Anthrax threat places Clinical Center staff in crucial role

Lt. Cmdr. Lucienne Nelson and her colleagues face the realities of anthrax. They aren't wearing contamination suits and testing for spore traces in legislative buildings and post offices, but they are calming nerves, wiping tears and comforting the thousands of people affected by the deadly bacteria.

A group of 27 Clinical Center nurses and pharmacists were deployed to the Washington, D.C. area, to educate and test postal workers and congressional staff, and dispense antibiotics to anyone who may have come in contact with the anthrax spores. "It's what I train for," said Lt. Cmdr. Nelson, R.N., research nurse, Pediatric Oncology Branch. "We just came to try and help."

Nelson was called to the Hart Senate office building two days after returning from New York City, where she was among the 43 people on the Commissioned Corps Readiness Force, an immediate response team sent to Ground Zero to assist rescue workers. "It was like being in a foreign country looking at ancient ruins. All you could do is stare in total disbelief," said Nelson. "I needed those two days just to regroup and get my bearings."

At the Hart Senate office building, Nelson helped set up a treatment area for Capital Hill employees from Senator Tom Daschle's (D-South Dakota) office, where one of several anthrax-laced letters was mailed. Nelson worked two 17-hour days taking nasal swabs and educating employees about the nature of anthrax before being sent to the main Capital building.

"Most people were more concerned about whether or not they were going to bring this home to their kids," said Nelson. "We were trained in infectious diseases, so we knew that you couldn't get the disease from casual contact, however, we had to ease the minds of these individuals. They were concerned for their lives and for their families lives."

Anthrax is an illness caused by bacteria called bacillus anthracis. The bacteria can form a protective coat around themselves called spores. When actively multiplying, the bacteria release poisonous substances into the bodies of infected people. According to the Centers for Disease Control and Prevention (CDC), anthrax is not easily transferable. An infected person cannot pass the disease on by coughing or touching another person. The skin form, or cutaneous anthrax, can only be harmful if the bacteria enter through a cut in the skin. A sore develops and in a few days turns into a blister with a black scab in the center. Skin anthrax is more easily treated than inhalation anthrax. Inhalation anthrax is the most serious form of the disease and is caused by inhaling the anthrax spores. The spores begin to nest in the lymph nodes where the bacteria multiply, creating toxins. The body responds to the toxins by creating flu-like symptoms. The increase in toxins is what eventually causes death.

"This is what gets people confused. They come in to the hospital and tests are negative, so they think they have the flu. However a couple of days later, when the toxins begin to take over the body, the individual thinks that it couldn't be anthrax because the initial test was negative," said Nelson. "By then, unfortunately, the person may die and the problem wasn't that they had a bad doctor or that they went to a poor hospital, it's just the nature of the organism."

It's that nature that sent thousands of postal workers and others who work in the Washington, D.C. area to D.C. General Hospital to be tested and receive antibiotics. The hospital, which was downsized and taken over by a private company earlier this year, reopened portions of the building to handle the barrage of people.

"There were some angry people," said Lt. Felicia Andrews, R.N., unit coordinator on 13 West. "They were afraid and would come into the hospital and have panic attacks because they were so upset."

Andrews spent two days at D.C. General Hospital and saw nearly 2,000 people each day. The first two days that the hospital was open, nasal swabs were taken from each individual. Afterwards, no swabs were taken, but most individuals were given a 10-day supply of antibiotics.

"People were under the impression that they were going to be swabbed, because they thought it would determine if they had anthrax," said Andrews. "When we told them that we weren't doing anymore swabs, and the person knew that their buddy was swabbed the day before, they became upset and wondered why they couldn't be swabbed."

Since there is no type of screening for anthrax, no test exists to determine if an individual has been exposed to the bacteria. Based on a CDC report, the only way exposure can be determined is through a public health investigation. Nasal swabs and environmental tests are done to determine the extent of exposure in a given building or workplace, not to determine whether an individual should be treated. Even the use of a home test kit cannot determine if a person has been infected with the bacteria, but rather is a device to test environmental samples.

By the second day, workers at D.C. General Hospital had swabbed enough people to determine what areas in Greater Washington were of high risk. "We were answering questions and dispensing antibiotics to anyone who walked in the door," said Lt. Cmdr. Katherine Berkhousen, R.N., B.S.N., clinical research nurse, HIV/AIDS Outpatient Research Clinic.

Postal officials were bringing employees by the busload, while concerned citizens lined up to receive antibiotics. "Their main concern was that they wanted to be treated," said Lt. Cmdr. Scott Dallas, senior staff pharmacist. "We had exactly what they needed, but we wanted to make sure that they got the maximum beefit from it." Dallas evaluated individuals and then dispensed Ciprofloxacin or Doxycycline, two antibiotics used to fight the anthrax bacteria. Berkhousen spoke with people one-on-one to ease their concerns, and in some cases made phone calls to parents and guardians of employees with disabilities and special needs. "We didn't turn anyone away. Our main concern was dispensing antibiotics to people not at risk. We didn't want to say no and turn them away, because we really did not know."

