Here are my responses to the questions:
1. G. All of the above. A single HIV sequence added to a database can provide information about genotypic drug resistance, possible transmission linkages, direction of transmission, genotypic/demographic data about the individual, and who may be at increased risk for acquisition.
2. E. Poor - HIPAA provides some protections but better options exist, and as seen in examples privacy breaches can still occur even when HIPAA is followed.
3. 2. Yes - since HIV sequence data is nearly unique to an individual, it constitutes identifiable private information and is therefore considered a HIPAA identifier.
4. I. All of the above. PHI
You have to trust in something - your gut, destiny, life, karma. This approach has never let me down, and it has made all the difference in my life. - Steve Jobs
Control your own destiny or someone else will. - Jack Welch
Richard Garfein, Ph.D., M.P.H., of UC San Diego Department of Medicine, presents "HIV, HCV, and TB Infection among Injection Drug Users in San Diego" at AIDS Clinical Rounds
You have to trust in something - your gut, destiny, life, karma. This approach has never let me down, and it has made all the difference in my life. - Steve Jobs
Control your own destiny or someone else will. - Jack Welch
Richard Garfein, Ph.D., M.P.H., of UC San Diego Department of Medicine, presents "HIV, HCV, and TB Infection among Injection Drug Users in San Diego" at AIDS Clinical Rounds
A new CDC report finds that hepatitis A infections in the U.S. have risen by 294% since 2015. In nine states and Washington, D.C., the increase in rates was 500% compared to previous years. Hepatitis A, which is the most common cause of viral hepatitis worldwide, is spread fecal-orally after contact with an infected person but is preventable through a vaccine. In the new report, which looked at transmissions between 2016 and 2018, the CDC received 15,000 reports of infections in the U.S.: People who reported drug use or homelessness made up the majority of those who had infections, followed by cases among men who have sex with men and among people who ate contaminated food.
Selon une étude, publiée en décembre 2020, la population de la ville de Manaus (Brésil) aurait atteint l’immunité collective. Laurent AVENTIN, PhD – Consultant en santé publique, fait le point pour Le Courrier des Stratèges…
Vitamin D and COVID-19
Presentation at the Ancestral Health Symposium (AHS) 2021
by Chris Masterjohn, PhD
Watch the presentation recording, download a PDF version of the slides, and read the written report at https://chrismasterjohnphd.com/vitamind
A new CDC report finds that hepatitis A infections in the U.S. have risen by 294% since 2015. In nine states and Washington, D.C., the increase in rates was 500% compared to previous years. Hepatitis A, which is the most common cause of viral hepatitis worldwide, is spread fecal-orally after contact with an infected person but is preventable through a vaccine. In the new report, which looked at transmissions between 2016 and 2018, the CDC received 15,000 reports of infections in the U.S.: People who reported drug use or homelessness made up the majority of those who had infections, followed by cases among men who have sex with men and among people who ate contaminated food.
Selon une étude, publiée en décembre 2020, la population de la ville de Manaus (Brésil) aurait atteint l’immunité collective. Laurent AVENTIN, PhD – Consultant en santé publique, fait le point pour Le Courrier des Stratèges…
Vitamin D and COVID-19
Presentation at the Ancestral Health Symposium (AHS) 2021
by Chris Masterjohn, PhD
Watch the presentation recording, download a PDF version of the slides, and read the written report at https://chrismasterjohnphd.com/vitamind
Slides from Northern California Business Marketing Association January 28th 2015 Meeting.
Panel discussion: How Stories Can Boost Your Marketing Success
Laura Ramos, VP/Principal Analyst, Forrester - Moderator
Clay Hausmann, Principal, Treatment
Jeff Paris, SVP, Group Creative Director, MRM // McCann
Mariana Cherner, PhD (UC San Diego HIV Neurobehavioral Research Program) presents "Genetic Differences in Vulnerability to Methamphetamine-related Brain Dysfunction: Implications for HIV"
C.2. Risk and Risk Assessments HCA 402Risk and Community Risk .docxclairbycraft
C.2. Risk and Risk Assessments HCA 402
Risk and Community Risk Assessment: From the case below, complete the risk assessment with the information provided in the case below regarding Duval County M. tuberculosis.
