Aerosolized ribavirin: the most expensive drug for pneumonia.

Dramatic, overnight cost increases of important orphan and generic medications have recently come under public and government scrutiny. We highlight the case of aerosolized ribavirin, an important antiviral agent in hematopoietic stem cell transplantation which, because of substantial price increases, may now cost more than the transplant procedure itself.

Disseminated Mycobacterium immunogenum infection presenting with septic shock and skin lesions in a renal transplant recipient.

Mycobacterium immunogenum is a relatively new species within the Mycobacterium chelonae-Mycobacterium abscessus group of rapidly growing mycobacteria (RGM). M. immunogenum was first characterized in 2001 and, similar to other RGM, is an ubiquitous environmental organism. This organism has most commonly been implicated in cutaneous infection in both healthy and immunosuppressed patients. To our knowledge, this is the first reported case of septic shock in the setting of disseminated M. immunogenum infection. Definitive identification of this organism requires gene sequencing at specialized centers, which may limit its detection. M. immunogenum is resistant to many anti-mycobacterial agents, and treatment can be especially challenging in transplant patients, given potential drug interactions and added toxicities. It is important to distinguish M. immunogenum from other RGM and determine the susceptibility profile to devise a successful treatment plan, particularly in the transplant population in which it can potentially cause severe, disseminated disease.

Plant a tree in cyberspace: metaphor and analogy as design elements in Web-based learning environments.

Analogy and metaphor are figurative forms of communication that help people integrate new information with prior knowledge to facilitate comprehension and appropriate inferences. The novelty and versatility of the Web place cognitive burdens on learners that can be overcome through the use of analogies and metaphors. This paper explores three uses of figurative communication as design elements in Web-based learning environments, and provides empirical illustrations of each. First, extended analogies can be used as the basis of cover stories that create an analogy between the learner's position and a hypothetical situation. The Dragonfly Web pages make extensive use of analogous cover stories in the design of interactive decision-making games. Feedback from visitors, patterns of usage, and external reviews provide evidence of effectiveness. A second approach is visual analogies based on the principles of ecological psychology. An empirical example suggests that visual analogies are most effective when there is a one-to-one correspondence between the base and visual target analogs. The use of learner-generated analogies is a third approach. Data from an offline study with undergraduate science students are presented indicating that generating analogies are associated with significant improvements in the ability to place events in natural history on a time line. It is concluded that cyberspace itself might form the basis of the next guiding metaphor of mind.

Immunizations: recommendations and resources for active patients.

Although childhood vaccination rates are at an all-time high, those for adolescents and adults are suboptimal. All adolescents and adults should be immunized against measles, mumps, rubella, varicella, tetanus, and diphtheria, and many should also receive hepatitis A, hepatitis B, influenza, and pneumococcal vaccines. In addition, active patients who engage in outdoor activities may benefit from vaccination against Lyme and meningococcal disease. Regular, strenuous exercise and foreign travel may increase the risk of some infectious diseases. Athletes often see a physician only for sports physical exams and injuries, so it is important for providers to take the opportunity to vaccinate patients during these visits.

Assessing the Winning Teams program of interactive satellite-based training.

This research assessed an interactive satellite-based training program integrating interactive audiovisual experiences with face-to-face interactions. Key elements were content created by experts, high-quality video segments, satellite-based interaction, off-line interactions among teams of parents and caregivers, workshops, and team building exercises. For pragmatic reasons, it was necessary to develop brief assessment instruments concurrently with training. A large set of survey items were created from draft materials and reduced empirically through piloting to those with the best psychometric properties. To avoid the appearance of traditional testing, knowledge was assessed with Likert items. Surveys measured participant satisfaction, knowledge, attitudes, and the application and articulation of concepts. Participant satisfaction was high. Participants increased positive attitudes and learned appropriate vocabulary. Training was more effective than no training or watching videotapes. The program appears to represent a viable model of training that could successfully be applied to Internet technologies.

Impact of anti-vaccine movements on pertussis control: the untold story.

To assess the impact of anti-vaccine movements that targeted pertussis whole-cell vaccines, we compared pertussis incidence in countries where high coverage with diphtheria-tetanus-pertussis vaccines (DTP) was maintained (Hungary, the former East Germany, Poland, and the USA) with countries where immunisation was disrupted by anti-vaccine movements (Sweden, Japan, UK, The Russian Federation, Ireland, Italy, the former West Germany, and Australia). Pertussis incidence was 10 to 100 times lower in countries where high vaccine coverage was maintained than in countries where immunisation programs were compromised by anti-vaccine movements. Comparisons of neighbouring countries with high and low vaccine coverage further underscore the efficacy of these vaccines. Given the safety and cost-effectiveness of whole-cell pertussis vaccines, our study shows that, far from being obsolete, these vaccines continue to have an important role in global immunisation.