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During September 27-28, 1995, a workshop entitled "Public Health Response to Nasopharyngeal Radium Irradiation" was convened in New Haven, Connecticut, to address issues regarding possible adverse health effects of this former medical treatment. Workshop participants discussed the strengths and weaknesses of possible epidemiologic studies.
Twenty cases of posttransplant lymphoproliferative disorders arising in solid organ allograft recipients (18 patients) or bone marrow allograft recipients (2 patients: 1 autologous; 1 allogeneic) were selected for presentation at the Society for Hematopathology Workshop. In the course of the Workshop discussions, based both on the submitted cases and the combined experience of the participants, it was possible to agree on several distinctive categories of PTLD. These include (1) early lesions, (2) polymorphic posttransplant lymphoproliferative disorders (PTLDs), (3) monomorphic PTLDs (B- and T-cell lymphomas), (4) plasmacytoma-like lesions, and (5) T-cell-rich large B-cell lymphoma/Hodgkin's disease-like lesions. Monomorphic lesions should be classified according to a recognized classification of non-Hodgkin's lymphoma, although specified in the report as PTLD. Polymorphic lesions should be carefully evaluated for clonality; by immunophenotyping; and, if necessary, analysis of antigen-receptor and Epstein-Barr virus (EBV) genomes. Minimal pathological evaluation should include routine morphology, immunophenotyping on fresh tissue (flow cytometry or frozen section), and preservation of tissue for molecular genetic analysis. Analysis of the presence of EBV can be useful in establishing whether early or equivocal lesions represent PTLD (EBV+) or unrelated processes, but is not required in most cases. The pathologist can make an important contribution to the management of patients with PTLD by providing a complete diagnostic evaluation of the biopsy specimens (this is the least expensive part of the care of a transplant patients, not a place to try to cut costs) and making sure the attending physicians understand the special issues in management of PTLD.
An assessment of the food-safety and nutritional aspects of lactic acid fermentation for the preparation of weaning food at the household level was carried out during a Joint FAO/WHO Workshop held in Pretoria, South Africa, in December 1995. In particular, lactic acid fermentation was evaluated as a part of food preparation processes involving other operations such as soaking, cooking, and the germination of cereal grains. The use of germinated cereals is of particular interest since they can be used to prepare semi-liquid porridges of high nutrient density. After reviewing the present state of knowledge concerning the antimicrobial effects of the lactic acid in fermented foods, and the nutritional benefits of fermentation and the use of germinated cereals, the Workshop made an inventory of gaps in current knowledge and priorities for further research. High priority areas for research include the following: the effect of lactic acid fermentation on viruses, parasites, certain bacteria, and mycotoxins; certain physiological and nutritional effects of the consumption of fermented foods; the characterization and optimization of fermentation processes and the development of appropriate fermentation starters; and risk mitigation using the Hazard Analysis Critical Control Point system, the health education of food handlers, and efforts to change the consumer perception of fermented foods.
Little emphasis has been placed by clinicians on the need for routine evaluation of outcomes of community mental health nursing interventions. Although numerous descriptive studies exist, there is little systematic evaluation of the work of community mental health nurses, and this problem is particularly acute in the field of preventative work. This paper presents the results of a small initiative to incorporate outcome evaluation into the clinical work of a community mental health team. Ninety-nine participants in a series of stress management workshops completed stress questionnaires before a series of 2-day workshops and were followed up at between 3 and 6 months afterwards. At follow-up, participants reported greater gains in terms of stress management than did no-treatment controls. The study offers tentative evidence for the effectiveness of community mental health nurses in offering effective preventative interventions and also indicates that such interventions are amenable to outcome evaluation within the context of routine clinical practice.
We present the experience accumulated during 3 years of having performed 10 workshops related to the topics of Sexuality and Affection, offered to 175 adolescents between the ages of 13 and 19 years, from public schools within the Panamá, City Metropolitan Area and who correspond to different socioeconomical strata. Analytical information provided from the results of two questionnaires related to knowledge about the two topics, applied prior to and after the workshops is also offered.
On September 29-30, 1997, CDC sponsored a workshop to coordinate a multistate response to public health issues about Pfiesteria piscicida. Workshop attendees included representatives from the health departments of eight states (Delaware, Florida, Georgia, Maryland, North Carolina, South Carolina, Virginia, and West Virginia) and the District of Columbia, the U.S. Food and Drug Administration, the National Institutes of Health's National Institute of Environmental Health Sciences, CDC's National Institute for Occupational Safety and Health, and the U.S. Environmental Protection Agency.
To investigate the existence of the non-species specific antibody in plasma of the employees working in an automobile engine testing workshop, and to use it as a scanning marker of various hazards, the heat-stress protein antigen method and western blot technique were used. This study showed that employees working in the automoblile engine testing workshop were affected by various hazards, such as noise, toxic chemicals (carbon monoxide, lead fume, benzene, and so on), and there existed non-species specific antibodies against protein 103,900 and 54,200 of rat liver in their plasma, which were postulated as the specific products produced by exposure to occupational hazards, such as noise, carbon monoxide, et al.
The purpose of the National Institutes of Health research planning workshops is to assess the research status of clinically important areas. This article reports on a workshop whose meetings were held between May 1995 and November 1996 in Bethesda, Maryland, and Chicago, Illinois. Its specific purpose was to develop standardized and unambiguous definitions for fetal heart rate tracings. The recommendations for interpreting fetal heart rate patterns are being published here and simultaneously by the Journal of Obstetric, Gynecologic, and Neonatal Nursing.
A workshop on viral epidemiology was held on September 29, 1995 at the Medical School of the Universidad Nacional Autónoma de Mexico. The aim of this workshop was to promote interaction among scientists working in viral epidemiology. Eighteen scientists from ten institutions presented their experiences and work. General aspects of the epidemiology of meaningful viral diseases in the country were discussed, and lectures presented on the rota, polio, respiratory syncytial, dengue, papiloma, rabies, VIH and hepatitis viruses.
The 4th Copenhagen Workshop "Carcinoma in situ Germ Cell and Testicular Cancer: Molecular and Endocrine Aspects" was held in Copenhagen, Denmark, May 18-21, 1997. This paper discusses the major themes that emerged during the workshop and summarises the most important contributions.
Approximately 100 therapists attended the PT/OT Casting Workshop at the twenty-ninth Annual Meeting of the American Burn Association in New York City, N.Y., on March 20, 1997. The workshop consisted of four groups: two demonstrating hand/wrist casting and two demonstrating casting of the foot/ankle. Participants had the opportunity to attend one upper extremity group and one lower extremity group lasting approximately 50 minutes each. Instructors provided a demonstration of a casting procedure while addressing general guidelines, indications, contraindications, and precautions related to casting each area. Thorough handouts were provided, and each participant had the opportunity to apply two casts. The following article is a compilation of the four handouts and their bibliographies.
Many exciting discoveries are being made that are providing new insights into how molecules, cells and tissues respond to ionizing radiation. There remains a need, however, to translate these findings into more effective treatments for cancer patients, including those treated with radiation therapy. This complex task will require the collaboration of scientists studying molecular, cellular and tissue responses, and those performing clinical trials of emerging therapies. The Radiation Research Program of the National Cancer Institute sponsored a workshop entitled "Molecular Biology to Radiation Oncology: A Model for Translational Research?" to bring together basic scientists and clinicians to exchange ideas and fundamental concepts and to identify opportunities for future research and collaboration. Four broad topics were addressed: signal transduction and apoptosis, the cell cycle, repair of radiation damage, and the microenvironment. The development, selection and use of appropriate experimental models is crucial to finding and developing new therapies, and opportunities exist in this area as well. This paper and the accompanying paper by Coleman and Harris that provides the viewpoint of radiation oncologists (Radiat. Res. 150, 134-147, 1998) summarize the background concepts and opportunities for translational research identified by the workshop participants.
Studies of water chlorination by-products have suggested a possible increased risk of bladder and colon cancers, as well as adverse reproductive and developmental effects such as increased spontaneous abortion rates and fetal anomalies. A workshop for an expert working group was convened to advise Health Canada on the need for further action. Participants were given background papers and a set of key questions to review prior to the meeting. At the workshop, experts presented an overview of what was known to date on water chlorination by-products from toxicologic studies, epidemiologic studies of cancer and adverse reproductive/developmental effects, and risk assessment. This paper summarizes the information provided in the background papers and presentations, describes the consensus arrived at regarding assessment of evidence for level of risk and presents a number of suggestions for future research.