CDC, Notes from the Field: Tuberculosis Cluster Associated with Homelessness — Duval County, Florida, 2004–2012. Notes from the Field: Tuberculosis Cluster Associated with Homelessness — Duval County, Florida, 2004–2012. July 20, 2012 / 61(28); 539-540
This module you begin your second skills assessment, i.e., a community risk assessment. The next two pages of this document are a case study and then the assessment survey form makes up the remaining pages of the document. You will use the Duval Case and assume you are from Duval County, FL. There is a lot of information available from the TB surveillance and epidemiological field work completed in this county on the Internet. Assume your facility is the Golden Retreat Assisted-Living Facility and you are part of the risk management team that is responsible for performing the risk assessment surveys.
Example: In November 2008, the local health department discovered an outbreak of tuberculosis in a Jacksonville assisted-living facility, Golden Retreat. The CDC was called in to assist the health department and found 18 active cases of TB (Jacksonville.com, 2012).
A suggestion regarding work flow is to print out the two pages of the case, and use it and the supplemental links below to fill in the survey form. Know that you need to fill it out to the best of your ability based on the case information available. You may not have information for every box on the survey form. However, you may make some logical assumptions when filling it out based on what you find (in other words, abstract and report as the information found will allow). The goal here is to learn what type of information is in the various risk assessment surveys.
If you need help finding Duval County, FL statistics, here are some links:
LINK:LINK:LINK:
Article on Golden Retreat Assisted-Living Facility Palm Beach County. (2012). Center of TB outbreak often cited, rarely punished.
Tuberculosis Cluster Associated with Homelessness — Duval County, Florida, 2004–2012
Despite a decrease in incidence of tuberculosis (TB) in Duval County, Florida, from 102 cases (11.2 per 100,000 population) in 2008 to 71 cases (8.2 per 100,000) in 2011,* analysis of Mycobacterium tuberculosis genotyping data revealed a substantial increase in the percentage of TB cases with the same genotype.† That percentage increased from 27% (10 of 37) of genotyped cases in 2008 to 51% (30 of 59) of genotyped cases in 2011 (Florida Department of Health, unpublished data, 2012). During this period, the percentage of patients with this genotype who were homeless or who abused substances also increased. Because of concern over potential ongoing TB transmission involving these hard-to-reach populations, the Duval County Health Department, Florida Departme.
Dr. Lyons-Weiler provide the evidence that CDC had access to a test that was validated and refused it, failed to test their own test, shipped a flawed test, and that leadership in CDC lied to HHS Director Azar and thereby the POTUS. See presentation here
https://www.youtube.com/watch?v=iRgfDd9jkZY
Stephen Rawlings, MD, PhD
Clinical Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
THE VACCINE DEATH REPORT
Evidence of millions of deaths and serious adverse events
resulting from the experimental COVID-19 injections
EL INFORME DE MUERTE POR VACUNA
Evidencia de millones de muertes y eventos adversos graves.
resultante de las inyecciones experimentales de COVID-19
David John Sorensen - Dr Vladimir Zelenco
09.2021
A 5-Year Retrospective Analysis of Legal Intervention Injuries and Mortality ...Jim Bloyd, DrPH, MPH
There has been a public outcry for the accountability of law enforcement agents who kill and injure citizens. Epidemiological surveillance can underscore the magnitude of morbidity and mortality of citizens at the hands of law enforcement. We used hospital outpatient and inpatient databases to conduct a retrospective analysis of legal interventions in Illinois between 2010 and 2015. We calculated injury and mortality rates based on demographics, spatial distribution, and cause of injury. During the study period, 8,384 patients were treated for injuries caused during contact with law enforcement personnel. Most were male, the mean age was 32.7, and those injured were disproportionately black. Nearly all patients were treated as outpatients, and those who were admitted to the hospital had a mean of length of stay of 6 days. Most patients were discharged home or to an acute or long-term care facility (83.7%). It is unclear if those discharged home or to a different medical facility were arrested, accidentally injured, injured when no crime was committed, or injured when a crime was committed. Surveillance of law enforcement-related injuries and deaths should be implemented, and injuries caused during legal interventions should be recognized as a public health issue rather than a criminal justice issue.
