bluuebunny/crossref_metadata_2025 huggingface dataset:
Interventionelle Behandlung der Mitralklappe – was gibt es Neues 2019?
Authors: Körber Maria Isabel , Pfister Roman , Baldus Stephan
Published: October 2019

Mitral regurgitation (MR) is one of the most common valvular defects in the eldery. In patients suffering from heart failure, secondary MR is common and associated with worse prognosis. Due to the usually very high operative risk these patients are immensely under-treated. This leads to an increased need for interventional treatment strategies. Until now there were no randomized data regarding the prognostic impact of interventional treatment of secondary MR. This article is supposed to sum up evidence derived from recent studies regarding this issue. Finally we will provide an outlook on catheter-based mitral valve prothesis.
Erworbene thrombotisch-thrombozytopenische Purpura – Patientenmanagement im Licht neuer Therapien
Authors: Völker Linus Alexander , Grundmann Franziska , Brinkkötter Paul Thomas
Published: October 2019

Anamnese Eine 42-jährige Patientin stellte sich zunächst mit einer Pyelonephritis vor. Zwei Tage später traten Hämatome und punktuelle Einblutungen der Extremitäten auf.

Diagnostik/Befunde Eine erworbene thrombotisch-thrombozytopenische Purpura wurde diagnostiziert. Der klinische Befund zeigte das Bild einer thrombotischen Mikroangiopathie mit einer Thrombopenie von 8 × 10E9/l. Es konnten eine erniedrigte ADAMTS13-Aktivität und Autoantikörper nachgewiesen werden.

Therapie und Verlauf Bei positivem PLASMIC Score wurde vor Erhalt der ADAMTS13-Diagnostik eine Therapie mittels Plasmaseparation, Steroiden und Caplacizumab eingeleitet und im Verlauf um Rituximab ergänzt. Darunter kam es zu einer raschen klinischen Remission mit jedoch persistierenden ADAMTS13-Antikörpern und reduzierter -Aktivität, so dass Caplacizumab für insgesamt 58 Tage appliziert wurde.

Diskussion Mit Caplacizumab steht eine wirkungsvolle neue Therapie der erworbenen thrombotisch-thrombozytopenischen Purpura zur Verfügung. Die Zeit bis zum klinischen Ansprechen und die Zahl der Rückfälle können deutlich reduziert werden. Liegt jedoch eine persistierende Autoimmunaktivität über den Therapiezeitraum hinaus vor, geht diese mit einem hohen Rückfallrisiko einher und erfordert engmaschige Kontrollen.
Guided and Unguided Biopsy in the Diagnostic of Periprosthetic Infections of the Knee – Evaluation of an Evidence-based Algorithm
Authors: Scheele Christian , Krauel Isabelle , Pohlig Florian , Muehlhofer Heinrich , Gerdesmeyer Ludger , Lasic Igor , Prodinger Peter Michael , Banke Ingo , von Eisenhart-Rothe Rüdiger , Harrasser Norbert
Published: October 2019

Background Periprosthetic joint infection (PPI) is one of the most common reasons for revision in total knee arthroplasty (TKA). Percutaneous synovial biopsy is considered as a well-established diagnostic tool in ambiguous cases of chronic pain after TKA. The exact number of undetected low-grade infections remains unclear.

Objectives The aim of this prospective study was to compare the diagnostic accuracy of arthroscopically guided and unguided synovial biopsy. Additionally, the prevalence of initially undetected PPI during synovial biopsy and revision surgery was assessed.

Materials and Methods 40 patients suffering from chronic pain after TKA and the clinical suspicion of PPI were included in the study. Synovial biopsies were collected in a standardized manner first without and then with arthroscopic visual control. Using both techniques, six samples were collected each (5 for microbiology, 1 for histology). 19 patients, initially classified aseptic, underwent revision surgery later.

Results The diagnosis of PPI was made in 10.0% of unguided biopsies (4 cases, 2× microbiologically, 2× histologically), 7.5% of arthroscopic biopsies (3 cases, 3× histologically) and 12.5% (5 cases, 3× histologically, 2× microbiologically) of all cases. Only histologic evaluation led to concordant positive findings using both techniques in two patients. The proportion of non-representative biopsies was twice as high after unguided tissue collection than after arthroscopic biopsy (30.0 vs. 15.0%). Microbiologic evaluation of arthroscopically collected biopsies did not lead to the diagnosis of PPI, which might have been essential to the selection of the appropriate antimicrobial therapy. During revision surgery the diagnosis of PPI was made in 22.2% of cases.

Conclusions In patients suffering from chronic pain after TKA, periprosthetic low-grade infection was diagnosed in a relevant proportion of cases. Therefore, synovial biopsies for histological and microbiological evaluation should be collected whenever thereʼs clinical suspicion of PPI. For histological evaluation, samples should be collected using arthroscopic control and ideally multiple biopsies should be taken. For microbiological evaluation, excessive joint lavage should be avoided.
Influence of unconventional current-phase relation of Josephson junction on the escape rate in macroscopic quantum tunneling regime
Authors: Askerzade I. N.
Published: October 2019

In this study, we carried out the analysis of the quantum fluctuations on Josephson junction (JJ) dynamics with unconventional current-phase relation (CPR). We analyzed two case CPR: anharmonic term case and the case of Majorana term. The expression was obtained for the escape rate in macroscopic tunneling regime. It is shown that the changing of the escape rate JJ with unconventional CPR is determined by the renormalized critical current of JJ.
Effects of nanoparticle chromium mixed with γ-polyglutamic acid on the chromium bioavailability, growth performance, serum parameters and carcass traits of pigs
Authors: Lien Tu-Fa , Lan Yu-Shan
Published: October 2019

