Anatomic Fat Depots and Coronary Plaque Among Human Immunodeficiency Virus-Infected and Uninfected Men in the Multicenter AIDS Cohort Study.

Methods.  In a cross-sectional substudy of the Multicenter AIDS Cohort Study, noncontrast cardiac computed tomography (CT) scanning for coronary artery calcium (CAC) scoring was performed on all men, and, for men with normal renal function, coronary CT angiography (CTA) was performed. Associations between fat depots (visceral adipose tissue [VAT], abdominal subcutaneous adipose tissue [aSAT], and thigh subcutaneous adipose tissue [tSAT]) with coronary plaque presence and extent were assessed with logistic and linear regression adjusted for age, race, cardiovascular disease (CVD) risk factors, body mass index (BMI), and human immunodeficiency virus (HIV) parameters. Results.  Among HIV-infected men (n = 597) but not HIV-uninfected men (n = 343), having greater VAT was positively associated with noncalcified plaque presence (odds ratio [OR] = 1.04, P < .05), with a significant interaction (P < .05) by HIV serostatus. Human immunodeficiency virus-infected men had lower median aSAT and tSAT and greater median VAT among men with BMI <25 and 25-29.9 kg/m(2). Among HIV-infected men, VAT was positively associated with presence of coronary plaque on CTA after adjustment for CVD risk factors (OR = 1.04, P < .05), but not after additional adjustment for BMI. There was an inverse association between aSAT and extent of total plaque among HIV-infected men, but not among HIV-uninfected men. Lower tSAT was associated with greater CAC and total plaque score extent regardless of HIV serostatus. Conclusions.  The presence of greater amounts of VAT and lower SAT may contribute to increased risk for coronary artery disease among HIV-infected persons

Spectroscopy of Bright QUEST RR Lyrae Stars: Velocity Substructures toward Virgo

Using a sample of 43 bright (V<16.1, distance <13 kpc) RR Lyrae stars (RRLS) from the QUEST survey with spectroscopic radial velocities and metallicities, we find that several separate halo substructures contribute to the Virgo overdensity (VOD). While there is little evidence for halo substructure in the spatial distribution of these stars, their distribution in radial velocity reveals two moving groups. These results are reinforced when the sample is combined with a sample of blue horizontal branch stars that were identified in the SDSS, and the combined sample provides evidence for one additional moving group. These groups correspond to peaks in the radial velocity distribution of a sample of F type main-sequence stars that was recently observed in the same directon by SEGUE, although in one case the RRLS and F star groups may not lie at the same distance. One of the new substructures has a very narrow range in metallicity, which is more consistent with it being the debris from a destroyed globular cluster than from a dwarf galaxy. A small concentration of stars have radial velocities that are similar to the Virgo Stellar Stream (VSS) that was identified previously in a fainter sample of RRLS. Our results suggest that this feature extends to distances as short as ~12 kpc from its previous detection at ~19 kpc. None of the new groups and only one star in the sample have velocities that are consistent with membership in the leading tidal stream from the Sagittarius Dwarf Spheroidal Galaxy, which some authors have suggested is the origin of the VOD.Comment: Accepted for publication in the A

Multidisciplinary pediatric trauma team training using high-fidelity trauma simulation

Abstract Background: Trauma resuscitations require a high level of team performance. This study evaluated the impact of a comprehensive effort to improve trauma care through multidisciplinary education and the use of simulation training to reinforce training and evaluate performance. Methods: For a 1-year period, expanded trauma education including monthly trauma simulation sessions using high-fidelity simulators was implemented. All members of the multidisciplinary trauma resuscitation team participated in education, including simulations. Each simulation session included 2 trauma scenarios that were videotaped for debriefing as well as subsequent analysis of team performance. Scored simulations were divided into early (initial 4 months) and late (final 4 months) for comparison. Results: For the first year of the program, 160 members of our multidisciplinary team participated in the simulation. In the early group, the mean percentage of appropriately completed tasks was 65%, whereas in the late group, this increased to 75% (P b .05). Improvements were also observed in initial assessment, airway management, management of pelvic fractures, and cervical spine care. Conclusions: Training of a multidisciplinary team in the care of pediatric trauma patients can be enhanced and evaluated through the use of high-fidelity simulation. Improvements in team performance using innovative technology can translate into more efficient care with fewer errors

Example case of using the model in a piecewise treatment plan.

