In the Department of Veterans Affairs, through our more than 1,000 VHA health care facilities nationwide, we have the opportunity to provide state.of.the art care of HIV.infected individuals along with an array of evidence.based prevention measures. The VA has lately introduced routine HIV serologic screening, of which the primary goal is to test every Veteran at least once in his or her lifetime. With the second edition of the VA HIV Prevention Handbook: A Guide for Clinicians, the VA Office of Public Health is providing VHA clinicians in primary care and specialty care settings with guidance on approaches to prevention such as routine HIV testing and risk.reduction counseling.

关键词：艾滋病毒；预防医学；医疗保健；医药

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No abstract available.

关键词：毒理学；三甘醇酸乙酯甲基丙烯酸；医药

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While much advancement has been made in breast cancer treatment, metastatic breast cancer remains an incurable disease. MUC1 is a glycoprotein expressed on normal glandular epithelial but is over-expressed and underglycosylated in over 90% of human breast tumors and 100% of metastatic lesions, which lead to its ranking by NCI as the second most targetable antigen. Vaccines against tumor antigens have several benefits, including the chance to eliminate metastatic lesions that express the vaccinating tumor antigen. To this end, we have proposed vaccinating with peptides from the MUC1 protein core, which is only visible to the immune system on the tumor- associated form of the protein. Previous work from our lab has demonstrated that this vaccine does elicit a MUC1-specific immune response that can only be functional if the immunosuppressive tumor microenvironment is altered to allow efficient killing of tumor cells. Thus, we investigated the effectiveness of MUC1 vaccination in combination with drugs known to inhibit immunosuppression to determine which drug is the most effective. Methods: Mice that are transgenic for human MUC1 (MUC1.Tg) mice were orthotopically injected with a syngenic breast cancer cell line expressing human MUC1 (Mtag.MUC1). Mice were vaccinated after palpable tumor formation with the vaccine cocktail, consisting of two MHC class I-restricted MUC1 tandem repeat peptides and a class II pan helper peptide mixed with GM-CSF and CpG ODN, in incomplete Freund s adjuvant. Previous work in our lab has shown that blocking the cyclooxygenase pathway (COX) resulted in an inhibition of immunosuppression. Thus we used the following drugs in combination with the MUC1-vaccine therapy: Indomethacin (COX1 and COX2 inhibitor), Celecoxib (COX2 inhibitor), 1-methyl tryptophan (indoleamine 2,3 dioxygenase inihibitor), and AH6809 (EP2 receptor antagonist). Mice were euthanized and tissue was collected post the final vaccination.

关键词：乳腺癌；糖蛋白；免疫抑制；转移；医药

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Servicemembers with combat-related limb loss often require substantial rehabilitative care. The prevalence of traumatic brain injury (TBI), which may impair cognitive and functional abilities, among servicemembers has increased. The primary objectives of this study were to determine the frequency of TBI among servicemembers with traumatic amputation and examine whether TBI status was associated with discharge to civilian status and medical and rehabilitative service use postamputation. U.S. servicemembers who had a combat- related amputation while deployed in Iraq or Afghanistan between 2001 and 2006 were followed for 2 yr postamputation. Data collected includes injury mechanism; postinjury complications; Injury Severity Score (ISS); and follow-up data, including military service discharge status and number of medical, physical, occupational therapy, and prosthetic-related visits. Of the 546 servicemembers with combat-related amputations, 127 (23.3%) had a TBI diagnosis. After adjusting for ISS and amputation location, those with TBI had a significantly greater mean number of medical and rehabilitative outpatient and inpatient visits combined (p less than 0.01). Those with TBI were also at greater odds of developing certain postinjury complications. We recommend that providers treating servicemembers with limb loss should assess for TBI because those who sustained TBI required increased medical and rehabilitative care.

关键词：截肢；军事人员；创伤性脑损伤；爆炸；医药

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Attention deficit/hyperactivity disorder (ADHD) is a neurobehavioral disorder marked by excessive hyperactivity, impulsivity, or inattention. Although these disorders are typically diagnosed in childhood, symptoms may persist into adulthood. About two thirds (66 percent) of children aged 4 to 17 diagnosed with ADHD took medication for the disorder in 2007, and stimulant medications remain the first-line treatment for these disorders in both children and adults. When used as directed, ADHD stimulant medications can be effective treatment, but they can also have negative side effects, such as nervousness, insomnia, dizziness, and cardiovascular or psychiatric problems. ADHD stimulant medications can also be misused to suppress appetite, enhance alertness, or cause feelings of euphoria. Past year nonmedical use of Adderall, a common ADHD stimulant medication, increased among adults from 2006 to 2010, particularly among young adults aged 18 to 25. Whether ADHD stimulant medications are misused or adverse reactions occur when the medication is taken as prescribed, monitoring dangerous health effects that require immediate medical attention can help guide intervention efforts.