Because chromium is a mineral that is difficult to absorb, nanotechnology was used to produce nanoparticle trivalent chromium, which has a reduced particle size and increased surface area to increase chromium bioavailability. The aim of the present study was to investigate the effect of dietary supplementation nanoparticle trivalent chromium with or without γ-polyglutamic acid (γ-PGA) on the chromium bioavailability, growth performance, serum parameters and carcass traits of pigs. In Trial 1, eight growing pigs (Landrace × Yorkshire × Duroc; LYD) with an initial average weight of 51.3 ± 2.0 kg were used in a 4 × 4 Latin square design as the control group (without chromium supplements), the chromium picolinate group (CrPic), the nanoparticle chromium picolinate group (NanoCrPic) and the nanoparticle chromium picolinate mixed with γ-polyglutamic acid (NanoCrPic–PGA) group. Chromium was added at a level of 200 μg/kg to a basal diet containing 728 µg Cr/kg DM, using different forms of chromium, so as to evaluate the chromium bioavailability. The results of Trial 1 indicated that the bioavailability of the supplemented chromium was as follows: NanoCrPic–PGA > NanoCrPic > CrPic (P < 0.05). In Trial 2, 64 LYD growing pigs (average bodyweight 74.46 ± 3.9 kg) were randomly allotted to the same four dietary treatment groups as in Trial 1 and the same levels of chromium were added to the diet. Each group contained four pens and there were four pigs in each pen. The experimental results indicated that the gain:feed ratio in the NanoCrPic–PGA group was better than that in the NanoCrPic group (P < 0.001). The serum chromium concentrations in the NanoCrPic–PGA group were higher than in the control group (P < 0.05), the serum insulin concentration in the chromium supplementation groups was lower than that in the control group (P < 0.05), and blood glucose in the NanoCrPic group was lower than that in the control group (P < 0.05). The carcass traits were not affected by chromium supplementation. In conclusion, nanoparticle trivalent chromium, either alone or together with γ-PGA, improved chromium bioavailability and feeding effectiveness.
Two types of possessive passives in Japanese
Authors: Chen Yunchuan
Published: October 2019

Many East Asian languages have possessive passives, whose subjects are interpreted as the possessor of the direct
object. This paper investigates Japanese Possessive Passives (JPPs) and proposes that there are two types of possessive passives
in Japanese: one with a ‘by-phrase’ headed by ni (ni JPPs) and the other with a
‘by-phrase’ headed by ni yotte (ni yotte JPPs). While previous studies
assumed that JPPs are a sub-type of indirect passive, I propose that such an analysis is untenable. Instead, JPPs exhibit the same
dichotomy as ni-passives and ni yotte-passives exhibit (Kuroda 1979, Kitagawa & Kuroda 1992): While subjects of
ni JPPs are base-generated like ni-passives, subjects of ni yotte JPPs
undergo NP movement like ni yotte-passives.
The Yezidi Wednesday and the Music of the Spheres
Authors: Rodziewicz Artur
Published: October 2019

The article is an attempt to answer the question why Wednesday has the status of a holy day in Yezidism. Wednesday can be seen as a commemoration of the fourth day of creation, when the life on earth began and the Peacock Angel became its ruler. The article points to the Yezidi worship of the Moon and the Sun and related angels (Melek Fakhradin and Melek Sheikh Shams) and connects it with the Pythagorean concept concerning the movement of the planets and the Music of the Spheres. Two sacred Yezidi instruments, def and shibab, appear as allegories of celestial bodies in the Yezidi sacred hymns in the cosmogonic context of the creation of the macrocosm and microcosm (Adam). The article also points out the meaning of Wednesday in Judaism as the day when God created the sun, moon and stars and briefly discusses relationships with planet worship in Harran, Zoroastrianism and Mandaeism, especially in the context of the Yezidi Çarşemiya Sor festival which takes place on the first Wednesday of the month of Nisan.
Coupled experimental-computational analysis of primary static recrystallization in low carbon steel
Authors: Diehl Martin , Kühbach Markus
Published: October 2019

Primary static recrystallization is a restoration process during which the critically strong deformed microstructure is atomistically reconstructed into a polycrystal with orders of magnitude lower defect density. Advances in diffraction methods catalyzed research activities directed towards more accurate understanding of recrystallization. While these efforts rendered most mechanisms by now qualitatively well understood, many quantitative details remain still unknown. Computer simulations are a viable option to provide qualitative insights into the complex recrystallization process as they provide unlimited observability. However, simulation tools for studying recrystallization in volumes that are significantly large enough for making predictions of mean-field descriptors, such as the distribution of grain sizes or texture evolution, are typically based on continuum models. The use of such models requires to accept certain assumptions on how the collective behavior of multiple thousands of atoms can be homogenized. One aspect of special importance for continuum models is the correct prediction of the nucleation process as it influences virtually all quantitative descriptors of the recrystallized microstructure. This study presents a one-to-one comparison of simulation results to quasi in situ scanning electron microcopy/electron backscatter diffraction results revealing how two different assumptions for the crystallographic orientation of the nuclei perform in reproducing the experimentally observed recrystallization microstructure. Moreover, by comparing the recrystallized microstructure at the surface and in the interior of the three-dimensional model, it is shown how quasi in situ experiments systematically underestimate the recrystallization rate and predict a distorted grain size distribution.
Tuning the order of the nonequilibrium quantum phase transition in a hybrid atom-optomechanical system
Authors: Mann N , Pelster A , Thorwart M
Published: October 2019