The models will predict POC values which could be used to determine ideal times between follow-up visits and identify times of low patient compliance. This demonstration assumes 1 month between follow up visit. The model prediction is shown in red with fictitious patient data shown in blue. The model is updated at each follow-up visit which can then be used to alter treatment plans and adjust the predicted treatment duration.</p

Model effects for ΔPT models (Eqs 4 and 5).

Pectus carinatum is a chest wall deformity that is often treated through the wearing of an external brace. The treatment of the deformity could benefit from a greater understanding of chest wall characteristics under prolonged loading. These characteristics are difficult to model directly but empirical studies can be used to create statistical models. 185 patients from 2018-2020 received bracing treatment. Data on the severity of the deformity, treatment pressures, and time of wear were recorded at the first fitting and all subsequent follow-up visits. This data was analyzed using a statistical mixed effects model to identify significant measures and trends in treatment. These models were designed to help quantify changes in chest wall characteristics through prolonged bracing. Two statistical models were created. The first model predicts the change in the amount of pressure to correct the deformity after bracing for a given time and pressure. The second model predicts the change in pressure response by the body on the brace after bracing for a given time and pressure. These models show a high significance in the amount of pressure and time to the changes in the chest wall response. Initial deformity severity is also significant in changes to the deformity. The statistical models predict general trends in pectus carinatum brace treatment and can assist in creating treatment plans, motivating patient compliance, and can inform the design of future treatment systems.</div

An example case of using the Δ<i>PT</i> model found in Eq 5 at predicting the pressure exerted by the brace on the deformity as a function of time.

The example case shown has a PT of 1 PSI at 12 hrs/day of wear.</p

Model effects for POC models (Eqs 2 and 3).

Pectus carinatum is a chest wall deformity that is often treated through the wearing of an external brace. The treatment of the deformity could benefit from a greater understanding of chest wall characteristics under prolonged loading. These characteristics are difficult to model directly but empirical studies can be used to create statistical models. 185 patients from 2018-2020 received bracing treatment. Data on the severity of the deformity, treatment pressures, and time of wear were recorded at the first fitting and all subsequent follow-up visits. This data was analyzed using a statistical mixed effects model to identify significant measures and trends in treatment. These models were designed to help quantify changes in chest wall characteristics through prolonged bracing. Two statistical models were created. The first model predicts the change in the amount of pressure to correct the deformity after bracing for a given time and pressure. The second model predicts the change in pressure response by the body on the brace after bracing for a given time and pressure. These models show a high significance in the amount of pressure and time to the changes in the chest wall response. Initial deformity severity is also significant in changes to the deformity. The statistical models predict general trends in pectus carinatum brace treatment and can assist in creating treatment plans, motivating patient compliance, and can inform the design of future treatment systems.</div

Demonstrations of an example use of the POC model (Eq 3).

The predicted time to obtain a zero POC, assuming the same PT through the entire treatment, can be seen by where the lines intersect the horizontal axis. The prediction starts at 1 month as no first follow-up visit was less than 18 days from the initial fitting. (A) Three cases with the same initial POC value are shown with varying PT values. (B) Three cases demonstrating the effect of varying hours of daily wear for the same initial POC and PT on the correction time.</p

The brace system used in this study.

The system is made from curved aluminum segments, shoulder straps, cushioned compression plates, and pads to cushion the defect. The clinical also uses an instrumented pad to obtain measurements and assist in fitting the brace.</p