Risk assessment and the utility of CT coronary angiography for coronary artery disease in HIV infection

Background Human immunodeficiency virus (HIV) infection is now considered a chronic, treatable disease, although treatment is associated with increased rates of coronary artery disease (CAD). Screening of this at-risk population for CAD remains contentious. The aim of this thesis is to provide some guidance into the management of cardiovascular disease in HIV and examine the utility of screening CTCA in this population group. Methods We set out to disseminate our generated results via publications. The first paper was a literature review that sought to provide insight into the management of this complex population, in particular focusing on the risk assessment and screening of this population group. The second paper was original research; a retrospective single centre analysis that compared the CTCA findings and clinical endpoints of a group (n=32) of HIV patients to their uninfected counterparts (n=65), in an effort to appraise the efficacy of CTCA in the screening and prediction of adverse cardiac outcomes. Results Regarding the literature review we provided a formulaic approach to the risk assessment and screening of CAD in HIV. In our research article, patients with HIV were shown to have higher prevalence of non-calcified, high risk plaque (0.8±1.5 versus 0.3±0.7, p=0.03), experience greater rates of non-ST elevation acute coronary syndromes (ACS) (16% (5) versus 3% (2), p Conclusion Currently there are no guidelines pertaining to the screening and further management of HIV patients at risk of CAD. Our literature review outlines a proposed approach for assessing and managing CAD in HIV patients. In our clinical research we demonstrated that HIV patients screened with CTCA were susceptible to developing at-risk coronary plaques and had higher rates of adverse cardiac events despite less frequent invasive coronary intervention compared to HIV negative controls. This thesis provides early evidence for the use of CTCA in the screening of HIV patients and highlights a need for further investigation to establish appropriate screening and risk assessment protocols as well as more rigorous examination of why HIV patients may be less aggressively managed following adverse cardiac events

Myeloperoxidase in human atherosclerosis

This dissertation explores the pathobiological role of the inflammatory enzyme myeloperoxidase (MPO) in human atherosclerotic plaque, and how intraplaque MPO activity can potentially be employed as a diagnostic probe for the detection of vulnerable and ruptured atheroma. The work is presented as a hybrid text containing peer-reviewed publications including a literature review and two original research articles as well as a currently unpublished chapter. The thesis was facilitated through the establishment of two single-centred clinical studies which prospectively collected human carotid and coronary plaques. A total of 117 plaques were accrued from 42 patients undergoing carotid endarterectomy and the coronary trees from native hearts of 12 heart transplant recipients who received allografts for ischaemic cardiomyopathy. Specimens underwent assessment by histology and immunohistochemistry, as well as biochemical analyses utilising liquid chromatography mass spectrometry, inductively coupled mass spectrometry, high performance liquid chromatography and near-infrared autofluorescence. Blood biochemistry was performed including enzyme-linked immunosorbent assays for MPO protein quantification. Additionally, non-invasive imaging was undertaken by in vivo carotid magnetic resonance (MRI) imaging as well as ex vivo molecular MRI and computed tomography coronary angiography (CTCA); with the latter requiring the establishment of novel methodological approaches. Through this translational research a relationship between elevated intraplaque MPO activity, plaque destabilisation and rupture is demonstrated, and the way in which the enzyme can be targeted as a diagnostic tool elucidated. Future in vivo clinical studies using novel non-invasive imaging probes that detect MPO activity should be undertaken to further advance the findings contained within this thesis

Acute coronary syndrome in Australia

BackgroundAcute coronary syndrome (ACS) is a significant contributor to both morbidity and mortality in Australia. Generally speaking, sufferers of ACS who live in rural areas and are treated at rural hospitals have poorer outcomes than those living in metropolitan areas.AimsTo characterise the differences in the management and outcomes of rural and metropolitan populations in the context of ACS, as well as identify factors responsible for these differences and suggest how they may be addressed.MethodA review of the current literature surrounding ACS in Australia was undertaken. Through the MEDLINE/PubMed database a thorough search using the terms “acute coronary syndrome” and “Australia” identified 460 papers for review, excluding abstracts and adding “rural”, “metropolitan”, “reperfusion”, and “outcomes” to this search narrowed the results to 149 papers for review. Data was also extracted from the Australian Institute of Health and Welfare and other Australian government publications. The review draws on insights from both local and international resources and seeks to provide an understanding of the contemporary landscape of ACS in both rural and metropolitan Australia. The review is broken down into three key sections:1. An outline of the 2011 National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand (NHF/CSANZ) guidelines and adjuvant tools used in the assessment and treatment of ACS, and to what extent these guidelines have been implemented clinically.2. An exploration of the current landscape of ACS in Australia and identification of the disparities facing rural populations compared to those in metropolitan areas.3. Discussion of the factors that are resulting in poorer outcomes for ACS sufferers and suggestions of novel approaches towards addressing these factors.ConclusionDisparities exist between the management and outcomes of rural and metropolitan populations experiencing ACS. While the causes of these discrepancies are multifactorial, the onus is on the healthcare system to effectively reduce associated morbidity and mortality. Improvements in the management of ACS may be achieved through a continued reduction in call-to-needles time via the use of remote and mobile thrombolysis services as well as improvements in in-hospital risk assessment in order to flag and investigate those at risk of ACS