We show that a hybrid atom-optomechanical quantum many-body system with two internal atom states undergoes both first- and second-order nonequilibrium quantum phase transitions (NQPTs). A nanomembrane is placed in a pumped optical cavity, whose outcoupled light forms a lattice for an ultracold Bose gas. By changing the pump strength, the effective membrane-atom coupling can be tuned. Above a critical intensity, a symmetry-broken phase emerges which is characterized by a sizeable occupation of the high-energy internal states and a displaced membrane. The order of this NQPT can be changed by tuning the transition frequency. For a symmetric coupling, the transition is continuous below a certain transition frequency and discontinuous above. For an asymmetric coupling, a first-order phase transition occurs.
The effects of commercial privileges in late medieval Bordeaux, 1348–1449
Authors: Blackmore Robert
Published: October 2019

This article examines the impact of a developed bourgeois legal status on late medieval Bordeaux’s wine market, between 1348—the year of the arrival of the Black Death—and 1449, shortly before the end of Plantagenet rule (in 1453). Through their control of the city’s powerful commune, the bourgeoisie acquired a portfolio of commercial advantages that distorted the export market in the interests of its members: a minority of influential townspeople, ecclesiastics—both individuals and institutions—as well as knights and secular lords allied to the English crown. Using considerable new quantitative evidence from Bordeaux’s customs books, this group is shown to have increased its exports at a time when trade was in decline, and—in turn—invested profits in the city’s hinterland, its suburbs and the wider Bordelais.
Identification of the intersegmental plane during thoracoscopic segmentectomy: state of the art
Authors: Andolfi Marco , Potenza Rossella , Seguin-Givelet Agathe , Gossot Dominique
Published: October 2019

During thoracoscopic segmentectomy, where direct palpation of the tumour is not always possible, achieving adequate margins from the cancer is of crucial importance. It is thus mandatory to accurately identify the intersegmental plane (ISP). Indeed, inadequate determination and division of the ISP can lead to unsatisfactory oncological results. Our systematic review focused on the effectiveness of the different techniques for identifying the ISP, highlighting the fact that a 1-size-fits-all method is not feasible. Based on the published evidence, 6 main methods were reported, each with its pros and cons: inflation–deflation technique, selective resected segmental inflation, systemic injection of indocyanine green, injection of endobronchial dye, 3-dimensional simulation using multidetector computed tomography and virtual-assisted lung mapping. In conclusion, ISP demarcation is mandatory to achieve a high rate of success of thoracoscopic segmentectomy, and it is very helpful in surgical planning, especially when preoperative multidetector computed tomography and 3-dimensional reconstructions are routinely performed.
Respiratory Epithelial Cells Can Remember Infection: A Proof of Concept Study
Authors: Bigot Jeanne , Guillot Loic , Guitard Juliette , Ruffin Manon , Corvol Harriet , Chignard Michel , Hennequin Christophe , Balloy Viviane
Published: October 2019

Human bronchial epithelial cells play a key role in airway immune homeostasis. We hypothesized that these sentinel cells can remember a previous contact with pathogen compounds and respond nonspecifically to reinfection, a phenomenon called innate immune memory. We demonstrated that their pre-exposure to Pseudomonas aeruginosa flagellin modify their inflammatory response to a second, non-related stimulus, including live pathogens or lipopolysaccharide. Using histone acetyltransferase and methyltransferase inhibitors, we showed that this phenomenon relied on epigenetic regulation. This report is a major breakthrough in the field of multi-microbial respiratory tract infections, wherein control of inflammatory exacerbations is a major therapeutic issue.
Prionailurus rubiginosus (Carnivora: Felidae)
Authors: Langle Paige R
Published: October 2019

Prionailurus rubiginosus (Geoffroy Saint-Hilaire, 1831), the smallest felid at nearly one-half the size of a domestic cat, is commonly called the rusty-spotted cat. One of five species in the genus Prionailurus, it is found in wet or dry deciduous forests as well as scrubby grasslands throughout Sri Lanka, India, and Nepal’s western Terai. Habitat loss, road accidents, and the spread of agricultural cultivation are considered major threats throughout its range. Rare in captivity and museum collections, it is considered “Near Threatened” by the International Union for Conservation of Nature and Natural Resources, with the Indian population listed under Appendix I and the Sri Lankan and Nepali populations listed with all Felidae under Appendix II of the Convention on International Trade in Endangered Species of Wild Fauna and Flora.
Structural insight into the length-dependent binding of ssDNA by SP_0782 from Streptococcus pneumoniae, reveals a divergence in the DNA-binding interface of PC4-like proteins
Authors: Li Shuangli , Lu Guoliang , Fang Xiang , Ramelot Theresa A , Kennedy Michael A , Zhou Xin , Gong Peng , Zhang Xu , Liu Maili , Zhu Jiang , Yang Yunhuang
Published: October 2019

