The rapid changes in the healthcare system, with revolutionary advancements in imaging, along with the lack of any existing imaging standards in our country, have raised the need for an accreditation structure. The Quality Council of India (QCI) has therefore introduced standards for medical imaging services, focusing on the control of services, personnel, imaging processes and procedures, facility and environment, equipment, and documentation, as well as risk control and safety. This article deals briefly with the standards structured by the QCI for accreditation of imaging services. Changing market forces, increasing health awareness, the advent of medical tourism and health insurance, and the entry of the corporate sector into health delivery have raised the demand for quality in healthcare services. Initial attempts were made by the Bureau of Indian Standards in the late 1980s, when the organization set down the standards for the voluntary accreditation of 30-, 100-, and 250-bedded hospitals. The National Institute of Health and Family Welfare specified rules for hospitals with more than 50 beds. Health is a state responsibility in India and therefore attempts have also been made in some states to frame standards for hospitals. However, such compartmentalized initiatives have led to further fragmentation of an already segmented sector. Realizing the need to establish a uniform accreditation structure across the country, which would suit Indian conditions and at the same time be credible in the eyes of international observers, an inter-ministerial taskforce was set up in 1991. As an outcome of its recommendations, the Quality Council of India (QCI) was established in 1997, as an autonomous body, with the mandate to establish and operate a national accreditation structure and to obtain international recognition for its accreditation schemes.The National Accreditation Board for Hospitals and Healthcare Providers (NABH) was set up under the QCI to establish and operate accreditation programs for healthcare organizations. Diagnostic imaging forms an integral part of healthcare. The clinical advantages of these services are enormous and imaging affects critical decision-making at every stage of patient management. However, it could also represent an unnecessary cost to healthcare systems in the country, if the quality provided is less than optimal. The phenomenal growth in diagnostic imaging in the last two decades has further enhanced the importance of this field. NABH for healthcare takes into account some major aspects of imaging services in a hospital, although its role and scope are limited. Hence, to assess the quality and safety of imaging services and to have a method for the monitoring of quality standards, a basic accreditation program has been introduced in the country. These standards reflect the expectation of good services from the viewpoint of the service provider, the patient, and the referrer, as well as the safety regulatory bodies. These standards also take into consideration the requirements of safety and service standards of the Atomic Energy Regulatory Board (AERB) and the Pre-Natal Sex Determination (PNDT) regulations relevant to our country.PET/CT, SPECT, radionuclide imaging and therapy, and so on.The medical imaging services (MIS) cover investigations of patients that provide imaging information for the diagnosis, prevention, and treatment of disease or assessment of health. It includes conventional radiation-based diagnostic radiology as well as a wide variety of specialized techniques including USG, Doppler studies, bone densitometry, CT scan, MRI, The MIS also include in its scope, the arrangements for requisition, patient identification, choice of appropriate (most informative and cost-effective) imaging techniques, patient information, patient consent, patient preparation, performance of imaging procedures, interpretation, reporting, and advice regarding the result, in addition to the consideration of safety and ethics in diagnostic imaging services.Medical imaging standards are applicable to single and multiple service providers as well as hospital services. They include all modalities related to x-rays, fluoroscopy-based investigative and interventional procedures, mammography and related interventional procedures, bone mineral densitometry, USG, diagnostic as well as interventional, Doppler, MRI, CT scan, nuclear medicine, and procedures such as, radiofrequency ablation and laser / cryo / thermoablation.The standards have been grouped into six chapters dealing with all aspects of imaging services, from control of services, facilty and environment, imaging processes and procedures, equipment, documentation of records and control of risk and safety. Every chapter, after a brief description that explains its purpose, sets out a number of standards that need to be objectively assessed. The defined standards are patient-focused, cover the functions and systems of medical imaging as a whole, interventional as well as nuclear medicine service, and address the dimensions of quality, and support quality improvement. The standards take into account the need for all statutory compliance — AERB, Preconception and Prenatal Diagnostic Techniques (PC-PNDT), pollution control, and so on.The MIS standards emphasize the need to work collaboratively with clinical colleagues, to agree upon and select the appropriate imaging pathways to ensure diagnosis and / or treatment within a defined time frame, with minimal delays. The services have to be patient-focused and respectful to the patient and address their specific requirements. Proper attention has to be given to ensure the patients' privacy, dignity, and security. It is also essential to encourage the patients and their attendants to give feedback and to use this feedback for the betterment of the service delivery. The MIS, as per the guidelines, must provide a facility that is safe, clean, comfortable, and fit for the staff, patients, and others. The MIS has to ensure the provision of safe water, electricity, bio-waste and sewage disposal, and so on. The organization must have in place plans for the management of disasters and emergencies within the facility.The MIS have to ensure that all images are acquired and reported in accordance with the agreed protocols, by competent staff working within their defined scope of practice. Optimal diagnostic quality, with essential image characteristics, must be obtained in accordance with the best current practices. Interventional procedures must be conducted as per the defined protocols, by competent staff. It is also essential to ensure that drugs, isotopes, contrast media, and radiopharmaceuticals are stored, prescribed, prepared, and administered safely as per the statutory requirements. There have to be appropriate arrangements to deal with adverse reactions promptly, efficiently, and effectively.The management of staff has to be effective, fair, consistent, and supportive. The service contracts are to be managed effectively and efficiently to ensure high-quality care to patients. The organization should have a well-documented performance-appraisal system to be used as a tool for further development.The MIS has a duty to ensure appropriate procurement, installation, operation, maintenance, quality assurance, and replacement of all equipment, including ancillary equipment, such as, resuscitation equipment, protective clothing, and consumables. Records pertaining to the same should be maintained.The MIS have a duty to ensure that documents pertaining to policies, procedures, applicable laws and regulations, as well as guidelines for dealing with vulnerable patients , obstetric patients, patients being administered sedation or anesthesia, and patients undergoing radiation, interventional or nuclear medicine services, are in place. It is the duty of the MIS to manage, store, and transfer all data in a secure manner, which must adhere to the statutory requirements (if any).The MIS have a duty to ensure that the organization has arrangements and general protection measures for staff, patients, and others, to restrict exposure to ionizing radiation and risks associated with the use of MRI, ablative and therapeutic devices, radionuclides, and so on. The organization has a duty to minimize and manage risk due to potentially violent and / or aggressive behavior in the facility. The management should promote a good and safe ambience, be prepared to manage adverse healthcare events, and minimize the risks associated with fire, electrocution, and other disasters.Accreditation of medical diagnostic services is the need of the hour. NABH accreditation for MIS is based on optimum standards and professional accountability, and encourages healthcare organizations to pursue excellence. The formulated standards have focused on statutory compliance, patient and staff safety, improved workflow, learning, self-development, improved performance, and reduction of risk. Its assessment relies on establishing management and technical competence in terms of accreditation standards, for delivering all the services within its scope. It goes beyond compliance and calls for the pursuit of excellence on a continuing basis.