关键词：急诊；急救医疗服务；精神障碍；医药

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The Technology Watch (Tech Watch) project is a NASA project that is operated under the Human Research Programs (HRP) Exploration Medical Capability (ExMC) element, and focuses on ExMC technology gaps. The project coordinates the efforts of several NASA centers, including the Johnson Space Center (JSC), Glenn Research Center (GRC), Ames Research Center (ARC), and the Langley Research Center (LaRC). The objective of Tech Watch is to identify emerging, high-impact technologies that augment current NASA HRP technology development efforts. Identifying such technologies accelerates the development of medical care and research capabilities for the mitigation of potential health issues encountered during human space exploration missions. The aim of this process is to leverage technologies developed by academia, industry and other government agencies and to identify the effective utilization of NASA resources to maximize the HRP return on investment. The establishment of collaborations with these entities is beneficial to technology development, assessment and/or insertion and further NASAs goal to provide a safe and healthy environment for human exploration. In 2012, the Tech Watch project expanded the scope of activities to cultivate student projects targeted at specific ExMC gaps, generate gap reports for a majority of the ExMC gaps and maturate a gap report review process to optimize the technical and managerial aspects of ExMC gap status. Through numerous site visits and discussions with academia faculty, several student projects were initiated and/or completed this past year. A key element to these student projects was the ability of the project to align with a specific ExMC technology or knowledge gap. These projects were mentored and reviewed by Tech Watch leads at the various NASA centers. Another result of the past years efforts was the population of the ExMC wiki website that now contains more the three quarters of the ExMC gap reports. The remaining gap reports will be completed in FY13. Finally, the gap report review process for all ExMC gaps was initiated. This review process was instrumental in ensuring that each gap report was thoroughly reviewed for accuracy and relevant content prior to its public release.

关键词：航天医学；技术评估；空间探索；医药

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In this project, we developed an innovative methodology to solve a long-standing traffic engineering problem, i.e. measuring traffic speed using data from single inductive loop detectors. Traditionally, traffic speeds are estimated using aggregated detector data with a manually calibrated effective vehicle length. The calibration effort (usually through running probe vehicles), however, is time consuming and costly. Instead of using aggregated data, in this project, our data collection system records every vehicle-detector actuation 'event' so that for each vehicle we can identify the time gap and the detector occupation time. With such high-resolution 'event-based' data, we devised a method to differentiate regular cars with longer vehicles. The proposed method is based on the observation that longer vehicles will have longer detector occupation time. Therefore, we can identify longer vehicles by detecting the changes of occupation time in a vehicle platoon. The 'event-based' detector data can be obtained through the implementation of the SMART-Signal (Systematic Monitoring of Arterial Road Traffic Signals) system, which was developed by the principal investigator and his students in the last five years. The method is tested using the data from Trunk Highway 55, which is a high-speed arterial corridor controlled by coordinated traffic signals. The result shows that the proposed method can correctly identify most of the vehicles passing by inductive loop detectors. The identification of long vehicles will improve the estimation of effective vehicle length on roads. Consequently, speed estimation from the inductive loop detector is improved.

关键词：汽车；高速公路；速度

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Hypertension affects one third of adults in the United States (1) and is a major risk factor for heart disease and stroke (2). A previous report found differences in the prevalence of hypertension among racial/ethnic populations in the United States; blacks had a higher prevalence of hypertension, and Hispanics had the lowest use of antihypertensive medication (3). Recent variations in geographic differences in hypertension prevalence in the United States are less well known (4). To assess state-level trends in self-reported hypertension and treatment among U.S. adults, CDC analyzed 20052009 data from the Behavioral Risk Factor Surveillance System (BRFSS). The results indicated wide variation among states in the prevalence of self-reported diagnosed hypertension and use of antihypertensive medications. In 2009, the age-adjusted prevalence of self-reported hypertension ranged from 20.9% in Minnesota to 35.9% in Mississippi. The proportion reporting use of antihypertensive medications among those who reported hypertension ranged from 52.3% in California to 74.1% in Tennessee.

关键词：高血压；心脏病；心血管疾病；医药

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No abstract available.

关键词：毒理学；对健康的影响；锍化合物；藻类；医药

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As of May 6, 2013, Michigan had reported 167 (52%) of the 320 paraspinal or spinal infections without meningitis associated with the 20122013 fungal meningitis outbreak nationally. Although the index patient (1) had a laboratory-confirmed Aspergillus fumigatus infection, the fungus most often identified, including in unopened vials of methylprednisolone acetate (MPA), remains Exserohilum rostratum, a common black mold found on plants and in soil (2). Exposures have occurred through epidural, paraspinal, peripheral nerve, and intra-articular injection with MPA from contaminated lots compounded by the New England Compounding Center in Framingham, Massachusetts. The Michigan Department of Community Health and CDC conducted case ascertainment to describe epidemiologic and clinical characteristics of Michigan patients and to determine factors that might have contributed to the high percentage of spinal and paraspinal infections reported from Michigan. A distinct epidemiologic or clinical difference was not observed between patients with paraspinal or spinal infection with and without meningitis. Lengthy periods (range: 12121 days) were observed from date of last injection with contaminated MPA to date of first magnetic resonance imaging (MRI) finding indicative of infection. Clinicians should continue to maintain a higher index of suspicion for patients who received injections with contaminated MPA but have not developed infection.

关键词：发病率；死亡率；脊柱感染；医药

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