SP_0782 from Streptococcus pneumoniae is a dimeric protein that potentially binds with single-stranded DNA (ssDNA) in a manner similar to human PC4, the prototype of PC4-like proteins, which plays roles in transcription and maintenance of genome stability. In a previous NMR study, SP_0782 exhibited an ssDNA-binding property different from YdbC, a prokaryotic PC4-like protein from Lactococcus lactis, but the underlying mechanism remains unclear. Here, we show that although SP_0782 adopts an overall fold similar to those of PC4 and YdbC, the ssDNA length occupied by SP_0782 is shorter than those occupied by PC4 and YdbC. SP_0782 exhibits varied binding patterns for different lengths of ssDNA, and tends to form large complexes with ssDNA in a potential high-density binding manner. The structures of SP_0782 complexed with different ssDNAs reveal that the varied binding patterns are associated with distinct capture of nucleotides in two major DNA-binding regions of SP_0782. Moreover, a comparison of known structures of PC4-like proteins complexed with ssDNA reveals a divergence in the binding interface between prokaryotic and eukaryotic PC4-like proteins. This study provides insights into the ssDNA-binding mechanism of PC4-like proteins, and benefits further study regarding the biological function of SP_0782, probably in DNA protection and natural transformation.
Causal Inference Engine: a platform for directional gene set enrichment analysis and inference of active transcriptional regulators
Authors: Farahmand Saman , O’Connor Corey , Macoska Jill A , Zarringhalam Kourosh
Published: October 2019

Inference of active regulatory mechanisms underlying specific molecular and environmental perturbations is essential for understanding cellular response. The success of inference algorithms relies on the quality and coverage of the underlying network of regulator–gene interactions. Several commercial platforms provide large and manually curated regulatory networks and functionality to perform inference on these networks. Adaptation of such platforms for open-source academic applications has been hindered by the lack of availability of accurate, high-coverage networks of regulatory interactions and integration of efficient causal inference algorithms. In this work, we present CIE, an integrated platform for causal inference of active regulatory mechanisms form differential gene expression data. Using a regularized Gaussian Graphical Model, we construct a transcriptional regulatory network by integrating publicly available ChIP-seq experiments with gene-expression data from tissue-specific RNA-seq experiments. Our GGM approach identifies high confidence transcription factor (TF)–gene interactions and annotates the interactions with information on mode of regulation (activation vs. repression). Benchmarks against manually curated databases of TF–gene interactions show that our method can accurately detect mode of regulation. We demonstrate the ability of our platform to identify active transcriptional regulators by using controlled in vitro overexpression and stem-cell differentiation studies and utilize our method to investigate transcriptional mechanisms of fibroblast phenotypic plasticity.
American Society for Stereotactic and Functional Neurosurgery Position Statement on Magnetic Resonance-Guided Focused Ultrasound for the Management of Essential Tremor
Authors: Pouratian Nader , Baltuch Gordon , Elias W Jeff , Gross Robert ,   on behalf of the American Society for Stereotactic and Functional Neurosurgeons
Published: October 2019

Magnetic resonance-guided focused ultrasound thalamotomy is a novel tool in the neurosurgical armamentarium for management of essential tremor (ET). Given the recent introduction of this technology, the American Society of Stereotactic and Functional Neurosurgery (ASSFN), which acts as the joint section representing the field of stereotactic and functional neurosurgery on behalf of the Congress of Neurological Surgeons and the American Association of Neurological Surgeons, provides here the expert consensus opinion on evidence-based best practices for the use and implementation of this treatment modality. Indications for treatment are outlined, including confirmed diagnosis of ET, failure to respond to first-line therapies, disabling appendicular tremor, and unilateral treatment are detailed, based on current evidence. Contraindications to therapy are also detailed. Finally, the evidence and authority on which the ASSFN bases this consensus position statement is detailed.
Flavor moonshine
Authors: Shiba Funai Shotaro , Sugawara Hirotaka
Published: October 2019

The flavor moonshine hypothesis is formulated to suppose that all particle masses (leptons, quarks, Higgs, and gauge particles—more precisely, their mass ratios) are expressed as coefficients in the Fourier expansion of some modular forms just as, in mathematics, dimensions of representations of a certain group are expressed as coefficients in the Fourier expansion of some modular forms. The mysterious hierarchical structure of the quark and lepton masses is thus attributed to that of the Fourier coefficient matrices of certain modular forms. Our intention here is not to prove this hypothesis starting from some physical assumptions but rather to demonstrate that this hypothesis is experimentally verified and, assuming that the string theory correctly describes the natural law, to calculate the geometry (Kähler potential and the metric) of the moduli space of the Calabi–Yau manifold, thus providing a way to calculate the metric of the Calabi–Yau manifold itself directly from the experimental data.
INBONE Revision Total Ankle Arthroplasty
Authors: DeOrio James K.
Published: October 2019

The INBONE total ankle replacement is both a primary and a revision total ankle replacement. It is a modular tibial ankle with the ability to increase the length of the stem as necessary for stability. It also has available an enlarged baseplate for the tibia and a modular talar extension component for use when the talar bone is insufficient for the standard prosthesis. Its flexibility in use makes it an ideal ankle replacement for revision ankle replacement surgery.
Neuroinflammation impact in epileptogenesis and new treatment strategy
Authors: Mahfoz Amal Mohamed , Shahzad Naiyer
Published: October 2019