A novel mentorship programme for residents integrating academic development, clinical teaching and graduate medical education assessment

Introduction: Mentorship fosters career development and growth. During residency training, mentorship should support clinical development along with intellectual and academic interests. Reported resident mentoring programmes do not typically include clinical components. We designed a programme that combines academic development with clinical feedback and assessment in a four-year emergency medicine residency programme. Methods: Incoming interns were assigned an advisor. At the conclusion of the intern year, residents actively participated in selecting a mentor for the duration of residency. The programme consisted of quarterly meetings, direct clinical observation and specific competency assessment, assistance with lecture preparation, real-time feedback on presentations, simulation coaching sessions, and discussions related to career development. Faculty participation was recognized as a valuable component of the annual review process. Residents were surveyed about the overall programme and individual components. Results: Over 88 % of the respondents said that the programme was valuable and should be continued. Senior residents most valued the quarterly meetings and presentation help and feedback. Junior residents strongly valued the clinical observation and simulation sessions. Conclusions: A comprehensive mentorship programme integrating clinical, professional and academic development provides residents individualized feedback and coaching and is valued by trainees. Individualized assessment of clinical competencies can be conducted through such a programme

Toward a second-person neuroscience

LS & BT : equal contributions (shared first-authorship)Peer reviewedPreprin

Is It Safe to Irradiate the Newest Generation of Ventricular Assist Devices? A Case Report and Systematic Literature Review.

An increasing number of mechanical assist devices, especially Left Ventricular Assist Devices (VAD), are being implanted for prolonged periods and as destination therapy. Some VAD patients require radiotherapy due to concomitant oncologic morbidities, including thoracic malignancies. This raises the potential of VAD malfunction via radiation-induced damage. So far, only case reports and small case series on radiotherapy have been published; most of them on HeartMate IITM (HMII, Abbott, North Chicago, IL, USA). Significantly, the effects of irradiation on the HeartMate 3TM (HM3, Abbott, North Chicago, IL, USA) remain undefined, despite the presence of controller components engineered within the pump itself. We report the first case of a patient with a HM3 who successfully underwent stereotactic hypo-fractionated radiotherapy due to an early stage non-small-cell lung cancer. The patient did not suffer from any complications; including toxicity or VAD malfunction. Based on this case report and on published literature, we think that performing radiotherapy after VAD implantation with the aid of a multidisciplinary team could be performed, but more in-vitro and cases series are needed to reinforce this statement

Portfolio Vol. I N 3

Sweitzer, Harry J. Portfolio Goes to Press . Prose. 1. Browne, Phil. William Howard Doane Library . Picture. 2. Overhuls, James. Out of Himself . Prose. 3. MacNeill, Annie Marie. To President and Mrs. Shaw . Poem. 6. Baker, George. Saint in a Silo . Prose 7. Beckham, Adela. In Moods . Poem. 8. Vincent, Charles. Incident of August 7, 1930. Prose. 9. Flory, Doris. Opinions . Poem. 10. Flory, Doris. Thoughts in Spring . Poem. 10. Flory, Doris. Breakfast Scene . Poem. 10. Shaw, Robert B. A Date for the Dances . Prose. 11. Cronberger, Barbara. And the Years Go On . Prose. 13. Hanna, Stanley. Reola, Reola . Poem. 14. Hanna, Stanley. The Dance of the Kobolds . Poem. 14. Nadel, Norman. I died Last Night . Prose. 15. Bethune, Don S. Adolescence . Poem 16. Vodev, Eugene. The Black Day of Bulgaria . Prose. 17. Dick, Pewilla. To a White Violet . Poem. 18. Dick, Pewilla. As With Your Shadow . Poem. 18. Dwelly, Thorndike. Of Mice and Men . Prose. 19. Clements, Helen. Our Town . Prose. 19. Schlle, Alice. Marion is an Old Costume . Picture. 20. Chadeayne, Robert. Factory . Picture. 20. Nadel, Norman. Dmitri Shostakovitch . Prose. 21. Stewart, John. Duke Ellington\u27s Records . Prose. 21. Beck, Virginia. The Dance as an Art . Prose. 22. Dick, Pewilla. Death . Poem. 23. Flory, Doris. On Reforms . Poem. 24. Beckham, Adela. The Lie . Poem. 24. Bethune, Don. Futility . Poem. 24

Intersubjective action-effect binding: Eye contact modulates acquisition of bidirectional association between our and others’ actions

In everyday social life, we predict others’ actions in response to our own actions.Subsequently, on the basis of these predictions, we control our actions to attain desired social outcomes and/or adjust our actions to accommodate the anticipated actions of the others. Representation of the bidirectional association between our and others’ actions, that is, intersubjective action-effect binding, could make such intersubjective action control easier and smoother. The present study investigated not only whether or not intersubjective action-effect binding was acquired but also whether or not eye contact modulated it. Experiment 1 showed that after a repeated experience during which participants’ finger movements triggered a target female individual’s mouth gesture, observing the target’s mouth gestures came to automatically trigger the participants’finger movements. Experiments 2 and 3 revealed that this effect was not observed when the target’s gaze direction was averted (Experiment 2) or when the target’s eyes were closed (Experiment 3) throughout the acquisition phase. These results indicate that intersubjective action-effect binding occurs and that an ostensive signal, that is, eye contact modulates it