Faculty Bibliography

'Children affected by AIDS are now more visible and are taken more seriously in global, regional and national forums where they had received little consideration before,' the United Nations children's agency said in a report Tuesday. Better testing to find children with HIV, the AIDS virus, and simpler formulations of the anti-retroviral drugs that combat the infection have increased the number of children under treatment, Unicef said. Additional factors were lower prices for the drugs and improved skills among health workers. The progress since then, though small, has exceeded Unicef's expectations, Peter McDermott, Unicef's chief for HIV/AIDS, told reporters by telephone. 'Children do very well on treatment.' Still, about 10 percent of pregnant women in capital cities in sub-Saharan Africa are HIV-infected. But the vast majority of pregnant African women do not have access to drugs that would prevent transmitting the virus to their infants. So about one-third of their children will become infected at or shortly after birth, Unicef said

''Children affected by AIDS are now more visible and are taken more seriously in global, regional and national forums where they had received little consideration before,'' the United Nations agency said in a report. Better testing to find children with H.I.V., the virus that causes AIDS, and simpler formulations of the antiretroviral drugs that combat the infection have increased the number of children under treatment, Unicef said. Additional factors were lower prices for the drugs and improved skills among health workers. Still, about 10 percent of pregnant women in capital cities in sub-Saharan Africa are infected with H.I.V. But the vast majority of pregnant African women do not have access to drugs that would prevent transmitting the virus to their infants. So about one-third of their children will become infected at or shortly after birth, Unicef said. The data available for 2005 shows that only seven countries cited in the report provided drugs to at least 40 percent of infected pregnant women to prevent H.I.V. among newborns: Argentina (87 percent), Brazil (48 percent), Botswana (54 percent), Jamaica (86 percent), Russia (84 percent), Thailand (46 percent) and Ukraine (90 percent)

OBJECTIVES: The purpose of this work was to determine the prognostic value of normal exercise myocardial perfusion imaging (MPI) tests and exercise echocardiography tests, and to determine the prognostic value of these imaging modalities in women and men. BACKGROUND: Exercise MPI and exercise echocardiography provide prognostic information that is useful in the risk stratification of patients with suspected coronary artery disease (CAD). METHODS: We searched the PubMed, Cochrane, and DARE databases between January 1990 and May 2005, and reviewed bibliographies of articles obtained. We included prospective cohort studies of subjects who underwent exercise MPI or exercise echocardiography for known or suspected CAD, and provided data on primary outcomes of myocardial infarction (MI) and cardiac death with at least 3 months of follow-up. Secondary outcomes (unstable angina, revascularization procedures) were abstracted if provided. Studies performed exclusively in patients with CAD were excluded. RESULTS: The negative predictive value (NPV) for MI and cardiac death was 98.8% (95% confidence interval [CI] 98.5 to 99.0) over 36 months of follow-up for MPI, and 98.4% (95% CI 97.9 to 98.9) over 33 months for echocardiography. The corresponding annualized event rates were 0.45% per year for MPI and 0.54% per year for echocardiography. In subgroup analyses, annualized event rates were <1% for each MPI isotope, and were similar for women and men. For secondary events, MPI and echocardiography had annualized event rates of 1.25% and 0.95%, respectively. CONCLUSIONS: Both exercise MPI and exercise echocardiography have high NPVs for primary and secondary cardiac events. The prognostic utility of both modalities is similar for both men and women

One of them, Jason Ventress (David Arquette), accidentally shoots himself in the foot with a large handgun while contemplating suicide. [Joanna Lupone] bandages the foot and he is released. Another alumnus, Harry Kennison is punched in the nose. Lupone touches his tender nose and pronounces it broken. He is then sent home without treatment. The medical questions: What is the medical purpose of listing a person as someone to contact 'in case of emergency'? Shouldn't an accidental gunshot wound lead to questions about a possible suicide attempt? Is cleaning out and bandaging the wound (the treatment Ventress received) sufficient, or would he be given X-rays and antibiotics? Can a broken nose be diagnosed so easily -- without X- rays or at least a careful examination?

