bluuebunny/crossref_metadata_2025_split huggingface dataset:
I-106 Hepatitis viruses in HIV infection
Authors: Sherman Kenneth 
Published: April 2018

Viral hepatitis represents an important comorbidity among those with HIV infection. The epidemiology and pathophysiology is often altered compared to the general population with increased prevalence, increased risk of chronicity, alteration of viral setpoints, and more rapid progression of hepatic fibrosis in many co-infected individuals. Recently, outbreaks of hepatitis A among MSM with HIV have been reported. Hepatitis B infection is often unrecognized and represents an important contributor to morbidity through both liver failure and increased risk of hepatocellular carcinoma. Hepatitis C is also associated with higher rates of chronicity following acute infection, and rapid hepatic fibrosis leading to liver related death. Treatment of HCV is efficacious but must take into account the underlying antiretroviral regimen. Hepatitis D may be more frequent among HBV/HIV infected persons than has been previously recognized, and also represents an independent risk of HCC. Hepatitis E infection can lead to chronic infections in those with HIV and other immunosuppressed states. Standard vaccination practices that are highly effective in the general population to prevent hepatitis A and B are of lower utility among those with HIV and alternative vaccine strategies should be employed.

Conclusion:
Co-infection of hepatitis viruses with HIV leads to alterations in natural history, as well as prevention and treatment strategies. Care providers must be cognizant to these differences in order to provide optimal care for the HIV-infected patient.
I-107 Optimisation of a therapeutic vaccine; the importance of immune modulation
Authors: Dalgleish Angus , Sommerfelt Maja , Sorensen Birger , Smith Peter 
Published: April 2018

Vacc-4X is a p24 (gag) peptide based vaccine, shown to reduce viral load (HIVRNA) in HAART interrupted patients, confirmed in a randomised phase II study, which also confirmed vaccination had no effect on the CD4 count. A programme to improve the efficacy of Vacc4X has included peptide modifications to increase uptake by dendritic cells and the breadth of the responses to these peptides.
A recent study (Sorensen B et al, ARHRV 2017) showed that in 3 cohorts of patients, antibodies to the novel heterodimeric construct designed to enhance the immunogenicity of this region containing C5 (501-512) and gp41 (732-44), was associated with slower disease progression and lower viral loads, antibodies to the C5 (501-506) domain correlated with preserved CD4 counts. It is proposed to combine this construct with the Vacc4X to enhance efficacy.
These patient cohorts are all long term infected patients with compromised immune responses, even on HAART. The IMiDs, including Lenalidomide, have been shown to enhance immune responses to cell based vaccines in-vivo and Prevnar in clinical trials. Priming patients with Lenalidomide before Vacc4X led to an increase in CD4 counts in a small randomised study. It is proposed that if Lenalidomide had been given for longer, the effect would have been more significant.
In addition, an immune modulator, M.vaccae, has been shown to reduce the incidence of TB in a randomised study in HIV infected subjects in Africa. M.vaccae and its commercial derivative (IMM-101) have been shown to be ideal adjuvants for anticancer based vaccines. It is proposed that immune modulation by Lenalidomide and IMM-101 could enhance clinical benefit seen with Vacc4X and enhanced responses to C5.
J-102 Decreased levels of seroreactivity in individuals subjected to antiretroviral therapy early in acute HIV infection
Authors: Manak Mark , Shutt Ashley , Eller Leigh , Robb Merlin , Jagodzinski Linda , Ananworanich Jintanat , Peel Sheila 
Published: April 2018