Epilepsy is considered a major serious chronic neurological disorder, characterized by recurrent seizures. It is usually associated with a history of a lesion in the nervous system. Irregular activation of inflammatory molecules in the injured tissue is an important factor in the development of epilepsy. It is unclear how the imbalanced regulation of inflammatory mediators contributes to epilepsy. A recent research goal is to identify interconnected inflammation pathways which may be involved in the development of epilepsy. The clinical use of available antiepileptic drugs is often restricted by their limitations, incidence of several side effects, and drug interactions. So development of new drugs, which modulate epilepsy through novel mechanisms, is necessary. Alternative therapies and diet have recently reported positive treatment outcomes in epilepsy. Vitamin D (Vit D) has shown prophylactic and therapeutic potential in different neurological disorders. So, the aim of current study was to review the associations between different brain inflammatory mediators and epileptogenesis, to strengthen the idea that targeting inflammatory pathway may be an effective therapeutic strategy to prevent or treat epilepsy. In addition, neuroprotective effects and mechanisms of Vit D in clinical and preclinical studies of epilepsy were reviewed.
Evaluating Association Between Coronary Calcifications Visualized During Invasive Coronary Angiography With Total Mortality
Authors: Movahed Mohammad Reza , Sattur Sudhakar , Vu John
Published: October 2019

Background:

High calcium score is independently associated with a greater cardiac event rate. Using a large database of patients who underwent coronary angiography for clinical reasons, we evaluated the association between reported degree of coronary calcification with mortality and baseline risk factors.

Methods:

Using angiographic data of 1917 patients from 1993 to 1997, we studied any association between the locations of coronary calcium that were seen during coronary angiography with coronary artery risk factors. Furthermore, we correlated the locations of calcium with all cause mortality.

Results:

A total of 1917 patients who underwent cardiac catheterization from 1993 to 1997 were studied. Total mortality was 22.9%. There was no association between the classic coronary risk factors (history of hypertension, hyperlipidemia, smoking, diabetes mellitus and family history) or race (White, Black, Hispanic, and Asian) with the occurrence of angiographic visible calcium in any location. Furthermore, we did not find any association between the locations of coronary calcium with all cause mortality. (All cause mortality occurred in 21.8% of patients with left main calcification vs. 23.3%, P = 0.63, in 24.6% of patients with left anterior descending artery calcification vs. 22.7%, P = 0.48, in 25.6% of patients with circumflex calcification vs. 23.1%, P = 0.52, in 25.7% of right coronary calcification vs. 22.7%, P = 0.47, in 24.6 of any coronary calcification vs. 22.5%, P = 0.4).

Conclusions:

Race, coronary risk factors, and all cause mortality are not associated with angiographic documented coronary calcification in any location in patients undergoing diagnostic coronary angiography.
Addressing Police Occupational Safety During an Opioid Crisis
Authors: Beletsky Leo , Abramovitz Daniela , Arredondo Jaime , Baker Pieter , Artamonova Irina , Marotta Phil , Mittal Maria Luisa , Rocha-Jimenez Teresita , Cepeda Javier A. , Morales Mario , Clairgue Erika , Patterson Thomas A. , Strathdee Steffanie A.
Published: October 2019

Objective:

To develop and validate syringe threat and injury correlates (STIC) score to measure police vulnerability to needlestick injury (NSI).

Methods:

Tijuana police officers (N = 1788) received NSI training (2015 to 2016). STIC score incorporates five self-reported behaviors: syringe confiscation, transportation, breaking, discarding, and arrest for syringe possession. Multivariable logistic regression was used to evaluate the association between STIC score and recent NSI.

Results:

Twenty-three (1.5%) officers reported NSI; higher among women than men (3.8% vs 1.2%; P = 0.007). STIC variables had high internal consistency, a distribution of 4.0, a mode of 1.0, a mean (sd) of 2.0 (0.8), and a median (interquartile range [IQR]) of 2.0 (1.2 to 2.6). STIC was associated with recent NSI; odds of NSI being 2.4 times higher for each point increase (P-value <0.0001).

Conclusions:

STIC score is a novel tool for assessing NSI risk and prevention program success among police.
Preferred Physical Therapist/Physical Therapist Assistant Relationship Content in a Doctor of Physical Therapy Curriculum: A Longitudinal Approach
Authors: Sellheim Debra Ough , Scholl Jessica
Published: October 2019

Background and Purpose.

The need for physical therapist (PT) students to graduate with strong teamwork knowledge and skills has never been greater. Although many PT educational programs are preparing graduates to work effectively in an interprofessional team environment, attention to the corresponding importance of collaborative intraprofessional (PT/PT assistant [PTA]) preparation for efficient, cost-effective patient care must not be lost.

Method/Model Description.

Starting in the first course of the program, learning experiences on the preferred PT/PTA relationship are woven throughout multiple courses over the 3-year Doctor of Physical Therapy (DPT) curriculum. Students practice components of effective teaming, make decisions about the direction and supervision of a PTA, and deepen their understanding of the legal and ethical complexities of PT/PTA teams in practice. Specific learning activities on the PT/PTA relationship are described.

Outcomes.

Survey data and class learning experience and assignment feedback on the PT/PTA curriculum reveal multiple themes related to PT student learning using this model. Themes include increased understanding and confidence in PTA knowledge, skills, and roles; recognition of the potential for increased efficiency and improved patient care with PT/PTA teaming; and the importance of PT/PTA communication and relationship. Most respondents to a 1-year postgraduation alumnae/i survey report the collaborative PT/PTA educational experiences helped prepare them for clinical practice with PTAs.

Discussion.

The need for physical therapy services is increasing, and as professionals, PTs have an obligation to meet this need in a cost-effective way. Using the skills of a PTA continues to be an effective strategy to address this issue. PT students are often not prepared to direct and supervise PTAs in the clinic due to insufficient educational preparation.