Experimental reality in molecular and cell biology, as revealed by advanced research technologies and methods, is manifestly inconsistent with the design perspective on the cell, thus creating an apparent paradox: where do order and reproducibility in living systems come from if not from design?I suggest that the very idea of biological design (whether evolutionary or intelligent) is a misconception rooted in the time-honored and thus understandably precious error of interpreting living systems/organizations in terms of classical mechanics and equilibrium thermodynamics. This error, introduced by the founders and perpetuated due to institutionalization of science, is responsible for the majority of inconsistencies, contradictions, and absurdities plaguing modern sciences, including one of the most startling paradoxes - although almost everyone agrees that any living organization is an open nonequilibrium system of continuous energy/matter flow, almost everyone interprets and models living systems/organizations in terms of classical mechanics, equilibrium thermodynamics, and engineering, i.e., in terms and concepts that are fundamentally incompatible with the physics of life.The reinterpretation of biomolecules, cells, organisms, ecosystems, and societies in terms of open nonequilibrium organizations of energy/matter flow suggests that, in the domain of life, order and reproducibility do not come from design. Instead, they are natural and inevitable outcomes of self-organizing activities of evolutionary successful, and thus persistent, organizations co-evolving on multiple spatiotemporal scales as biomolecules, cells, organisms, ecosystems, and societies. The process of self-organization on all scales is driven by economic competition, obeys empirical laws of nonequilibrium thermodynamics, and is facilitated and, thus, accelerated by memories of living experience persisting in the form of evolutionary successful living organizations and their constituents. The cell is a fundamental building block of all living organisms. A typical cell represents a highly concentrated  aqueousTo understand design means to control the designed. Naturally, in order to gain some measure of control over our diseases and inevitable aging and death, we direct our best efforts and resources at deciphering the evolutionary design of the cell, using our most reliable and successful analytical methods, reductionism and reverse engineering. The incessant and rapid progress of research technology enables us to isolate and analyze increasingly smaller parts on an increasingly larger scale with increasingly better precision and at an increasingly faster pace. We have sequenced our own genome and know the blueprints of almost every protein and RNA produced in our cells. Modern biophysical and computational methods allow us to analyze individual proteins on both population and single-molecule levels, as well as to scrutinize and model protein structure and dynamics at atomic resolution and on multiple timescales, from femtoseconds to seconds. Internationally coordinated initiatives in structural genomics aim at high-throughput determination of all relevant biomolecular structures, with thousands of protein structures being deposited in the Protein Data Bank each year. Mass spectrometry-based proteomics technologies allow us to obtain "parts lists" for virtually any macromolecular complex, organelle, or sub-cellular structure. Robotics-assisted large-scale protein interaction studies reveal the relationships between individual parts of the cellular machinery on the scale of whole proteomes. Hundreds of years' expertise in engineering is combined with the unprecedented powers of modern computational technologies to equip systems biology for the analysis and modeling of systems of almost any degree of complexity. Paradoxically, extraordinary advances in our understanding of the parts do not seem to bring about significant progress in our understanding of the whole. In fact, it appears that the design of the cell becomes increasingly elusive as experimental data accumulate.Comparative analysis of the "parts lists" obtained for various organelles, sub-cellular structures, and macromolecular complexes suggests, for example, that there may be no pre-defined locations for individual proteins inside the cell, but rather statistically preferred ones. Moreover, even statistically preferred spatiotemporal distributions of proteins inside the cell are not fixed. Instead, they appear to change on multiple scales of space and time upon changes in the internal state of the cell and/or its environment ,4. The fDefying traditional, static views on proteins embodied in such metaphors as "locks," "keys," and "Lego blocks," recent technological and conceptual advances in protein biophysics have brought about a new image of the protein as a highly dynamic, versatile, and continuously changing physicochemical organization -13. It ia choice, for they can interact with different partners, join different macromolecular organizations, perform different actions, and contribute in different ways to the functioning of diverse macromolecular complexes and structures.The so-called natively unfolded proteins, which do not possess a defined structure when isolated in solution, but acquire a structure upon interactions with other molecules, represent an extreme example of protein ambiguity and plasticity. The discovery of intrinsically disordered proteins came as a total surprise, for the concept of natively unfolded proteins is incommensurate within the design perspective on the cell . SubsequTo summarize, the experimental reality in molecular and cell biology, as revealed by advanced technologies and methods, is manifestly inconsistent with the design perspective on the cell, creating an apparent paradox: where do order and reproducibility in living systems come from if not from design?A recent theoretical study may provide an answer to this and other questions accumulated in biology over many years of research. This study demonstrates that the experimental reality in molecular and cell biology becomes largely devoid of paradoxes, inconsistencies and contradictions, and is thus best understood if the cell and biological organization in general are reinterpreted within an alternative paradigm of biological organization based on the concepts and empirical laws of nonequilibrium thermodynamics .nonequilibrium physicochemical system of interacting molecules, the vast majority of researchers working in molecular and cell biology continue to treat and interpret the cell and its components in terms of classical mechanics, equilibrium thermodynamics, and engineering, i.e., in terms and concepts that are fundamentally incompatible with the physical nature of the cell, thus faithfully reproducing and reinforcing the mistakes and misconceptions of the founders. This is in itself a good example demonstrating that many things in life can be faithfully reproduced in the absence of any design.Whether explicitly stated or tacitly implied, the phenomena studied in molecular and cell biology are traditionally interpreted and rationalized within the conceptual framework of classical physics, i.e., classical mechanics and equilibrium thermodynamics. This is not particularly surprising, for the foundations of molecular and cell biology were laid down by physicists and biochemists whose mental structures and, thus, habitual interpretations were shaped by their rigorous training in classical physics and engineering. Accordingly, as exemplified by the first paragraph of this article, the conventional image of the cell came to carry within it all the familiar logic, inferences, and assumptions of classical physics and engineering, including the belief that the order and reproducibility observed in living systems are a consequence of design. What is really surprising is that, even though today very few scientists would argue that the cell is not an open organization of relationships between interacting components, a form, but not physical components comprising a given macrostructure. Members come and go, but the organization persists. Normally, the same set of interacting microcomponents can generate multiple alternative organizational configurations differing in the organization of energy/matter exchanges transiently maintained among the interacting components that make up and flow through a given configuration. As a consequence, macrostructures emerging in far-from-equilibrium systems are dynamic in two different senses, for they display both configurational dynamics and flow dynamics [Studies of relatively simple inorganic nonequilibrium systems such as the Belousov-Zhabotinsky (BZ) reaction, Benard instability Figure , and othdynamics .is an open nonequilibrium physicochemical system of interacting molecules, the cell is expected to exist and function as a complex metastable organization of conjugated fluxes, steady-state compartments, and interdependent gradients. This implies that molecular partitioning, ordering, and macro-organization within the cell are not pre-determined by a pre-existing design, but are driven by the same physical principles and forces that drive self-organization in open, inorganic, far-from-equilibrium systems studied in the field of nonequilibrium thermodynamics. As suggested elsewhere [Since the cell lsewhere , one of lsewhere -29, the The other empirical (self-) organizational laws of nonequilibrium thermodynamics that are especially helpful in understanding the organizational dynamics of living systems are as follows. Increasing the rate of energy/matter flow through an open nonequilibrium organization/system of interacting components normally leads to the growth of the organization/system in size and complexity. The increase in complexity proceeds through stepwise organizational transitions from states of relatively low order (low negative entropy) to states of relatively high order (high negative entropy) and is accompanied by the formation of multiscale organizational hierarchies. Maintaining a nonequilibrium organization/system at a given level of order and complexity requires a continuous and stable flux of energy/matter through the system. Decreasing the rate of energy/matter flow through an organization/system leads to a stepwise hierarchical relaxation of its organizational structure and a loss of complexity and order, ultimately culminating in the dissolution and death of the organization .flow rates of their constituents (nonequilibrium thermodynamics) and not concentrations, as commonly assumed (equilibrium thermodynamics) [One of the practically important predictions that can be immediately made from these empirical laws is that the critical parameters defining the physiological state of any living system, such as the cell or the organism, for example, are ynamics) . Indeed,ynamics) . At the The cell should thus be pictured as a multiscale system of structured circulation of energy/matter forms in which individual configurations of energy/matter flow are manifested as steady-state sub-cellular structures, compartments, complexes, and macromolecules that make up the cell. Various metastable configurations/patterns of flowing energy/matter continuously compete and cooperate one with another in order to obtain and to ensure stable and accelerating flows of energy/matter passing through them, which they require for their maintenance and growth within the cellular economy they comprise. In a conceptually analogous way, various business, social, and political organizations compete and cooperate one with another in order to obtain and ensure stable and accelerating flows of resources passing through them, which they require for their maintenance and growth within the socio-politico-economic system they form ,32. Thosanima ex anima principle, another fundamental difference between nonliving nonequilibrium systems and living nonequilibrium organizations is that, while nonliving macrostructures emerge and persist only when provided with a flux of energy/matter, living nonequilibrium organizations strive to live long and prosper, i.e., to persist as specific dynamic structures and to grow in size, complexity, and influence. As a consequence, at each and every level of the biological organizational hierarchy, living nonequilibrium organizations continuously compete and cooperate one with another as they search for, obtain, transform, and exchange energy/matter forms to ensure a continuous and accelerating flux of energy/matter, which they need both individually (hence competition) and collectively (hence cooperation) for their maintenance and growth in size, complexity, and influence. As time passes, surviving life forms become increasingly interconnected and integrated - both within and across organizational levels and spatiotemporal scales - into a multiscale continuum of structured energy/matter circulation/flow, which favors cooperation and organization over unbridled competition. In this way, proteins and other molecules self-organize into cells, cells self-organize into organisms, organisms self-organize into ecosystems and organizations, and organizations self-organize into economies [In addition to what can be called the conomies .individual choice as a force of both innovation and conservation becomes a decisive factor in organizational dynamics, either promoting or inhibiting the survival and success of the developing and adapting whole.To summarize, the self-organization of living systems is driven by economic competition, obeys empirical laws of nonequilibrium thermodynamics, and is facilitated and, thus, accelerated by memories of living experience embodied in the adaptive structures and dynamics of interacting constituents. Because the structures and dynamics  of individual constituents at all levels of organizational hierarchy always remain ambiguous and unspecified, albeit shaped by evolution and experience, the knowledge or intelligence, a combined and self-organized product of living experience represented by and preserved in the structures and dynamics of interdependent and interconnected living organizations co-evolving on multiple scales of space and time. Evolutionary memories in the form of proteins, cells, organisms, ecosystems, organizations, and economies continuously recall the past by virtue of their own incessant reproduction, adapt to the present by making individual choices and acting upon them, and mold the future by interacting with and molding their environments that, in turn, mold them. In this way, the past, the present, and the future, as well as multiple spatiotemporal scales, converge within one self-organizing process of life. Life is intelligence. Intelligence implies and involves order, reproducibility, continuous change and development, but no design. Life/intelligence is an open-ended, evolving structure-process of energy/matter flow, a stream of consciousness. And we all are a part of it.To conclude, in the domain of life, order and reproducibility do not come from design. Instead, they come from what can be called The author declares that they have no competing interests.AK is the sole author of this paper and is responsible for developing the concepts and for writing and revising the manuscript.