WHO guidelines recommend antiretroviral treatment (ART) of all HIV infected individuals regardless of CD4 count. Early treatment minimizes the risk of HIV transmission, lowers the natural reservoir of the virus, and reduces subsequent serious AIDS related events, but may also disrupt emergence of HIV diagnostic markers.
High-risk individuals at early stages of HIV infection, (HIV-1 RNA positive, Western Blot negative or indeterminate), were enrolled into an IRB approved study to examine the outcomes of early HAART initiation. Plasma samples collected at week 0, 2, 12, and 24 were tested by EIA 1/2 Plus O, HIV-1/2 Ag/Ab Combo, HIV-1/2 MultiSpot (MS), and HIV-1 Western Blot (WB) (all from Bio-Rad, Redmond, WA). HIV Viral Load was determined by Abbott m2000 HIV-1 RT PCR (Chicago, IL). Stage of HIV infection was based on the Fiebig staging system.
Of individuals treated at Fiebig I and II, 63.6 and 59.1%, respectively, were antibody negative at 12 weeks. At week 12, MS was reactive in 18.2%, 53.7% and 35.0% of individuals treated at Fiebig I, II, and Fiebig III/IV, and decreased to 9.1%, 48.4% and 30.0%, respectively, by week 24. 52.9% of individuals treated at Fiebig III/IV were negative at week 24. In contrast, all untreated individuals were highly reactive by EIA, WB, MS and RNA by week 2–3 after infection and remained reactive thereafter.
Absence of serological markers in individuals treated early in infection presents challenges in determining status of infection, as some individuals under therapy may test serologically non-reactive and RNA negative, but are infected. These findings may also have implications in monitoring individuals on Pre-exposure Prophylactics (PrEP) by serological tests alone.
J-103 Performance and usability of the OraQuick® HIV Self-test, an oral fluid based HIV self-test, in South Africa
Authors: Reed Michael , Majam Mohammed 
Published: April 2018

With 30% of persons living with HIV globally still not knowing their status, increasing access to HIV testing using self-tests is an approach to achieving the United Nations' target goal of diagnosing 90% of all people living with HIV by 2020. The OraQuick HIV Self-Test is an oral fluid based self-test providing results in as little as 20 minutes and is the first self-test to receive WHO Prequalification (July 2017). WHO Prequalification allows access to high quality, easy to use, accurate HIV self-testing in countries wishing to broaden their HIV testing and treatment programs.
This talk describes the results and observations of studies conducted in South Africa to demonstrate ease of use and generation of accurate results in the hands of a lay user. The OraQuick® HIV Self-Test results were compared to results from a fourth Gen EIA with sensitivity of 100% (n=76) and specificity of 99.1% (n=324). A separate comprehension study was conducted to assess lay users' ability to understand information provided on the outer packaging and product insert. Comprehension scores were high 99.5% (n=200) for all critical and safety related concepts. Understanding of the next steps for positive results was 97.5% (n=200) [1].
Many studies have shown and continue to demonstrate that the OraQuick HIV Self-Test is a robust test that provides accurate and reliable results. Incorporating an easy to use oral fluid test into current HIV testing strategies can increase the number of individuals testing, especially those hard to reach high risk populations currently not accessing testing.
P-A5 HIV Infected Cells Have Depolarized Membrane Potentials and Increased Intracellular Calcium Levels
Authors: Furler Robert 
Published: April 2018

Introduction/Background:
Ion distribution between the extracellular, cytoplasmic, and organellar spaces creates membrane potentials which drive many of life's processes. This bioelectric membrane potential, driven by ion channel and pump activity, can be harnessed to allow or prevent entry of signaling mediators like Ca2+ into the cytoplasm. Several HIV proteins have been reported to function as ion channels or alter ion channel activity. This activity likely influences cell fate including activation and apoptosis.

Hypothesis:
HIV depolarizes the plasma membrane and alters intracellular calcium levels. Changing the polarization of the plasma membrane would alter the levels of HIV infection.

Methods:
HIV infected cells were identified using anti-Env antibody PG9-AF647. Membrane potential measurements were done by flow cytometry using the DiBAC4(3) dye as previously reported. Intracellular Ca2+ measurements were also done by flow cytometry using the Fluo-4 dye. Ionomycin and PMA were used to show the contrast in intracellular Ca2+ levels between infected and uninfected cells. To assess the effects of membrane potential changes on HIV replication, 200µM diazoxide was added to cells during infections.

