorbed energy is wasted by the flow kinetic energy. For the lower wall density, the front velocity is supersonic and can devote almost all of the absorbed energy to heating the wall.

Hohlraum-driven ignitionlike double-shell implosions on the omega laser facility.

High-convergence ignitionlike double-shell implosion experiments have been performed on the Omega laser facility [T. R. Boehly, Opt. Commun. 133, 495 (1997)] using cylindrical gold hohlraums with 40 drive beams. Repeatable, dominant primary (2.45 MeV) neutron production from the mix-susceptible compressional phase of a double-shell implosion, using fall-line design optimization and exacting fabrication standards, is experimentally inferred from time-resolved core x-ray imaging. Effective control of fuel-pusher mix during final compression is essential for achieving noncryogenic ignition with double-shell targets on the National Ignition Facility [Paisner, Laser Focus World 30, 75 (1994)].

Modeling of frequency doubling and tripling with measured crystal spatial refractive-index nonuniformities.

Efficient frequency doubling and tripling are critical to the successful operation of inertial confinement fusion laser systems such as the National Ignition Facility currently being constructed at the Lawrence Livermore National Laboratory and the Omega laser at the Laboratory for Laser Energetics. High-frequency conversion efficiency is strongly dependent on attainment of the phase-matching condition. In an ideal converter crystal, one can obtain the phase-matching condition throughout by angle tuning or temperature tuning of the crystal as a whole. In real crystals, imperfections in the crystal structure prohibit the attainment of phase matching at all locations in the crystal. We have modeled frequency doubling and tripling with a quantitative measure of this departure from phase matching in real crystals. This measure is obtained from interferometry of KDP and KD*P crystals at two orthogonal light polarizations.

Hard metal exposures. Part 1: Observed performance of three local exhaust ventilation systems.

Not every ventilation system performs as intended; much can be learned when they do not. The purpose of this study was to compare observed initial performance to expected levels for three saw-reconditioning shop ventilation systems and to characterize the changes in performance of the systems over a one-year period. These three local exhaust ventilation systems were intended to control worker exposures to cobalt, cadmium, and chromium during wet grinding, dry grinding, and welding/brazing activities. Prior to installation the authors provided some design guidance based on Industrial Ventilation, a Manual of Recommended Practice. However, the authors had limited influence on the actual installation and operation and no line authority for the systems. In apparent efforts to cut costs and to respond to other perceived needs, the installed systems deviated from the specifications used in pressure calculations in many important aspects, including adding branch ducts, use of flexible ducts, the choice of fans, and the construction of some hoods. After installation of the three systems, ventilation measurements were taken to determine if the systems met design specifications, and worker exposures were measured to determine effectiveness. The results of the latter will be published as a companion article. The deviations from design and maintenance failures may have adversely affected performance. From the beginning to the end of the study period the distribution of air flow never matched the design specifications for the systems. The observed air flows measured within the first month of installation did not match the predicated design air flows for any of the systems, probably because of the differences between the design and the installed system. Over the first year of operation, hood air flow variability was high due to inadequate cleaning of the sticky process materials which rapidly accumulated in the branch ducts. Poor distribution of air flows among branch ducts frequently produced individual hood air flows that were far below specified design levels even when the total air flow through that system was more than adequate. To experienced practitioners, it is not surprising that deviations from design recommendations and poor maintenance would be associated with poor system performance. Although commonplace, such experiences have not been documented in peer-reviewed publications to date. This publication is a first step in providing that documentation.

Hard metal exposures. Part 2: Prospective exposure assessment.

Hard metal exposures may precipitate lung disease in exposed workers. This article reports on a project investigating the relationship between local exhaust hood air flow levels and workplace hard metal exposures. Airborne cobalt, chromium, and cadmium exposure concentrations, and ventilation system function were monitored for three consecutive days prior to installation of three new ventilation systems, and then were followed monthly for one year. Work activities included wet and dry grinding of saw blades, brazing, welding, and setup. Work task exposures were highly variable over the period of the study. Ventilation air flows failed to meet design goals due to low total air volume and poor distribution; however, worker exposures to metals were controlled in most cases. Hood design, worker acceptance, and use of the hoods were as important in controlling exposures as were exhaust hood air flow levels.

Munchausen syndrome by proxy: a different kind of child abuse.

Munchausen syndrome by proxy (MSBP) continues to mystify health care professionals, law enforcement officials and the judicial system. Even though the first cases were described in 1977, it remains puzzling why a parent would want to induce fictitious symptoms and illnesses in a child. Many professionals do not consider MSBP as a diagnosis because the parent, usually the mother, is so convincing that she is a "good" mother, cares about and wants the best for her child. This article is offered to further educate physicians that MSBP exists, can present in the form of anything and should be considered as a diagnosis in cases that do not make medical sense. Case examples are provided, along with common and not so common presentations. MSBP is a form of severe child abuse that must be reported to Child Protection Service when a child is endangered. Physicians play a critical role in identifying these children and recommending the best course of action to the rest of the system.

Domestic violence: a health concern.

Domestic violence may be the single most common etiology for injuries in women presenting to the health care system. There is a national effort to begin to ask all female patients about family violence. Physicians have a responsibility to identify, educate and appropriately manage and/or refer patients in violent relationships.

Child abuse education: do not overlook dental professionals.

Dental professionals are mandated by law to report suspicions of child abuse and neglect (CAN), but surveys show dentists do not fulfill their obligation to report. Even though more than 50 percent of physical abuse occurs to the head and facial area, and more than 70 percent of child abuse and neglect fatalities are caused by injuries to the head and neck, dental professionals are often overlooked in efforts to educate the public on the problem. Pre-program questionnaires completed by dental professionals attending an educational program on identifying and reporting child abuse indicated that 70 percent had no previous training in identifying and reporting child abuse, 65 percent had suspected child abuse in their patients, but only 19 percent reported the abuse. As a result of this educational program, it is expected that some children in the state of Indiana will receive improved assessments by dentists and suspected child abuse and neglect will be reported to the proper agencies when identified.