The applications of remote sensing and geographic information systems (GIS) to vector-borne and helminthic diseases have progressed far beyond the pretty pictures which dominated their early use. As Wood et al. indicate in the last chapter, the number of papers in the area has increased drastically over the last decade, in number and sophistication. The editors of this special volume of Advances in Parasitology have been in the forefront of applying statistical and biological approaches to the mapping of vector-borne diseases and have brought together experts to review existing knowledge, identify gaps in understanding, and describe future applications of these powerful approaches. This book is a timely overview of satellite imagery, GIS, and spatial statistics. The emphasis is on vector-borne diseases, with one chapter devoted to helminthic diseases. With the exception of the chapter on spatial statistic and GIS, there is little mention of other epidemiologic applications . The book is divided into three parts: three introductory chapters describing the methodology; four chapters which review the applications and provide examples from the authors’ experiences in studying African trypanosomiases, malaria, tick-borne diseases, and human helminthic diseases; and three concluding chapters which describe environmental variables, disease risk forecasting, and the education about and future of remote sensing in human health.Although remote sensing, GIS, and spatial statistics have been reviewed separately elsewhere, the encompassing review, the inclusion of lists of URLs, and the extensive references make the introductory chapters timely and instructive for new users. The audiences that will benefit most from the book include researchers and public health administrators who want to integrate these tools into research, surveillance, and control efforts. This audience, as well as more experienced users, can gain much from the chapters that provide examples of specific applications derived from deep understanding of the biology of disease. The chapters by Rogers, Randolph, and Brooker and Michael, in particular, are based their own research and expertise in trypanosomiasis, tick-borne diseases, and helminthic diseases, respectively.Remote sensing and GIS are particularly relevant to emerging infectious diseases. The chapter entitled Forecasting Disease Risk for Epidemic Preparedness provides a road map for developing early warning systems. While this chapter, like the rest of the book, is clearly written by advocates of the applications of remote sensing and GIS, the authors remain aware of critical issues, such as the distinction between statistical and biological models and the notion that insights gained by false negatives and positives predicted by models are as important as successful predictions. Other issues that have hampered more extensive applications of remote sensing and GIS to vector-borne diseases include lack of training, gaps in data , inadequate tools for data gathering, and limits on management and understanding. This book goes a long way to address these issues and is likely to lead to more and improved applications of remote sensing and GIS.


Francisella tularensis: Biology, Pathogenicity, Epidemiology, and Biodefense, published by Blackwell Publishing Limited on behalf of the New York Academy of Sciences. This book is a much-needed comprehensive overview of recent research on the causative agent of tularemia, a potentially serious illness that occurs naturally in the United States. F. tularensis is a marvel among vector-borne agents of infectious disease. It has a wide geographic distribution (covering most of the Northern Hemisphere) and can be transmitted through a variety of routes including 1) tick or insect bites; 2) handling of infected animals; 3) contact with or ingestion of water, food, or soil; and 4) inhalation of contaminated aerosols. Indeed, F. tularensis is notorious for infecting laboratory workers and is a potential bioterrorism agent. The bacterium includes 4 biovars, with the pathogenic type A recently shown to consist of at least 2 subtypes in North America. Natural transmission cycles of F. tularensis are complex and poorly understood.I am pleased to recommend F. tularensis as a disease agent in humans and the 1970s, but few studies focused on this pathogen during the 1980s and 1990s. The recent designations of F.tularensis by the National Institute of Allergy and Infectious Diseases as a priority A pathogen and a potential bioterrorism agent has resulted in an explosion of new studies on this intriguing pathogen. Primary focal points of these studies have included vaccine development, improved pathogen detection methods, evaluation of the genetic variability of F. tularensis biovars commonly associated with human disease, description of the F. tularensis genome, and determination of virulence factors. The wealth of information gained from recent studies is elegantly outlined by an impressive group of world leaders in the field of tularemia research. Chapter topics vary from molecular epidemiology, evolution, and ecology of Francisella to genetics, genomics, and proteomics of F. tularensis, molecular and genetic basis of pathogenesis of F. tularensis, animal models, immunity and immunopathogenesis, diagnosis and therapy, vaccine development, and biosafety issues.Research on a broad variety of topics was carried out between the 1914 recognition of F. tularensis, and the role of different transmission routes to humans. As the field of F. tularensis and tularemia research moves forward in the 21st century, the explosion of knowledge related to genetics, immunology, and pathogenesis of F. tularensis needs to be complemented by renewed studies on natural transmission cycles, transmission routes to humans, and epidemiology.Reflecting a disturbing paucity of epidemiologic and field-oriented studies in the past 20 years, especially in North America, only a few chapters include some information on epidemiology, natural transmission cycles of


Human enteric viruses and protozoal parasites are important causes of emerging food and waterborne disease. Epidemiologic investigation and detection of the agents in clinical, food, and water specimens, which are traditionally used to establish the cause of disease outbreaks, are either cumbersome, expensive, and frequently unavailable or unattempted for the important food and waterborne enteric viruses and protozoa. However, the recent introduction of regulatory testing mandates, alternative testing strategies, and increased epidemiologic surveillance for food and waterborne disease should significantly improve the ability to detect and control these agents. We discuss new methods of investigating foodborne viral and parasitic disease and the future of these methods in recognizing, identifying, and controlling disease agents.


Cancer incidence during 1972-90 in Asian migrants to New South Wales, Australia, is described. Overall cancer incidence was lower than in the Australia born in most migrant groups, and this reached significance in migrants born in China/Taiwan, the Philippines, Vietnam and India/Sri Lanka, and in male migrants born in Indonesia. For the majority of cancers, rates were more similar to those in the Australia born than to those in the countries of birth. For cancers of the breast, colorectum and prostate, rates were relatively low in the countries of birth, but migrants generally exhibited rates nearer those of the Australia born. For cancers of the liver and cervix and, in India/Sri Lanka-born migrants, of the oral cavity, incidence was relatively high in the countries of birth but tended to be lower, nearer Australia-born rates, in the migrants. For these cancers, environmental factors related to the migrant's adopted country, and migrant selection, appeared to have a major effect on the risk of cancer. For certain other cancers, incidence was more similar to that in the countries of birth. Nasopharyngeal cancer, and lung cancer in females, had high rates in both the countries of birth and in migrants to Australia. Nasopharyngeal cancer rates were highest in China/Taiwan and Hong Kong-born migrants, and were also significantly high in migrants from Malaysia/Singapore, Vietnam and the Philippines. Rates of lung cancer were significantly high in women born in China/Taiwan, and the excess was greater for adenocarcinoma than for squamous cell carcinoma. Melanoma had low rates in both the migrants and in the countries of birth. For these cancers, it was probable that genetic factors, or environmental factors acting prior to migration, were important in causation.


