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Introduction. Some degree of recirculation occurs during venovenous extracorporeal membrane oxygenation (VV ECMO) which, (1) reduces oxygen (O2) delivery, and (2) renders venous line oxygen saturation monitoring unreliable as an index of perfusion adequacy. Ultrasound dilution allows clinicians to rapidly monitor and quantify the percent of recirculation that is occurring during VV ECMO. The purpose of this paper is to test whether accurate patient mixed venous oxygen saturation (SVO2) can be calculated once recirculation is determined. It is hypothesized that it is possible to derive patient mixed venous saturations by integrating recirculation data with the ECMO circuit arterial and venous line oxygen saturation data. Methods. A test system containing sheep blood adjusted to three venous saturations (low-30%, med-60%, high-80%) was interfaced via a mixing chamber with a standard VV ECMO circuit. Recirculation, arterial line and venous line oxygen saturations were measured and entered into a derived equation to calculate the mixed venous saturation. The resulting value was compared to the actual mixed venous saturation. Results. Recirculation was held constant at 30.5 ± 2.0% for all tests. A linear regression comparison of 'actual' versus 'calculated' mixed venous saturations produced a correlation coefficient of R2 = 0.88. Direct comparison of actual versus calculated saturations for all three test groups respectively are as follows; Low: 31.8 ± 3.95% vs. 37.0 ± 6.7% (NS), Med: 61.7 ± 1.5% vs. 72.3 ± 1.8% (p < 0.05), High: 84.4 ± 0.9% vs. 91.2 ± 1.1% (p < 0.05). Discussion. There was a strong correlation between actual and calculated mixed venous saturations; however, significant differences between actual and calculated values where observed at the Med and High groups. While this data suggests that using quantified recirculation data to calculate SVO2 is promising, it appears that a straightforward derivative of the oxygen saturation-based equation may not be sufficient to produce clinically accurate calculations of actual mixed venous saturations. [ABSTRACT FROM AUTHOR]

The first outbreak of avian influenza A (H5N1) occurred among humans in Hong Kong in 1997. To estimate the risk of person-to-person transmission, a retrospective cohort study was conducted to compare the prevalence of H5N1 antibody among health care workers (HCWs) exposed to H5N1 case-patients with the prevalence among nonexposed HCWs. Information on H5N1 case-patient and poultry exposures and blood samples for H5N1-specific antibody testing were collected. Eight (3.7%) of 217 exposed and 2 (0.7%) of 309 nonexposed HCWs were H5N1 seropositive (P=.01). The difference remained significant after controlling for poultry exposure (P=.01). This study presents the first epidemiologic evidence that H5N1 viruses were transmitted from patients to HCWs. Human-to-human transmission of avian influenza may increase the chances for the emergence of a novel influenza virus with pandemic potential. Copyright © 2000 The University of Chicago [ABSTRACT FROM AUTHOR]

Issue Addressed: As the population ages the prevalence of dementia increases and children are increasingly experiencing family members and older friends living with dementia. Unfortunately, stigma about living with dementia is common. Increasing understanding about dementia among children has the potential to reduce this stigma. This paper reports on the qualitative findings of Project DARE (dementia knowledge, art, research and education), a school-based, multi-modal, arts program designed to increase understanding about dementia among children aged 8-10 years., Methods: A constructivist grounded theory approach was used to understand students' experience of the intervention. Thematic analysis was used to identify key themes emerging from interviews with randomly selected students (n = 40) who had taken part in the program., Results: The data analysis generated three themes related to students' awareness of dementia and experiences of the program: (1) nurturing empathy, (2) memory loss is complex, (3) learning about dementia through the arts to promote resilience. These themes show that the intervention increased students' awareness of dementia, and empathy towards people who are both directly and indirectly affected by dementia., Conclusions: Although dementia education can be viewed as too sensitive for primary aged students, the current study demonstrates that such initiatives are feasible and can be effectively implemented with this age group. SO WHAT?: Changing student's beliefs about dementia can positively impact their relationships with people living with dementia., (© 2023 The Authors. Health Promotion Journal of Australia published by John Wiley & Sons Australia, Ltd on behalf of Australian Health Promotion Association.)