Results:
HIV infected cells consistently had depolarized membrane potentials in both primary cells and cell lines. Additional depolarization increased infection. Membrane depolarization was accompanied by increased intracellular Ca2+. Ionomycin induced a drastic difference in Ca2+ flow between uninfected and HIV-infected cells. In uninfected cells, ionomycin induced an influx of Ca2+ while PMA had little effect. In contrast, both ionomycin and PMA induced a large efflux of Ca2+ from HIV infected cells.
Measuring Medical Housestaff Teamwork Performance Using Multiple Direct Observation Instruments: Comparing Apples and Apples
Authors: Weingart Saul N. , Yaghi Omar , Wetherell Matthew , Sweeney Megan 
Published: April 2018

Purpose
To examine the composition and concordance of existing instruments used to assess medical teams’ performance.

Method
A trained observer joined 20 internal medicine housestaff teams for morning work rounds at Tufts Medical Center, a 415-bed Boston teaching hospital, from October through December 2015. The observer rated each team’s performance using nine teamwork observation instruments that examined domains including team structure, leadership, situation monitoring, mutual support, and communication. Observations recorded on paper forms were stored electronically. Scores were normalized from 1 (low) to 5 (high) to account for different rating scales. Overall mean scores were calculated and graphed; weighted scores adjusted for the number of items in each teamwork domain. Teamwork scores were analyzed using t tests, pairwise correlations, and the Kruskal–Wallis statistic, and team performance was compared across instruments by domain.

Results
The nine tools incorporated five major domains, with 5 to 35 items per instrument, for a total of 161 items per observation session. In weighted and unweighted analyses, the overall teamwork performance score for a given team on a given day varied by instrument. While all of the tools identified the same low outlier, high performers on some instruments were low performers on others. Inconsistent scores for a given team across instruments persisted in domain-level analyses.

Conclusions
There was substantial variation in the rating of individual teams assessed concurrently by a single observer using multiple instruments. Because existing teamwork observation tools do not yield concordant assessments, researchers should create better tools for measuring teamwork performance.
The Development of Kyphosis and Lordosis in the Growing Spine
Authors: Gardner Adrian , Berryman Fiona , Pynsent Paul 
Published: April 2018

Study Design.
A longitudinal cohort study.

Objective.
The aim of this study was to do the analysis of the development of kyphosis and lordosis in the growing spine.

Summary of Background Data.
Previous studies have measured kyphosis and lordosis in different ways with differing techniques. None of the previous literature has a truly longitudinal design and there is disagreement as to whether there exists a difference between the development of kyphosis and lordosis between males and females.

Methods.
Repeated measures using Integrated Shape Imaging System Integrated Shape Imaging System 2 surface topography over 5 years of a group of children aged 5 to 16 years without spinal deformity. Longitudinal analysis was performed using linear mixed effects modeling.

Results.
There were 638 measures in 194 children. Both kyphosis and lordosis increased with age in both males and females (P < 0.001 for kyphosis and P = 0.002 for lordosis). There was no statistical difference in the development of kyphosis between males and females (P = 0.149). However, there was a significant difference in lordosis between males and females (P < 0.001) with female lordosis larger than that seen in males. Kyphosis and lordosis increased in a nonlinear fashion with age.

Conclusion.
Kyphosis and lordosis increase as children age. Between males and females there is no difference in the increase in the size of kyphosis, but there is difference in the size of lordosis with females having greater lordosis versus males at the same age.

