In our investigation of a varicella outbreak among students in preschool, kindergarten, and grades 1-3 in Winnebago County, Illinois, we found an overall varicella vaccine efficacy of 88%, evidence that the circulating virus was a wild-type strain (as determined by polymerase chain reaction analysis), and evidence that vaccination of children =15 months of age was associated with an increased risk for breakthrough varicella (relative risk, 3.7; 95% confidence interval, 1.1-13.1; P=.04). The efficacy of varicella vaccine might be improved if administration of the initial vaccine dose is delayed until children are >/=15 months of age.
Members of the National Science Advisory Board for Biosecurity explain its recommendations on the communication of experimental work on H5N1 influenza.
The Program Requirements for Fellowship Education identify the knowledge and skills that physicians must master through the course of a training program to be certified in the subspecialty of clinical informatics. They also specify accreditation requirements for clinical informatics training programs. The AMIA Board of Directors approved this document in November 2008.
Objective:To test the hypothesis that a prehospital time threshold (PhTT) exists that when exceeded, significantly increases the mortality of trauma patients transported directly from the scene of injury to a trauma center rather than to the closest hospital.Design:Review of data contained within the Illinois Trauma Registry encompassing the period from fall 1989 through spring 1991.Participants:A total of 5,215 injured persons with an Injury Severity Score (ISS) >10, cared for in an Illinois level-I or -II trauma center outside of the city of Chicago.Measurements:Injury severity expressed as ISS, scene time (ST), transport time (TrT), total emergency medical services time (TEMST), and outcome were determined for each patient. Patients were stratified into groups on the basis of ISS.Results:Patient outcomes were significantly different statistically between ISS groups (p <0.001, X2). Mean ST and TEMST, but not TrT, were significantly different statistically between ISS groups (p <0.001, analysis of variance). Lower ISS was associated with longer times. Mean ST, TrT, and TEMST were significantly different statistically between survivors and nonsurvivors (p <0.001, two-sample t-tests). Survival was associated with longer times. Each of the mean times remained significantly different between survivors and nonsurvivors after controlling for severity of injury (p <0.001, two-way analysis of variance).Conclusion:No PhTT beyond which time patient transport to the closest hospital would have decreased mortality was identifiable, because no prehospital time <90 minutes exerted a significant adverse effect upon survival.
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