Issue Addressed: To develop, implement and evaluate the impact of a short education intervention on the understanding of dementia through visual art by primary school-aged children., Methods: A series of three lessons were developed in consultation with a local schoolteacher and community artists and taught in a local primary school. Stage 2 students (8-10 years old) created an artwork about memory, learned about dementia and adapted their artworks to represent their developing understanding of dementia. Empirical data were collected through pre and postinterventions surveys and content analysis of the artworks., Results: Matched pre and postintervention survey data were obtained for 74 students and showed a significant improvement in seven domains. This indicated that the students had an increased understanding of dementia and its impact on the individual following the intervention. Matched artwork was analysed from lessons 1 and 3 for 109 students using a coding schema developed specifically for this project. The students developed their artwork to show memories fading or being lost altogether. They also used abstract shapes to create a sense of disorder and chaos., Conclusion: Participation in the intervention was shown to increase students' understanding and knowledge of dementia using both qualitative and quantitative measures. SO WHAT?: It is likely that by educating children about dementia, we have the potential to reduce the stigma faced by people living with dementia and their carers. This is important, as the ageing population means that more people within the community, including children, will know someone living with dementia. Further, this represents the cornerstone in creating dementia-friendly communities., (© 2020 Australian Health Promotion Association.)

Pompe disease (PD) is a rare, autosomal-recessively inherited deficiency in the enzyme acid α-glucosidase. It is a spectrum disorder; age at symptom onset and rate of deterioration can vary considerably. In affected infants prognosis is poor, such that without treatment most infants die within the first year of life. To lose a baby in their first year of life to a rare disease causes much regret, guilt, and loneliness to parents, family, and friends. To lose a baby needlessly when there is an effective treatment amplifies this sadness. With so little experience of rare disease in the community, once a baby transfers to their home they are subject to a very uncertain and unyielding diagnostic journey while their symptomology progresses and their health deteriorates. With a rare disease like PD, the best opportunity to diagnose a baby is at birth. PD is not yet included in the current newborn screening (NBS) panel in Australia. Should it be? In late 2018 the Australian Pompe Association applied to the Australian Standing committee on Newborn Screening to have PD included. The application was not upheld. Here we provide an overview of the rationale for NBS, drawing on the scientific literature and perspectives from The Australian Pompe Association, its patients and their families. In doing so, we hope to bring a new voice to this very important debate., Competing Interests: Conflicts of InterestThe authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results., (© 2020 by the authors.)

Preclinical development of and research on potential Middle East respiratory syndrome coronavirus (MERS-CoV) medical countermeasures remain preliminary; advancements are needed before most countermeasures are ready to be tested in human clinical trials. Research priorities include standardization of animal models and virus stocks for studying disease pathogenesis and efficacy of medical countermeasures; development of MERS-CoV diagnostics; improved access to nonhuman primates to support preclinical research; studies to better understand and control MERS-CoV disease, including vaccination studies in camels; and development of a standardized clinical trial protocol. Partnering with clinical trial networks in affected countries to evaluate safety and efficacy of investigational therapeutics will strengthen efforts to identify successful medical countermeasures.

Despite substantial investments since the events of 2001, much work remains to prepare the nation for a chemical, biological, radiological or nuclear (CBRN) attack or to respond to an emerging infectious disease threat. Following a 2010 review of the US Public Health Emergency Medical Countermeasures Enterprise, FDA launched its Medical Countermeasures initiative (MCMi) to facilitate the development and availability of medical products to counter CBRN and emerging disease threats. As a regulatory agency, FDA has a unique and critical part to play in this national undertaking. Using a three-pillar approach, FDA is addressing key challenges associated with the regulatory review process for medical countermeasures; gaps in regulatory science for MCM development and evaluation; and issues related to the legal, regulatory and policy framework for an effective public health response. Filling the gaps in the MCM Enterprise is a huge national undertaking, requiring the collaboration of all stakeholders, including federal partners, current and prospective developers of medical countermeasures, relevant research organizations, and state and local responders. Especially critical to success are an appreciation of the long timelines, risks and high costs associated with developing medical countermeasures - and the systems to deliver them - and the requisite support of all stakeholders, including national leadership., (Published 2012. This article is a U.S. Government work and is in the public domain in the USA.)