DQ11) N-LHi Class-In 2023 we are will educate about STDs and be aware.docxrosaliaj1
DQ1
1)Â N.L
Hi Class,
In 2023 we are will educate about STDs and be aware of how most of them can be transmitted. HIV or human immunodeficiency virus attacks the body’s immune system resulting in a compromised immune system and can result in AIDS or acquired immunodeficiency syndrome if untreated (Centers for Disease Control and Prevention, 2022).  Mandating HIV screening can be tricky depending on where you are mandating people to get tested at. For example, In Urgent care or hospitals, it should be okay to mandate everyone to get tested as a precaution due to the atmosphere and environment one is in. Whereas in a job that doesn’t deal with any exposure it isn’t ethically fair to be exposed to this when there isn’t a reason to be. In my opinion, it should be offered during the other mandated vaccinations like the flu shots and Tuberculosis.
Reference:
Centers for Disease Control and Prevention. (2022, June 30).
About HIV/AIDS
. Centers for Disease Control and Prevention. Retrieved November 28, 2022, from
https://www.cdc.gov/hiv/basics/whatishiv.html
2) E.P
Regarding HIV/AIDS specifically, the duty of confidentiality is nearly ubiquitous in professional codes of conduct. Patients' right to privacy and the public's need to be safe from contagions are in tension with one another. Presumably, only patients themselves will have a full understanding of how their disclosures to third parties will affect their personal, social, and professional life (Rennie et al 2006). Even more so than in other areas of life, the doctor-patient relationship is one in which a person living with HIV/AIDS has a right to confidentiality. Any intentional disclosure of protected information to a third party is a crime. One case in which a doctor divulged his patients' HIV status to a coworker on the golf course without their permission resulted in a court awarding damages to the patients. Confidentiality, as a subset of information privacy, refers to the protection of information shared inside a trusting relationship from being shared outside of that relationship (Knight et al 2014). Only if the person (or institution) to whom confidential information was supplied fails to secure the information or knowingly exposes it to a third party without first party agreement does the right to confidentiality be violated. A breach of privacy, rather than confidentiality, occurs when an unauthorized person accesses patient records or other sensitive information stored in a computer system. No one other than the intended recipient in a confidential connection may be held liable for disclosure of the information.
Reference
Rennie, S., & Behets, F. (2006). Desperately seeking targets: the ethics of routine HIV testing in low-income countries. Bulletin of the World Health Organization, 84, 52-57.
Knight, R., Shoveller, J., Greyson, D., Kerr, T., Gilbert, M., & Shannon, K. (2014). Advancing population and public health ethics regarding HIV testing: a sc.
Chapter 3Public Health Data and Communications.docxwalterl4
Chapter 3
Public Health Data and Communications
Learning Objectives
Identify six basic types of public health data
Explain the meaning, use, and limitations of the infant mortality rate and life expectancy measurements
Explain the meanings and uses of HALEs and DALYs
Identify criteria for evaluating the quality of information presented on a website
Explain ways that perceptions affect how people interpret information
Learning Objectives
Explain the roles of probabilities, utilities, and the timing of events in combining public health data
Explain the basic principles for the construction of decision trees and their uses
Explain how attitudes, such as risk-taking attitudes, may affect decision making
Identify three different approaches to clinical decision making and their advantages and disadvantages
Vignette 1
You read that the rate of use of cocaine among teenagers has fallen by 50% in the last decade.
You wonder where that information might come from.
Vignette 2
You hear that life expectancy in the United States is now approximately 80 years.
You wonder what that implies about how long you will live and what that means for your grandmother, who is 82 and in good health.
Vignette 3
You hear on the news the gruesome description of a shark attack on a young boy from another state and decide to keep your son away from the beach.
While playing at a friend’s house, your son nearly drowns after falling into the backyard pool.
You ask why so many people think that drowning in a backyard pool is unusual when it is far more common than shark attacks.
Vignette 4
“Balancing the harms and benefits is essential to making decisions,” your clinician says.
The treatment you are considering has an 80% chance of working, but there is also a 20% chance of side effects.
“What do I need to consider when balancing the harms and the benefits?” you ask.
