bluuebunny/crossref_metadata_2025_split huggingface dataset:
Biomarkers of Aging in HIV-Infected Children on Suppressive Antiretroviral Therapy
Authors: Shiau Stephanie , Strehlau Renate , Shen Jing , Violari Avy , Patel Faeezah , Liberty Afaaf , Foca Marc , Wang Shuang , Terry Mary Beth , Yin Michael T. , Coovadia Ashraf , Abrams Elaine J. , Arpadi Stephen M. , Kuhn Louise 
Published: May 2018

Background:
Data on accelerated aging in HIV-infected children are limited. In this study, we assess 2 biomarkers of aging—telomere length and DNA methylation (DNAm) age—in a cohort of early-treated HIV-infected children and compare these aging biomarkers with HIV-exposed uninfected (HEU) and HIV-unexposed uninfected (HUU) children.

Setting:
Cross-sectional study of 120 HIV-infected, 33 HEU, and 25 HUU children enrolled in a cohort study in Johannesburg, South Africa. The mean age of children was 6.4 years at the time of measurement. HIV-infected children initiated ritonavir-boosted lopinavir–based antiretroviral therapy before 2 years of age and had been on continuous antiretroviral therapy until biomarker measurement.

Methods:
Telomere length was determined using multiplex quantitative polymerase chain reaction. DNAm was measured using the Illumina 450K array and DNAm age was calculated as the acceleration residual from regressing DNAm age on chronological age.

Results:
Telomere length (ln[Kb/genome]) was shorter in HIV-infected children compared with HUU children (4.14 ± 0.85 vs. 4.53 ± 0.79, P = 0.038) and in HEU children compared with HUU children (4.05 ± 0.74 vs. 4.53 ± 0.79, P = 0.023). Age acceleration residual based on DNAm levels was not different between HIV-infected (−0.003 ± 2.95), HEU (0.038 ± 2.39), and HUU (0.18 ± 2.49) children in unadjusted analysis and after adjustment for cell type proportions.

Conclusions:
Unlike reports of accelerated DNAm age in HIV-infected adults, there was no evidence of accelerated biological aging by DNAm levels in this cohort of early-treated HIV-infected children. By contrast, absolute telomere length was shorter in HIV-infected and HEU children compared with HUU children, but did not differ between HIV-infected and HEU children.
Continuum of HIV Care in Rural Mozambique: The Implications of HIV Testing Modality on Linkage and Retention
Authors: Lopez-Varela Elisa , Fuente-Soro Laura , Augusto Orvalho J. , Sacoor Charfudin , Nhacolo Ariel , Karajeanes Esmeralda , Vaz Paula , Naniche Denise 
Published: May 2018

Introduction:
Context-specific improvements in the continuum of HIV care are needed to achieve the UNAIDS target of 90-90-90. This study aimed to assess the linkage to and retention in HIV care according to different testing modalities in rural southern Mozambique.

Methods:
Adults newly diagnosed with HIV from voluntary counseling and testing, provider-initiated counseling and testing, and home-based HIV testing services were prospectively enrolled between 2014 and 2015 at the Manhiça District. Patients were passively followed up through chart examination. Tracing was performed at 12 months to ascertain causes of loss to follow-up. Fine and Gray competing risk analysis was performed to determine factors associated with the each step of the cascade.

Results:
Overall linkage to care as defined by having a CD4 count at 3 months was 43.7% [95% confidence interval (CI): 40.8 to 46.6] and 25.2% of all participants initiated antiretroviral therapy. Factors associated with increased linkage in multivariable analysis included testing at voluntary counseling and testing, older age, having been previously tested for HIV, owning a cell phone, presenting with WHO clinical stages III/IV, self-reported illness-associated disability in the previous month, and later calendar month of participant recruitment. Ascertaining deaths and transfers allowed for adjustment of the rate of 12-month retention in treatment from 75.6% (95% CI: 70.2 to 80.5) to 84.2% (95% CI: 79.2 to 88.5).

