Emphysema distribution and diffusion capacity predict emphysema progression in human immunodeficiency virus infection

Background Chronic obstructive pulmonary disease (COPD) and emphysema are common amongst patients with human immunodeficiency virus (HIV). We sought to determine the clinical factors that are associated with emphysema progression in HIV. Methods 345 HIV-infected patients enrolled in an outpatient HIV metabolic clinic with \uf42 chest computed tomography scans made up the study cohort. Images were qualitatively scored for emphysema based on percentage involvement of the lung. Emphysema progression was defined as any increase in emphysema score over the study period. Univariate analyses of clinical, respiratory, and laboratory data, as well as multivariable logistic regression models, were performed to determine clinical features significantly associated with emphysema progression. Results 17.4% of the cohort were emphysema progressors. Emphysema progression was most strongly associated with having a low baseline diffusion capacity of carbon monoxide (DLCO) and having combination centrilobular and paraseptal emphysema distribution. In adjusted models, the odds ratio (OR) for emphysema progression for every 10% increase in DLCO percent predicted was 0.58 (95% confidence interval [CI] 0.41-0.81). The equivalent OR (95% CI) for centrilobular and paraseptal emphysema distribution was 10.60 (2.93-48.98). Together, these variables had an area under the curve (AUC) statistic of 0.85 for predicting emphysema progression. This was an improvement over the performance of spirometry (forced expiratory volume in 1 second to forced vital capacity ratio), which predicted emphysema progression with an AUC of only 0.65. Conclusion Combined paraseptal and centrilobular emphysema distribution and low DLCO could identify HIV patients who may experience emphysema progression

Kedudukan Anak Akibat Batalnya Perkawinan Karena Hubungan Darah Menurut Hukum Positif

Penelitian ini dilakukan dengan tujuan untuk mengetahui bagaimana pengaturan hukum tentang Pembatalan Perkawinan karena hubungan darah menurut Hukum Positif Di Indonesia dan bagaimana kedudukan hukum anak yang lahir setelah pembatalan perkawinan menurut Hukum Positif di Indonesia. Dengan menggunakan metode penelitian yuridis normatif, maka dapat disimpulkan: 1. Pengaturan hukum mengenai pembatalan perkawinan di Indonesia masih beragam walaupun Undang-Undang perkawinan yaitu Undang-Undang Nomor 1 Tahun 1974 seringkali disebut unifikasi hukum perkawinan. Pembatalan perkawinan merupakan putusnya perkawinan disebabkan persyaratan perkawinan yang diatur dalam undang-undang dan larangan perkawinan tidak dipenuhi. 2. Status hukum anak yang lahir dalam perkawinan yang telah batal pada dasarnya merupakan anak yang sah sebagaimana diatur dalam Undang-Undang Nomor 1 Tahun 1974 dalam Pasal 28. Berdasarkan Putusan Mahkamah Konstitusi Nomor 46/PUU-VIII/2010 Tentang Pengujian pasal 2 ayat 2 dan pasal 43 ayat 1 Undang-Undang Perkawinan yaitu Undang-Undang Nomor 1 Tahun 1974 yang menyatakan bahwa pasal 43 ayat Undang-Undang Nomor 1 Tahun 1974 melanggar Undang-Undang Dasar Republik Indonesia pasal 28 B ayat 1 dan 2 dan pasal 28 D ayat 1

Aortic Annulus Diameter Determination by Multidetector Computed Tomography Reproducibility, Applicability, and Implications for Transcatheter Aortic Valve Implantation