Vignette 5
You are faced with a decision to have a medical procedure.
One physician tells you there’s no other choice and you must undergo the procedure, another tells you about the harms and benefits and advises you to go ahead and the third lays out the options and tells you it’s your decision.
Why are there such different approaches to making decisions these days?
Questions-to-Ask (1)
What is the scope of health communications?
Where does public health data come from?
How is public health information compiled to measure the health of a population?
How can we evaluate the quality of the presentation of health information?
What factors affect how we perceive public health information?
Questions-to-Ask (2)
What type of information needs to be combined to make health decisions?
What other data needs to be included in decision making?
How do we utilize information to make health decisions?
How can we use health information to make healthcare decisions?
Table 3-1 The 6 Ss of Quantitative Sources of Public Health Data (1/3)Type
ExamplesUsesAdvantages/
DisadvantagesSingle case or small seriesC.
This is the first time in history that ZIKV has been associated with the development of adverse birth outcomes and has been linked to perinatal transmission. Little is known regarding the natural history, epidemiological transmission patterns, and major risk factors associated with ZIKV. Data on the outcomes of pregnancies in ZIKV infected women as well as specific trimesters when pregnant women are at highest risk for developing an adverse birth outcome remains sparse. This presentation discusses the epidemiological background and history of Zika Virus, preventative methods, and risk factors. In addition, the presentation discusses a research proposal to evaluate potential risk factors associated with the development of adverse birth outcomes in pregnant women with a laboratory confirmed diagnosis of ZIKV versus those Zika Virus infected pregnant women that did not develop adverse birth outcomes in three low-income regions of Northeastern Brazil.
Katherine Promer Flores, MD (she/her)
Staff Physician
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California San Diego
Daniel Lee, MD
Clinical Professor of Medicine
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Leandro Mena, MD, MPH
Chair and Professor of Population Health Science
Department of Population Health Science
University of Mississippi Medical Center
Maile Young Karris, MD
Associate Professor
Co-Director San Diego Center for AIDS Research Clinical Investigations Core
Divisions of Infectious Diseases & Global Public Health and Geriatrics & Gerontology
Department of Medicine
University of California San Diego
Edward Cachay, MD, MAS
Professor of Medicine
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Gabriel Wagner, MD
Associate Clinical Professor
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Jocelyn Keehner, MD
Infectious Disease Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Richard Garfein, PhD, MPH
Professor
Herbert Wertheim School of Public Health and Human Longevity Science
Adjunct Professor
Division of Infectious Disease and Global Public Health
Department of Medicine
University of California, San Diego
Laura Bamford, MD, MSCE
Associate Professor of Medicine
Medical Director, Owen Clinic
Division of Infectious Diseases and Global Public Health
Department of Medicine
University of California, San Diego
Davey Smith, MD, MAS
Professor of Medicine
Chief, Division of Infectious Diseases and Global Public Health
Co-Director, San Diego Center for AIDS Research (CFAR)
Department of Medicine
University of California, San Diego
Elliot Welford, MD
Infectious Diseases Fellow
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Darcy Wooten, MD
Assistant Professor of Medicine
Associate Program Director, Infectious Diseases Fellowship
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Amutha Rajagopal, MD
Associate Physician Diplomate
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
More from UC San Diego AntiViral Research Center (20)
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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1. AIDS CLINICAL ROUNDS
The UC San Diego AntiViral Research Center sponsors weekly
presentations by infectious disease clinicians, physicians and
researchers. The goal of these presentations is to provide the most
current research, clinical practices and trends in HIV, HBV, HCV, TB
and other infectious diseases of global significance.
The slides from the AIDS Clinical Rounds presentation that you are
about to view are intended for the educational purposes of our
audience. They may not be used for other purposes without the
presenter’s express permission.
2. Privacy vs. Public Health
November 15,2013
Sanjay Mehta MD
Susan Little MD
4. Question #1
What can be learned from a single pol HIV
sequence (ie drug resistance test) added to a
database of locally sampled HIV sequences?
A.
B.