Background: The frequency of avian influenza A virus infections among poultry workers is not well understood., Methods: A seroprevalence study of market poultry workers and persons without occupational poultry exposure was conducted during 2001 in Hanoi, Vietnam. Sera were tested for avian influenza H5 and H9 antibodies by microneutralization and Western blot assays., Results: Seroprevalence of H5 and H9 antibodies was 4% and 3% in poultry workers and 1% and 3.5% in non-poultry workers, respectively., Conclusions: Seroprevalence of H5 and H9 antibodies was low among Hanoi market poultry workers in 2001, but can serve as a baseline for additional studies.

Recirculation during dual lumen veno-venous (DLVV) extracorporeal membrane oxygenation (ECMO) is a dynamic event that results in a fraction of the oxygenated blood exiting the arterial lumen and immediately shunting back into the venous lumen. Excessive recirculation will result in suboptimal oxygen delivery to the patient. Ultrasound dilution is a technology that has been shown to rapidly quantify recirculation in veno-venous (VV) ECMO animal models. This manuscript reports the first clinical application of ultrasound dilution in quantifying recirculation during neonatal VV ECMO. A 2.8-kg neonate with congenital diaphragmatic hernia was placed on VV ECMO using a single DLVV cannula inserted into the right atrium through the internal jugular vein. Ultrasound sensors were clamped to the arterial and venous lines near the dual lumen cannula and 3- to 5-mL bolus injections of isotonic saline were used proximal to the circuit heat exchanger to make the recirculation measurements. Recirculation measurements were made after initiation and periodically thereafter. During the 12-day ECMO period, 86 recirculation measurements were performed. The average recirculation was 34.3% (range, 15-57%). Reproducibility of paired measurements was 5.6%. Changes in patient positioning resulted in significant changes in recirculation. Measurements using platelet injections were compared with those made with saline. The two were found to closely correlate (mean difference, .25% +/- 2.8%). Ultrasound dilution measurements of recirculation provided rapid monitoring data during a clinical VV ECMO procedure. Application of this technique could provide early data that will assist the clinician in guiding interventions to minimize recirculation.

In 1997, outbreaks of highly pathogenic influenza A (H5N1) among poultry coincided with 18 documented human cases of H5N1 illness. Although exposure to live poultry was associated with human illness, no cases were documented among poultry workers (PWs). To evaluate the potential for avian-to-human transmission of H5N1, a cohort study was conducted among 293 Hong Kong government workers (GWs) who participated in a poultry culling operation and among 1525 PWs. Paired serum samples collected from GWs and single serum samples collected from PWs were considered to be anti-H5 antibody positive if they were positive by both microneutralization and Western blot testing. Among GWs, 3% were seropositive, and 1 seroconversion was documented. Among PWs, approximately 10% had anti-H5 antibody. More-intensive poultry exposure, such as butchering and exposure to ill poultry, was associated with having anti-H5 antibody. These findings suggest an increased risk for avian influenza infection from occupational exposure.

In April 1999, isolation of avian influenza A (H9N2) viruses from humans was confirmed for the first time. H9N2 viruses were isolated from nasopharyngeal aspirate specimens collected from two children who were hospitalized with uncomplicated, febrile, upper respiratory tract illnesses in Hong Kong during March 1999. Novel influenza viruses have the potential to initiate global pandemics if they are sufficiently transmissible among humans. We conducted four retrospective cohort studies of persons exposed to these two H9N2 patients to assess whether human-to-human transmission of avian H9N2 viruses had occurred. No serologic evidence of H9N2 infection was found in family members or health-care workers who had close contact with the H9N2-infected children, suggesting that these H9N2 viruses were not easily transmitted from person to person.

Avian influenza A H9N2 viruses are widespread among domestic poultry and were recently isolated from humans with respiratory illness in China. Two antigenically and genetically distinct groups of H9N2 viruses (G1 and G9) are prevalent in China. To evaluate a strategy for vaccination, we compared G1 and G9 viruses for their relative immunogenicity and cross-protective efficacy. Infection of BALB/c mice with representative viruses of either group protected against subsequent challenge with the homologous or heterologous H9N2 virus in the absence of detectable cross-reactive serum hemagglutination inhibition antibody. Mice injected intramuscularly with inactivated G1 whole virus vaccine were completely protected from challenge with either H9N2 virus. In contrast, mice administered inactivated G9 vaccine were only partially protected against heterologous challenge with the G1 virus. These results have implications for the development of human vaccines against H9N2 viruses, a priority for pandemic preparedness.

