Mitral Annular and Coronary Artery Calcification Are Associated with Mortality in HIV-Infected Individuals.

BackgroundHIV infection increases cardiovascular risk. Coronary artery calcification (CAC) and mitral annular calcification (MAC) identify patients at risk for cardiovascular disease (CVD). The purpose of this study was to examine the association between MAC, CAC and mortality in HIV-infected individuals.Methods and resultsWe studied 152 asymptomatic HIV-infected individuals with transthoracic echocardiography (TTE) and computed tomography (CT). MAC was identified on TTE using standardized criteria. Presence of CAC, CAC score and CAC percentiles were determined using the modified Agatston criteria. Mortality data was obtained from the Social Security and National Death Indices (SSDI/NDI). The median age was 49 years; 87% were male. The median duration of HIV was 16 years; 84% took antiretroviral therapy; 64% had an undetectable viral load. CVD risk factors included hypertension (35%), smoking (62%) and dyslipidemia (35%). Twenty-five percent of individuals had MAC, and 42% had CAC. Over a median follow-up of 8 years, 11 subjects died. Subjects with CAC had significantly higher mortality compared to those with MAC only or no MAC. The Harrell's C-statistic of CAC was 0.66 and increased to 0.75 when MAC was added (p = 0.05). MAC, prior CVD, age and HIV viral load were independently associated with higher age- and gender-adjusted CAC percentiles in an adjusted model (p < 0.05 for all).ConclusionIn HIV patients, the presence of MAC, traditional risk factors and HIV viral load were independently associated with CAC. Presence of CAC and MAC may be useful in identifying HIV-infected individuals at higher risk for death

Delphi with feedback of rationales: how large can a Delphi group be such that participants are not overloaded, de-motivated, or disengaged?

In this paper, we investigate the effect of Delphi group size and opinion diversity on group members’ information load as well as on their overall experience of the Delphi process - in terms of task involvement (enjoyment and interest) and in terms of group sway (the influence and helpfulness of others’ rationales). For Delphi applications involving the exchange of rationales between participants, we found no evidence that group sizes of up to 19 participants cause information overload or de-motivation and disengagement of participants

Maternal and fetal outcomes in pregnancies complicated by the inherited aortopathy Loeys–Dietz syndrome

Objective Pregnancies in women with Loeys–Dietz syndrome (LDS) are rare and are typically documented in case reports only. Early reports suggested high rates of maternal complications during pregnancy and the puerperium, including aortic dissection and uterine rupture, but information on fetal outcomes was very limited. Design A retrospective cohort study. Setting Eight specialist UK centres. Sample Pregnant women with LDS. Methods Data was collated on cardiac, obstetric, and neonatal outcomes. Main outcome measures Maternal and perinatal outcomes in pregnancies complicated by LDS. Results Twenty pregnancies in 13 women with LDS were identified. There was one miscarriage, one termination of pregnancy, and 18 livebirths. In eight women the diagnosis was known prior to pregnancy but only one woman had preconception counselling. In four women the diagnosis was made during pregnancy through positive genotyping, and the other was diagnosed following delivery. Five women had a family history of aortic dissection. There were no aortic dissections in our cohort during pregnancy or postpartum. Obstetric complications were common, including postpartum haemorrhage (33%) and preterm delivery (50%). In all, 14/18 (78%) of deliveries were by elective caesarean section, at a median gestational age at delivery of 37 weeks. Over half the infants (56%) were admitted to the neonatal unit following delivery. Conclusion Women with LDS require multidisciplinary specialist management throughout pregnancy. Women should be referred for preconception counselling to make informed decisions around pregnancy risk and outcomes. Early elective preterm delivery needs to be balanced against a high infant admission rate to the neonatal unit

Online training courses on Expert Knowledge Elicitation (EKE)

This report summarises the training courses delivered under the contract OC/EFSA/AMU/2021/02 EKE: “Develop and conduct online training courses on Expert Knowledge Elicitation (EKE)”. The objective of the courses was to develop and conduct online training courses on applying the methodology described in the EFSA Guidance on Expert Knowledge Elicitation in Food and Feed Safety Risk Assessment” for EFSA staff and experts, as well as corresponding experts from EU member states. In addition to the three standard EKE methods (Sheffield, Delphi and Cooke), the training included a semi-formal method of EKE. All these methods may be used when EKE is performed within an existing EFSA working group to support uncertainty analysis as outlined in “The principles and methods behind EFSA\u27s Guidance on Uncertainty Analysis in Scientific Assessment”. In total, 12 courses were organised: two on “Steering an Expert Knowledge Elicitation”, two on “Conduct of the Sheffield protocol for an EKE”, one on “Conduct of the Cooke protocol for an EKE”, one on “Conduct of the Delphi protocol for an EKE”, two on “Conduct of a Semi-formal EKE”, two on “Reporting an Expert Knowledge Elicitation” and two on “Writing an Evidence Dossier for an Expert Knowledge Elicitation”. The courses had in total 149 participants and received very good feedback from the participants with a mean value of 4.2 of 5 possible, considering all numerical questions in the feedback questionnaire. Recommendations for future activities on training EKE methodologies are provided