Genotypic Drug Resistance
Possible Transmission linkage (ie from who or to who HIV
may have been transmitted)
C. Direction of an identified transmission
D. Genotypic and Demographic Information about the individual
E. Who may be at Increased Risk for HIV Acquisition
F. A&B
G. All of the Above
5. Question #2
How well does HIPAA protect patient privacy if
guidelines are followed?
A. Extremely Well- privacy will remain unequivocally protected
B. Very Well –privacy remains protected nearly all of the time
C. Well – privacy remains protected most of the time, and is
usually adequate.
D. Fair – privacy is somewhat protected, but better options do not
exist
E. Poor – privacy is somewhat protected but better options do
exist
6. Question #3
Is an HIV sequence a HIPAA identifier?
1) Yes – all genetic data is explicitly
designated as a HIPAA identifier
2) Yes – since HIV sequence data is nearly
unique to an individual, it is an identifier
3) No – it is not listed as one of the 18 HIPAA
identifiers.
7. Question #4
Protected Health Information (PHI) can be
released/used without authorization for the
following purpose(s):
A.
B.
C.
D.
E.
F.
G.
H.
I.
Treatment
Billing
Other Healthcare issues
Public Health
Research
A&B
A,B,&C
A,B,C,&D
All of the Above
8. Question #5
How worried are you that your personal health
information would be unintentionally released
during normal public health investigations?
Eg. 1) Partner notification
2) Epidemic Outbreak Investigations
3) Year End Summary Reports
A) I think this is a real risk
B) This would only happen with a breach in
security
C) I have no concerns
9. Question #6
What do you feel is the appropriate threshold to
disclose PHI for public health benefit?
A. Only a raging epidemic of a deadly disease with
thousands affected. (eg TB,HIV, malaria)
B. An epidemic of a deadly disease with 100s of
individuals affected (Ebola, polio)
C. Any raging epidemic of infectious origin (eg
influenza, west nile virus)
D. Prevention of any infectious disease (eg norwalk
virus, MRSA)
10. Question #7
If you could predict which individuals were at
risk for transmitting or acquiring HIV using
viral sequence data, would it be reasonable
to act on this information (i.e., prioritize
prevention and treatment services to these
individuals)?
A. Yes
B. No
11. Case #1
On 2-11-2005 the NYC Dept of Health reported
that a 46 yo MSM using crystal
methamphetamine and regularly having
unprotected sex was found to have acquired
multidrug resistant HIV that rapidly
progressed to AIDS (Patient X)
MMWR July 28, 2006
12. Case #1
Timeline showing total lymphocyte count and serologic
testing results (arrows). Infection is presumed to have
occurred ~October 2004 (double line)
Markowitz et al, Lancet 2005
13. Case #1
• Host and viral
genotyping results
**Virus was 36%
more fit than wild type
HIV (i.e., potential for
increased virulence)
Markowitz et al, Lancet 2005
14. Case #1
“Rare strain of multi-drug resistant HIV
that rapidly progresses to AIDS.”
Tom Freiden
The potential for transmission
of a highly virulent virus was
deemed an emergency by the
NYC Dept of Health!
NewYorkTimes.com
15. Case #1
CDC and NYCDOH requested that Patient X’s
pol sequence be compared to sequences from
1) Sequence databases of the 28 laboratories
conducting HIV genotyping in NYC
2) CDC sequence database
3) New York State Department of Health Wadsworth
Center sequence database
4) Databases from 3 large US commercial laboratories
5) Databases from 2 laboratories in Canada
6) Database from a commercial lab in Europe
16. Case #1
NYC providers were asked to report any new
HIV and recent MDR HIV to authorities
NYCDOH then performed
- Partner tracing on 14 identified partners
- 10/14 previously known to be HIV positive
- Genotypes different
- Other 4 unavailable, HIV negative, or refused
17. Case #1
What did the molecular epidemiology show?
-- 3 individuals identified with >95%
sequence similarity to Patient X. All had
attended similar venues or events as
Patient X, but no direct contact. All 3 were
stable on ARV
Markowitz et al, Lancet 2005
18. Case #1
1) Did the molecular epidemiology analysis
provide useful information?