Conclusion.

This curricular thread model incorporates content pertaining to direction and supervision of PTAs and intraprofessional team building across a 3-year DPT program to better prepare clinicians for practice.
Characteristic findings of acute spontaneous coronary artery dissection by cardiac computed tomography
Authors: Pozo-Osinalde Eduardo , García-Guimaraes Marcos , Bastante Teresa , Aguilera María Cruz , Rodríguez-Alcudia Daniel , Rivero Fernando , Hernández Susana , Jiménez-Borreguero Luis Jesús , Alfonso Fernando
Published: October 2019

Background:

Spontaneous coronary artery dissection (SCAD) is an infrequent cause of acute coronary syndrome (ACS); however, its detection carries relevant clinical implications. Cardiac computed tomography (CCT) has been found to be useful for follow-up, but data during the acute phase are scarce. Thus, our aim was to evaluate the early diagnostic ability of CCT to detect SCAD.

Methods:

We retrospectively analyzed all the in-hospital CCT performed in a prospective cohort of patients with SCAD from 2012 to 2016. An independent expert blindly evaluated the studies and described the radiologic characteristics of the lesions. These features were compared with the invasive coronary angiography (ICA) and optical coherence tomography (OCT) findings.

Results:

18 lesions were analyzed from 12 episodes identified in 11 patients (100% females; median age of 57 years old). CCT recognized the presence of SCAD in 14 (78%) of the lesions, with four different morphological patterns. Most commonly (10, 71%) SCAD presented as a diffuse lumen narrowing surrounded by a ‘sleeve-like’ wall thickening, which corresponded to intramural hematoma in OCT evaluation. When compared with ICA, CCT showed a positive correlation (Spearman’s Rho = 0.775; P = 0.001) and excellent concordance (ICC = 0.8; P = 0.004) in stenosis grading, but not for lesion length and minimal luminal area.

Conclusion:

CCT was able to identify the presence of SCAD in most of the patients in the acute phase of this elusive and challenging clinical entity. In addition, in this setting, CCT revealed unique and distinct radiologic features and provided a precise assessment of lesion severity.
Treatment for Individuals With Severe Mental Illness Who Use Illicit Drugs While Maintained on Methadone
Authors: Wupperman Peggilee , Burns Nancy , Pugach Cameron P. , Edwards Emily
Published: October 2019

Substantial research has noted the serious consequences of 1) co-occurring severe mental illness (SMI) and substance use disorders, and 2) use of illicit drugs while maintained on methadone for opioid dependence. However, treatment needs of individuals who meet both of the above criteria remain largely unmet. This pilot study investigated the feasibility and acceptability of a 12-week, transdiagnostic group therapy (mindfulness and modification therapy [MMT]) tailored for opioid-dependent individuals (N = 6) with SMI and illicit drug use. Retention was 83%. At posttreatment and 2-month follow-up, participants rated the treatment as highly helpful (9 of 10; 8.67 of 10, respectively), reported routinely practicing the guided-mindfulness exercises, and reported high confidence that they would continue to practice. Assessments revealed clinically meaningful decreases in reported days of illicit drug use at posttreatment and follow-up, with large effect sizes. Preliminary evidence suggests that MMT may be a feasible and acceptable therapy that may improve treatment engagement in this underserved population.
Sexually Transmitted Infections in Pregnancy and Reproductive Health: Proceedings of the STAR Sexually Transmitted Infection Clinical Trial Group Programmatic Meeting
Authors: Wynn Adriane , Bristow Claire C. , Cristillo Anthony D. , Murphy Sara McCurdy , van den Broek Nynke , Muzny Christina , Kallapur Suhas , Cohen Craig , Ingalls Robin R. , Wiesenfeld Harold , Litch James A. , Morris Sheldon R. , Klausner Jeffrey D.
Published: October 2019

The goal of the STAR Sexually Transmitted Infection Clinical Trial Group (STI CTG) Programmatic meeting on Sexually Transmitted Infections (STIs) in Pregnancy and Reproductive Health in April 2018 was to review the latest research and develop recommendations to improve prevention and management of STIs during pregnancy. Experts from academia, government, nonprofit, and industry discussed the burden of STIs during pregnancy; the impact of STIs on adverse pregnancy and birth outcomes; interventions that work to reduce STIs in pregnancy, and the evidence, policy, and technology needed to improve STI care during pregnancy. Key points of the meeting are as follows: (i) alternative treatments and therapies for use during pregnancy are needed; (ii) further research into the relationship between the vaginal microbiome and STIs during pregnancy should be supported; (iii) more research to determine whether STI tests function equally well in pregnant as nonpregnant women is needed; (iv) development of new lower cost, rapid point-of-care testing assays could allow for expanded STI screening globally; (v) policies should be implemented that create standard screening and treatment practices globally; (vi) federal funding should be increased for STI testing and treatment initiatives supported by the Centers for Disease Control and Prevention (CDC), the Centers of Excellence in STI Treatment, public STD clinics, and the President's Emergency Plan for AIDS Relief (PEPFAR).
Corneal Endothelial Blebs Induced in Scleral Lens Wearers
Authors: Giasson Claude J. , Rancourt Josiane , Robillard Josiane , Melillo Marc , Michaud Langis
Published: October 2019

SIGNIFICANCE

In the bleb phenomenon, some endothelial cells transiently lose their specular reflection. This has been reported during contact lens wear and goggle-induced hypoxia or hypercapnia.

