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Objectives Increasing knowledge about the toxicology of drug overdose and substance misuse (DOSM) is important in improving our understanding of the epidemic. We describe the Minnesota Drug Overdose and Substance Use Pilot Surveillance Activity, which started collecting data on emergency department (ED) visits attributable to DOSM in 2017, with a focus on the toxicology results of a subset of clinical encounters.Methods From November 1, 2017, through January 30, 2020, we collected near–real-time data on DOSM-related ED encounters. The Minnesota Department of Health Public Health Laboratory tested leftover clinical specimens (blood and/or urine) for the presence of various substances for patients who died, were hospitalized, had an atypical clinical presentation, or were part of a local drug overdose cluster. Testing looked for >250 drugs or their metabolites, including those commonly misused (eg, methamphetamine, cocaine), prescription medications, synthetic cannabinoids and cathinones, and opioids. We describe characteristics of the overall group and a subgroup of clinical encounters with toxicology results.Results Specimens submitted from 6 EDs during the study period represented 239 clinical encounters. Methamphetamine was the most frequently detected substance (67.4%) but was suspected in only 45.6% of encounters. At least 1 opioid was detected in 42.5% of encounters but suspected in only 29.7%. Testing also detected potential adulterants and additives (eg, fentanyl, fentanyl analogues, levamisole) and showed frequent patient exposure to substances not reported by patients or suspected by clinicians. Nearly half (44.4%) of clinical encounters had >1 substance detected.Conclusions ED surveillance for DOSM encounters, enhanced by toxicology testing, can provide local situational awareness on overdoses, prevent potential mischaracterization of the true drug overdose epidemic, and inform harm reduction and drug overdose prevention efforts.

Surgical resection of nonmelanoma skin cancer (NMSC) may be performed via Mohs micrographic surgery (MMS) or standard surgical excision with complete margin analysis. Whereas MMS may necessitate delayed reconstruction surgery, intraoperative frozen section analysis (IFSA) may be used to ensure clear surgical margins before proceeding with reconstruction. To achieve curative resection while optimizing aesthetic outcomes, surgeons may use surgical excision guided by IFSA to forego extensive or delayed reconstruction. Patients undergoing wide local excision for NMSC using IFSA from October 2008 to November 2016 were evaluated. Analysis included IFSA versuspermanent section outcomes, the number of required excisions, and the recurrence rate. Our analysis contained 145 patients involving 162 lesions. IFSA demonstrated that 73.4 per cent of margins were negative after one excision and 26.5 per cent were re-excised until achieving negative margins. Analysis revealed one false-positive case (0.62%) and four false-negative cases (2.47%). Nine patients had local recurrence (5.56%). Frozen section sensitivity was 88.99 per cent and specificity 99.20 per cent. The positive predictive value was 96.97 per cent, and negative predictive value was 96.90 per cent. Mean follow-up time was 39 months. Both resection and recurrence data of excised NMSC lesions at our institution suggest that surgical excision using IFSA is a safe and effective alternative to MMS.

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ABSTRACTBackground: Increasing rates of opioid-related deaths, state naloxone legislation changes, and negativity prompted investigation of predictive factors associated with willingness to prescribe naloxone to populations at risk of overdose, including knowledge of risk factors, assessment of persons at risk, awareness of legislative changes, perceptions of professional responsibility, and confidence around naloxone prescribing and distribution. Methods: Cross-sectional, Web-based, anonymous, voluntary survey to prescribers of 2 regional health care systems serving urban and rural North Dakota, northern Minnesota, and northwestern Wisconsin. Human subject research was approved by university and health care systems' institutional review boards. Results: Overall, 203 of 1586 prescribers responded; however, not all prescribers completed each survey item. A majority (89.4%, n= 127/142) of respondents had never prescribed naloxone for overdose prevention. Willingness to prescribe naloxone for 4 patient care scenarios involving substantial opioid overdose risk ranged from 43.4% to 70.5%. Knowledge mean score was 15.5 (SD = 2.9) out of 22 with median 15 (range: 5–22). Naloxone legislation awareness score was 8.8 (SD = 3.8) out of 15 with median 8 (range: 3–15). There was a statistically significant but modest correlation between willingness to prescribe naloxone and the other variables, including awareness of state naloxone-related legislation (r= 0.43, P< .0001), level of self-confidence about dosing, prescribing, and writing protocols for naloxone (r= 0.37, P< .0001), general knowledge (r= 0.24, P= .0032), and perception of professional responsibility (r= 0.19, P= .03). Multivariate regression analysis indicated willingness to prescribe naloxone was associated with statistically significant predictors, including awareness of the naloxone laws (P= .0016) and self-confidence about dosing, prescribing, and writing protocols (P= .0011). Conclusions: Prescribers who are more aware of state laws regarding naloxone and confident in their knowledge of dosing, administration, and writing protocols may be more willing to prescribe naloxone.