Conclusions:
Home-based HIV testing reached a sociodemographically distinct population from that of clinic-based testing modalities but low linkage to care points to a need for facilitated linkage interventions. Distinguishing between true treatment defaulting and other causes of loss to follow-up can significantly change indicators of retention in care.
Using a Social Network Strategy to Distribute HIV Self-Test Kits to African American and Latino MSM
Authors: Lightfoot Marguerita A. , Campbell Chadwick K. , Moss Nicholas , Treves-Kagan Sarah , Agnew Emily , Kang Dufour Mi-Suk , Scott Hyman , Sa'id Aria M. , Lippman Sheri A. 
Published: May 2018

Background:
Men who have sex with men (MSM) continue to be disproportionately impacted globally by the HIV epidemic. Studies suggest that HIV self-testing (HIVST) is highly acceptable among MSM. Social network strategies to increase testing are effective in reaching MSM, particularly MSM of color, who may not otherwise test. We tested a social network–based strategy to distribute HIVST kits to African American MSM (AAMSM) and Latino MSM (LMSM).

Setting:
This study was conducted in Alameda County, California, a large, urban/suburban county with an HIV epidemic mirroring the national HIV epidemic.

Methods:
From January 2016 to March 2017, 30 AAMSM, LMSM, and transgender women were trained as peer recruiters and asked to distribute 5 self-test kits to MSM social network members and support those who test positive in linking to care. Testers completed an online survey after their test. We compared peer-distributed HIVST testing outcomes to outcomes from Alameda County's targeted, community-based HIV testing programs using χ2 tests.

Results:
Peer-distributed HIVST to 143 social and sexual network members, of whom 110 completed the online survey. Compared with MSM who used the County's sponsored testing programs, individuals reached through the peer-based self-testing strategy were significantly more likely to have never tested for HIV (3.51% vs. 0.41%, P < 0.01) and to report a positive test result (6.14% vs. 1.49%, P < 0.01).

Conclusion:
Findings suggest that a network-based strategy for self-test distribution is a promising intervention to increase testing uptake and reduce undiagnosed infections among AAMSM and LMSM.
Individual and Network Factors Associated With HIV Care Continuum Outcomes Among Nigerian MSM Accessing Health Care Services
Authors: Ramadhani Habib O. , Ndembi Nicaise , Nowak Rebecca G. , Ononaku Uchenna , Gwamna Jerry , Orazulike Ifeanyi , Adebajo Sylvia , Crowell Trevor A. , Liu Hongjie , Baral Stefan D. , Ake Julie , Charurat Man E. ,   For the TRUST/RV368 Study Group
Published: May 2018

Background and Setting:
Because data on the determinants of the HIV care continuum from key populations such as men who have sex with men (MSM) in resource-limited settings are limited, the study aimed to characterize HIV care continuum outcomes and assess individual and network barriers to progression through the HIV care continuum among MSM in Abuja and Lagos, Nigeria.

Methods:
TRUST/RV368 study used respondent-driven sampling to accrue MSM into community-based clinics in Nigeria. Participants received HIV testing at enrollment. HIV-infected participants were offered antiretroviral therapy (ART) with HIV RNA testing every 3 months (Abuja) or 6 months (Lagos). Multiple logistic regression models were used to calculate adjusted odds ratios for factors associated with each point in the HIV care continuum, including HIV testing, ART initiation, and 6-month viral suppression.

Results:
A total of 1506 MSM were recruited, 1178 (78.2%) tested for HIV and 369 (31.3%) were HIV positive newly diagnosed. Of these, 188 (50.1%) initiated ART, 136 (72.3%) completed 6 months, and 96 (70.6%) were virally suppressed. Larger network size and stronger social network support were each positively associated with HIV testing uptake. Factors associated with ART initiation were higher education and stronger social network support. Having stronger social network support was associated with increased odds of viral suppression at 6 months.

Conclusions:
Social determinants of health potentiated increased HIV care continuum outcomes. Integration of HIV prevention, HIV counseling and testing services, and universal coverage of ART into a community-based clinic is critical in achieving better HIV care continuum outcomes.
Brief Report: No HIV Transmission From Virally Suppressed Mothers During Breastfeeding in Rural Tanzania
Authors: Luoga Ezekiel , Vanobberghen Fiona , Bircher Rahel , Nyuri Amina , Ntamatungiro Alex J. , Mnzava Dorcas , Mollel Getrud J. , Letang Emilio , Battegay Manuel , Weisser Maja , Gamell Anna ,   on behalf of the KIULARCO Study Group
Published: May 2018

Background:
To what extent antiretroviral therapy (ART) reduces mother-to-child HIV transmission (MTCT) during breastfeeding remains unclear. We assessed the MTCT risk from mothers on ART to their infants during breastfeeding.