On Friday, 21 September 2007, in Lyon, France, we lost a great human being, a staunch advocate for public health, a thorough and delving scientist, and a humanitarian par excellence. Lorenzo Tomatis, MD, above all, was a learned teacher and creative innovator. His accomplishments are legion, and his far-reaching impact on human health, including the well-being of future generations, will be impossible to replace. Tomatis was clearly a true pioneer and admired leader in primary disease prevention. He stands tall among other giants and trailblazers of environmental health science and public health advocacy including Cesare Maltoni, Norton Nelson, David Rall, and Irving Selikoff. At the same time, Tomatis was respected, admired, and loved by his colleagues and fellow public health advocates as a man whose warmth, humor, strength, and sweetness were as compelling as his command of science.IARC Monographs on the Evaluation of Carcinogenic Risk to Humans . Since 1972, when the first monograph was published, this series of nearly 100 volumes has provided objective evaluations of carcinogenicity on agents, mixtures, and exposure circumstances. Not only did Tomatis design and develop the IARC Monographs, he was a principal leader in the scientific community in recognizing the essential value of transplacental and transgenerational carcinogenesis and developing methodologies to determine the influence of early-life exposures. Then and over time, these innovations spurred further primary prevention strategies of action and additional experimental derivatives. As a champion of modern carcinogenesis bioassays, Tomatis led the difficult course of defining the applicability and utility of these experimental animal findings for preventing cancers in humans, especially in workers and children.During his tenure at the International Agency for Research on Cancer (IARC), Tomatis was instrumental in creating what has come to be recognized and known as the monument of primary prevention of cancer: the Tomatis was born in Sassoferrato, Italy, and began his professional career upon graduating from the University of Turin with a degree in medicine in 1953, in hygiene and preventive medicine in 1955, and in occupational health in 1957. Tomatis recognized early on that, although he enjoyed serving the medical needs of individuals, his passion for fostering public health, merged with scientific undergirding, led him to new and different challenges. In 1959, newly arrived at the University of Chicago, he began studying occupational disease and became immersed in cancer research, particularly cancer causation. Almost immediately he recognized the obvious value and significance of preventing disease, particularly occupational cancers, rather than relying on the then-current direction of cancer diagnoses and treatment. His lifework was ultimately dedicated to this vital mission.IARC Monographs. This public health breakthrough had instantaneous and, as we now know, enduring impact throughout the world. In fact, IARC quickly became known predominantly for the IARC Monographs, its most visible and useful product. This international recognition of the value and authority of the IARC Monographs was bolstered by the impartial and scientific process initiated by Tomatis for evaluating chemical carcinogens. Tomatis and IARC staff brought together working groups of independent scientists with vast knowledge of chemical carcinogenesis to evaluate the available information used to prepare the objective IARC Monographs.In 1967, Tomatis moved to Lyon, France, as one of the first leadership employees of the newly established IARC. Upon arriving, he formed the Unit of Chemical Carcinogenesis. There he envisioned and began to effectuate more than a monolithic cancer research program—he insisted on a solid effort on primary prevention of cancer. His view on prevention came to fruition in 1972 with the publication of the first volume of the In January 1982, in recognition of his outstanding career and contributions in understanding cancer causation and prevention, Tomatis was elected by the World Health Organization (WHO) member nations as the second director of IARC. He was reelected and served as director for a full 12 years, until his retirement in December 1993. During his tenure at IARC, Tomatis and the international IARC staff developed a mutual respect and appreciation for each other and were unified in promoting the agency’s mission of improving public health through primary disease prevention. Upon retirement from IARC/WHO, he served as scientific director of the Institute of Child Health “Burlo Garofolo” in Trieste, Italy, from 1996 to 1999.Shortly thereafter, Tomatis joined the National Institute of Environmental Health Sciences (NIEHS) in North Carolina to focus on issues that he had little time to pursue while serving as the director of IARC. Under the International Scholar Program, Tomatis worked at the NIEHS for six summers, sharing his professional experience and writing important papers on environmental public health and prevention. During that time, he was also the chairman of the Scientific Committee of the International Society of Doctors for the Environment in Arezzo, Italy.The Unlimited Research 1974, Seen from the Inside 1981, Natural History of the Researcher 1985, The Laboratory 1993, The Reelection 1996, and The Refugee 2005.Tomatis was born in Italy, worked in the United States, and spent most of his professional career in France; he was a person of immense global scientific and public health impact. Able to speak four languages—Italian, French, English, and German—Tomatis traveled the world to spread his undiluted message of primary prevention of diseases, especially cancer. He was as prolific as he was dedicated to protecting the environment, including workplaces and public health, and he was an early and long-standing champion of environmental and social justice. Much of his science is captured in 10 books and more than 350 scientific papers. Being a renaissance man, Tomatis also wrote books for the public based on his medical, scientific, and humanitarian experiences: His gifts to humanity are well recognized in saved lives and a cadre of scientists influenced by his magnanimity, honesty, sense of ethics, and moral character. Most will remember Tomatis for his brilliance in science and public health thought, but he will more likely be venerated for his generosity and compassion. His heroic scientific determination and his adventurous spirit and love of people inspired Tomatis to live life to its fullest. He is survived by his wife, Delia, in Trieste, and their son, Paolo, who lives and works in Rome.His gifts to humanity are well recognized in saved lives and a cadre of scientists influenced by his magnanimity, honesty, sense of ethics, and moral character.


In the globalized political economy of the late 20th century, increasing social, political, and economic interdependence is occurring as a result of the rapid movement of people, images, values, and financial transactions across national borders. Another consequence of the increase in transnational trade, travel, and migration is the greater risk of cross-border transmission of infectious diseases. As the world becomes more interconnected, diseases spread more rapidly and effectively. With more than one million people crossing international borders every day, and with the globalization of food production, manufacturing, and marketing, the risk of infectious disease transmission is greater. Economic globalization has also increased the need for governmental budget austerity, and consequent national preparedness has been eroded. The emergence of new infectious diseases, as well as the reemergence of old ones, thus represents a crucial transnational policy issue. These problems cannot be resolved by national governments alone; they require international cooperation. This article analyzes the role of foodborne disease surveillance programs, nationally and internationally, in the control of foodborne diseases.


In the present paper, we consider the impact of HIV/AIDS on human development in African countries, showing that, beyond health issues, this disease should and must be seen as a global development concern, affecting all components of human development. Consequently, we stress the necessity of multidisciplinary approaches that model, estimate and predict the real impact of HIV/AIDS on human development of African countries in order to optimise the strategies proposed by national countries, international institutions and their partners.In our search strategy, we relied on secondary information, mainly through National Human Development Reports of some African countries and regular publications released by the United Nations (UN), United Nations Development Programme (UNDP), World Health Organization (WHO) and the World Bank. We restricted ourselves to reports dealing explicitly with the impact of HIV/AIDS on human development in African countries.HIV/AIDS is affecting the global human development of African countries through its devastating impact on health and demographic indicators such as life expectancy at birth, healthcare assistance, age and sex distribution, economic indicators like income, work force, and economic growth, education and knowledge acquisition and other indicators like governance, gender inequality and human rights.On the basis of the national reports reviewed, it appears clearly that HIV/AIDS is no longer a crisis only for the healthcare sector, but presents a challenge to all sectors. Consequently, HIV/AIDS is a development question and should be viewed as such. The disease is impeding development by imposing a steady decline in the key indicators of human development and hence reversing the social and economic gains that African countries are striving to attain. Being at the same time a cause and consequence of poverty and underdevelopment, it constitutes a challenge to human security and human development by diminishing the chances of alleviating poverty and hunger, achieving universal primary education, promoting gender equality, reducing child and maternal mortality, and ensuring environmental sustainability. Since 1990, five main composite indices were developed by the United Nations to measure the average achievements in basic human development (human development index (HDI), gender-related development index (GDI), human poverty indices (HPI-1 and HPI-2) and the gender empowerment measure (GEM) . HDI is In the present paper, we consider the impact of HIV/AIDS on human development in African countries, showing that, beyond health issues, this disease should and must be seen as a global development concern, affecting education and knowledge acquisition, income and social status, productivity and economic growth, and other direct and indirect components of human development such as gender equality and human rights. Consequently, we stress the necessity of multidisciplinary approaches that model, estimate and predict the real impact of HIV/AIDS on human development of African countries in order to optimise the strategies proposed by national countries, international institutions and their partners.In our search strategy, we relied on secondary information mainly through National Human Development Reports of some African countries and regular publications released by the United Nations (UN), United Nations Development Programme (UNDP), World Health Organization (WHO) and the World Bank. For national reports, we restricted ourselves to the eight National Human Development Reports which dealt explicitly with the impact of HIV/AIDS globally on human development, or partially on its components during the last years.With malnutrition as a common contributor, the five biggest infectious killers in the world are HIV/AIDS, malaria, tuberculosis, acute respiratory infections and diarrhoeal disease, responsible for nearly 80% of the total infectious disease burden and claiming about 12 million people per year Table  5]. Des. Des5]. During the last decades, the prevalence and incidence of HIV/AIDS have seen an exponential growth Figure . AfricanThe 2007 Zambia Human Development Report (HDR) focuses on the sixth Millennium Development Goal (MDG), which is combating HIV/AIDS, malaria and other diseases. Under the title "Enhancing household capacity to respond to HIV and AIDS" , it is iStressing the danger of the growing prevalence of HIV/AIDS Table , the MozKenya National HDR 2006 has dealt with HIV/AIDS as a challenge to human security and human development . As streUnder the title "reversing HIV/AIDS in Malawi", the Malawi HDR 2005 devoted a chapter to the impact of HIV and AIDS on households welfare, orphaned children, the extended family, educational and health sectors, agricultural production, business and public service delivery. The chapter concludes that HIV and AIDS have the potential to reverse those gains made in human development in the last few years .According to the Benin HDR 2005, HIV/AIDS is at the same time a cause and consequence of poverty and underdevelopment . AccordiThe prevalence of HIV/AIDS varies according to different regions of Benin. The region with the highest prevalence has the lower life expectancy index Table .Zimbabwe HDR 2003 "towards reducing vulnerability: the ultimate war for survival", states that HIV/AIDS is impeding development by imposing a steady decline in the key indicators of human development. The report concludes that it is critical that the relationship between epidemic and human development be acknowledged at all levels and that the principles of sustainable development be a major focus and priority of the country's policies and programmes . ZimbabwSouth Africa HDR 2003 indicates the magnitude and far-reaching consequences of the HIV/AIDS pandemic, stressing that the disease is no longer a crisis only for the healthcare sector, but presents a challenge to all sectors . The repUnder the title "Towards an AIDS-Free generation" , the BotAs indicated in Table In 1999, the Commission on Macroeconomics and Health was established to explore the relationship between health and economic development. In the report published by the commission in 2001, empirical evidence was provided on how investing in health can achieve economic development and poverty reduction. It was indicated that, by 2010, eight million lives per year could be saved by essential interventions against infectious diseases and nutritional deficiencies, resulting in economic benefits adding up to more than US$ 360 per year by 2015 . In ordeHowever, beyond the international agreement on principles, at the 7-year juncture, most African countries, have made little (if any) headway in preventing and controlling the HIV/AIDS epidemics in particular, nor in reducing the rates of extreme poverty and making progress in the MDGs targeted for 2015 in general ,24. MeanHIV/AIDS is directly affecting heath and demographic indicators such as mortality rates, life expectancy, and sex and age distributions. By 2000-2005, Zimbabwe, Botswana, Swaziland and Lesotho have lost respectively 35, 28, 28 and 24 years of life expectancy ,18-20. MThe burden of the disease is not felt only at individual level; it affects households, communities and the whole nation  ,15,17. MContrary to the majority of diseases, HIV/AIDS kills and disables adults in the most productive part of their lives. Consequently, it is affecting business, investment, industry and agricultural sustainability, and ultimately reducing families' income and economic growth. Although at different degrees, all the national reports reviewed stress the negative impact of HIV/AIDS on income at individual, community and national levels -18.At the moment, it is difficult to estimate precisely the real economic impact of HIV/AIDS on the whole African continent. However, many tentative estimates have been made. In 2000, the World Health Organization estimated a yearly reduction of 1% of the GDP in the most affected African countries. In 2002, UNAIDS gave a much higher estimation of 2.6%. According to the Macroeconomics and Health Commission, in 2001, the cost of HIV/AIDS was between 11.7% and 35.1% of the Gross National Product in Africa . For SouThese partial and sometimes controversial estimates, combined with the paucity of national data, indicate the necessity of global interdisciplinary studies that can model, estimate and predict the economic impact of HIV/AIDS in Africa.As stressed in the MDGs, education is essential for human development and needs to be enhanced especially in low- and medium-income countries. Unfortunately, HIV/AIDS is reversing the trend towards the achievement of universal primary education in most African countries. In Africa, less than 65% of children are enrolled in primary school ,29 and tOn the basis of the national reports reviewed, it appears clearly that HIV/AIDS is no longer a crisis only for the healthcare sector, but presents a challenge to all sectors . ConsequWe are aware of the importance of the topic considered in this paper and the necessity to deal with it seriously and precisely. However, our search relied only on published data by different African countries and international institutions. Consequently, we were limited to data and the numbers available and this may be frustrating not to give a complete panorama of this interesting subject.This paper is dedicated to African children afflicted by poverty and HIV/AIDS epidemics.The author declares that they have no competing interests.