Cell Dispersal Influences Tumor Heterogeneity and Introduces a Bias in NGS Data Interpretation

Short and long distance cell dispersal can have a marked effect on tumor structure, high cellular motility could lead to faster cell mixing and lower observable intratumor heterogeneity. Here we evaluated a model for cell mixing that investigates how short-range dispersal and cell turnover will account for mutational proportions. We show that cancer cells can penetrate neighboring and distinct areas in a matter of days. In next generation sequencing runs, higher proportions of a given cell line generated frequencies with higher precision, while mixtures with lower amounts of each cell line had lower precision manifesting in higher standard deviations. When multiple cell lines were co-cultured, cellular movement altered observed mutation frequency by up to 18.5%. We propose that some of the shared mutations detected at low allele frequencies represent highly motile clones that appear in multiple regions of a tumor owing to dispersion throughout the tumor. In brief, cell movement will lead to a significant technical (sampling) bias when using next generation sequencing to determine clonal composition. A possible solution to this drawback would be to radically decrease detection thresholds and increase coverage in NGS analyses. © 2017 The Author(s)

Effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock. The VANISH Randomized Clinical Trial

IMPORTANCE: Norepinephrine is currently recommended as the first-line vasopressor in septic shock; however, early vasopressin use has been proposed as an alternative. OBJECTIVE: To compare the effect of early vasopressin vs norepinephrine on kidney failure in patients with septic shock. DESIGN, SETTING, AND PARTICIPANTS: A factorial (2×2), double-blind, randomized clinical trial conducted in 18 general adult intensive care units in the United Kingdom between February 2013 and May 2015, enrolling adult patients who had septic shock requiring vasopressors despite fluid resuscitation within a maximum of 6 hours after the onset of shock. INTERVENTIONS: Patients were randomly allocated to vasopressin (titrated up to 0.06 U/min) and hydrocortisone (n = 101), vasopressin and placebo (n = 104), norepinephrine and hydrocortisone (n = 101), or norepinephrine and placebo (n = 103). MAIN OUTCOMES AND MEASURES: The primary outcome was kidney failure-free days during the 28-day period after randomization, measured as (1) the proportion of patients who never developed kidney failure and (2) median number of days alive and free of kidney failure for patients who did not survive, who experienced kidney failure, or both. Rates of renal replacement therapy, mortality, and serious adverse events were secondary outcomes. RESULTS: A total of 409 patients (median age, 66 years; men, 58.2%) were included in the study, with a median time to study drug administration of 3.5 hours after diagnosis of shock. The number of survivors who never developed kidney failure was 94 of 165 patients (57.0%) in the vasopressin group and 93 of 157 patients (59.2%) in the norepinephrine group (difference, -2.3% [95% CI, -13.0% to 8.5%]). The median number of kidney failure-free days for patients who did not survive, who experienced kidney failure, or both was 9 days (interquartile range [IQR], 1 to -24) in the vasopressin group and 13 days (IQR, 1 to -25) in the norepinephrine group (difference, -4 days [95% CI, -11 to 5]). There was less use of renal replacement therapy in the vasopressin group than in the norepinephrine group (25.4% for vasopressin vs 35.3% for norepinephrine; difference, -9.9% [95% CI, -19.3% to -0.6%]). There was no significant difference in mortality rates between groups. In total, 22 of 205 patients (10.7%) had a serious adverse event in the vasopressin group vs 17 of 204 patients (8.3%) in the norepinephrine group (difference, 2.5% [95% CI, -3.3% to 8.2%]). CONCLUSIONS AND RELEVANCE: Among adults with septic shock, the early use of vasopressin compared with norepinephrine did not improve the number of kidney failure-free days. Although these findings do not support the use of vasopressin to replace norepinephrine as initial treatment in this situation, the confidence interval included a potential clinically important benefit for vasopressin, and larger trials may be warranted to assess this further. TRIAL REGISTRATION: clinicaltrials.gov Identifier: ISRCTN 20769191

The pedagogy and principles of teaching therapeutic practice with children and young people.

Technical approaches suggesting that systematically produced, generalized, and scientific knowledge are the most solid foundations for practice present significant challenges for the social work profession, in which the decisions faced often are not technical but rather moral, requiring the application of ethically based and intuitive skills. Meanwhile, the command, control, and measurement of outcomes in social work practice also present significant conundrums for the delivery of relational person-centered social work and social care. With a focus too often on efficiency rather than on effectiveness, this managerialistic approach frequently fails to acknowledge the complexity inherent in the act of caring. In this context and framework, teaching therapeutic practice with children draws a balance between traditional systematic teaching methods and use of creative media including art, play, and music. This article outlines the positive contribution to professional social work practice that the teaching of therapeutic approaches to child care can make

Structure of the TPR Domain of AIP: Lack of Client Protein Interaction with the C-Terminal alpha-7 Helix of the TPR Domain of AIP Is Sufficient for Pituitary Adenoma Predisposition

PMCID: PMC3534021This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited