BACKGROUND:Clinicians often encounter information about drug-drug interactions (DDIs) during clinical practice. This information is found within product information (hardcopy and electronic) and various electronic systems. Prescribers may receive medication-related communications in practice that are distributed by facsimile (fax), mail, or telephone from pharmacies and pharmacy benefit managers (PBMs). The purpose of this study was to determine if near-real time fax alerts for potential drug-drug interactions (PDDIs) would influence prescribing.METHODS:A prospective study, in cooperation with a pharmacy benefit manager (PBM), was conducted targeting 18 clinically important PDDIs. Fax alerts included an individualized letter to the prescriber with a list of the interacting drugs, PDDI evidence summaries with citations, and recommended clinical management strategies. Among the 18 PDDIs, 13 PDDIs could be assessed for prescription therapy changes using pharmacy claims data. A prospective cohort design was used to evaluate changes in prescription dispensing 90-days following a PDDI fax alert.RESULTS:A total of 8,075 fax alerts were sent to prescribers and there were 4,712 alerts for the 13 PDDIs that could be assessed for change using pharmacy claims data. There were 2,019 patients (interventions) for which fax alerts were sent to their prescribers who were matched with a control group consisting of patients with the same PDDIs but for whom no fax alert was sent. Overall, this study found 154 (7.6%) of patients in the fax alert group compared to 132 (6.5%) in the control group had changes in therapy (p=0.177).CONCLUSIONS:This fax alert intervention program observed no statistically significant differences in prescribing with a fax alert compared to the control group. If PBMs chose to send individualized, evidence-based information to clinicians regarding drug-drug interactions, this study suggests it may not be an effective intervention to mitigate harm.

BACKGROUND: Formalized risk management (RM) is an internationally accepted process for reducing hazards in the workplace, with defined steps including hazard scoping, risk assessment, and implementation of controls, all within an iterative process. While required for all industry in the European Union and widely used elsewhere, the United States maintains a compliance-based regulatory structure, rather than one based on systematic, risk-based methodologies. Firefighting is a hazardous profession, with high injury, illness, and fatality rates compared with other occupations, and implementation of RM programs has the potential to greatly improve firefighter safety and health; however, no descriptions of RM implementation are in the peer-reviewed literature for the North American fire service. METHODS: In this paper we describe the steps used to design and implement the RM process in a moderately-sized fire department, with particular focus on prioritizing and managing injury hazards during patient transport, fireground, and physical exercise procedures. Hazard scoping and formalized risk assessments are described, in addition to the identification of participatory-led injury control strategies. Process evaluation methods were conducted to primarily assess the feasibility of voluntarily instituting the RM approach within the fire service setting. RESULTS: The RM process was well accepted by the fire department and led to development of 45 hazard specific-interventions. Qualitative data documenting the implementation of the RM process revealed that participants emphasized the: value of the RM process, especially the participatory bottom-up approach; usefulness of the RM process for breaking down tasks to identify potential risks; and potential of RM for reducing firefighter injury. CONCLUSIONS: As implemented, this risk-based approach used to identify and manage occupational hazards and risks was successful and is deemed feasible for U.S. (and other) fire services. While several barriers and challenges do exist in the implementation of any intervention such as this, recommendations for adopting the process are provided. Additional work will be performed to determine the effectiveness of select controls strategies that were implemented; however participants throughout the organizational structure perceived the RM process to be of high utility while researchers also found the process improved the awareness and engagement in actively enhancing worker safety and health.

Niacin has been in clinical use for over 50 years and was the first drug shown in a randomized trial to improve outcomes after MI, but substantial uncertainty remains about its efficacy and safety in the context of current standard medical therapy. This thesis explores the biochemical efficacy, tolerability and safety of extended release (ER) niacin/laropiprant in the large, randomized HPS2-THRIVE trial. Laropiprant is a prostaglandin D₂ receptor (DP1) antagonist which reduces the main adverse effect of niacin, namely “flushing” (an unpleasant cutaneous vasodilation) that makes a large trial of niacin practicable. ER niacin/laropiprant increases high density lipoprotein cholesterol (HDL-C) and apolipoprotein A1, and reduces low density lipoprotein cholesterol (LDL-C), apolipoprotein B, triglycerides and lipoprotein (a), consistent with previous studies of ER niacin. The reasons for stopping ER niacin/laropiprant reflected the known adverse effect profile of ER niacin, although unlike previous trials flushing was not the most frequent reason for stopping. Skin (pruritus and rash), gastrointestinal (nausea, pain and diarrhoea) and diabetes-related (hyperglycaemia) adverse events were the most common reasons for stopping ER niacin/laropiprant during 3.9 years’ follow-up. The analyses presented here identified three major previously unknown hazards of ER niacin. ER niacin/laropiprant increased the risk of statin-related myopathy almost five-fold, and this effect was greater among participants in China than Europe. ER niacin/laropiprant also increased the risk of bleeding (intracranial, gastrointestinal and other sites) and infection. Compared to placebo there was an absolute excess of 3.1% of serious adverse events (excluding cancer and major vascular events [MVEs]) among participants assigned ER niacin/laropiprant. ER niacin/laropiprant did not significantly reduce MVEs. These findings suggest that the use of niacin to reduce vascular risk should now be reconsidered.

Doctor of Philosophy / Diagnostic Medicine/Pathobiology / David G. Renter / Shiga toxin-producing Escherichia coli serogroups (O26, O45, O103, O111, O121, O145, and O157; STEC-7) are recognized as major food-borne pathogens with outbreaks, human infections, and occasional deaths associated with the consumption of contaminated foods. Cattle are recognized as the primary reservoir for STEC-7 and shed these bacteria in their feces, which are considered a principal source of contamination of cattle hides and carcasses at harvest. Pre-harvest interventions that effectively reduce fecal shedding of STEC-7 have the potential to reduce the public health concerns and economic impact of these bacteria and enhance food safety. In the research presented in this dissertation, distinct study designs were used to evaluate the impact of commercially available pre-harvest interventions and develop a better understanding of the epidemiology of STEC-7 in commercial feedlot cattle. A randomized pen-level trial indicated that a commercially available vaccine significantly reduced the fecal prevalence of STEC O157 and prevalence of high shedders compared to unvaccinated pens. However, there was no evidence of a direct-fed microbial (DFM) effect on either measure of STEC O157 shedding. In a continuum of the efficacy study, the performance and carcass characteristics associated with these pre-harvest interventions were quantified. Results indicated that feeding the DFM to cattle improved performance, whereas the vaccine negatively impacted performance during the intervention period, though most of these attributes were not reflected at the time the animals were harvested. Later, a cross-sectional observational study was used to determine the regional-, feedlot- and pen-level fecal prevalence of enterohemorrhagic Escherichia coli (EHEC), a subset of STEC, in commercial feedlot cattle. Results indicated that EHEC serogroup O157 was detected more frequently than non-O157 serogroups of EHEC; however, all feedlots had at least one sample positive for both O157 and non-O157 EHEC. Further, risk factors associated with non-O157 serogroups of EHEC were identified; further evaluation of these factors as potential control points may enable the ability to positively impact public health concerns and food safety by reducing the pathogen load prior to harvest. Overall, the research described in this dissertation provides an assessment of pre-harvest interventions and multi-level prevalence estimates of STEC-7 in commercial feedlot operations.

<p>Firefighters and asphalt pavers are exposed to polycyclic aromatic hydrocarbons (PAHs) during various work activities. The purpose of this study was to evaluate urinary PAH levels and compare these bio-monitoring levels among firefighters, asphalt pavers, and non-occupationally exposed individuals. The National Institute of Standards and Technology (NIST) urinary PAH levels were used for non-occupationally exposed controls. When compared to the NIST standard for smokers and non-smokers, firefighters demonstrated statistically significant differences in urinary concentration differences for the following metabolites: 2-OH-fluorene, 3-OH-fluorene and 1-OH-pyrene, which were lower in firefighters than the NIST mean for smokers. 1-OHphenanthrene, 2-OH-phenanthrene and 3-OH-phenanthrene were higher among world trade center exposed firefighters than the NIST mean for smokers. When firefighters were compared to the NIST non-smoker standard, firefighters demonstrated elevated levels in all tested PAH biomarkers due to a mixture of smokers and non-smokers in the firefighter cohort. </p><p> Asphalt workers had statistically significant higher urinary concentration elevations in 2OH-fluorene, 1-OH-phenanthrene and 3-OH-phenanthrene as compared to the NIST smoker mean. When asphalt pavers were compared to the NIST non-smoker mean, asphalt pavers had statistically significant increases in all tested PAH biomarkers, with the exception of 2-OHphenanthrene. While firefighters did not demonstrate a substantial change in urinary PAH metabolite levels compared to control populations of smokers and non-smokers, asphalt pavers experienced concentrations that were in some cases increased by orders of magnitude compare to NIST controls. Future research may be needed to evaluate any potential health risk posted to occupational exposed asphalt pavers. </p>

The purpose of this thesis is to analyze current housing and supplemental income programs on a national level to measure success and failures of different programs like Temporary Assistance to Needy Families, Earned Income Tax Credit, and Housing Vouchers. Furthermore, this thesis attempt to discuss questions of ethics and precedent in determining to what degree the United States should engage in social safety net policies. This paper analyzes contemporary American social safety net policies on the basis of their cost to American taxpayers as well as how well it benefits those in poverty.

International Telemetering Conference Proceedings / October 27-30, 1997 / Riviera Hotel and Convention Center, Las Vegas, Nevada / The Vessel Traffic Management System is a cooperative effort of the Naval Undersea Warfare Center and the Naval Air Warfare Center Aircraft Division, funded by the OSD's Test Technology Development and Demonstration Program. The project is establishing the capability to acquire ship tracking information from numerous sources (GPS and radar target extractors), and combine them into a comprehensive, integrated view of the range safety target area. The consolidated tracking information will be transmitted to range safety vessel personnel and presented on portable display systems to aid in clearing the surveillance area of unauthorized vessels. The communications module is media independent in that positional and image data can be routed via RF modem, cellular phone, Intranet or Internet, singly or in any combination. The software systems for data acquisition, display and control are also platform independent, with the system under development operating under WindowsNT and Windows95. Additionally, the use of Java and VRML tools permits a user to display data (including three dimensional presentations of the data) without requiring the applications software. This system has numerous applications including range safety, commercial vessel traffic management, port authority and services monitoring, and oceanographic data gathering.

ITC/USA 2015 Conference Proceedings / The Fifty-First Annual International Telemetering Conference and Technical Exhibition / October 26-29, 2015 / Bally's Hotel & Convention Center, Las Vegas, NV / In this paper, we present our research on using computer-vision analysis for vehicular safety applications. Our research has potential applications for both autonomous vehicles and connected vehicles. In particular, for connected vehicles, we propose three image analysis algorithms that enhance the quality of a vehicle's on-board video before inter-vehicular information exchange takes place. For autonomous vehicles, we are investigating a visual analysis scheme for collision avoidance during back up and an algorithm for automated 3D map building. These algorithms are relevant to the telemetering domain as they involve determining the relative pose between a vehicle and other vehicles on the road, or between a vehicle and its 3D driving environment, or between a vehicle and obstacles surrounding the vehicle.

ITC/USA 2005 Conference Proceedings / The Forty-First Annual International Telemetering Conference and Technical Exhibition / October 24-27, 2005 / Riviera Hotel & Convention Center, Las Vegas, Nevada / The PAM representation was used to formulate a reduced-complexity detector for the Enhanced Flight Termination System (EFTS) whose performance is 5.6 dB better than limiter-discriminator detection when no phase noise is present and 3.4 dB better in the presence of expected phase noise in EFTS.

This thesis derives and validates Performance Indicators for Safe Mobility for Older Road Users in Urban Areas. Performance Indicators are objective, auditable parameters, which when used as a set can provide additional information to decision-makers about the operation of the transport system. Great Britain, in common with many countries across Europe has an ageing population. The proportion of older people who hold a driving licence and have the use of a car is also expected to rise, with future generations of older people travelling further and more frequently than previous generations. Older road users are already over-represented in traffic fatalities, particularly in urban areas. Measures to protect older road users from risk in traffic will be of crucial importance as the population ages. However, against this background the need remains for them to access key facilities such as shops, leisure activities and health care. Maintaining independent mobility is essential in maintaining mental and physical health. Traditionally, outcomes-based measures such as accident or casualty figures have been used to monitor road safety. Techniques such as hotspot analysis have identified locations on the road network where accident numbers are high, allowing modifications to road infrastructure to be designed and implemented. Using outcomes measures alone however, it is difficult to ascribe improvements in accident or casualty figures to particular policy interventions. Moreover, the effect of road safety interventions on other related policy areas mobility being one is impossible to assess without access to detailed, disaggregated exposure data. To make fully informed policy decisions about infrastructure design and how it affects older users, a better understanding of the linkages between safety and mobility is required. Performance Indicators offer the possibility to look at these linked policy objectives within a single framework. Focus group data was used in conjunction with the results of previous studies to identify the infrastructure features which present a barrier to older users safe mobility in urban areas. These included factors which increased risk, such as wide carriageways, complex junctions and fast-moving traffic, and factors which hindered mobility, such as uneven or poorly maintained pavements, poor lighting and traffic intrusion. A thematic audit of infrastructure in a case study city (Coventry) was undertaken, in order that the incidence of such infrastructure could be recorded. It was found that in many areas of the city, safe mobility for older road users was not well provided for, with the majority of locations having barriers to safety and/or mobility for both drivers and pedestrians. The audit data was then used to calculate a set of Performance Indicators, presented via spider graphs, which describe the degree to which the infrastructure caters for the safety and mobility of older drivers and pedestrians. The spider graphs allow for easy comparisons between the different geographical areas, and also between the different policy areas, allowing policy priorities to be identified. The calculated Performance Indicators were validated using case studies collected from the focus group participants. The case studies identified features that affected travel habits by causing a change of route or change of mode, providing evidence of the link between infrastructure design and safe mobility for older users. The results of the Performance Indicator analysis were then compared to accident figures, in order to identify differences between the two approaches, and to understand what policy implications would result from a monitoring framework that used Performance Indicators for safe mobility, rather than outcomes-based measures alone. One implication of the Performance Indicator approach is that it may identify different areas for priority action from those identified by accident or casualty figures. A location which does not have high accident numbers may nevertheless perform poorly on a Safety Performance Indicator measure. This is because older users who feel at risk make different route or mode choices to avoid the infrastructure, the lower accident rate being explained by lower exposure to risk. Conversely, measures to promote independent mobility for older users may increase their accident involvement, not because the environment becomes more risky, but because the exposure of older users to risk increases, because they are willing and able to walk or drive in an area they previously avoided. The thesis concludes that infrastructure design does not currently cater well for the needs of older pedestrians and drivers, and that a framework which incorporated Performance Indicators could make more explicit the trade-offs between safety and mobility, and between different categories of user. This additional information would enable policy makers and practitioners to make more informed decisions about how to prioritise competing objectives in complex urban areas.