New information about the infected letters, and a continuous stream of buildings that tested positive for the bacteria was constantly changing. With no bathroom breaks and shortened lunch breaks, Berkhousen said it was like being cut off from the world. "When you are seeing 2,000 patients a day it's hard to keep up with what is happening. When the patients came in they were almost more up-to-date and educated than we were."

Despite the never-ending workdays, just to be able to help is reward enough. "I was on a mission and I was going to do whatever it took to accomplish that mission," said Nelson. "If all I get is a couple of hours of sleep each day, then I appreciate it. I'm just honored to be able to do my job."

–by Tanya C. Brown

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Making the switch to Title 42

Nurses and allied health professionals hired under the General Schedule (Title 5) now have the opportunity to convert to Title 42, an alternative personnel system that gives managers flexibility in salary negotiation and allows employee promotion based on job performance without a waiting period.

Conversion is optional and solely dependent upon the individual. However, once the switch is made, an employee cannot go back into Title 5.

"If people don't perceive it to be advantageous to move into Title 42, then there is no pressure to make a change," said Tom Reed, director, Office of Human Resources Management. "I think that the trend toward Title 42 allows the Clinical Center to be successful in recruiting more people, faster. Title 42 make us more competitive and encourages people to come here instead of going to other places."

More than 93 nurses and allied health professionals have been hired under Title 42 since its inception last May. In fact, the nursing department has hired 48 nurses within six months, creating a low one percent vacancy rate.

"Title 42 has been incredibly helpful because it has enabled us to reduce our vacancy rate quickly, while also dramatically reducing the time from inquiry to offer," said Clare Hastings, chief, Nursing and Patient Care Services. "It has also allowed us to offer more competitive salaries at the senior staff levels."

Hiring under Title 42 does not require the General Schedule rating and ranking system that selects the top three candidates, passing their applications along to the hiring official. Instead, all qualified applications are submitted to the hiring official, creating a larger pool of applicants.

The General Schedule follows job grades and steps, that limit employees to a set salary and generally require a one-year in-grade waiting period before being promoted. With Title 42 employees can be promoted at any time based on their performance. Salary is based on pay bands that use competency and not longevity to determine the amount of individual pay increase or supplemental pay (awards, bonuses), given to employees.

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CC QWI & Diversity Council recognized during ceremony

The Council was highlighted at the Nov. 5 CC Director's Awards Ceremony as a CC activity benefiting employees. This year, membership was expanded with an increased emphasis in diversity appreciation and education.

CC Director Dr. John Gallin expressed his support of council undertakings, particularly the Employee Suggestion Program. There are two suggestion boxes for QWI and/or Diversity suggestions: one is outside the second floor cafeteria, near the vending machines; the other is in the B1 cafeteria, on the wall near the B1 level entrance. Employees may also contact Sue Fishbein 301-435-0031 or Jacques Bolle 301-594-9768 for comments.

At the Director's Awards Ceremony Dr. Gallin not only underscored his interest in responding to feasible suggestions that bring about positive changes, but mentioned the new plan to expand the Building 10, 14th floor exercise facility so employees and patients can use it. For facility availability, contact George Patrick at 301-496-2278.

Celebrating American Indian/Alaska Native Heritage Month

The first observance of the American Indian/Alaska Native Heritage Month, on Nov. 16, was sponsored by the NIH American Indian/Alaska Native Employee Council. The theme was "Leading the Way to Good Medicine." Speakers included Dr. Jared Jobe, Cherokee, NHLBI; Dr. Clifton Poodry, Seneca, NIGMS; Leo Nolan, M. Ed., St. Regis (Akwesasne) Mohawk, IHS; and Dr. Everett Rhoades, Kiowa, former Director, IHS and currently Director, Native American Prevention Research Center, College of Public Health, University of Oklahoma and Adjunct Professor of Medicine, University of Oklahoma. All currently work in the fields of health, health policy, and/or medicine.

American Indian and Alaskan native contributions have been numerous and significant. These contributions range from the use and development of herbal medicines to participation in research studies which lead to the development of vaccines for Hepatitis B and influenza. The program included the presentation of award-winning artwork, flute and drum music, and dancing, and emphasized the themes of healing, spirituality, and reverence for nature and for the community.

A number of common misperceptions about American Indians were dispelled simply, and with humor. For example, the term "Chief" was first used by early Europeans who thought the feather war bonnets American Indians wore resembled the hats of "chefs." For more information about the program or the organization, e-mail the NIH American Indian/Alaska Native Employee Council at: WebO@od.nih.gov, or call 301-402-3681.

