“I don’t want to look sick skinny”: Perceptions of body image and weight loss in Hispanics living with HIV in South Texas

Objective: Obesity is rising in people with HIV (PLWH) and Hispanics. Both HIV and obesity are associated with cardiovascular disease morbidity and mortality. Our goal is to understand perceptions of body image and lifestyle in Hispanics with HIV to adapt interventions appropriately. Methods: We conducted semi-structured interviews with 22 Hispanic PLWH and 6 providers. Purposive sampling selected patient participants across weights and genders. Interviews were coded and analyzed using grounded theory, comparing perspectives between patients with and without obesity, and patients and providers. Results: Participants felt obesity and diabetes were “normal” in the community. Patients exhibited understanding of healthy diet and lifestyle but felt incapable of maintaining either. Traditionally Hispanic foods were blamed for local obesity prevalence. Five patients equated weight with health and weight loss with illness, and four expressed concerns that weight loss could lead to unintentional disclosure of HIV status. Participants with overweight or obesity expressed awareness of their weight and felt shamed by providers. Providers found weight loss interventions to be ineffective. Conclusion: Interventions in this population must address identified barriers: overweight/obesity as a normative value, lack of self-efficacy, cultural beliefs surrounding food, fear of HIV-associated weight loss and stigma, and provider perspectives on intervention futility

Time Averaged Quantum Dynamics and the Validity of the Effective Hamiltonian Model

We develop a technique for finding the dynamical evolution in time of an averaged density matrix. The result is an equation of evolution that includes an Effective Hamiltonian, as well as decoherence terms in Lindblad form. Applying the general equation to harmonic Hamiltonians, we confirm a previous formula for the Effective Hamiltonian together with a new decoherence term which should in general be included, and whose vanishing provides the criteria for validity of the Effective Hamiltonian approach. Finally, we apply the theory to examples of the AC Stark Shift and Three- Level Raman Transitions, recovering a new decoherence effect in the latter.Comment: 7 pages, 2 figure

Online Health Social Networks and Patient Health Decision Behavior: A Research Agenda

Patients and health care practitioners alike are using the Internet and specifically online health social networks to gain access to knowledge and social support that they could not obtain as quickly or efficiently from their traditional face-to-face social networks. Given concerns about the quality of information available on the Internet and the differences between social interaction online and offline, it is important to determine whether this new phenomenon influences health decision behavior. We propose a framework for investigating the influence online health social networks may have on the health decisions that patients and their physicians make. We also propose a number of research questions that flow from this framework

Five- to nine-year follow-up results of balloon angioplasty of native aortic coarctation in infants and children

AbstractObjectives. To evaluate the usefulness of balloon angioplasty for relief of native aortic coarctation, we reviewed our experience with this procedure, with special emphasis on follow-up results.Background. Controversy exists with regard to the role of balloon angioplasty in the treatment of native aortic coarctation.Methods. During an 8.7-year period ending September 1993, 67 neonates, infants and children underwent balloon angioplasty for native aortic coarctation. A retrospective review of this experience with emphasis on long-term follow-up forms the basis of this study.Results. Balloon angioplasty produced a reduction in the peak-to-peak coarctation gradient from 46 ± 17 (mean ± SD) to 11 ± 9 mm Hg (p < 0.001). No patient required immediate surgical intervention. At intermediate-term follow-up (14 ± 11 months), catheterization (58 patients) and blood pressure (2 patients) data revealed a residual gradient of 16 ± 15 mm Hg (p > 0.1). When individual results were scrutinized, 15 (25%) of 60 had recoarctation, defined as peak gradient >20 mm Hg. Recoarctation was higher (p < 0.01) in neonates (5 [83%] of 6) and infants (7 [39%] of 18) than in children (3 [8%] of 36), respectively. Two infants in our early experience had surgical resection with excellent results. Three patients had no discrete narrowing but had normal arm blood pressure and had no intervention. The remaining 10 patients had repeat balloon angioplasty with reduction in peak gradient from 52 ± 13 to 9 ± 8 mm Hg (p < 0.001). Reexamination 31 ± 18 months after repeat angioplasty revealed a residual gradient of 3 to 19 mm Hg (mean 11 ± 6). Three (5%) of 58 patients who underwent follow-up angiography developed an aneurysm. Detailed evaluation of the femoral artery performed in 51 (88%) of 58 patients at follow-up catheterization revealed patency of the femoral artery in 44 (86%) of 51 patients. Femoral artery occlusion, complete in three (6%) and partial in four (8%), was observed, but all had excellent collateral flow. Blood pressure, echocardiography-Doppler ultrasound and repeat angiographic or magnetic resonance imaging data 5 to 9 years after angioplasty revealed no new aneurysms and minimal (2%) late recoarctation.Conclusions. On the basis of these data, it is concluded that balloon angioplasty is safe and effective in the treatment of native aortic coarctation; significant incidence of recoarctation is seen in neonates and infants; repeat balloon angioplasty for recoarctation is feasible and effective; and the time has come to consider balloon angioplasty as a therapeutic procedure of choice for the treatment of native aortic coarctation