Level of Evidence: 2
Disseminated Granulomatous Perifollicular Dermatosis With Comedones: A Follicular Variant of Lichen Nitidus or a New Entity?
Authors: Deza Gustavo , Gallardo Fernando , Barranco Carlos , Marquès Laura , Pujol Ramon M. 
Published: April 2018

Abstract:
The presence of acquired generalized keratotic follicular papules and comedones developing in adulthood constitute an uncommon clinical situation. Although this clinical presentation has been described in several noninflammatory, inflammatory, and neoplastic skin disorders, its association with an exclusive perifollicular epitheliod or granulomatous inflammatory reaction represents an exceedingly rare phenomenon. We report a case of a 57-year-old male patient presenting clinically numerous acquired disseminated follicular papules and comedones, showing isolated perifollicular sarcoid-like granulomatous inflammatory infiltrates at the histological examination. These lesions experienced a complete spontaneous resolution after several months. The possibility that this disseminated, epithelioid, granulomatous, perifollicular dermatosis may represent an isolated follicular variant of lichen nitidus or a previously nonreported skin disorder is discussed.
Attitudes Toward Interprofessional Education: Comparing Physical Therapist and Other Health Care Professions' Students
Authors: Smith Barbara S. , Anderson Kelly 
Published: April 2018

Background and Purpose.
Interprofessional teams provide the potential of comprehensive and reliable care for patient/clients with complex problems. Interprofessional education (IPE) may change students' attitudes and knowledge necessary to maintain interprofessional (IP) teamwork after graduation. Learning experiences that include interaction with standardized patients enable students to increase their skills to become IP health care providers. This case study assessed the first-time experience of a College of Health Professions in using standardized patients for an IPE activity.

Case Description.
Interprofessional student teams, representing 178 students, were formed representing the following health professions education programs: physical therapist (PT), physician assistant (PA), communication sciences and disorders (CSD), dental hygiene (DH), nursing, medical laboratory science, and public health. Standardized patients interacted with the students. Students participated in a faculty facilitator–guided discussion related to each disciplines' professional roles and patient care goals. Each discipline had faculty representation. Students received feedback from standardized patients and faculty facilitators. A pre-post design was used with a mixed quantitative–qualitative methodology. Quantitative data were analyzed using 1-way analysis of variance. Qualitative data were evaluated using frequency data.

Outcomes.
Only PT, PA, CSD, and DH students participated in sufficient numbers for use in analyses. All groups improved their ratings on the postsurvey statements. Percentages of students whose ratings improved on the postevent survey were examined by department. Physical therapist and PA students showed similar percentages. These percentages of improvements were smaller than improvements of CSD and DH students. Qualitative analysis of open-ended questions revealed four themes: collaborating without judgment of others, learning about the roles and responsibilities of their profession, as well as those of other professions, learning about themselves, and communicating with different personalities.

Discussion and Conclusion.
Students' perceptions of themselves and of other health care professional students changed. Overall, this 4-hour IPE exercise had a positive influence on these students' attitudes toward working as a team member and in being an effective member of that team.
Student Debt in Professional Doctoral Health Care Disciplines
Authors: Pabian Patrick S. , King Kathleen P. , Tippett Steve 
Published: April 2018

Introduction.
Higher education has been experiencing funding shortfalls in the past several years. While it is apparent that the financial burden has been impacting students in all fields in both undergraduate and graduate education, there is a potentially even greater impact to those earning professional doctoral degrees. With continuously rising costs of professional education, many concerns are arising in regard to the student debt that is being accumulated by students in these disciplines. Therefore, the objective of this research article is to examine the affordability of doctoral education in medicine, pharmacy, and physical therapy. The primary aim is to analyze the financial impact and economic burden of the degree attainment on graduates in their early careers with a secondary aim to assess the trends in historic physical therapy education costs.

Methodology.
This study utilized publicly available data from the US Bureau of Labor Statistics to identify salary trends in the professions with a cross comparison to economic frameworks defining the hardships due to loan repayment dollar amounts and structure to examine economic strain on early career providers in medicine, pharmacy, and physical therapy. To assess trends in physical therapy education, Consumer Price Index adjustments were made to professional data, outlining annual and total costs of physical therapy education.

Key Findings, Discussion, and Implications.
Student indebtedness and salary data suggest significant impact to all disciplines upon their entry into their given profession. However, the implications to entry-level and early career physical therapists are much more severe due to lower earning potential compared to the other disciplines.