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New online and after-hours tech support

Need to change your computer password, have a question about your Parachute account, or just want to know how to change your desktop telephone service? If so, look no further than the new online service from the NIH Center for Information Technology (CIT). Available 24-hours a day, seven days a week, CIT can provide expert assistance when users need it.

The new Customer Support online service not only provides answers to basic Information Technology (IT) questions using the CIT Knowledge Base, it displays up-to-the-minute IT news and frequently asked questions. If none of these options provides the solution, an electronic "Help" request ticket can be issued. Customers may also submit tickets via the web interface when the Technical Assistance Support Center (TASC) is open. TASC will respond to all electronic requests the following business day. The new website even lets users review the status of their existing service calls online.

Also debuting is CIT's emergency after-hours live telephone support. The new service, staffed from 6 p.m. to 7 a.m., is intended for emergencies and problem reports only. A call to the TASC helpline 301-496-6248, allows users the option of leaving a voice message for non-emergency issues, or speaking with the on-call technician. TASC will contact users the next business day after a call. The TASC help desk is open from 7 a.m. to 6 p.m., Monday through Friday. The hours of operation will change during the holidays.

TASC Holiday Schedule

Closed:
Christmas (12/25/01)
New Year's Day (1/1/02)

Open:
12/24/01 - Christmas Eve - 7 a.m. to 2 p.m.
12/31/01 New Year's Eve - 7 a.m. to 2 p.m.
12/26-28/01- Christmas Week - 8 a.m. to 4:30 p.m.

The TASC help desk resumes its regular schedule on Wednesday, Jan. 2, 2002. TASC holiday hours are also available at http://support.cit.nih.gov.

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TSP open season
The Thrift Savings Plan open season runs through Jan. 31, 2002. Effective Jan. 2002, employee contributions will increase to 12 percent for FERS employees and 7 percent for CSRS employees and members of the uniformed services. All participants who want to contribute the maximum must submit requests before Jan. 31, 2002.

Foil the flu
Beginning Dec. 17, the Occupational Medical Service will provide flu vaccinations by appointment only. The program is only for NIH employees with an NIH photo ID. Contractors are not permitted to receive the flu vaccine through this program. Call OMS at 301-496-4411 to make an appointment.

Family lodge support
Support the family lodge by contributing to the Foundation for NIH (#7109) during the 2001 Combined Federal Campaign. The Family Lodge is an on-campus residence for families of adult patients participating in clinical trials.

IPPCR registration
Registration is now open for the 2002 Introduction to the Principles and Practice of Clinical Research. The course will run from January 15, 2002 - April 23, 2002. Classes will be held on the NIH campus on Tuesday and Wednesday evenings from 5:30 p.m. to 7:00 p.m. There is no charge for the course; however, the purchase of a textbook is required. A certificate will be awarded upon the successful completion of the course, including a final exam. Deadline for registering is January 4, 2002. For information regarding coursework or to register, visit the course website at http://www.cc.nih.gov/od/core.

Support NIH School
To help NIH School earn free educational equipment, shoppers at Safeway and Giant Foods need only register for a club card and give the school code: Giant #2983, and Safeway #0623. Registered shoppers automatically earn credit for the school each time they use their club cards.

NIH/PITT training
Applications for training in clinical research from the University of Pittsburgh will be available beginning November 1 in Building 10, Room B1L403. The program requires that students spend 8 weeks in residence at the University of Pittsburgh, beginning in July 2002. The 8-week summer program is then supplemented by additional courses offered at the Clinical Center via videoconferencing. Tuition for the 2002-2003 academic year is $480 per credit, with partial tuition waivers for some courses. The room charge for the 8-week summer session is $800. Prospective participants should consult with their institute or center regarding the official training nomination procedure. For more information please send an e-mail to crtp@imap.pitt.edu or call (412) 692-2686. Deadline for applying is March 1, 2002.

Free concert
Come and enjoy the thirteenth season of the Manchester String Quartet on Nov. 19 at 12:30 p.m. in Masur Auditorium. For more information, call Sharon Greenwell at 301-496-4713.

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Healthy adults needed
Healthy African American, Taiwanese and Japanese adults are needed to donate blood. Blood samples will be used to test for a platelet membrane glycoprotein that is absent from the platelets of a small percentage of people in these ethnic groups. Must be at least 18 years of age. Compensation provided. For information call 301-496-5150.

Post-traumatic stress study
Healthy adults over age 18 are needed for a study to determine if a combination of medications can improve post-traumatic stress. For information call 1-866-627-6464.

Bipolar disorder study
The Mood and Anxiety Disorders Program at the NIMH is conducting a study to examine the effectiveness of pramipexole (Mirapex) in the depressive phase of bipolar disorder. Participants will be placed on pramipexole or a placebo for eight weeks. The medication will be added to the patientÕs current treatment of lithium or valproate. Participants should be between the ages of 18 to 60, be diagnosed with bipolar disorder and currently depressed. Participants must also be taking lithium or valproate for mood stabilization. For information call 301-496-5645.