In December 1997, the National Cancer Institute sponsored "The International Workshop on Microsatellite Instability and RER Phenotypes in Cancer Detection and Familial Predisposition," to review and unify the field. The following recommendations were endorsed at the workshop. (a) The form of genomic instability associated with defective DNA mismatch repair in tumors is to be called microsatellite instability (MSI). (b) A panel of five microsatellites has been validated and is recommended as a reference panel for future research in the field. Tumors may be characterized on the basis of: high-frequency MSI (MSI-H), if two or more of the five markers show instability (i.e., have insertion/deletion mutations), and low-frequency MSI (MSI-L), if only one of the five markers shows instability. The distinction between microsatellite stable (MSS) and low frequency MSI (MSI-L) can only be accomplished if a greater number of markers is utilized. (c) A unique clinical and pathological phenotype is identified for the MSI-H tumors, which comprise approximately 15% of colorectal cancers, whereas MSI-L and MSS tumors appear to be phenotypically similar. MSI-H colorectal tumors are found predominantly in the proximal colon, have unique histopathological features, and are associated with a less aggressive clinical course than are stage-matched MSI-L or MSS tumors. Preclinical models suggest the possibility that these tumors may be resistant to the cytotoxicity induced by certain chemotherapeutic agents. The implications for MSI-L are not yet clear. (d) MSI can be measured in fresh or fixed tumor specimens equally well; microdissection of pathological specimens is recommended to enrich for neoplastic tissue; and normal tissue is required to document the presence of MSI. (e) The "Bethesda guidelines," which were developed in 1996 to assist in the selection of tumors for microsatellite analysis, are endorsed. (f) The spectrum of microsatellite alterations in noncolonic tumors was reviewed, and it was concluded that the above recommendations apply only to colorectal neoplasms. (g) A research agenda was recommended.
The linear no-threshold extrapolation from a dose-response relationship for ionizing radiation derived at higher doses to doses for which regulatory standards are proposed is being challenged by some scientists and defended by others. It appears that the risks associated with exposures to doses of interest are below the risks that can be measured with epidemiological studies. Therefore, many have looked to biology to provide information relevant to risk assessment. The workshop reported here, "The Impact of Biology on Risk Assessment", was planned to address the need for additional information by bringing together scientists who have been working in key fields of biology and others who have been contemplating the issues associated specifically with this question. The goals of the workshop were to summarize and review the status of the relevant biology, to determine how the reported biological data might influence risk assessment, and to identify subjects on which more data are needed.
Due to a survey of the CKM insufficient communication among different professional groups is one of the main causes for unused quality reserves and neglected potentials of efficiency in German hospitals. An essential reason for this insufficiency lies in the traditional concepts of education which are designed for the specialties of the different professional groups. With this these concepts only impart key qualifications such as social authority, ability for communication and ability for problem-solving in a small amount. The goal of the virtual workshop is to train students and trainees in communication and interdisciplinary problem-solving early by working together on a practical case in a Virtual Workshop team. On the other hand all relevant persons to talk to are involved in order to support a qualified preparation of decisions: employees of the project hospital, partners from industry and members of universities.
The National Institute of Allergy and Infectious Disease, National Institutes of Health convened a workshop on Kawasaki disease, May 1997, co-chaired by Drs. Karyl Barron and Stanford Shulman. The goal of the workshop was to review the latest scientific advances relating to the epidemiology, etiology, pathogenesis, treatment, and complications of Kawasaki disease, along with future therapeutic options and proposed future research directions.
Adeno-associated virus (AAV) mediated gene therapies has emerged as a potentially transformative treatment approaches for neuromuscular disorders, with two FDA-approved products now in widespread clinical use: onasemnogene abeparvovec (Zolgensma) for spinal muscular atrophy and delandistrogene moxeparvovec-rokl (Elevidys) for Duchenne Muscular Dystrophy. However, severe and occasionally fatal adverse events affecting vital organs, including the blood, liver, muscle, and heart, have emerged in both clinical trials and real-world post marketing settings. The 289th European NeuroMuscular Centre (ENMC) workshop convened 38 participants from patient advocacy groups, industry, and preclinical and clinical research groups to collaboratively review these toxicities, their underlying mechanisms, and potential mitigation and monitoring strategies. Discussions addressed the clinical spectrum and biological drivers of these events, the respective roles of innate and adaptive immunity, the contribution of specific vector characteristics as well as of the specific disease and recipient. The application of risk stratification and immunosuppressive regimens for prevention, monitoring, and management were considered. Emerging toxicities, including capillary leak syndrome, endothelial and dorsal root ganglia injuries, were reviewed alongside corresponding preclinical data from non-human primates. Participants agreed on the need to harmonize standard operating procedures, clinical guidelines, and data-sharing practices, and endorsed collaborative initiatives to proactively address critical gaps and unresolved key questions through a patient-centered framework.