Conclusion.
Students in professional doctoral health care disciplines of medicine, pharmacy, and physical therapy need to be cognizant of their borrowing patterns and institutional costs of their education to avoid possessing financial hardships upon their entry into their given field of practice. Physical therapy students, however, possess high potential for obtaining unmanageable debt due to the costs of education and earning potential early in their career.
Clinical Usefulness of 18F-FDG PET/CT for Staging Cancer of the External Auditory Canal
Authors: Toriihara Akira , Nakadate Masashi , Fujioka Tomoyuki , Oyama Jun , Tsutsumi Takeshi , Asakage Takahiro , Tsunoda Atsunobu , Tateishi Ukihide 
Published: April 2018

Objective:
Our objective was to evaluate the clinical usefulness of positron emission tomography/computed tomography using 2-deoxy-2-[F-18]fluoro-D-glucose (FDG-PET/CT) for staging cancer of the external auditory canal (EAC).

Study Design:
Retrospective case review.

Setting:
Tertiary referral center.

Patients:
Twenty-three patients (seven men, 16 women, mean age of 59.6-year-old) who underwent FDG-PET/CT and high-resolution CT within 1 month for staging cancer of the EAC between July 2006 and December 2014 were enrolled in this study.

Intervention:
FDG-PET/CT, high-resolution CT.

Main Outcome Measures:
Sensitivity, specificity, and accuracy for diagnosing nodal metastases.

Results:
Most primary tumors were FDG-avid and maximum standardized uptake values were 7.72 ± 3.04 and 9.06 ± 3.94 for the early (60 min) and delayed (120 min) phases of FDG-PET/CT, respectively. FDG-PET/CT was capable of detecting small nodal metastases (short axis <10 mm), and patient-based sensitivity, specificity, and accuracy of FDG-PET/CT for the N staging were 71.4, 81.3, and 78.3%, respectively. There were no patients with distant metastases in our cohort. Compared with the combination of clinical examination and conventional imaging methods, additional FDG-PET/CT resulted in a change in the surgical strategy in five patients (21.7%).

Conclusions:
Most primary cancers of the EAC are FDG-avid, and FDG-PET/CT is useful for detecting small nodal metastases, followed by the change in the surgical strategy.
Temporal Bone Histopathology in Cockayne Syndrome
Authors: Handzel Ophir , Nadol Joseph B. 
Published: April 2018

Cockayne syndrome (CS) is a rare autosomal recessive syndrome resulting in defective DNA repair. Its features include cachectic dwarfism, hearing loss, skin hypersensitivity to sunlight, premature aging, and dementia. Presented is a right temporal bone of a patient who died at the age of 29 years. The clinical course was compatible with type 1 CS, the classical form. Homozygous missense variant in the ERCC6 gene (Excision Repair Cross-Complementation group 6) was found, compatible with CS complementation group B. Five years before his death he complained of tinnitus. An audiogram 3 and a 1/2 years before his death demonstrated a moderate symmetrical sensorineural hearing loss at 2 to 8 kHz. The speech reception threshold was 20 dB, and the word recognition score was 100% on the right.
Histopathology revealed a near normal population of inner hair cells except in the basal 5 mm of the cochlea, and mild loss of outer hair cells particularly at the base of the cochlea. Severe atrophy of the spiral ligament and atrophy of stria vascularis and spiral prominence was present. There was loss of Claudius cells, outer sulcus cells, and mesenchymal cells on the scala tympani side of the basilar membrane and loss of cellularity of the limbus. There was a moderate loss of Scarpa's and spiral ganglion neurons, with the most severe loss in the basal segment. The vestibular neuro-epithelium was nearly intact, with the exception of mild loss in the saccule. The vestibular perilymphatic, and to a lesser extent endolymphatic spaces, were filled with filamentous material and osteoid. The patient had better hearing and a larger complement of neurons compared with the few published case reports.
Neurodegenerative symptoms are likely attributed to the effect of intramitochondrial reactive oxygen species. The pathogenesis of hearing loss in CS may shed light on other causes of hearing loss, such as that induced by noise.