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Melioidosis is a fatal infectious disease in the tropics and subtropics. Currently, bacterial culture is the gold standard for diagnosis of the disease, but its sensitivity is relatively low. In this study, we evaluated four ELISAs using sera collected from culture-confirmed cases of melioidosis (n = 63), cases with other bacterial infections (n = 62), and healthy donors (n = 60). Antigens used for ELISAs were the whole-cell (WC) antigens and recombinant proteins of hemolysis co-regulated protein 1 (Hcp1), chaperonin GroEL1, and alkyl hydroperoxide reductase subunit C (AhpC). Using the cutoff values for optical density at 490 nm defined at a specificity of > 95%, the sensitivity of the WC, Hcp1, GroEL1, and AhpC ELISAs was 93.7%, 87.3%, 61.9%, and 57.1%, respectively. The combined WC/Hcp1 ELISA showed the greatest sensitivity and specificity of 98.4% and 95.1%, respectively. Of 511 and 500 sera collected from clinically suspected febrile patients admitted to the General Hospital of Ha Tinh Province and the Hue Central Hospital, respectively, combined WC/Hcp1 ELISAs showed 52 (10.2%) and 41 (8.2%) patients positive for melioidosis, respectively. The assay detected 14 of 14 (100%) and 21 of 23 (91.3%) culture-confirmed cases of melioidosis at Ha Tinh and Hue, respectively. A follow-up study of 38 patients positive for melioidosis by combined WC/Hcp1 ELISAs but negative for Burkholderia pseudomallei by culture method or not assigned to examine for bacterial culture resulted in 2 (5.3%) culture-reconfirmed patients with melioidosis, 9 (23.7%) deaths, 17 (44.7%) unhealthy patients, and 10 (26.3%) healthy persons. Combined WC/Hcp1 ELISA was a reliable serological method to detect underdiagnosed cases of melioidosis. Further investigations are needed to estimate the true sensitivity and specificity of the assay and the true number of cases of melioidosis.

ObjectivesThe aim of this study was to determine the extent, type (e.g., staff, equipment), and sources of funding for published cardiovascular research.BackgroundImportant cardiovascular research is often performed without direct financial support. The degree to which medical research is conducted on an unfunded basis remains uncertain.MethodsWe sent an electronic survey (Survey Monkey) to 938 corresponding authors who published papers in the Journal of the American College of Cardiology from 2007 through 2009. The data sought included the authors' characteristics (e.g., age, institution, type of research), funding, sources of funding, and types of support for their research.ResultsThe response rate was 41% (388 of 938). The percentage of authors who were fully funded was 26%, 44.1% were partially funded, and those without any direct funding amounted to 30%. Most funding came from government (41.8%) and industry (35.1%), whereas institutional, foundation, association, philanthropy, and other grants contributed the remaining 23.1%. Funded authors received supplies (43.6%), staff (41.5%), and salary (39.7%) to a greater extent than equipment (27.3%) or administrative (24.7%) support. Significantly fewer authors 40 years of age or younger (24.3%) were partially funded relative to authors older than 40 years of age (≥47%) (p = 0.001). Significantly fewer authors from a community hospital (0%), from Europe (16.7%), or conducting interventional (7.3%) or heart rhythm (11.5%) studies were fully funded (all p < 0.05). Although only a trend, clinical investigators were more likely to be unfunded (35.7%) relative to basic/basic and clinical investigators (19.1%) (p = 0.001). Those significantly more likely to be fully funded were authors from the United States (35.3%) relative to non-American authors (≤28.6%) (p = 0.006). In addition, authors received more funding working in a government or VA hospital (45.9%) than nongovernment hospitals (≤27.1%) (p = 0.001). The authors who were 50 years of age or older, from the United States, had PhD degrees, doing basic as well as clinical research, or studying genetics/genomics had significantly more sources of funding and types of support (all p < 0.05).ConclusionsConsiderable published cardiovascular research is currently being conducted without direct financial support. This is particularly true for young clinical investigators. The inability to accommodate this investigation in the medical enterprise might substantially diminish the amount of new knowledge coming forth.

Background. The potential of pocket-sized ultrasound devices (PUDs) to improve global healthcare delivery is limited by the lack of a suitable imaging protocol and trained users. Therefore, we investigated the feasibility of performing a brief, evidence-based cardiac limited ultrasound exam (CLUE) through wireless guidance of novice users. Methods. Three trainees applied PUDs on 27 subjects while directed by an off-site cardiologist to obtain a CLUE to screen for LV systolic dysfunction (LVSD), LA enlargement (LAE), ultrasound lung comets (ULC+), and elevated CVP (eCVP). Real-time remote audiovisual guidance and interpretation by the cardiologist were performed using the iPhone 4/iPod (FaceTime, Apple, Inc.) attached to the PUD and transmitted data wirelessly. Accuracy and technical quality of transmitted images were compared to on-site, gold-standard echo thresholds. Results. Novice versus sonographer imaging yielded technically adequate views in 122/135 (90%) versus 130/135 (96%) (P < 0.05). CLUE's combined SN, SP, and ACC were 0.67, 0.96, and 0.90. Technical adequacy (%) and accuracy for each abnormality (n) were LVSD (85%, 0.93, n = 5), LAE (89%, 0.74, n = 16), ULC+ (100%, 0.94, n = 5), and eCVP (78%, 0.91, n = 1). Conclusion. A novice can perform the CLUE using PUD when wirelessly guided by an expert. This method could facilitate PUD use for off-site bedside medical decision making and triaging of patients.

Biais and colleagues [1] have shown that echocardiographers can adequately perform a three-view cardiac examination in the emergency setting using a pocket ultrasound device (PUD). We have similarly noted that an evidence-based 'quick-look', cardiac limited ultrasound examination has diagnostic and prognostic value [2], can affect medical decision-making [3], and can be successfully taught to internal medicine residents [4]. As few data describe the learning curve of ultrasound imaging with PUDs, we observed the initial quality and prognostic value of six 'quick-look' signs obtained by residents learning to use the PUD. Internal medicine residents in an ultrasound training program [4] recorded a brief, previously described [2] cardiac limited ultrasound examination designed to detect six 'quick-look' signs of left ventricular systolic dysfunction, left atrial enlargement, ultrasound lung comet (ULC) tail artifact representing interstitial lung edema, elevated central venous pressure, pleural effusion, and right ventricular enlargement on a convenience-sample of intensive care unit (ICU) patients with respiratory failure, shock, or severe cardiac disease, using a PUD (Vscan, GE Healthcare, Wauwatosa, WI, USA). An expert echocardiographer reviewed the resident-acquired images and assigned a quality score: 0 (no image), 1 (only motion detected; off-axis), 2 ('suboptimal', poor delineation of structures), 3 ('adequate' for diagnosis of particular sign), or 4 ('optimal', good delineation of all structures). Only technically adequate quality views (score >2) were entered into a multivariate logistic regression combining the six signs, clinical presentation and inpatient mortality (SPSS version 12.0). A P-value