Many cases of human exposures to high-dose radiation have been documented, including individuals exposed during the detonation of atomic bombs in Hiroshima and Nagasaki, nuclear power plant disasters (e.g., Chernobyl), as well as industrial and medical accidents. For many of these exposures, injuries to the skin have been present and have played a significant role in the progression of the injuries and survivability from the radiation exposure. There are also instances of radiation-induced skin complications in routine clinical radiotherapy and radiation diagnostic imaging procedures. In response to the threat of a radiological or nuclear mass casualty incident, the U.S. Department of Health and Human Services tasked the National Institute of Allergy and Infectious Diseases (NIAID) with identifying and funding early-to mid-stage medical countermeasure (MCM) development to treat radiation-induced injuries, including those to the skin. To appropriately assess the severity of radiation-induced skin injuries and determine efficacy of different approaches to mitigate/treat them, it is necessary to develop animal models that appropriately simulate what is seen in humans who have been exposed. In addition, it is important to understand the techniques that are used in other clinical indications (e.g., thermal burns, diabetic ulcers, etc.) to accurately assess the extent of skin injury and progression of healing. For these reasons, the NIAID partnered with two other U.S. Government funding and regulatory agencies, the Biomedical Advanced Research and Development Authority (BARDA) and the Food and Drug Administration (FDA), to identify state-of-the-art methods in assessment of skin injuries, explore animal models to better understand radiation-induced cutaneous damage and investigate treatment approaches. A two-day workshop was convened in May 2019 highlighting talks from 28 subject matter experts across five scientific sessions. This report provides an overview of information that was presented and the subsequent guided discussions.

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To estimate malaria rates in association with birth country, we analyzed routine surveillance data for US military members. During 2002–2010, rates were 44× higher for those born in western Africa than for those born in the United States. Loss of natural immunity renders persons susceptible when visiting birth countries. Pretravel chemoprophylaxis should be emphasized.

OR the first time, those who practice psychotherapy need to show results, and not just to the patient. The therapist-patient relationship has acquired a third member: the Health Maintenance Organization ("HMO"). Thus, patient satisfaction is no longer enough: the insurer must also be satisfied. Because their decisions to pay for treatment are based on predictions about effectiveness, and not on post-treatment actual success, HMOs are only satisfied by (and will only pay for) treatments supported by scientifically generated data. This need to justify economically the cost of treatment has collided with the philosophical foundation of the profession pursuant to which treatment choices may be based upon philosophy, and not upon a track record of success.' The source of this collision lies in managed care, which will reimburse treatment only insofar as it can be proven effective, and only for the fewest sessions that can be justified. 2 The therapist must