Pulmonary hypertension (PH) is a very complex disease, characterized by a progressive increase of pulmonary vascular resistance and pulmonary artery pressure, leading to right ventricular failure and death. The mediIn 1987, three PH patients decided to change this very dismal picture for those who suffered from PH. At that time there was not much hope and little knowledge, secondary to very few and inconsistent research activities. The three patients, Dorothy Olson, Teresa Knazik, and Shirley Brown met each other through the National Organization for Rare Disorders (NORD) and were soon joined by a fourth person, Pat Paton. These four agreed to organize their work in order to: help patients and their families in coping with this devastating disease, provide networking opportunities to end the feeling of loneliness of a rare illness, assist in locating doctors and medical facilities with expertise in managing PH, form support groups to allow patients to communicate with others, and begin to publish a newsletter that would build a sense of community.Only three years later, the Pulmonary Hypertension Association (PHA) was formed by more than 100 members, and a newsletter, “Pathlight”, was published. A Scientific Advisory Board was created and a PH hotline number for patients (manned by a patient volunteer) was established. In 1994, PHA held its first International Conference. Since 1994, PHA has grown to an organization of more than 3,400 members, which includes patients, caregivers, physicians, and other professionals treating the disease.The Saudi Advisory Group for Pulmonary Hypertension (SAPH) has a very similar history. After recognition of lack of PH awareness among local physicians and caregivers, and the very poor outcome of this devastating disease that affects many patients in Saudi Arabia, five Saudi physicians constituted the nucleus of SAPH in 2004. The mission of SAPH was to devote its efforts toward the patients suffering from PH, by support, education, and treatment. The initial goals of SAPH were to carry out a national registry of PH cases all over the Kingdom of Saudi Arabia (KSA), to determine the reliable prevalence of PH in the KSA, to establish updated and complete guidelines for the diagnosis and treatment of this disease, to increase the awareness of PH, and to promote the interest for epidemiological and interventional studies in the field of PH.By 2009, the number of SAPH members increased to more than 65, mostly physicians. The followings were achieved:SAPH is now recognized regionally and somewhat internationally for its services in the field of PH. Since 2007, it has joined and represents the Eastern Mediterranean Region (EMR) office for the global Pulmonary Vascular Research Institute (PVRI)Publication of Saudi Guidelines for the Diagnosis and Management of PAHSAPH has started a national registry for PH in the KSAResearch work: SAPH has recognized the importance of research, and continues to work on raising funds for this particular issue. At present, different research proposals have been forwarded to the SAPH research committee for approval, such as, prevalence of sickle cell and PH in Saudi Arabia (EMR project), Schistosoma and PH in Saudi Arabia (EMR project), high altitude PH, Saudi Experience, genetic studies in Saudi patients with congenital heart disease, Bronchiectasis and PH in Saudi patients, role of selective therapy in submassive pulmonary embolism, and lloprost experience in PH patients in a tertiary care Saudi hospital,www.saph.med.sa. The website describes all the activities of the different task forces and is open to the general public for communication.Website: SAPH has finalized the website, which has both English and Arabic locations. The website address is: Scientific and education: Annual PH Scientific Meetings: Two scientific meetings have already been carried out. The first and second were conducted in Dubai, UAE and Casablanca, Morocco, in the years 2007 and 2009, respectively. The Third Joint (SAPH / PVRI) International PH Meeting  will be held in Sharm El-Sheik, Egypt in April 2010. The scientific activities have also included awareness days for physicians and nurses, PH day, and awareness materials. SAPH is educating the community and the patients (and their families) by distributing articles and media presentations in both Arabic and English. SAPH has decided to start training sessions for Pulmonary and Cardiology Fellows in the field of PH.We, in the SAPH, invite all interested physicians, caregivers, and patients to join this group. We hope that our effort will meet the effort of the others in order to reach our target and to fulfill our mission toward our patients.


George Martin Baer, DVM, MPH, who for many years was chief of the Rabies Laboratory in the Division of Viral and Rickettsial Diseases at the Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA, died suddenly at his home in Mexico City on June 2, 2009, at the age of 73. He was an eminent veterinary virologist whose book, The Natural History of Rabies, the second edition of which was published in 1991, is the major reference work in the field.He has been widely acclaimed as “the father of oral rabies vaccination” as a result of his discovery of a strain of rabies virus (SAD strain) that immunizes foxes when given into the mouth cavity. His intensive work on the development of baits for vaccine administration to canines paved the way for successful mass fox vaccination campaigns conducted in Switzerland, several other European countries, and Canada.Dr Baer was born in London in 1936, but after the outbreak of World War II his family moved to the United States, and he was brought up in New York. He attended Cornell University in Ithaca, New York, and received a bachelor of science degree in agricultural sciences in 1954 and a Doctor of Veterinary Medicine degree in 1959. In 1961, he earned a Master of Public Health degree from the University of Michigan at Ann Arbor. He then came to CDC as an Epidemic Intelligence Service Officer, initially assigned to the New York State Health Department in Albany, where he first became interested in rabies. He subsequently joined the CDC Southwest Rabies Investigations Laboratory in Las Cruces, New Mexico, and from 1966 through 1969 was a consultant for the Pan American Health Organization in Mexico. He returned to CDC in Atlanta in 1969 to become chief of the Rabies Laboratory and served until his retirement in August 1991. He and his family then moved to Mexico City, where he founded a diagnostic laboratory and continued to use his expertise on rabies as a member of the Mexican International Steering Committee for the Rabies in the Americas Conference.Dr Baer was a valued supporter of and reviewer for Emerging Infectious Diseases and will be greatly missed. We offer our condolences to his wife, Maria Olga, and daughters, Katherine, Alexandra, and Isabella, as well as to his 4 granddaughters.