Dr. [Margaret F. C. Chan] is the first person from China to head a United Nations agency. China has been criticized severely for not sharing information with the world about diseases like influenza and SARS, or severe acute respiratory syndrome. Asked whether she felt pressure to favor China, Dr. Chan pledged to be fair, transparent and accountable. ''As an international civil servant, I commit to serve the interests of the member states of the organization,'' she said. In recent decades, as progress in medicine raced ahead, resources for public health grew more slowly, leading to greater global imbalances. Some people live longer and healthier lives while others die prematurely from preventable diseases. ''This is not a healthy situation -- for populations or world security,'' Dr. Chan said. Dr. Chan, who most recently was the health organization's assistant director general for communicable diseases, urged the world to remain vigilant against the threat of H5N1 avian influenza. The peak flu season normally occurs during cold weather. ''Complacency is our biggest enemy,'' she said, in preparing for the next influenza pandemic that could be caused by any strain. She said that scientists had not learned enough about the role of migratory birds in spreading avian flu viruses

The physician, Dr. Howard M. Snyder, injected morphine and other drugs, none specific for a heart attack or for Eisenhower's falling blood pressure and irregular pulse. Dr. Snyder, a general surgeon, let Eisenhower sleep until noon at [Mamie Eisenhower]'s family home in Denver where he was staying. Then he called a cardiologist to do an electrocardiogram. Later, the president went by car to a hospital. There, he was largely confined for almost seven weeks to bed, chair rest and limited physical activity. As the son of a radiologist whose office was in our home, I grew up seeing conventional X-rays displayed on my father's light boxes. When I went to London in 1973 to report on the first brain CT scanner, I was astonished to see how it could detect tumors, strokes and other disorders that never could be seen on X-rays. I recalled all the patients with neurological symptoms who had to undergo a special X-ray procedure known as a pneumoencephalogram. In it, a needle was inserted through the back to remove spinal fluid and to inject air to outline structures in the brain. The technique was painful and unable to detect the tiny lesions that are now seen on scans. Then consumerism in medicine grew, more women became doctors, mammography was used more widely along with other advances to detect breast cancer earlier and the government invested more in research on breast cancer. From these changes, doctors began to understand that the cancer was systemic and not confined to the breast. The studies documented that simpler and less disfiguring procedures, often combined with radiation and drugs, were safe treatments

Minimally invasive procedures are increasingly attractive to patients and medical personnel because they can reduce operative trauma, recovery times, and overall costs. However, during these procedures, the physician has a very limited view of the interventional field and the exact position of surgical instruments. We present an image-guided platform for precision placement of surgical instruments based upon a small four degree-of-freedom robot (B-Robll; ARC Seibersdorf Research GmbH, Vienna, Austria). This platform includes a custom instrument guide with an integrated spiral fiducial pattern as the robot's end-effector, and it uses intra-operative computed tomography (CT) to register the robot to the patient directly before the intervention. The physician can then use a graphical user interface (GUI) to select a path for percutaneous access, and the robot will automatically align the instrument guide along this path. Potential anatomical targets include the liver, kidney, prostate, and spine. This paper describes the robotic platform, workflow, software, and algorithms used by the system. To demonstrate the algorithmic accuracy and suitability of the custom instrument guide, we also present results from experiments as well as estimates of the maximum error between target and instrument tip.

OBJECTIVE: To determine whether parental literacy is related to emergency department visits, hospitalizations, and days of school missed for children with asthma. METHODS: We performed a retrospective cohort study at a university pediatric clinic. We enrolled children between 3 and 12 years old with a diagnosis of asthma and a regular source of care at the site of the study and their parent or guardian. Primary asthma care measures included self-reported rates of emergency department visits, hospitalizations, and days of school missed. Secondary asthma care measures included rescue and controller medication use, classification of asthma severity, and parental asthma-related knowledge. RESULTS: We enrolled 150 children and their parents. Twenty-four percent of the parents had low literacy. Children of parents with low literacy had greater incidence of emergency department visits (adjusted incidence rate ratio [IRR] 1.4; 95% confidence interval 0.97, 2.0), hospitalizations (IRR 4.6; 1.8, 12), and days missed from school (IRR 2.8; 2.3, 3.4) even after adjusting for asthma-related knowledge, disease severity, medication use, and other sociodemographic factors. Parents with low literacy had less asthma-related knowledge, and their children were more likely to have moderate or severe persistent asthma and had greater use of rescue medications. CONCLUSIONS: Low parental literacy is associated with worse care measures for children with asthma.

Several new image-guidance tools and devices are being prototyped, investigated, and compared. These tools are introduced and include prototype software for image registration and fusion, thermal modeling, electromagnetic tracking, semiautomated robotic needle guidance, and multimodality imaging. The integration of treatment planning with computed tomography robot systems or electromagnetic needle-tip tracking allows for seamless, iterative, "see-and-treat," patient-specific tumor ablation. Such automation, navigation, and visualization tools could eventually optimize radiofrequency ablation and other needle-based ablation procedures and decrease variability among operators, thus facilitating the translation of novel image-guided therapies. Much of this new technology is in use or will be available to the interventional radiologist in the near future, and this brief introduction will hopefully encourage research in this emerging area.