19. Case #1
Many cases when Molecular Epidemiology has
provided important information
1) Detection of Enterobacteriaceae Isolates Carrying
Metallo-Beta-Lactamase --- United States, 2010
-
MMWR Weekly June 25, 2010 / 59(24);750
2) Listeria Cantalope, Multistate Outbreak of Listeriosis
Associated with Jensen Farms Cantaloupe --- United
States, August--September 2011,
- MMWR Weekly October 7, 2011/ 60(39);1357-1358
Personal.psu.edu
Pritzkerlaw.com
20. Case #1
2) Was the Department of Public Health
justified in using phylogenetic analysis to
identify and investigate potential sourcepartner pairs involving this hypervirulent
strain as a matter of public health concern?
When looking back at epidemiologic data,
1/1000 HIV infected individuals have this
type of rapid infection.
21. Case #2
In 2020
- Dept. of Public Health has access to
everyone’s vaccination records.
-The city launches a campaign to find
individuals delinquent on their vaccinations in
the name of public health.
- Each time a person is identified that has
missed at least one vaccine dose, the county
van drives to his/her house.
22. Case #2
1) What is the public health benefit gained
by getting everyone completely
vaccinated (e.g. Mumps, Measles)
23. Case #2
• Marginal benefit
depends upon
R0, vaccination
rate in the
population, and
severity of
disease
Cohen et al. Medical Decision Making 2013
25. Case #2
2) Was the benefit to the public outweighed by
the privacy issues associated with
notification?
Depends upon
1) Disease --- variations in severity and R0
2) Vaccination rate in the population
3) The negative consequence of privacy loss
26. Case #3
A young woman in her mid to late 20s is
called by the Department of Public Health.
She is notified that she may be at risk for
syphilis, and that she should come to the
agency to get tested and treated.
27. Case #3
The woman has only been sexually active with
one individual in the last 5 years. The
information provided by the Department of
Public Health was HIPAA compliant, yet
personal identifying information was
unintentionally released as a part of the
partner notification program.
28. Case #3
Given this information by Public Health
She knows that Brian, her partner
1) Has syphilis
2) Has not been in a monogamous
relationship with her
29. Case #3
What is HIPAA?
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Name
Geographic subdivision smaller than State*
All dates related to an individual (except year) and age if 89 or older**
Phone number
Fax number
Electronic mail address
Social Security number
Medical record number
Health plan beneficiary number
Account numbers
Certificate/License number
Vehicle Identifiers and serial numbers
Device identifiers and serial numbers
Web Universal Resource Locators (URLs)
Internet Protocol (IP) address numbers
Biometric identifiers
Facial photographs
Any other unique identifier, characteristic or code
*street address, city, county, precinct, zip code
**birth date, admission date, discharge date, date of death
31. Case #3
1) Excess paperwork
2) Complicates patient care
3) But does it even work?
-HIPAA was followed in this case, but disclosure
resulted
-Not only can actual data broach privacy… but
the process in which data is released can
as well
32. Case #3
Another Example
Gymrek et al (Science, Jan 2013) deduced the
identity of individuals from personal genome
information
33. Case #3
• Subjects – individuals donating samples for genetic analysis,
and signing releases that they understood privacy
breach was a potential risk
• Resources
– Free Genealogy Databases (eg ysearch, SMGF)
• Associate Y-chromosome tandem repeats (Y-STR) with
surname
– Genetic databases: include age, state of residence
• Not HIPAA identifiers
– Public record search engines
• Can search for people by age, state and surname
34. Case #3
• With these resources were able to identify a
median of 12 individuals associated with a
genetic sample
• Focusing on 3 individuals with published genomes
Gymrek, 2013
35. Case #3
• Next
– Evaluated the Utah Residents with
Northern and Western European
Ancestry (CEU) Database
– 10 Y-STR haplotypes from Illumina seqs
from 1000 genomes project
– 8 of 10 were associated with Mormon
Ancestry using ysearch, SMGF
– In 5 cases – able to identify and link not
only subject but paternal distant
relatives
36. Case #3
Genetic Information
• Advances in technology have not kept pace
with guidelines for use of genetic data that
minimize privacy risks
• Genetic Information Non-discrimination Act of
2008 (GINA) was written to prevent
discrimination based on genetic information
• GINA does not address: community level
genetic information or non-host genetic
information.