The Molecular Biology of Cancer; Blackwell Publishing, Oxford (U.K.); 2006. 531 pages, 214 illustrations, ISBN 9-78140-511-814-9, £31.99.Here, a review of "The Molecular Biology of Cancer" (Stella Pelengaris and Michael Khan [Editors]) is given. The detailed description of the book is provided here: Pelengaris S, Khan M (Eds):  There are a fair number of books, dealing with cancer biology; unfortunately, they arelimited to certain cancertypes and dated. Here, Pelengaris and Khan familiarize the reader with the cancer cell in Chapter one and selected human cancers in Chapter two. A capturing, comprehensive, clearly written and absolutely accurateintroduction into cancer biology, necessary to understand how tumors evolve, develop and progress is offered in Chapters three through fourteen. This book deserves great praise for the readable presentation of this complex field. Nothing is simplified for the sake of the flow of the text. A brief description of the content of Chapters three to fourteen is presented below.Chapter three focuses on 'nature and nurture in oncogenesis' with emphasis on the role of environmental carcinogens and the influence of environmental as well as individual risk factors on development and progression of cancers along with a brief introduction into the multi-stage-concept of cancers. DNA replication and cell cycle are discussed in Chapter four. Here, concepts like duplication of DNA, addiction of cancer cells to oncogenes and phases/checkpoints of the cell cycle & currently accepted understanding of signaling cascades, utilized to tightly control the progression through the cell are presented and discussed. In turn, the foundation to comprehend one of the hallmarks of cancer – uncontrolled progression through the cell cycle – is provided. Logically, interested readers find an introduction into the regulation of growth in Chapter five. For example, growth factors and cognate receptors, signaling pathways, cellular senescence, apoptosis and survival are elegantly introduced and woven into an appropriately simplified view with plenty of cited reference for further reading. A more detailed discussion of oncogenes and tumor suppressor genes is the given in the next two Chapters, followed by an expanded introduction into the cell death in Chapter eight. Cellular senescence is then discussed in Chapter nine, beginning with the classical observation of a crisis in a cultured cell population and ending with a briefing on telomeres. Leaving the basic cellular machinery and moving into genetic instability, Chapter ten opens the horizon for caretaker genes and how signaling machines recognize damaged DNA and regulate and tune the repair process. Epigenetic levels, post-transcriptional modifications of mRNA, RNA interference and post-translational modifications of proteins are presented in Chapter eleven with a narrowed view on cancer biology. It is noteworthy that the rapidly emerging field of RNA biology, e.g. micro and piwi-interacting RNA and non-coding RNA is fairly under-represented.One of the properties of cancer cells is the anchorage-independent growth. Concordantly, the topic, including but not limited to, cell-matrix adhesion, cell-cell interactions and malignancy is discussed in Chapter twelve. Beginning with the architecture of tissues in general, the reader is introduced into the cell biology of the basal membrane, adhesion molecules and, then, the field of cell-cell interactions. With this knowledge, the critical steps in the dissemination of metastases are highlighted, leading to an elegant description of the 'seed and soil' hypothesis. Chapter twelve closes with a perspective on cell invasion. Considering the ever-growing field of cancer immunity research, Chapter thirteen provides an insightful introduction along with a selection of questions, remaining to be addressed. A brief background in innate and adaptive response of the human immune system, including a description of major effector cells, cancer immunosurveillance and immunosuppression and tumor antigens enables a reader to comprehend concepts like antigen-specific therapeutic approaches and the usage of cytokines in cancer management and treatment. How tumor cells invade an immune response is highlighted at the end of Chapter thirteen. Related to the preceding discussion, angiogenesis is introduced in considerable depth in Chapter fourteen; for instance, a discussion of general principles of new vessel growth leads to a reflection on pathological angiogenesis and the role of inhibitors in angiogenesis. Further reading directs to nicely written articles, allowing a more detailed exploration of the accumulating evidence. In sum, the philosophical approach to cancer biology and all related topics discussed in the book, along with well-chosen aphorisms, capture the attention of a reader and stimulate creative reading. Especially pleasing is the construction of chapters into introduction, classical experiments, conclusions and future directions. Study questions and topical suggestions for further readinground the chapter into a rich source of information. Balancing the wealth of molecular and cellular information, it is re-iterated that caring for the cancer patient must be part of any successful attempt to manage or, in the best case, cure this devastating disease. In this context, the book covers aspects of diagnosis and treatment of cancer in order to provide a full view of efforts to understand cancers at the most detailed levels, yielding profound strategies to prevent and cure malignancies. Diagnosis of cancer, its treatment options and the concept of patient care are presented in Chapters fifteen through seventeen. Here, the true synthesis of bench and bedside approaches is marvelously achieved by giving a thoughtful background in the role of molecular pathology in cancer diagnosis and staging, imaging techniques, radio- and chemotherapy, palliative care and the quality of a life at its end with numerous examples of recent developments and practical and ethical issues around cancer research.The only weakness of the bookis the last chapter, dealing with genomic and proteomic approaches in cancer research and diagnostic. While the chapter in itself is superbly written and of outstanding merit, it could have been incorporated into the Chapters three through fourteen, thus, elevating this book to the status of a classical textbook. Students, preparing for exams, seasoned colleagues and laypersons will find it difficult to ignore and resist the book. As the field progresses and new avenues are opened, this textbook will pass the test of time and remain a companion to the community.Molecular Cancer and receives no remuneration for his efforts.C.S. is Deputy Editor of C.S. drafted, finalized and approved of the final version of this article.


Travel is a potent force in the emergence of disease. Migration of humans has been the pathway for disseminating infectious diseases throughout recorded history and will continue to shape the emergence, frequency, and spread of infections in geographic areas and populations. The current volume, speed, and reach of travel are unprecedented. The consequences of travel extend beyond the traveler to the population visited and the ecosystem. When they travel, humans carry their genetic makeup, immunologic sequelae of past infections, cultural preferences, customs, and behavioral patterns. Microbes, animals, and other biologic life also accompany them. Today's massive movement of humans and materials sets the stage for mixing diverse genetic pools at rates and in combinations previously unknown. Concomitant changes in the environment, climate, technology, land use, human behavior, and demographics converge to favor the emergence of infectious diseases caused by a broad range of organisms in humans, as well as in plants and animals.


Journal of Trauma Management & Outcomes an exciting, new, online journal, specifically dedicated to the epidemiology, care, and outcomes of severely injured patients.Welcome to The journal willconsider articles on all aspects of trauma research, with a focus on interventions with proven efficacy or inefficacy in improving clinically relevant outcomes such as mortality, morbidity, quality of life, function, and costs. It will serve as a scientific platform for clinical researchers and practitioners involved in the different stages of caring for patients with musculoskeletal, visceral, and multiple injuries.Journal of Trauma Management & Outcomes together with BioMed Central.Whilst other established journals exist in this field, several factors convinced me, and the fine members of our international Editorial Board , to launFirst, the projections of the World Health Organization on changes in the rank order of the global burden of disease are simply alarming. If they prove true (and there is no reason to doubt the forecasts), trauma will rank third (!) among all causes for disability in 2020 worldwide [Mobility is an integral part of our life, but we also have to deal with its adverse effects. With the exponential growth of motorization in developing nations, especially in Asia, and the demand for more powerful and faster vehicles in the industrial countries, the face of road crashes is changing. Traffic accidents affect both the rich and the poor, but the consequences on health-related outcomes are very different. There are few socio-economic areas where inequities and heterogeneity in health care services have such a strong influence on mortality and morbidity, beginning with proper resuscitation on scene, and not ending with physical and mental rehabilitation.Our interdisciplinary team had the opportunity of implementing accident research and prevention programs in Germany and Vietnam , and it Journal of Trauma Management & Outcomes are open access, meaning they are freely and universally accessible online. In addition, the authors hold copyright for their work and grant anyone the right to reproduce and disseminate the article, provided that it is correctly cited and no errors are introduced. The journal's articles are archived in PubMed Central, the US National Library of Medicine's full-text repository of life science literature, and also in other national repositories.This leads me to the second argument in favor of a new journal: Important biomedical information cannot change the world unless it is accessible to everybody. There are many highly reputed journals in the field, but few of them grant readers access to their full content. All articles published in Publishing online only meets the requirements of a modern world, and the quick turnover of medical information. It also shortens the time from peer-review to publication. All articles will primarily be reviewed in-house, and, if suiting the scope of JTMO, sent out to two or more international peer-reviewers. Peer-review will be conducted in an open manner, which, to my and the Editorial Board's members opinion, increases transparency.Apart from all these advantages, there is a little downer: article processing charges need to be covered by authors. This has, however, not impeded the stable growth in the number of articles available open-access, and taking part in this success story may clearly outweigh the inconvenience of paying for publishing. Also, there are many opportunities to apply for a waiver of processing charges that can be found on our website.JTMO will not publish basic research, but target the key components of modern health care-function, quality of life, and costs.Finally, the findings from basic trauma research contributed importantly to the knowledge of human physiology and pathophysiology. However, the research efforts and discoveries on the cellular, genomic, and molecular level are not paralleled by a similar progress in clinical and population-based research on trauma. Many established diagnostic and therapeutic interventions in trauma care have not yet been proven by studies of high methodological rigor, and we currently know much more about the interplay of cytokines than the quality of life of severely injured patients. BioMed Central who helped us in getting the journal started, the members of the Editorial Board, and, of course, the authors of the first articles who made JTMO the journal of their choice.I am thankful to the wonderful people at JTMO will soon become widely known among authors and readers, for the sake and benefit of trauma patients in a world without borders.I am pleased to lead this journal as the Editor-in-Chief, and I hope that the acronym