Setting:
Ifakara, rural Tanzania.

Methods:
We included infants born between January 2013 and May 2016 to mothers who initiated ART before delivery, had a negative HIV DNA polymerase chain reaction at 4–12 weeks and exclusively breastfed for ≥6 months. Mothers' plasma HIV-RNA viral loads (VLs) were measured up to 11 months postdelivery. Infants were tested for HIV following national guidelines.

Results:
Among 214 women with 218 pregnancies and 228 infants (10 twins), the median age at delivery was 33 years (interquartile range 28–36 years), and the mean time on ART was 23 months (interquartile range, 4–52 months). VL was measured twice in 53% (113/218) of pregnancies. During breastfeeding, 91% of mothers (199/218) had VL of <1000 copies per milliliter, and 75% (164/218) had <100 copies per milliliter. To November 2017, 8% (19/228) of infants were lost to follow-up (LTFU), 2% (5/228) transferred, and 8% (18/228) died before the determination of final HIV serostatus. Among the remaining 186 infants, 2 (1%; 95% confidence interval: 0.3% to 4%) were HIV positive: 1 born from a mother with high VL 1-month postdelivery and 1 from a mother who interrupted ART. Assuming a 15% MTCT risk through breastfeeding among the 42 infants LTFU, transferred, or dead, the overall MTCT risk would be 4%.

Conclusions:
We found no MTCT from mothers who were retained in care and had suppressed VL. Breastfeeding signifies a very low risk when mothers adhere to ART. Adherence counseling, VL monitoring, and strategies to trace back those LTFU should be a priority.
Modeling Gadoxetate Liver Uptake and Efflux Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging Enables Preclinical Quantification of Transporter Drug-Drug Interactions
Authors: Georgiou Leonidas , Penny Jeffrey , Nicholls Glynis , Woodhouse Neil , Blé François-Xavier , Naish Josephine H. , Hubbard Cristinacce Penny L. 
Published: May 2018

Objectives
The aim of this study was to model the in vivo transporter-mediated uptake and efflux of the hepatobiliary contrast agent gadoxetate in the liver. The efficacy of the proposed technique was assessed for its ability to provide quantitative insights into drug-drug interactions (DDIs), using rifampicin as inhibitor.

Materials and Methods
Three groups of C57 mice were scanned twice with a dynamic gadoxetate-enhanced magnetic resonance imaging protocol, using a 3-dimensional spoiled gradient-echo sequence for approximately 72 minutes. Before the second magnetic resonance imaging session, 2 of the groups received a rifampicin dose of 20 (n = 7) or 40 (n = 7) mg/kg, respectively. Data from regions of interest in the liver were analyzed using 2 simplifications of a 2-compartment uptake and efflux model to provide estimates for the gadoxetate uptake rate (k
i) into the hepatocytes and its efflux rate (k
ef) into the bile. Both models were assessed for goodness-of-fit in the group without rifampicin (n = 9), and the appropriate model was selected for assessing the ability to monitor DDIs in vivo.

Results
Seven of 9 mice from the group without rifampicin were assessed for model implementation and reproducibility. A simple 3 parameter model (k
i, k
ef, and extracellular space, v
ecs) adequately described the observed liver concentration time series with mean k
i = 0.47 ± 0.11 min−1 and mean k
ef = 0.039 ± 0.016 min−1. Visually, the area under the liver concentration time profile was reduced for the groups receiving rifampicin. Furthermore, tracer kinetic modeling demonstrated a significant dose-dependent decrease in the uptake (5.9- and 17.3-fold decrease for 20 mg/kg and 40 mg/kg, respectively) and efflux rates (2.2- and 7.9-fold decrease) compared with the first scan for each group.