PURPOSE

The purposes of this study were to determine whether blebs appear after scleral lens wear and if their appearance is influenced by lens clearance and to compare bleb and cell sizes.

METHODS

Twenty-one subjects were fitted with two similar scleral lenses with different targeted clearances of 200 and 400 μm (the SL200 and SL400, respectively). Each lens was worn unilaterally for 25 minutes, whereas the other eye served as a control. Before and after lens wear, the endothelium was photographed using specular microscopy. The number of blebs and measurements of the areas of cells and blebs were analyzed. Pairedttests compared differences in the areas of cells and blebs. Differences in median bleb number were evaluated using the Wilcoxon test.

RESULTS

After wearing the SL200 and SL400 lenses, respectively, 9 and 14 subjects had at least one bleb. The median bleb number after wearing lenses was significantly different (SL200, 0.00; SL400, 1.00;P= .02). Bleb and cell areas were significantly different (blebs, 293 ± 28; cells, 370 ± 32 μm2;P< .0001).

CONCLUSIONS

After 25 minutes of wearing scleral lenses with each of the two targeted clearances, SL400 induced significantly more blebs than did SL200, suggesting evidence of reduced oxygen and/or increased carbon dioxide levels under scleral lenses fitted with excessive clearance. Blebs may occur more in smaller cells.
Brief Report: Association Between Low HIV-1 DNA and Western Blot Reactivity to HIV-1 Pol in Chronically Infected Individuals
Authors: Muccini Camilla , Galli Laura , Spagnuolo Vincenzo , Poli Andrea , Rolla Serena , Mastrangelo Andrea , Rinaldi Francesca , Castagna Antonella
Published: October 2019

Background:

The aim of the study was to evaluate whether negative HIV-1 pol on Western blot (WB) was associated with low HIV-DNA in adults with chronic HIV-1 infection and suppressive antiretroviral therapy.

Methods:

Cross-sectional parent study of the APACHE trial, conducted in subjects with chronic infection, HIV-1 RNA <50 copies/mL for ≥10 years, no residual viremia for ≥5 years and CD4+ >500 cells/µL screened for HIV-1 DNA. HIV-1 DNA was quantified in peripheral blood mononuclear cells (PBMCs) by real-time polymerase chain reaction and HIV-1 serostatus was tested by HIV Blot 2.2 WB assay. Multivariate logistic regression was used to determine factors associated with low HIV-1 DNA.

Results:

We evaluated 96 patients: 78 (81%) and 18 (19%) subjects with HIV-1 DNA ≥100 copies/106 PBMCs and with HIV-1 DNA <100 copies/106 PBMCs, respectively. Median age was 32.5 (25.3–38.9), and 61 (64%) were men; moreover, we reported that nadir CD4+ was 253 (167–339) cells/µL and HIV-RNA <50 copies/mL for 11.7 (10.6–14.0) years. At multivariate analysis, higher nadir CD4+ [adjusted odds ratio (AOR) [95% confidence interval (CI) 1.35 (95% CI: 1.03 to 1.76), P = 0.029], longer years of HIV-1 RNA <50 copies/mL [AOR (95% CI) 2.98 (95% CI: 1.25 to 7.10), P = 0.014], a R5-tropic virus [AOR (R5 vs. non-R5) 0.20 (95% CI: 0.04 to 0.96), P = 0.044], and negative HIV-1 pol [AOR 6.59 (95% CI: 1.47 to 29.54), P = 0.014] were associated with low HIV-1 DNA.

Conclusions:

In patients with chronic HIV-1 infection and suppressive antiretroviral therapy, negative HIV-1 pol on WB was associated with low HIV-1 DNA as well as higher nadir CD4+, longer years of HIV-1 RNA <50 copies/mL, and a R5-tropic virus.
Antiretroviral Therapy Adherence Interruptions Are Associated With Systemic Inflammation Among Ugandans Who Achieved Viral Suppression
Authors: Musinguzi Nicholas , Castillo-Mancilla Jose , Morrow Mary , Byakwaga Helen , Mawhinney Samantha , Burdo Tricia H. , Boum Yap , Muzoora Conrad , Bwana Bosco M. , Siedner Mark J. , Martin Jeffrey N. , Hunt Peter W. , Bangsberg David R. , Haberer Jessica E.
Published: October 2019

Background:

Residual systemic inflammation, which is associated with non-AIDS clinical outcomes, may persist despite viral suppression. We assessed the effect of antiretroviral therapy (ART) adherence interruptions on systemic inflammation among Ugandans living with HIV who were virally suppressed.

Setting:

We evaluated adults initiating first-line ART at a regional referral hospital clinic in Mbarara, Uganda.

Methods:

Plasma concentrations of interleukin-6 (IL-6), D-dimer, soluble sCD14, sCD163, the kynurenine/tryptophan (K/T) ratio, and CD8+ T-cell activation (HLA-DR+/CD38+ coexpression) were measured at baseline and 6 months after ART initiation among participants who achieved viral suppression (<400 copies/mL) at 6 months. ART adherence was monitored electronically. Time spent in an adherence interruption was computed as the percentage of days when the running average adherence was ≤10%. We fit adjusted linear regressions to evaluate the effect of time spent in an interruption on the log-transformed plasma concentrations of the inflammation biomarkers.