Overweight women
NICHD seeks healthy African American and Caucasian overweight women, ages 18-40, to participate in a study on the effects of carbohydrates and fats on body composition and reproduction. Participants must be nonsmokers, have regular menstrual cycles, not be on any prescribed drugs and have no major illnesses. Participation involves one outpatient and two inpatient visits. Compensation provided. Call 301-496-7731.

African American men and women
The Heart Disease Risk Factors in African Americans Study is investigating the relationship of obesity to heart disease risk factors in healthy, nondiabetic African American men and premenopausal women, ages 18-50. Currently being enrolled are African American men who weigh 180 lbs. or more, and African American women who weigh 150 lbs. or more. There will be a series of four outpatient visits to the Clinical Center. Call 301-402-7119. Compensation provided.

Outpatient study
College-educated, middle-aged adults needed for a two-day outpatient study at NIMH. Involves blood draw and routine clinical, neurological and cognitive procedures. Compensation provided. For information call 301-435-8970.

Healthy children
Healthy children, ages 5-8, are sought by NINDS to participate in a study comparing language organization with that of children with epilepsy. Your children may be eligible if they speak English as their first language, do not have a learning disability, attention deficit disorder or any serious medical condition and do not wear braces or glasses (contacts allowed). Participation involves 2-4 outpatient visits over one year. Compensation is provided. Call Lynn at 301-402-3745.

Women needed
NICHD is seeking healthy women ages 18-55 or 60 and older, to participate in an ovarian function study involving five brief outpatient visits. Blood draws, ultrasound and an injection of a natural body hormone are involved. You may be eligible if you do not smoke or take any drugs, including birth control. A past pregnancy is necessary. Compensation is provided. For information call 301-435-8201.

Overweight women
NICHD seeks healthy African American and Caucasian overweight women, ages 18-40, to participate in a study on the effects of carbohydrates and fats on body composition and reproduction. Participants must be nonsmokers, have regular menstrual cycles, not be on any prescribed drugs, and have no major illnesses. Participation involves one outpatient and two inpatient visits. Compensation provided. Call 301-496-7731.

Healthy families
NIAAA seeks healthy parents and their adolescent children, ages 12-17, to participate in a study involving an interview and brain scan. No medication involved. Compensation is provided. Call 301-594-9950.

Men needed
NIAAA is seeking healthy males, ages 40-59, to participate in cognitive/psychological studies. No medication is involved. Call 301-594-9950. Compensation is provided.

Healthy kids
NIMH is seeking healthy children, ages 6-17, to participate in reviewing film clips, included among which will be humorous, sad and spooky clips. Your children may be eligible if they do not have a history of psychiatric problems or take any prescribed medications. Participation involves one outpatient visit and a possible second visit. Compensation is provided. Call 301-496-8381.

Evaluation study
The Clinical Neuroendocrinology Branch of NIMH seeks people with current or past depression as well as matched normal controls, to participate in an evaluation study. Participants must be between the ages of 18-65, be medically healthy, non smoker for the past year and able to spend at least one night in the Clinical Center. Compensation provided. For more information, call 301-496-5831 or 301-496-1892.

Japanese donors
The Department of Laboratory Medicine is seeking normal Japanese men and women to donate one tube of blood for a study of platelet function. You must be of full Japanese ancestry, have no evidence of anemia and be at least 18 years of age. Compensation provided. Call 301-496-5150.

Male volunteers
Men ages 45 and older are needed for a research study to assess risk factors for atherosclerosis. Medical history and blood samples are required to assess eligibility for the study. Compensation provided. For more information, call 301-496-3666.

Emotion study
The National Institute of Mental Health is seeking healthy children, ages 6-17, to participate in a mood and emotion study. Your child may not be eligible if he/she has medical or psychiatric problems, takes prescribed medications or has any first-degree relatives with psychiatric problems. Participation involves three-day screening and evaluation, two-day follow-up evaluation, MRI, physiological and psychological testing, and one month of at-home ratings. Compensation is provided. For more information or to volunteer, call 301-496-8381.

Female volunteers
The Behavioral Endocrinology Branch, NIMH, seeks healthy female volunteers ages 40-50, to participate in a longitudinal study of perimenopause. Volunteeers must have regular menstrual cycles and be medication free. Periodic hormonal evaluations, symptom rating completion and an occasional interview will be performed. Compensation provided. For more information call 301-496-9576.

Stuttering study
NIH seeks adults and children ages five or older who stutter or have family speech disorders for an experimental study of the causes of these disorders. Researchers offer speech, voice and language testing. Compensation provided. For information call 1-800-411-1222 (TTY: 1-866-411-1010).

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