ObjectivesThis study sought to determine the most reproducible multidetector computed tomography (MDCT) measurements of the aortic annulus and to determine methods to improve the applicability of these measurements for transcatheter aortic valve implantation.BackgroundThe reproducibility and applicability of MDCT annular measurements to guide transcatheter aortic valve implantation remain unclear.MethodsAnnular measurements were performed in 50 patients planed for transcatheter aortic valve implantation in multiple planes: basal ring (short- and long-axis, mean diameter, area-derived diameter), coronal, sagittal, and 3-chamber projections. A theoretical model was developed taking into account the differences between the most reproducible MDCT measurements and transesophageal echocardiography to guide valve size choice.ResultsThe most reproducible measurements were the area-derived diameter and basal ring average diameter (inter-reader intraclass correlation coefficient: 0.87 [95% confidence interval: 0.81 to 0.92] and 0.80 [95% confidence interval: 0.70 to 0.87]; respectively; intrareader >0.90 for all readers). These were generally larger than transesophageal echocardiography diameters (mean difference of 1.5 ± 1.6 mm and 1.1 ± 1.7 mm, respectively). When a strategy of valve-sizing is undertaken using these CT measurements using an echocardiographic sizing scale, a different THV size would be selected in 44% and 40% of cases, respectively. When adjusting the sizing cutoffs to account for the differences in observed diameters, this was reduced to 10% to 12% (p < 0.01 for both, respectively).ConclusionsThe most reproducible MDCT measurements of the annulus are the area-derived diameter and basal ring average diameter, with derived values generally larger than those obtained with echocardiography. If MDCT is used for valve sizing, a strategy incorporating these differences may be important. MDCT using these easily derived measurements may be ideally suited to sizing transcatheter aortic valves as they account for the eccentricity of the aortic annulus, are reproducible, and are noninvasive

Fall prevention intervention technologies: A conceptual framework and survey of the state of the art

In recent years, an ever increasing range of technology-based applications have been developed with the goal of assisting in the delivery of more effective and efficient fall prevention interventions. Whilst there have been a number of studies that have surveyed technologies for a particular sub-domain of fall prevention, there is no existing research which surveys the full spectrum of falls prevention interventions and characterises the range of technologies that have augmented this landscape. This study presents a conceptual framework and survey of the state of the art of technology-based fall prevention systems which is derived from a systematic template analysis of studies presented in contemporary research literature. The framework proposes four broad categories of fall prevention intervention system: Pre-fall prevention; Post-fall prevention; Fall injury prevention; Cross-fall prevention. Other categories include, Application type, Technology deployment platform, Information sources, Deployment environment, User interface type, and Collaborative function. After presenting the conceptual framework, a detailed survey of the state of the art is presented as a function of the proposed framework. A number of research challenges emerge as a result of surveying the research literature, which include a need for: new systems that focus on overcoming extrinsic falls risk factors; systems that support the environmental risk assessment process; systems that enable patients and practitioners to develop more collaborative relationships and engage in shared decision making during falls risk assessment and prevention activities. In response to these challenges, recommendations and future research directions are proposed to overcome each respective challenge.The Royal Society, grant Ref: RG13082

Identification of novel ‘inks’ for 3D printing using high throughput screening: bioresorbable photocurable polymers for controlled drug delivery

A robust discovery methodology is presented to identify novel biomaterials suitable for 3D printing. Currently the application of Additive Manufacturing is limited by the availability of functional inks, especially in the area of biomaterials-this method tackles this problem for the first time allowing hundreds of formulations to be readily assessed. Several functional properties, including the release of an antidepressive drug (paroxetine), cytotoxicity and printability are screened for 253 new ink formulations in a high-throughput format as well as mechanical properties. The selected candidates with the desirable properties are successfully scaled up using 3D printing into a range of objects architectures. A full drug release study, degradability and tensile modulus experiments are presented on a simple architecture to validating the suitability of this methodology to identify printable inks for 3D printing devices with bespoke properties

Space Science Opportunities Augmented by Exploration Telepresence

Since the end of the Apollo missions to the lunar surface in December 1972, humanity has exclusively conducted scientific studies on distant planetary surfaces using teleprogrammed robots. Operations and science return for all of these missions are constrained by two issues related to the great distances between terrestrial scientists and their exploration targets: high communication latencies and limited data bandwidth. Despite the proven successes of in-situ science being conducted using teleprogrammed robotic assets such as Spirit, Opportunity, and Curiosity rovers on the surface of Mars, future planetary field research may substantially overcome latency and bandwidth constraints by employing a variety of alternative strategies that could involve: 1) placing scientists/astronauts directly on planetary surfaces, as was done in the Apollo era; 2) developing fully autonomous robotic systems capable of conducting in-situ field science research; or 3) teleoperation of robotic assets by humans sufficiently proximal to the exploration targets to drastically reduce latencies and significantly increase bandwidth, thereby achieving effective human telepresence. This third strategy has been the focus of experts in telerobotics, telepresence, planetary science, and human spaceflight during two workshops held from October 3–7, 2016, and July 7–13, 2017, at the Keck Institute for Space Studies (KISS). Based on findings from these workshops, this document describes the conceptual and practical foundations of low-latency telepresence (LLT), opportunities for using derivative approaches for scientific exploration of planetary surfaces, and circumstances under which employing telepresence would be especially productive for planetary science. An important finding of these workshops is the conclusion that there has been limited study of the advantages of planetary science via LLT. A major recommendation from these workshops is that space agencies such as NASA should substantially increase science return with greater investments in this promising strategy for human conduct at distant exploration sites