Conclusions
This study presents the first in vivo implementation of a 2-compartment uptake and efflux model to monitor DDIs at the transporter-protein level, using the clinically relevant organic anion transporting polypeptide inhibitor rifampicin. The technique has the potential to be a novel alternative to other methods, allowing real-time changes in transporter DDIs to be measured directly in vivo.
The Influence of Socioeconomic Factors on the Epidemiology of Maxillofacial Fractures in Southern Italy
Authors: Sbordone Carolina , Barca Ida , Petrocelli Marzia , Dell’Aversana Orabona Giovanni , Vaira Luigi Angelo , Colangeli Walter , Cristofaro Maria Giulia , Giudice Mario , Giudice Amerigo , Cassandro Francesco Maria , Attanasi Federica , Iaconetta Giorgio , Califano Luigi 
Published: May 2018

Abstract
Maxillofacial fractures represent a serious public health problem. Their epidemiology is extremely variable and its analysis is crucial to establish effective treatment and prevention of these injuries. The aim of this multicentric retrospective study was to analyze causes, demographics, incidence, characteristics of 987 patients diagnosed with maxillofacial trauma between 2011 and 2015 at Complex Operative Unit of Maxillofacial Surgery of Federico II University of Naples and Magna Graecia University of Catanzaro, Italy; 657 male and 310 female patients were admitted in the study. The most frequently observed fracture involved the mandible (399 patients, 35.4%), followed by zygomatic complex (337 patients, 29.9%), orbital walls (160 patients, 14.2%), and nasal bones (129 patients, 11.4%). The most frequent cause of fracture was assaults (30.4%), followed by road traffic injuries (27.2%), falls (23.2%), sport accidents (15.4%), and others causes (2.6%). Significant variations of etiology have been detected between the 2 hospitals in relationship with different migration flow trends and cultural and socioeconomic features. Epidemiological analysis of maxillofacial fractures is crucial to identify the trauma burden and to help in developing a more efficient system to plan resource allocation and to deliver care and preventive measures establishing clinical and research priorities for effective treatment and prevention of these injuries.
Unilateral Buccinator Flap for Lengthening of Short Palate
Authors: Hassani Mohammad-Esmaiil , Latifi Noor-Ahmad , Karimi Hamid , Khakzad Mohammad 
Published: May 2018

Background:
Velopharyngeal insufficiency is one of the most frequent complications after cleft palate repair.

Purpose:
To evaluate the results and complications of unilateral Buccinator flap (BMF) in velopharyngeal insufficiency.

Materials and Methods:
During 4 years the authors performed unilateral BMF in all short palates. Age, sex, demographic data, length of palate, cause of short palate, nasopharyngoscopy and videofluroscopy results, hyper nasality, nasal escape, nasal emission, nasal fluid leak, speech evaluation and results, outcome and complications of the treatment were surveyed before surgery and in 1, 3, 6 months after treatment.

Results:
The authors had 43 patients, 29 below 8 years old and 14 adults. Velopharyngeal gap was between 10 and 27 mm, mean 21 mm. Buccinator flap were measuring 15 to 19 mm in width and 32 to 56 mm in length. The operation time was 80 to 100 minutes, mean 86 minutes.
Nasal emission, nasal escape, and nasal leak were treated in all patients.
Hyper nasality was completely improved in all of the patients below 8 years old (29 patients) and in 10 patients of the adults (totally 39 patients, 90.6%). And it was improved significantly in other 4 patients (9.4%). The speech evaluation reported between 70% and 86% improvements.
The lengthening of the palate was between 12 and 19 mm, mean 17 mm.
The satisfaction of the patients was as 0% poor, 2.3% fair, 72.1% good, and 25.6% excellent.

