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Handheld multi-gas meters (MGMs) are equipped with sensors to monitor oxygen (O2) levels and additional sensors to detect the presence of combustible or toxic gases in the environment. This report is limited to operational response-type MGMs that include at least four different sensors. These sensors can vary by type and by the chemical monitored. In real time, the sensors report the concentration of monitored gases in the atmosphere near the MGM. To provide emergency responders with information on handheld multi-gas meters, the System Assessment and Validation for Emergency Responders (SAVER) Program conducted a market survey. This market survey report is based on information gathered between November 2015 and February 2016 from vendors, Internet research, industry publications, an emergency responder focus group, and a government issued Request for Information (RFI) that was posted on the Federal Business Opportunities website.

Introduction Self-directed learning as a form of active learning is student centered rather than the faculty-centered model employed in traditional lectures or large-group teaching. In order to highlight the content taught during a microbiology course we developed a 2-hour workshop to help teach second-year medical students about pneumonia. Methods One week prior to session, the class is divided into groups of 30 and then further divided into groups of five, each of which is assigned one of six cases to review. The student then attend the session and perform a high-fidelity simulation matching the case they were assigned. After a debrief with a faculty facilitator each group is asked to diagnose their patient and present it to the other 25 learners. Results The workshop has received positive evaluations from our students and has been reported to achieve the learning objectives. Most second-year medical students (97.1%, n = 171) reported that the self-directed learning component and simulation complemented each other and enhanced the learning experience. Discussion Most students view working as a team as a positive experience and favor a student-facilitated session. Because of the success of this workshop, we have modified others to follow a similar format.

Context.—Despite the widespread practice of pathologist review of blood and body fluid smears, little is known about its impact on improving patient care. Objective.—To assess the clinical usefulness of pathologist review of blood and body fluid smears. Design.—Survey study. Pathology residents contacted the ordering physician after pathologist reviews were reported to assess their clinical impact. Results.—Ninety-six pathologist reviews met criteria for study inclusion, and 64 ordering physicians were successfully contacted during the 2-month study period. Of the 64 cases, 19 reviews (30%) had been seen by the physician within 24 to 48 hours after the report was issued and 33 (51%) had not been seen; in 4 (6%) instances, physicians did not remember whether they had seen the review. Eight reviews (13%) were considered urgent enough to warrant immediate communication by the pathologist. Of the 27 reviews that were seen or directly communicated, 23 (85%) contributed to clinical diagnosis and/or patient management. Conclusions.—This study demonstrates the contribution of pathologist reviews of blood and body fluids to clinical diagnosis and patient management. The results also highlight the problem of a lack of physician awareness of clinical pathology results.

Though the majority of antibody-mediated renal transplant rejections are thought to be due to HLA antibodies, there is increasing evidence that non-HLA antibodies also can mediate rejection. For example, antibodies directed against the Angiotensin II type 1 receptor (AT1R) have been implicated in humoral renal transplant rejection episodes and impaired graft survival. While many cases of acute rejection potentially due to AT1R antibodies have been reported, there is little published evidence relating to AT1R antibodies causing hyperacute rejection. We report the case of a patient with pre-existing AT1R antibodies and no donor-specific HLA antibodies who experienced an episode of hyperacute rejection. The patient is a 47 year old female with a longstanding history of type 1 diabetes and end stage renal disease secondary to diabetic nephropathy. She had received 2 previous renal transplants approximately 21 and 22 years ago. Pre-transplant she was highly sensitized with a T-cell flow PRA of 99% and B-cell flow PRA of 100%, but did not demonstrate any donor- specific HLA antibody. The T- and B-cell flow and T-cell CDC crossmatches performed between the patient and donor were negative. She had a pre-transplant AT1R antibody level of 18.5 Units/ml measured 8 days before transplant. During the surgical procedure the patient experienced a hyperacute rejection episode. Biopsy of the organ demonstrated possible antibody-mediated rejection. The patient was treated with plasmapheresis and IVIG and her renal function stabilized over the following 6 weeks. The patient has also been maintained on Losartan, an AT1R inhibitor. The patient has now continued to demonstrate stable renal function for the previous 2 years. Our case highlights the importance of appreciating the possible peri-transplant risks of AT1R antibody particularly as treatment with the AT1R inhibitor, Losartan, has been shown by others to provide therapeutic benefits.

ObjectivesOn March 11, 2011, Japan experienced the largest earthquake in its history. The undersea earthquake launched a tsunami that inundated much of Japan's eastern coastline and damaged nuclear power plants, precipitating multiple reactor meltdowns. We examined open-source disaster situation reports, news accounts, and disaster-monitoring websites to gather event-specific data to conduct a trauma signature analysis of the event.MethodsThe trauma signature analysis included a review of disaster situation reports; the construction of a hazard profile for the earthquake, tsunami, and radiation threats; enumeration of disaster stressors by disaster phase; identification of salient evidence-based psychological risk factors; summation of the trauma signature based on exposure to hazards, loss, and change; and review of the mental health and psychosocial support responses in relation to the analysis.ResultsExposure to this triple-hazard event resulted in extensive damage, significant loss of life, and massive population displacement. Many citizens were exposed to multiple hazards. The extremity of these exposures was partially mitigated by Japan's timely, expert-coordinated, and unified activation of an evidence-based mental health response.ConclusionsThe eastern Japan disaster was notable for its unique constellation of compounding exposures. Examination of the trauma signature of this event provided insights and guidance regarding optimal mental health and psychosocial responses. Japan orchestrated a model response that reinforced community resilience. (Disaster Med Public Health Preparedness. 2013;0:1-14)

Vol 349 • May 24, 1997 1551 1 ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17 187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988; ii: 349–60. 2 Pleumeekers JHCM, Hoes AW, van der Does E, et al. Aneurysms of the abdominal aorta in older adults; the Rotterdam study. Am J Epidemiol 1995; 142: 1291–99. 3 Simoni G, Pastorino C, Perrone R, Ardia A, Gianrossi R, Decian F. Screening for abdominal aortic aneurysms and associated risk factors in a general population. Eur J Vasc Endovasc Surg 1994; 8: 119–28. 4 Thomas D, Cooper L, Cooper J, et al. Direct fast track admission to a coronary care unit. J R Coll Physicians Lond 1997; 31: 188–91. Thrombolysis after acute myocardial infarction

Ten euthymic manic-depressive patients with therapeutic plasma lithium levels were each given two i.v. infusions of 30 mg of methylphenidate. The infusions were separated by at least 3 days. Before one infusion each patient was given 5 mg of haloperidol i.v. and before the other infusion each was given an identical volume of saline. A psychiatric observer was blind to the nature of the pretreatment and the order of pretreatment was randomized. Saline pretreated patients showed marked activation and euphoriant responses despite therapeutic lithium levels. Haloperidol pretreatment reduced this response in three patients and eliminated the euphoriant and activating response in the remaining seven patients. These results agree with the existence of a dopaminergic step in the induction of methylphenidate-induced activation and euphoria.