Space Science Opportunities Augmented by Exploration Telepresence

Since the end of the Apollo missions to the lunar surface in December 1972, humanity has exclusively conducted scientific studies on distant planetary surfaces using teleprogrammed robots. Operations and science return for all of these missions are constrained by two issues related to the great distances between terrestrial scientists and their exploration targets: high communication latencies and limited data bandwidth. Despite the proven successes of in-situ science being conducted using teleprogrammed robotic assets such as Spirit, Opportunity, and Curiosity rovers on the surface of Mars, future planetary field research may substantially overcome latency and bandwidth constraints by employing a variety of alternative strategies that could involve: 1) placing scientists/astronauts directly on planetary surfaces, as was done in the Apollo era; 2) developing fully autonomous robotic systems capable of conducting in-situ field science research; or 3) teleoperation of robotic assets by humans sufficiently proximal to the exploration targets to drastically reduce latencies and significantly increase bandwidth, thereby achieving effective human telepresence. This third strategy has been the focus of experts in telerobotics, telepresence, planetary science, and human spaceflight during two workshops held from October 3–7, 2016, and July 7–13, 2017, at the Keck Institute for Space Studies (KISS). Based on findings from these workshops, this document describes the conceptual and practical foundations of low-latency telepresence (LLT), opportunities for using derivative approaches for scientific exploration of planetary surfaces, and circumstances under which employing telepresence would be especially productive for planetary science. An important finding of these workshops is the conclusion that there has been limited study of the advantages of planetary science via LLT. A major recommendation from these workshops is that space agencies such as NASA should substantially increase science return with greater investments in this promising strategy for human conduct at distant exploration sites

The benefits and risks of bacille Calmette-Guérin vaccination among infants at high risk for both tuberculosis and severe combined immunodeficiency: assessment by Markov model

BACKGROUND: Bacille Calmette-Guérin (BCG) vaccine is given to Canadian Aboriginal neonates in selected communities. Severe reactions and deaths associated with BCG have been reported among infants born with immunodeficiency syndromes. The main objective of this study was to estimate threshold values for severe combined immunodeficiency (SCID) incidence, above which BCG is associated with greater risk than benefit. METHODS: A Markov model was developed to simulate the natural histories of tuberculosis (TB) and SCID in children from birth to 14 years. The annual risk of tuberculous infection (ARI) and SCID incidence were varied in analyses. The model compared a scenario of no vaccination to intervention with BCG. Appropriate variability and uncertainty analyses were conducted. Outcomes included TB incidence and quality-adjusted life years (QALYs). RESULTS: In sensitivity analyses, QALYs were lower among vaccinated infants if the ARI was 0.1% and the rate of SCID was higher than 4.2 per 100,000. Assuming an ARI of 1%, this threshold increased to 41 per 100,000. In uncertainty analyses (Monte Carlo simulations) which assumed an ARI of 0.1%, QALYs were not significantly increased by BCG unless SCID incidence is 0. With this ARI, QALYs were significantly decreased among vaccinated children if SCID incidence exceeds 23 per 100,000. BCG is associated with a significant increase in QALYs if the ARI is 1%, and SCID incidence is below 5 per 100,000. CONCLUSION: The possibility that Canadian Aboriginal children are at increased risk for SCID has serious implications for continued BCG use in this population. In this context, enhanced TB Control – including early detection and treatment of infection – may be a safer, more effective alternative