Background Increasing rates of opioid-related deaths, state naloxone legislation changes, and negativity prompted investigation of predictive factors associated with willingness to prescribe naloxone to populations at risk of overdose, including knowledge of risk factors, assessment of persons at risk, awareness of legislative changes, perceptions of professional responsibility, and confidence around naloxone prescribing and distribution.Methods Cross-sectional, Web-based, anonymous, voluntary survey to prescribers of 2 regional health care systems serving urban and rural North Dakota, northern Minnesota, and northwestern Wisconsin. Human subject research was approved by university and health care systems’ institutional review boards.Results Overall, 203 of 1586 prescribers responded; however, not all prescribers completed each survey item. A majority (89.4%, n= 127/142) of respondents had never prescribed naloxone for overdose prevention. Willingness to prescribe naloxone for 4 patient care scenarios involving substantial opioid overdose risk ranged from 43.4% to 70.5%. Knowledge mean score was 15.5 (SD = 2.9) out of 22 with median 15 (range: 5–22). Naloxone legislation awareness score was 8.8 (SD = 3.8) out of 15 with median 8 (range: 3–15). There was a statistically significant but modest correlation between willingness to prescribe naloxone and the other variables, including awareness of state naloxone-related legislation (r= 0.43, P< .0001), level of self-confidence about dosing, prescribing, and writing protocols for naloxone (r= 0.37, P< .0001), general knowledge (r= 0.24, P= .0032), and perception of professional responsibility (r= 0.19, P= .03). Multivariate regression analysis indicated willingness to prescribe naloxone was associated with statistically significant predictors, including awareness of the naloxone laws (P= .0016) and self-confidence about dosing, prescribing, and writing protocols (P= .0011).Conclusions Prescribers who are more aware of state laws regarding naloxone and confident in their knowledge of dosing, administration, and writing protocols may be more willing to prescribe naloxone.

Attempts to simplify and render more exact the methods available for estimating urobilinogen can meet only with approval. The difficulties inherent in the problem of determining this substance have prevented any method yet described from being more than roughly quantitative. The modification of Terwen's method which one of us (C. J. W.) has employed1 is admittedly not an exact procedure, but it was shown to recover added amounts of crystalline mesobilirubinogen and stercobilinogen with satisfactory limits of error; in addition, it has yielded consistent results in clinical work.2 This method provides for concentration, if necessary, of small amounts of urobilinogen from relatively large amounts of material, for instance, from grossly acholic feces, which may contain small but significant amounts of the substance. The same is true of relatively dilute urine containing urobilinogen in low concentration.The method requires a four day collection of feces, and the average per

The article features several information systems for homeland security and disaster preparedness in the U.S. in 2006. It includes information on Homeland Security Information Network, the Department of Homeland Security's Geospatial Data Model and the Federal Emergency Management Agency's Mapping and Analysis Center.

The article provides an overview of the Whole Building Design Guide (WBDG), a Web-based portal of the National Institute of Building Sciences (NIBS) that serves as a gateway to whole building design techniques and technologies. The portal offers government and industry practitioners a one-stop access to updated information on building-related guidance, criteria and technology from a whole-building perspective.

The article discusses the developments in the meeting of the National Institute of Building Science Facility Information Council. The meeting focused on developing national data collection strategy and standard that would enable building owners to realize the potential $15.8 billion cost avoidance documented in the 2004 National Institute of Science and Technology study. A national standard would consist of a standard data structure, and the standard products.

Describes the U.S. Department of Defense's (DOD) Directive 8320.2, "Data Sharing in a Net-Centric Department of Defense," which establishes policies and responsibilities to implement data sharing in accordance with the Chief Information Officer Memorandum, DOD Net-Centric Data Strategy dated May 9, 2003. Rules regarding the accessibility of data assets; Semantic and structural agreements for data sharing.

Reports on technology trends related to military engineers in the United States. Growth and effect of the Internet; Role of Internet protocols and infrastructure in supporting more-robust Web-based geographic information system applications in nearly all disciplines and types of organizations; Advances in resolution of aerial digital cameras, integrated aircraft Global Positioning System-based positioning and image-processing software.

Presents news briefs related to information systems in the U.S. as of September 17, 2003. Preparation of a report by Independent Task Force on Emergency Responders on obstacles that hamper emergency preparedness efforts in the U.S.; Sponsorship of an online system to update governmental unit boundary information for existing incorporated places undertaken by the U.S. Central Bureau; Advantages of New Industry Foundation Classes, a standard for automated exchange of data among computer life-cycle applications.

The article reports on the establishment of National 3-D, 4-D Building Information Model (BIM) program in 2003 by the Office of the Chief Architect of U.S. General Services Administration (GSA) Public Buildings Service. The said establishment has been evaluating and supporting more than 25 ongoing projects across the nation concerning the 3-D and 4-D BIM applications. GSA determined that BIM has created agency in meeting its customer' design, construction and program requirements.