Results:

Of 282 participants, 70% were women, and the median age was 34 years. At baseline, median CD4 and median log viral load were 135 cells per microliter and 5.1 copies per milliliter, respectively. In the adjusted analysis, a running average adherence of <10% was associated with higher sCD14 (+3%; P < 0.008), sCD163 (+5%; P = 0.002), D-dimer (+10%; P = 0.007), HLA-DR+/CD8+ (+3%; P < 0.025), IL-6 (+14%; P = 0.008), and K:T ratio (+5%; P = 0.002). These findings were largely robust to adjustment for average adherence, as well as higher thresholds of running average adherence, albeit with decreased statistical significance.

Conclusions:

Increased time spent in adherence interruptions is associated with increased levels of inflammation, despite viral suppression above and beyond average adherence.
Ten Things We Need to Do to Achieve the Goals of the End the HIV Epidemic Plan for America
Authors: Kelly Jeffrey A.
Published: October 2019

Problem:

DHHS announced a plan for Ending the HIV Epidemic (EtHE) by reducing new HIV infections in the United States by 75% within 5 years and 90% within 10 years through early diagnosis of all individuals with HIV, immediate treatment to achieve viral suppression, protection of high-risk but uninfected individuals including with pre-exposure prophylaxis (PrEP), and quickly responding to emerging HIV clusters.

Approach:

Ten steps are outlined that will help the field achieve EtHE Plan goals.

Findings:

Steps needed to reach EtHE goals are: (1) better reaching, understanding, and meeting the HIV prevention and care needs of Black men who have sex with men; (2) deployment of interventions that address social, cultural, behavioral, and structural determinants of HIV disparities; (3) improving uptake in biomedical HIV-prevention strategies in mid-sized cities across the country's center; (4) addressing with long-term commitment the urgent HIV-prevention needs in the US Southeast; (5) encouraging more frequent and regular HIV testing; (6) developing better strategies to not only encourage initiation but also the long-term and sustained use of PrEP by persons at high risk for contracting HIV infection; (7) improving the comfort and capacity of primary care providers to prescribe PrEP; (8) increasing HIV medical care retention and care re-engagement, especially among persons with competing life stressors; (9) developing sustainable implementation efforts; and (10) addressing policies that can facilitate or impede success in eliminating the HIV epidemic in the United States.

Conclusion:

EtHE goals are achievable but will require concerted, sustained effort.
Treatment as Prevention: Concepts and Challenges for Reducing HIV Incidence
Authors: Brault Marie A. , Spiegelman Donna , Hargreaves James , Nash Denis , Vermund Sten H.
Published: October 2019

Background:

Four of the largest HIV prevention trials have been conducted in sub-Saharan Africa, enrolling hundreds of thousands of participants in catchment areas of millions of people. The trials have focused on community-level interventions to increase diagnosis and initiation of antiretroviral therapy (ART) to improve health and reduce HIV transmission. Universal test-and-treat strategies are deployed to achieve viral suppression thereby reducing risk to uninfected persons, known as treatment as prevention (TasP).

Purpose:

We review the work that found HIV plasma load to correlate with transmission risk, demonstrated that ART could reduce genital tract viral expression, and showed early treatment to be beneficial for persons living with HIV, and that HIV-uninfected sexual partners were protected from infection. We review the seemingly inconsistent findings of the major TasP trials: the TasP [National Agency for AIDS Research (ANRS) 12249] study in South Africa, the SEARCH trial in Kenya and Uganda, the Botswana Combination Prevention Project Ya Tsie study, and the HIV Prevention Trials Network 071 (PopART) trial in Zambia and South Africa.

Findings:

All the trials reinforce the critical need to identify approaches to optimize programs and incentivize uptake and engagement in HIV testing and ART-based care in ways that consistently reduce HIV transmission. That other chronic conditions can be screened for and treated in the same infrastructures suggests added value of HIV investments.

Conclusions:

Implementation challenges are a principal frontier in the global struggle to reduce HIV transmission and mortality using TasP, complementing efforts to find a cure for HIV and an effective, deployable vaccine.
Increasing Diversity and Capacity in HIV Behavioral and Social Science Research: Reflections and Recommendations From the Inaugural Cohort of the Mid-Atlantic CFAR Consortium (MACC) Scholars Program
Authors: Brown Lily A. , Dangerfield Derek T. , Meanley Steven , Hickson DeMarc
Published: October 2019

Problem Statement:

There is a need to increase diversity among both researchers and participants in the area of HIV scholarship. The Mid-Atlantic Center for AIDS Research Consortium (MACC) Scholars Program was developed to promote diversity among HIV-related researchers and participants.

Approach:

Four Scholars were provided with mentorship from senior investigators at Johns Hopkins University, George Washington University, and the University of Pennsylvania. Each Scholar was awarded a grant to develop a pilot study on a topic related to HIV-prevention, treatment, or care. The paper will describe the benefits of the program, challenges that Scholars faced in their projects, and areas for growth of the program from the perspective of the Scholars.

Findings:

The Scholars unanimously agreed that the program was essential for gathering pilot data and for receiving practical training in grantsmanship and writing. For challenges, each Scholar encountered unanticipated delays in regulatory approval, resulting in a lag of project start-up. As an indication of the success of the program, Scholars reported on their productivity for grantsmanship, scientific publications, and grantsmanship over the first year of the program. Finally, the Scholars offered several suggestions for continuing to improve the MACC Program for future cohorts.

Conclusion:

The Scholars perceived the inaugural year of the MACC Scholars Program as extremely helpful and productive. Ongoing efforts should be made to continue to promote the development of diverse junior scientists in HIV research.