Recent outbreaks of avian influenza in humans have demonstrated the need for vaccines for influenza viruses with pandemic potential. Recombinant hemagglutinins are an attractive option for such vaccines because they do not require handling potentially highly pathogenic influenza viruses for vaccine production. In order to evaluate the immunogenicity, optimum dosing and timing of administration of a recombinant baculovirus-expressed H5 HA (rH5) in humans, 147 healthy adults were assigned randomly to receive intramuscular rH5 as two doses of 25, 45 or 90 microg each, one dose of 90 microg followed by a dose of 10 microg, or two doses of placebo, at intervals between doses of 21, 28 or 42 days. All doses of rH5 were well tolerated. The rH5 vaccine was modestly immunogenic at high dose. Neutralizing antibody responses to a titer of 1:80 or greater were seen in 23% (14/60) of individuals after a single dose of 90 microg, and in 52% (15/29) after two doses of 90 microg. Varying intervals between doses from 21 to 42 days had no significant effect on antibody responses to vaccination. These results suggest that baculovirus-expressed H5 HA can induce functional antibody in individuals who have not had prior exposure to H5 viruses, but that further studies to improve the immunogenicity of the vaccine are needed.

The first outbreak of avian influenza A (H5N1) occurred among humans in Hong Kong in 1997. To estimate the risk of person-to-person transmission, a retrospective cohort study was conducted to compare the prevalence of H5N1 antibody among health care workers (HCWs) exposed to H5N1 case-patients with the prevalence among nonexposed HCWs. Information on H5N1 case-patient and poultry exposures and blood samples for H5N1-specific antibody testing were collected. Eight (3.7%) of 217 exposed and 2 (0.7%) of 309 nonexposed HCWs were H5N1 seropositive (P=.01). The difference remained significant after controlling for poultry exposure (P=.01). This study presents the first epidemiologic evidence that H5N1 viruses were transmitted from patients to HCWs. Human-to-human transmission of avian influenza may increase the chances for the emergence of a novel influenza virus with pandemic potential.

The first documented outbreak of human respiratory disease caused by avian influenza A (H5N1) viruses occurred in Hong Kong in 1997. The kinetics of the antibody response to the avian virus in H5N1-infected persons was similar to that of a primary response to human influenza A viruses; serum neutralizing antibody was detected, in general, >/=14 days after symptom onset. Cohort studies were conducted to assess the risk of human-to-human transmission of the virus. By use of a combination of serologic assays, 6 of 51 household contacts, 1 of 26 tour group members, and none of 47 coworkers exposed to H5N1-infected persons were positive for H5 antibody. One H5 antibody-positive household contact, with no history of poultry exposure, provided evidence that human-to-human transmission of the avian virus may have occurred through close physical contact with H5N1-infected patients. In contrast, social exposure to case patients was not associated with H5N1 infection.

From May to December 1997, 18 cases of mild to severe respiratory illness caused by avian influenza A (H5N1) viruses were identified in Hong Kong. The emergence of an avian virus in the human population prompted an epidemiological investigation to determine the extent of human-to-human transmission of the virus and risk factors associated with infection. The hemagglutination inhibition (HI) assay, the standard method for serologic detection of influenza virus infection in humans, has been shown to be less sensitive for the detection of antibodies induced by avian influenza viruses. Therefore, we developed a more sensitive microneutralization assay to detect antibodies to avian influenza in humans. Direct comparison of an HI assay and the microneutralization assay demonstrated that the latter was substantially more sensitive in detecting human antibodies to H5N1 virus in infected individuals. An H5-specific indirect enzyme-linked immunosorbent assay (ELISA) was also established to test children's sera. The sensitivity and specificity of the microneutralization assay were compared with those of an H5-specific indirect ELISA. When combined with a confirmatory H5-specific Western blot test, the specificities of both assays were improved. Maximum sensitivity (80%) and specificity (96%) for the detection of anti-H5 antibody in adults aged 18 to 59 years were achieved by using the microneutralization assay combined with Western blotting. Maximum sensitivity (100%) and specificity (100%) in detecting anti-H5 antibody in sera obtained from children less than 15 years of age were achieved by using ELISA combined with Western blotting. This new test algorithm is being used for the seroepidemiologic investigations of the avian H5N1 influenza outbreak.