Conclusion:
Unilateral BMF is reliable, promising, and safe flap for lengthening of short palate and it can lengthen the palate up to 19 mm. The time of surgery is very short compared with other methods. It is an anatomical treatment versus pharyngeal flap which is not an anatomical one. Speech improvement will achieve in 70% to 86% patients.
Perceived Esthetic Outcomes of Face Transplantation: A Survey of the General Public
Authors: Cabrera Alessandra E. , Kimberly Laura L. , Kantar Rami S. , Atamian Elisa K. , Manjunath Amit K. , Rangel Lauren K. , McQuinn Michelle W. , Diaz-Siso J. Rodrigo , Rodriguez Eduardo D. 
Published: May 2018

Abstract
Facial transplantation (FT) has attracted the interest of individuals with facial disfigurement as a path to social reintegration. The perception among face transplant recipients and the reconstructive surgery community appears to be that superior functional and esthetic outcomes can be obtained with FT compared to autologous reconstruction (AR). Although lifelong immunosuppression adds well-known risks to FT, its benefits have proven difficult to quantify, especially because of its non-life-saving nature. Evidence that the general public perceives facial allograft recipients as less disfigured than AR patients may dramatically alter the currently accepted risk/benefit ratio of this novel procedure. A survey containing independent images of individuals in nondisfigured (ND), autologous facial reconstruction, and FT groups was administered to the general public in an urban environment. Participants assigned a disfigurement score to each photograph using the Observer-Rated Facial Disfigurement Scale, a validated instrument used to rate facial disfigurement among head and neck cancer patients. One-way analysis of variance was used to calculate differences in mean level of perceived facial disfigurement among the 3 groups. A total of 250 participants completed the survey. Mean perceived disfigurement scores assigned to the ND, FT, and AR groups were 1.2 ± 0.4, 4.9 ± 1.3, and 8.5 ± 0.6, respectively. A significant difference in disfigurement score was observed between all 3 groups (P < 0.001). This pilot study suggests that the general public perceives the esthetic outcome of FT to be superior to those obtained with AR in patients with severe facial defects.
Exploring Validation and Verification
Authors: Barnes John Jacob , Konia Mojca Remskar 
Published: May 2018

Summary Statement
The healthcare simulation (HCS) community recognizes the importance of quality management because many novel simulation devices and techniques include some sort of description of how they tested and assured their simulation's quality. Verification and validation play a key role in quality management; however, literature published on HCS has many different interpretations of what these terms mean and how to accomplish them. The varied use of these terms leads to varied interpretations of how verification process is different from validation process. We set out to explore the concepts of verification and validation in this article by reviewing current psychometric science description of the concepts and exploring how other communities relevant to HCS, such as medical device manufacturing, aviation simulation, and the fields of software and engineering, which are building blocks of technology-enhanced HCS, use the terms, with the focus of trying to clarify the process of verification. We also review current literature available on verification, as compared with validation in HCS and, finally, offer a working definition and concept for each of these terms with hopes to facilitate improved communication within, and with colleagues outside, the HCS community.
Using Technology to Enhance Teaching of Patient-Centered Interviewing for Early Medical Students
Authors: Kaltman Stacey , Talisman Nicholas , Pennestri Susan , Syverson Eleri , Arthur Paige , Vovides Yianna 
Published: May 2018

Introduction
Effective strategies for teaching communication skills to health professions students are needed. This article describes the design and evaluation of immersive and interactive video simulations for medical students to practice basic communication skills.

Methods
Three simulations were developed, focusing on patient-centered interviewing techniques such as using open-ended questions, reflections, and empathic responses while assessing a patient's history of present illness. First-year medical students were randomized to simulation or education-as-usual arms. Students in the simulation arm were given access to three interactive video simulations developed using Articulate Storyline, an e-learning authoring tool, to practice and receive feedback on patient-centered interviewing techniques to prepare for their Observed Structured Clinical Examination (OSCE). Trained raters evaluated videos of two OSCE cases for each participant to assess specific communication skills used during the history of present illness component of the interview.

Results
Eighty-seven percent of the students in the simulation arm interacted with at least one simulation during the history of present illness. For both OSCE cases, students in the simulation arm asked significantly more open-ended questions. Students in the simulation arm asked significantly fewer closed-ended questions and offered significantly more empathic responses in one OSCE case. No differences were found for reflections. Students reported that the simulations helped improve their communication skills.

Conclusion
The use of interactive video simulations was found to be feasible to incorporate into the curriculum and was appealing to students. In addition, students in the simulation arm displayed more behaviors consistent with the patient-centered interviewing model practiced in the simulations. Continued development and research are warranted.