The article features several information resources on the National Building Information Model Standard in the U.S. in 2006. It includes information on the draft document "A Road Map for Implementing Building Information Modeling (BIM) in Support of MILCON Transformation and Civil Works Projects within the U.S. Army Corps of Engineers (USACE)." The document outlines the implementation of BIM technology to improve the USACE's design and construction processes.

The article provides an overview of the Construction Operations Building Information Exchange (COBIE) Project designed to improve the process following the completion of capital projects. The project has been funded with a grant from the U. S. National Aeronautics and Space Administration and the National Institute of Standards and Technology. It involves providing truckload of paper or large electronic files to the facility manager for the care and feeding of the facility.

The article focuses on the transformation initiative under the President's Management Agenda (PMA) of the U.S. Department of Defense. The PMA focuses on five areas of management weakness across the U.S. government where improvements can be made. On the other hand, transformation initiative specifically addresses financial management, weapon system lifecycle management, human resource management, material supply and service management, and real property and installation lifecycle management.

The article focuses on the building information models (BIM) developed by the National Building Information Model Standard, under the National Institute of Building Sciences' Facilities Information Council. The BIM will allow the free flow of graphic and non-graphic information among all parties in the process of creating and sustaining the built environment. The information model will also work to coordinate with related international activities of the U.S. government.

Reports that the National Oceanic and Atmosphere Administration Satellite and Information Services Division has launched a study of international remote sensing markets for aerial and satellite data technologies in the United States. Analysis of trends which influence the global remote sensing community; Focus of the research on online information collection from individual respondents; Collection of the survey information in real time to obtain statistical research based on the current responses.

Reports on the definition of the term BIM by the National Institute of Building Science's Facility Information Council, as a computable representation of the physical characteristics of a facility, its related project and life cycle information. Integration of the relevant aspects into a coherent organization of data which computers can access; Requirement of information standards by computer-aided design; Transfer of the electronic versions of paper documents as a separate function.

Focuses on the enhanced features of the Department of Homeland Security's National Response Plan which forms the basis of how federal departments and agencies will work together during domestic incidents in the U.S. Homeland Security Operations Center; Joint Field Office; Interagency Incident Management Group.

Reports on the Defense Installation Spatial Data Infrastructure (DISDI) program's link with the Defense Department's Global Information Grid and the original National Spatial Data Infrastructure concept in the U.S. Goals of the DISDI program; Federal agencies that are interested with DISDI.

Focuses on the National Map, an initiative of the Geological Survey to provide public access to current, accurate, complete and nationally consistent digital geospatial data from multiple partners in the U.S. Benefits of the initiative; Typical areas of application for National Map.

Reports that the American Water Works Association Research Foundation, in conjunction with the Geospatial Information and Technology Association is conducting a joint research project entitled "Business Case Development and Return on Investment Methodology for Geographic Information Technology." Four areas applicable to military installation management geospatial data investments and critical infrastructure protection; Defense Installation Spatial Data Infrastructure's mission; Return on investment for information technology projects.

Reports on the extensive information on the issue of transportation system security generated by the U.S. Transportation Research Board (TRB) and the National Academies. Link of their Web site to other related Web sites that contain discussions of issues, actions which can be taken, guidance and training opportunities; Sponsorship of the TRB Committee on Critical Transportation Protection to the site; Budget of its Transit Cooperative Research Program for security-related research.

Reports on the launch of the Protected Critical Infrastructure Information Program by the U.S. Department of Homeland Security to protect information about terrorism and infrastructure concerns received from private industry. Protection of the infrastructure information provided by private organizations against public disclosure; Percentage of critical infrastructure, identified as those assets and systems that would threaten national security if disrupted, fall within the private sector; Proposed rules released by the agency for safeguarding the information.

Provides information on homeland security resources in the U.S. Features of the Geography Network, a global network of geographic information users and providers that provides the infrastructure needed to support the sharing of geographic information among data providers, service providers, and users around the world; Plan of the Geological Survey to acquire high resolution color orthoimagery for 133 most populated metropolitan areas of the U.S. as an essential element of the National Map; Description of the significant features of the Navy/Marine Corps GIS Communications Network.

Reports that the Federal Geographic Data Committee has invited public comments on draft framework data standards developed through the Geospatial One-Stop eGovernment initiative to help create common geographic base data for the National Spatial Data Infrastructure in the U.S. Period of the review; Objectives of the draft standards; Geospatial data themes.

Focuses on FedTeDS, an online dissemination solution designed to safeguard sensitive acquisition-related information for use by all federal agencies and their approved business partners in the United States. Distribution of sensitive but unclassified acquisition material; Integration of the tool within an agency's business process; Improvement in the efficiency, credibility and effectiveness of the acquisition and logistics support process by streamlining the federal procurement process.