37. Case #3
Questions
1) Do alternatives to HIPAA exist?
2) Is there anyway to protect privacy when
using partner notification?
38. Case #3
Public Health Perspective:
“Good quality partner notification should not
compromise rights to confidentiality but
should give practical support to disclose in a
safe way. Increasing our skills and practice in
this area will go a long way to solving the
problems associated with non-disclosure.
Moralising about the responsibilities of
individuals living with HIV will not.”
-Sarah Radcliffe (senior policy officer)
BMJ 2013;346:f2148
39. Case #3
How do you balance Risk to Privacy vs Public
Health Benefit?
Risk = Probability X Quality X Magnitude
1) Probability – Probability of Risk Occurring
2) Quality – How severe is the risk to the individual
3) Magnitude – How significant a breech will it be
40. Case #4
An individual who frequents prostitutes is
diagnosed with HIV.
- He becomes irate and wants to find the
person that has given him the disease.
- He finds out that he can figure this out using
viral sequence data.
- He gets his own virus sequenced and then
gets access to the local resistance database
-He finds a sequence that is very similar to
his own, from a woman living in Encinitas.
41. Case #4
He remembers vaguely that he had slept
with a prostitute from Encinitas in the last
couple of weeks.
42. Case #4
Partner Tracing –
If it is acceptable in the context of Public Health
(with the associated risk of privacy breach),
then should individuals be able to collect
these same data.
43. Case #4
1) If our subject wanted to pursue charges
against the prostitute, would this information
be sufficient for a case?
44. Case #4
German Singer Arrested for
Spreading HIV
Singer arrested in 2009 for “inflicting grievous
bodily harm” by sleeping with three men when
she knew she was HIV+, infecting one of them.
Received two-year suspended sentence and 300
hours of community service.
46. Question #1
What can be learned from a single pol HIV
sequence (ie drug resistance test) added to a
database of locally sampled HIV sequences?
A.
B.
Genotypic Drug Resistance
Possible Transmission linkage (ie from who or to who HIV
may have been transmitted)
C. Direction of an identified transmission
D. Genotypic and Demographic Information about the individual
E. Who may be at Increased Risk for HIV Acquisition
F. A&B
G. All of the Above
47. Question #2
How well does HIPAA protect patient privacy if
guidelines are followed?
A. Extremely Well- privacy will remain unequivocally protected
B. Very Well –privacy remains protected nearly all of the time
C. Well – privacy remains protected most of the time, and is
usually adequate.
D. Fair – privacy is somewhat protected, but better options do not
exist
E. Poor – privacy is somewhat protected but better options do
exist
48. Question #3
Is an HIV sequence a HIPAA identifier?
1) Yes – all genetic data is explicitly
designated as a HIPAA identifier
2) Yes – since HIV sequence data is nearly
unique to an individual, it is an identifier
3) No – it is not listed as one of the 18 HIPAA
identifiers.
49. Question #4
Protected Health Information (PHI) can be
released/used without authorization for the
following purpose(s):
A.
B.
C.
D.
E.
F.
G.
H.
I.
Treatment
Billing
Other Healthcare issues
Public Health
Research
A&B
A,B,&C
A,B,C,&D
All of the Above
50. Question #5
How worried are you that your personal health
information would be unintentionally released
during normal public health investigations?
Eg. 1) Partner notification
2) Epidemic Outbreak Investigations
3) Year End Summary Reports
A) I think this is a real risk
B) This would only happen with a breach in
security
C) I have no concerns
51. Question #6
What do you feel is the appropriate threshold to
disclose PHI for public health benefit?
A. Only a raging epidemic of a deadly disease with
thousands affected. (eg TB,HIV, malaria)
B. An epidemic of a deadly disease with 100s of
individuals affected (Ebola, polio)
C. Any raging epidemic of infectious origin (eg
influenza, west nile virus)
D. Prevention of any infectious disease (eg norwalk
virus, MRSA)
52. Question #7
If you could predict which individuals were at
risk for transmitting or acquiring HIV using
viral sequence data, would it be reasonable
to act on this information (i.e., prioritize
prevention and treatment services to these
individuals)?
A. Yes
B. No