General Practice/Family Medicine is a specialty focused on the provision of comprehensive, continuing, and community oriented, person-centred care. The lack of prestige and the difficulty in attracting trainees to the specialty have been longstanding problems in most countries around the world. In Europe, General Practice/Family Medicine is also hampered for not being recognized as a specialty throughout Europe. As for Portugal, General Practice/Family Medicine is undergoing a massive organizational reform, as well as unprecedented levels of popularity among trainees.General Practice/Family holds tremendous latent potential, and is thus a specialty with a bright future ahead. It could well establish itself as the specialty of the future if it is able to overcome the barriers that currently make of General Practice/Family Medicine an unpopular career choice. It is important to train confident, competent and polyvalent family physicians, but it is also necessary to overhaul payment schemes, to invest in primary care infra-structure and organization, and to continue to attract more and more bright and motivated trainees. General Practice has always lagged behind hospital specialties in terms of pulling power for the future generations of specialists.In a recent article, Dr Juan Gérvas defined Primary Health Care as "all the accessible and comprehensive services available to citizens for the follow-up of their health problems. Specialists, Hospitals and emergency departments provide services focused on problems, whereas primary health care is focused on person-centred care."According to the European Society of General Practice/Family Medicine (WONCA Europe), "General practitioners/family doctors are specialist physicians trained in the principles of the discipline. They are personal doctors, primarily responsible for the provision of comprehensive and continuing care to every individual seeking medical care regardless of age, sex and illness. "Core cThe clinical work of general practitioners/family physicians includes health promotion, family health, prevention and treatment of acute diseases, treatment of chronic diseases, adult health, child health, women's health, mental health, rehabilitation and palliative care/terminal care. In termDespite having a properly defined niche and purpose, General Practice/Family Medicine (GP/FM) suffers from lack of prestige. The causes of that lack of prestige include the contemporary culture of health consumerism and the triumph of the individual upon the population, the lack of awareness on behalf of the upper classes, a routine that is assumed to be too overburdened with trivialities and bureaucracy, the myth of a "primitive" and "non-scientific" medicine, and the low technological density.Many European countries and other countries around the world are currently struggling with lack of general practitioners/family physicians, which is aggravated by the classic lack of popularity of the field among medical students and junior doctors. In Portugal, this lack of doctors is concentrated in the metropolitan areas of the largest cities, and Dr Luís Pisco estimates that between 2013 and 2015, about a third of the actual workforce of 6000 primary care physicians will retire[In Portugal, specialist training in GP/FM was increased from three to four years in 2009, and includes, apart from four different rotations in primary health care, compulsory hospital rotations in gynaecology and obstetrics, paediatrics, mental health/psychiatry, and emergency medicine. It also caters for a number of elective rotations and short rotations aimed at the acquisition of specific skills. FurtherThe author of this article informally surveyed a number of family doctors and vocational trainees through national mailing lists in Portugal and Spain (with around 600 and 450 members respectively), as well as most trainees and tutors from his health care centre, in order to gauge what doctors considered to be the most positive and negative aspects of the specialty. Two members of the Portuguese mailing list and three members of the Spanish mailing list replied. The most positive aspects included being the least hierarchical specialty, the large number of opportunities available, the holistic approach, the possibility of solving the great majority of health problems, the absence of limits in terms of knowledge, and the greater compatibility with family life.The most negative aspects pointed out were the system of fixed salaries and lack of incentives in place, the "existential crisis" the specialty is going through in Europe, the greater tendency towards professional stagnation and isolation, the lack of time during appointments, and the limitations to carrying out technical procedures.At a European level, there is a lack of harmonization, as GP/FM is considered a specialty in most but not all European countries,9. StillDenmark, The Netherlands, UK, and Spain have been considered for a long time the leading nations in GP/FM. On the Contrarily to what many people think, GP/FM is alive and well, but there's still a long way to go. There are new challenges, new barriers, new threats, but also new opportunities.st century GP/family physician must be self-confident and believe in oneself, must know how to cooperate with other health care professionals and levels of care, must know how to think in terms of both the individual patient and in terms of the community the patient belongs to, must practice with human and technical quality, must fight against the abuse of technology and the fragmentation of healthcare, and is expected to be prestigious, competent and polyvalent[In order to succeed, the 21olyvalent.st century, and in the case of the Portuguese reality, has been growing frankly in terms of quality and quantity, fuelled in large part thanks to the massive organizational reform of primary health care in Portugal and the fact that General Practice/Family Medicine is already a first choice for many junior doctors in Portugal[General Practice/Family Medicine has great potential for scientific development in the 21 Portugal.It is already widely acknowledged that the countries with the best health systems are usually those with a strong primary care infrastructure: they tend to have healthier populations, fewer health-related disparities and lower overall costs for health care. If thatThe answer is not straightforward. Making General Practice/Family Medicine more attractive is surely part of the equation, but it is also undoubtedly important not to neglect the importance of improving payment schemes, as family physicians tend to earn less than hospital specialists, as well as of investing in primary care infra-structure and organization, like high quality health information technology.It is also important not to forget that there are significant differences between different European countries in terms of the existence of structured curricula for vocational training, funding for structured vocational training, professional recognition of trainers, equity of salary between hospital and GP trainees, and these are issues that must also be addressed in order to increase the appeal of GP/FM.st century medicine.The struggle for European recognition is ongoing, as general practice/family medicine aims to establish itself as the paradigm of 21Tiago Villanueva is a member of the Organizing Committee of the Second Virtual Congress of General Practice/Family Medicine.