Reports that additional homeland security-related data elements that support the United States Geological Survey/NGA Homeland Security Infrastructure Project Tiger Team Report have been incorporated into the Spatial Data Standard Release 2.31 in the United States.

Presents the final report on a U.S. National Oceanic and Atmospheric Administration-sponsored project that addresses the development of geospatial data to support Critical Infrastructure Protection. Discussions with responders on the operational and data quality requirements for infrastructure information; Development of a Critical Infrastructure Database; Recommendations applied on urban areas.

Focuses on the essential of common standards for data content and interoperability for the use of geospatial information and technologies that are involved in Homeland Security. Effectiveness in the transfer of data and analyses among different applications and users; Assessment in the distribution of metadata, or data about data; Development of the Spatial Data Standards for Facilities, Infrastructure, and Environment.

Presents recommended readings about information systems in the United States. Article titled "Infrastructure Wars," by Hank Chase and John Powers; "Osama vs Usama, The War on Terror Hamstrung by Information Management Issues," by George Kondrach; "Web of Terror, What al-Qaeda Knows About the United States," by Dan Verton.

Pays tribute to the late Sarah Emma Edmonds, who became a spy for the Union Army in Canada.

Reports that the annual Cooperative Agreements Program of the Federal Geographic Data Committee (FGDC) is providing fund assistance to organizations that implement the National Spatial Data Infrastructure (NSDI). Design of computer network resources; Reason for the implementation of the FGDC of the NSDI; Discussion of NSDI.

The article offers information about the life and work of female soldier Sarah Emma Edmonds, who pretended to be a boy to blend in.

The article focuses on some aspects of real property accountability. It provides access to secure, accurate and reliable physical, legal, financial and environmental information on real property assets. Accountability aims to facilitate management of lifecycle real property information while supporting enterprise requirements such as financial reporting. Increased access to more reliable and accurate real property information is one of the benefits of the real property accountability.

The article reports on the joint research project of the Geospatial Information & Technology Association, the American Water Works Association Research Foundation, and GeoConnections in Canada. The project has captured basic project data from water, wastewater, gas and electric utilities, government agencies and other organizations. The data provide tools to support geospatial information technology business case development.

The article looks into the accomplishments of the Federal Geographic Data Committee (FGDC). The subgroup of FGDC is developing a single standard data sharing agreement template for use by all levels of government that will facilitate and advance sharing of geospatial data by federal and local emergency management, homeland security and homeland defense organization within the U.S. A set of standard map symbols to support homeland security applications set by Emergency Response Symbology Subgroup.

The article focuses on the resource allocation process of the U.S. National Security Strategy for defining the resources necessary to support the warfighter. The process supports various elements of the political and economic strategies. The Navy War College has produced an excellent publication that defines the official resource allocation mechanisms used in the Pentagon, with an overview of the processes, products and the people that make it work.

The article highlights the 2006 Geospatial Technologies Symposium scheduled for March 20-24 in Denver, Colorado with Joint Services Environmental Management (JESEM) Conference. Topics in the symposium include Geographic Information Systems, CADD, Global Positioning System, remote sensing, and Building Information Models technologies. The JESEM conference provide new innovative ways the Department of Defense and other federal agencies how to meet mission needs while protecting the environment.

The article presents a guide to four major emergency data sharing standards. Common Alerting Protocol is a standard digital format for expressing the essential content of effective warning messages. The Federal Emergency Management Agency partnered with industry members of the Emergency Interoperability Consortium to develop a data formats for exchanging operational information beyond warnings. The technology for National Information Exchange Model facilitates growth of data models.

Offers information on the August 2004 report of the National Institute of Standards and Technology on the cost of interoperability problems in the United States capital facilities industry. Inhibition of the management of electronic product and project data between collaborating firms; Change of the industry with the introduction of information technology tools.

Reports on the National Oceanic and Atmosphere Administration's readjustment of the horizontal position and ellipsoidal heights in the National Spatial Reference System of the United States, to be completed in 2007. Consistency of the national coordinate system; Features of the National Geodetic Survey; Provision of a foundation for a number of scientific and engineering applications.

Focuses on the completion of the Best Practices for Project Security report completed by the Construction Industry Institute. Development of standards for cost-effective improvements to the safety and security of constructed facilities; Goals of the security-related practices.

Reports on guidelines issued by the General Services Administration (GSA), on the restrictions in the use of its federal supply schedule contracts for architecture, engineering, surveying and mapping services in the United States. Prevention of the use of the GSA schedule for services covered by the qualifications-based selection process.

Focuses on the request for information of the General Services Administration Public Buildings Service in the United States. Improvement of project deliveries for the capital construction program; Establishment of potential sources in the marketplace.