Intravenous and Oral Tranexamic Acid are Equivalent at Reducing Blood Loss in Thoracolumbar Spinal Fusion: A Prospective Randomized Trial Phase 2

Intravenous and oral tranexamic acid are equivalent at reducing blood loss in thoracolumbar spinal fusion: a prospective randomized trial. Discussion and Conclusion: Patients treated with IV and PO TXA experienced the same perioperative blood loss after spinal fusions. Given its lower cost, PO TXA represents an excellent alternative to IV TXA in patients undergoing elective posterior thoracolumbar fusion and may improve healthcare cost-efficiency in the studied population. Results: 91 patients received IV TXA and 80 patients received PO TXA. Patient demographic factors were similar between groups except for Age, Weight, and BMI. The mean reduction of hemoglobin was similar between IV and PO groups (3.48 g/dL vs. 3.19 g/dL, respectively; P = 0.004, equivalence). Similarly, the calculated blood loss was equivalent (1274 mL vs. 1206 mL, respectively; P = 0.001 equivalence). In addition, higher ASA (American Society of Anesthesiologists) level and longer surgical time were associated with more hemoglobin reduction (P = 0.01 and P \u3c 0.001, respectively) and blood loss (P \u3c 0.01 and P \u3c 0.001, respectively). Methods: A prospective randomized trial of patients enrolled at a university affiliated tertiary medical center between February 2017 and October 2018. 171 patients undergoing thoracolumbar fusion were randomized to receive 1.95g of PO TXA 2 hours preoperatively or 2g IV TXA (1g before incision and 1g before wound closure) intraoperatively. The sample was further stratified into 3 categories based on number of levels fused (1-2 level fusions, 3-5, and \u3e5). The primary outcome was the reduction of hemoglobin. Secondary outcomes included calculated blood loss, drain output, postoperative transfusion, complications, and length of hospital stay. Equivalence analysis was performed with a two one-sided test (TOST). A P-value of \u3c0.05 suggested equivalence between treatments.Introduction: The use of antifibrinolytic agents such as tranexamic acid (TXA) to decrease operative blood loss and allogenic blood transfusions is well documented in the literature. While evidence supports the use of intravenous (IV) and topical formulations of TXA in spine surgery, the use of oral (PO) TXA has not been studied. The objective of the study is to compare perioperative blood loss in patients undergoing elective posterior thoracolumbar fusion who were treated with IV versus PO TXA.https://scholarlycommons.henryford.com/merf2019clinres/1041/thumbnail.jp

5-(2-Bromo­phen­yl)-1,3,4-thia­diazol-2-amine

In the title compound, C8H6BrN3S, the thia­diazole ring is oriented at a dihedral angle of 48.35 (3)° with respect to the bromo­phenyl ring. In the crystal structure, inter­molecular N—H⋯N hydrogen bonds link the mol­ecules

Diethyl {[5-(2,4-dichloro­phen­yl)-1,3,4-thia­diazol-2-ylamino](4-methoxy­phenyl)methyl}­phospho­nate

The title compound, C20H22Cl2N3O4PS, was synthesized by the reaction of N-(4-methoxy­benzyl­idene)-5-(2,4-dichloro­phenyl)-1,3,4-thia­diazol-2-amine and diethyl phosphite. In the crystal, inter­molecular C—H⋯O and N—H⋯O hydrogen bonds link the mol­ecules

Methyl 2-({6-[(1-meth­oxy-2-methyl-1-oxopropan-2-yl)carbamo­yl]pyridin-2-yl}formamido)-2-methyl­propano­ate

In the title compound, C17H23N3O6, the two meth­oxy­carbonyl C—O—C=O planes are inclined at dihedral angles of 5.3 (4) and 83.9 (4)° with respect to the central pyridine ring. An intra­molecular N—H⋯O hydrogen bond generates an S(5) ring motif. In the crystal, mol­ecules are linked into a chain along the c axis via C—H⋯O hydrogen bonds

5-(2-Methoxy­benz­yl)-4-(2-methoxy­phen­yl)-4H-1,2,4-triazol-3-ol

In the mol­ecule of the title compound, C17H17N3O3, the triazole ring is oriented at dihedral angles of 88.09 (3) and 83.72 (3)° with respect to the 2-methoxy­benzyl and 2-methoxy­phenyl rings, respectively. The dihedral angle between the 2-methoxy­benzyl and 2-methoxy­phenyl rings is 52.95 (3)°. In the crystal structure, inter­molecular N—H⋯O hydrogen bonds link the mol­ecules into centrosymmetric dimers. There is a π–π contact between the 2-methoxy­phenyl rings [centroid–centroid distance = 3.811 (3) Å]