Diagnostic tests for detecting emerging influenza virus strains with pandemic potential are critical for directing global influenza prevention and control activities. In 2008, the Centers for Disease Control and Prevention received US Food and Drug Administration approval for a highly sensitive influenza polymerase chain reaction (PCR) assay. Devices were deployed to public health laboratories in the United States and globally. Within 2 weeks of the first recognition of 2009 pandemic influenza H1N1, the Centers for Disease Control and Prevention developed and began distributing a new approved pandemic influenza H1N1 PCR assay, which used the previously deployed device platform to meet a >8-fold increase in specimen submissions. Rapid antigen tests were widely used by clinicians at the point of care; however, test sensitivity was low (40%-69%). Many clinical laboratories developed their own pandemic influenza H1N1 PCR assays to meet clinician demand. Future planning efforts should identify ways to improve availability of reliable testing to manage patient care and approaches for optimal use of molecular testing for detecting and controlling emerging influenza virus strains.
Context: Sedentary behavior and inability to participate in organized physical activity has negatively affected the physical and mental health of children and adolescents; however, cardiac injury and associated risk for sudden cardiac death with return to activity remains a major concern. Guidelines have been proposed for return to activities; however, these fail to address the needs of younger children and those participating in more casual activities. Guidance is needed for primary care providers to facilitate safe return to everyday activity and sports and to help direct appropriate laboratory, electrocardiographic, and anatomical assessment. Evidence Acquisition: Review of computerized databases of available literature on SARS-CoV-2 infection in children and postinfection sequelae, risk factors for sudden cardiac death, and previous return to play recommendations. Study Design: Clinical guidelines based on available evidence and expert consensus. Level of Evidence: Level 4. Results: In this report, we review the literature on return to activity after SARS-CoV-2 infection and propose recommendations for cardiac clearance for children and adolescents. Though severe disease and cardiac injury is less common in children than in adults, it can occur. Several diagnostic modalities such as electrocardiography, echocardiography, cardiac magnetic resonance imaging, and serologic testing may be useful in the cardiac evaluation of children after SARS-CoV-2 infection. Conclusion: Gradual return to activity is possible in most children and adolescents after SARS-CoV-2 infection and many of these patients can be cleared by their primary care providers. Providing education on surveillance for cardiopulmonary symptoms with return to sports can avoid unnecessary testing and delays in clearance.
Environmental hazards have an unrecognized and unmet influence on operations. The mistranslation of vertical access and rescue customs and practices, to an environment with uncertain and unrecognizable hazards, can lead to catastrophic failure. Application of these customs and practices to meet the complex operational constraints and environmental hazards central to high-hazard mission sets, has persisted and confused operational vertical rescue teams. Improvised approaches, using minimal but readily available equipment, can close gaps between theory and practice and between discrete concepts in a continuously evolving environment. This paper addresses existing gaps in operational vertical response utilizing a context-specific approach similar to the authors of the original Tactical Combat Casualty Care (TCCC) project published in the 1996 supplement of Military Medicine (Butler FK, 1996). A pragmatic framework is introduced, which has been evolving for the past 10 years within USSOCOM, Federal special operations teams, and municipal special response elements termed Operational Vertical Mobility (OVM). Operational Vertical Mobility (OVM) creates an adaptable model within high-hazard vertical response in the same manner that TCCC disrupted prehospital tactical medicine (Butler FK Jr, 2007). Since normative traditional civilian vertical practices do not translate well into the context of a Volatile, Uncertain, Complex, Ambiguous, Threat containing, and Time-compressed (VUCA-T2) environment, OVM reframes vertical response key performance parameters (KPP’s) in opposition to traditional design principles. OVM promotes creating theories out of practice rather than forcing theories into practice. In order to appraise the key performance parameters of verticality within a VUCA-T2 environment, a panel of practitioners with expertise across multiple vertical disciplines and specialized units analyzed relevant guidelines, principles, industry recommendations, nonlinear sciences, and high reliability organizational characteristics for successful operational application.
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