Journal of Foot and Ankle Research (JFAR) is a new, open access, peer-reviewed online journal that encompasses all aspects of policy, organisation, delivery and clinical practice related to the assessment, diagnosis, prevention and management of foot and ankle disorders. JFAR will cover a wide range of clinical subject areas, including diabetology, paediatrics, sports medicine, gerontology and geriatrics, foot surgery, physical therapy, dermatology, wound management, radiology, biomechanics and bioengineering, orthotics and prosthetics, as well the broad areas of epidemiology, policy, organisation and delivery of services related to foot and ankle care. The journal encourages submission from all health professionals who manage lower limb conditions, including podiatrists, nurses, physical therapists and physiotherapists, orthopaedists, manual therapists, medical specialists and general medical practitioners, as well as health service researchers concerned with foot and ankle care. All manuscripts will undergo open peer review, and all accepted manuscripts will be freely available on-line using the open access platform of BioMed Central. Journal of Foot and Ankle Research (JFAR) is a new, open access peer-reviewed online journal that encompasses all aspects of policy, organisation, delivery and clinical practice related to the assessment, diagnosis, prevention and management of foot and ankle disorders. JFAR is the official research publication of the Society of Chiropodists and Podiatrists (UK) and the Australasian Podiatry Council. However, the Editorial Board encourages submission from all health professionals who manage lower limb conditions, including podiatrists, nurses, physical therapists and physiotherapists, orthopaedists, manual therapists, medical specialists and general medical practitioners, as well as health service researchers concerned with foot and ankle care.JFAR builds upon a long and proud history of scholarly publication in the podiatry profession. The first foot-related journal in the UK, The Chiropodist, was published by the National Society of Chiropodists in January 1914. The National Society of Chiropodists was wound up in 1915, to be replaced with the Incorporated Society of Chiropodists, which published its first journal as a continuation of The Chiropodist. Following the amalgamation of the Incorporated Society of Chiropodists with four other bodies at the end of 1945, the newly formed Society of Chiropodists produced its first journal, still called The Chiropodist, in January 1946. This incarnation of the journal was continuous up until January 1989, when it was merged with the British Journal of Chiropody . The new journal was still called The Chiropodist, but with a new sub-title: The Journal of British Podiatric Medicine, which became the full title in 1991. The final manifestation of the journal – the British Journal of Podiatry – represented a merger between The Journal of British Podiatric Medicine and the British Journal of Podiatric Medicine and Surgery, which occurred in response to the amalgamation of the Podiatry Association, the Association of Chief Chiropody Officers and the Society of Chiropodists to form the Society of Chiropodists and Podiatrists in 1998 [The Chiropodist did have a small number of eager subscribers in "The Colonies"  was published. This journal was renamed the Australian Podiatrist in 1974. Most recently, following the amalgamation of the Australian Podiatry Council and the New Zealand Society of Podiatrists to form the Australasian Podiatry Council in 1997, the Australian Podiatrist merged with the New Zealand Journal of Podiatric Medicine to form the Australasian Journal of Podiatric Medicine  was published in November 2007 [Australasian Journal of Podiatric Medicine  was published in December 2007 [Journal of Foot and Ankle Research (JFAR).In 2005, tentative steps were taken to extend the degree of collaboration between the two organisation's journals via the reciprocal publication of selected papers . Finally, following several discussions between 2005 and 2006, including a meeting held during the 21ber 2007 , and thetry Vol. , No. 4 wJFAR, is the world's largest open access publishing company, and currently produces 186 journals.The re-evaluation of scholarly publishing by the Australasian Podiatry Council and Society of Chiropodists and Podiatrists coincided with a major upheaval in biomedical publishing. Motivated by the growth of the internet and a desire to enable wider access to scientific information, the concept of open access publishing gathered considerable momentum in the late 1990s -14. OpenOpen access publishing with Biomed Central offers several significant benefits over the traditional publication model , includiJFAR, this process is streamlined due to BioMed Central's web-based system for submission and for referees to view manuscripts and return their reviews.(i) Rapid peer review: the peer review process in many journals is often frustrating and time-consuming, and may in some cases take over 12 months to complete. For JFAR provides authors with access to a truly global readership in medicine and allied health. PubMed [JFAR – the Australasian Journal of Podiatric Medicine and the British Journal of Podiatry – were not indexed in PubMed, and several current foot and ankle journals, such as Foot and Ankle Surgery and The Foot are also not indexed in PubMed. BioMed Central also participates in CrossRef [(ii) High visibility and accessibility: publishing in . PubMed , the worCrossRef  and the CrossRef , allowinJFAR, this unnecessary delay is removed, and articles will be published on-line within a few days of editorial acceptance.(iii) Vastly reduced time period between acceptance of a manuscript and its publication: for most journals, it can take between six and 24 months from acceptance of a paper to final availability in hard copy. This delay occurs because of the need to produce paper issues on a monthly, bimonthly or quarterly basis with a fixed number of pages, which can create a substantial publishing backlog. With (iv) The author retains copyright: with traditional journals, the author transfers ownership of their article to the publisher, who can legally restrict access to the article (even to the point of restricting sharing of the article between colleagues). With open access journals, the author retains copyright and grant any third party the right to use the article freely, as long as its integrity is maintained and its original authors, citation details and publisher are identified.(v) Web-based flexibility: traditional print journals are forced to restrict the size of articles due to the cost of producing printed issues. In some journals, articles are restricted to 2,000 words or less, which creates difficulties for authors and may require the deletion of potentially important information. In addition, many journals charge the author for reproduction of colour images. In contrast, the web interface of BioMed Central journals allows for larger articles, and the unrestricted inclusion of non-written material such as high resolution colour photographs, additional datasets and movie files.Articles published in open access journals are subject to an article processing charge, which helps fund the journal and enables free access to articles worldwide. If the submitting author of a manuscript belongs to an institution that has a subscription to BioMed Central, the article processing charge is waived. There are currently 319 Members and Supporter Members in 34 countries . AuthorsJFAR is supported by the premier bodies of the podiatry professions in Australasia and the UK, the journal will inevitably have a strong podiatry emphasis. However, the editors acknowledge that the management of foot conditions encompasses a range of health care professionals [JFAR will therefore welcome all manuscripts that advance our understanding of foot disorders, irrespective of the professional background or country of origin of the contributing authors. In doing so, we hope to foster greater awareness and collaboration between foot health professionals, and help break down historical, national and political barriers impeding the progress and advancement of foot and ankle care.Scholarly journals exist primarily as an avenue for the dissemination of research findings. For clinical journals, this dissemination should ideally encompass both "researcher to researcher" and "researcher to clinician" transfer of information, in order to educate clinicians and ultimately improve clinical outcomes for patients. However, it has been argued that journals have several broader roles, such as promoting and reforming the professions they serve . As JFARssionals , and thaJFAR will focus primarily on original research articles, but will also publish editorials, methodology articles, letters to the editor, study protocols and reviews. Case reports will only be considered if they provide unique or important additional insights into the causes or treatment of foot and ankle disorders. In addition, case reports must be evidence-based where good evidence is available [JFAR will initially be reviewed by the editors and subsequently by two external peer reviewers. Reviewers will be asked to indicate whether the manuscript is scientifically sound, relevant and also to indicate the level of interest to foot health professionals.vailable . ManuscrJFAR operates a fully open peer review system, meaning that the identity of the authors is known to the reviewers, and vice versa. There is no evidence that such a system produces better quality reviews or changes reviewers' recommendations compared to traditional "closed" peer review [JFAR website.r review . Howeverr review . All corJFAR, provisional versions of articles will be published on our website [JFAR web archives, as well as PubMed, Google Scholar, Scopus and several other scholarly databases. In addition to providing much wider dissemination of research articles , this alication .JFAR hope that the journal will be entertaining, educational, provocative and clinically useful to all health care professionals involved in the management of foot and ankle disorders. We look forward to receiving your submissions, general feedback as to how the journal is progressing and suggestions for how it can be improved.The editors of All authors assisted with drafting the manuscript, and all authors read and approved the final manuscript.


Dr. Paul Tessier's death comes as a rude shock to the Plastic Surgery community all around the world. Dr. Tessier, who was residing in Boulogne, France, was born in Brittany and attended medical school at the Ecole de Medicine in Nantes, France, and received his Doctor of Medicine from the Faculte de Medecine de Paris in 1943. From 1939 until 1941, Dr. Tessier was in military service, the last year of which he spent as a prisoner of war in a German military hospital.In 1942, Dr. Tessier interned with a general surgeon who operated on cleft lip and Dupuytren's contracture. He continued his work in the surgical profession by going to Paris and joining the pediatric surgery service at Hospital St. Joseph in 1944. Later that year, while Paris was still under occupation by Germany, Dr. Tessier became an assistant to the Center of Maxillo-Facial Surgery of the Military Region of Paris in Hospital Puteaux where he remained until 1946. In 1947, the hospital's administration was transferred to Hospital Foch (Paris), and 2 years later, Dr. Tessier became involved in plastic surgery and burn care. In 1949, he returned to Nantes where he became a surgical consultant in ophthalmology.In the mid 1950's, Dr. Tessier began innovative work on finding a way to perform osteotomies to correct congenital midfacial retrusion without the relapse which plagued the performance of the procedure years before by one of his mentors, Sir Harold Gillies. In 1958, he began his initial clinical practice of the overhauled procedure. In discovering the need for bone grafts to fill gaps in the bone that could potentially jeopardize the adjustments made during the procedure, Dr. Tessier started the surgical specialty of cranofacial surgery.Within 3 years, Dr. Tessier had improved on his initial work by providing exposure for much of the procedure through a coronal approach, he had begun to section the arch rather than the body of the zygoma, and he placed bone grafts in the pterygomaxillary gap, all of which gave added stability to the midface segment without requiring an external head frame. In 1967, he performed a number of demonstration procedures for his peers and asked for their vote on whether this new specialty had a place in the practice of surgery. The positive response launched craniofacial surgery into the profession.During the late 1960's and the 1970's, Dr. Tessier developed all of the procedures that are currently used in performing craniofacial surgery: transcranial and subcranial correction of orbital dystopias such as orbital hypertelorism, correction of the facial deformity of Teacher Collins Franceschetti syndrome, and correction of oro-ocular clefts. Also, in the 1970's, Dr. Tessier began traveling to the U.S. in order to demonstrate the procedures in cities such as Philadelphia, Chicago, Houston, Boston, and Norfolk.Using autogeneous bone grafts instead of silicone or acrylic to modify skull and facial contours.Transcranial and subcranial correction of orbital hypertelorism.Techniques for correcting Treacher Collins syndrome.Correction of oro-ocular clefts.Dr. Tessier started to improve surgical techniques to correct craniofacial deformations in mid-1950s. Throughout the 1960s and 1970s, he developed the following methods:The impact of Dr. Tessier's work has affected many surgical specialties, including plastic surgery, otorhinolaryngology, ophthalmology, neurosurgery, trauma surgery, and oral and maxillofacial surgery. Many of his techniques have found significant places in the performance of plastic surgery, where Dr. Tessier's methods of autogenous bone grafts have often been seen as an improvement over the traditional use of silicone or acrylic. He also coined the term SMAS and created the subperiosteal facelift, or masklift. Dr. Tessier's work is so far reaching that virtually everyone performing procedures of the craniofacial specialty were either trained by Dr. Tessier himself, or by surgeons he trained.Because of his work, Dr. Tessier was a founding member of the International Society of Craniofacial Surgery and the European Association of Maxillo-Facial Surgeons, and had been honored many times, including receiving honorary memberships in the American College of Surgeons, the Royal College of Surgeons (London), and the American Society of Plastic Surgeons. In addition, he has been given an honorary degree from Lund University in Sweden.Paul Tessier, MD, FACS (Honorary), was the recipient of the Jacobson Innovation Award of the American College of Surgeons for the year 2000. The purpose of this award is to honor living surgeons, or surgical teams, who have been innovators of a new development or technique in any field of surgery. Dr. Tessier won this award for his original thought combined with the first presentation of work that has led to a milestone in the advancement of surgical care. The fact that Cranio-facial Surgery is so popular the world over is an ample testimony to the greatness of this colossal man of surgical sciences.May his soul rest in peace.