Depression and its implications for human immunodeficiency virus (HIV) prevention among youth in the United States

Human immunodeficiency virus (HIV) is a leading cause of morbidity among youth in the United States (US) and imposes substantial economic burden on the healthcare system. Youth account for more than 1 in 5 new HIV diagnoses annually, a two-fold increase since 2004. Annual direct medical costs associated with youth HIV care in the US range between $5.6 billion and$6.3 billion. Early sexual debut, high rates of condom nonuse, large numbers of sexual partners, and low rates of HIV testing drive the spread of HIV among this cohort. Emergence of depression during adolescence and young adulthood may exacerbate these issues. In order to reduce the incidence of youth HIV and curtail its burden on the healthcare system, it is critical to develop a comprehensive understanding of how depression impacts HIV acquisition and case detection. Three quantitative studies using nationally representative samples of American youth were performed to examine the relationship between depression and: (1) sexual debut; (2) inconsistent condom use and multiple sexual partners; and (3) HIV testing. Findings from these studies were used to offer recommendations to improve the delivery of sexual health counseling, HIV testing, and mental health services to youth in the US. Analysis on data from three large population databases suggested depression is an important mental health indicator to be considered in future youth HIV prevention efforts. Study 1 and Study 2 found depressive symptoms were associated with a greater likelihood of sexual debut before age 16 and condomless vaginal or anal sexual intercourse among 18 to 24 year olds. Study 3 found depression was associated with a higher likelihood of ever being tested for HIV but not associated with past year testing. Overall, these findings suggest a need for primary care providers to screen for depression during well child visits and provide sexual health counseling and mental health treatment referrals to youth exhibiting above threshold symptom levels. Youth HIV testing rates may be increased by promoting testing services at mental health treatment facilities and at offices of mental health professionals. Care coordination and organization are critical to the implementation of these recommendations

Gestión del conocimiento. Perspectiva multidisciplinaria. Volumen 5

El libro “Gestión del Conocimiento. Perspectiva Multidisciplinaria”, Volumen 5, de la Colección Unión Global, es resultado de investigaciones. Los capítulos del libro, son resultados de investigaciones desarrolladas por sus autores. El libro es una publicación internacional, seriada, continua, arbitrada de acceso abierto a todas las áreas del conocimiento, que cuenta con el esfuerzo de investigadores de varios países del mundo, orientada a contribuir con procesos de gestión del conocimiento científico, tecnológico y humanístico que consoliden la transformación del conocimiento en diferentes escenarios, tanto organizacionales como universitarios, para el desarrollo de habilidades cognitivas del quehacer diario. La gestión del conocimiento es un camino para consolidar una plataforma en las empresas públicas o privadas, entidades educativas, organizaciones no gubernamentales, ya sea generando políticas para todas las jerarquías o un modelo de gestión para la administración, donde es fundamental articular el conocimiento, los trabajadores, directivos, el espacio de trabajo, hacia la creación de ambientes propicios para el desarrollo integral de las instituciones

Risk factors for early PICC removal: A retrospective study of adult inpatients at an academic medical center.

BackgroundUse of PICCs has been rising since 2001. They are used when long-term intravenous access is needed and for blood draws in patients with difficult venous access.ObjectiveTo determine which risk factors contribute to inappropriate PICC line insertion defined as removal of a PICC within five days of insertion for reasons other than a PICC complication.DesignRetrospective, observational study.SettingTertiary-care, Level 1 trauma center.PatientsAdult patients with a PICC removed 1/1/2017 to 5/4/2020.MeasurementsFrequency of PICC removal within five days of insertion and associated risk factors for early removal.ResultsBetween 1/1/2017 and 5/4/2020, 995 of 5348 PICCs inserted by the IV nursing team were removed within five days (19%). In 2017, 5 of 429 PICCs developed a central line-associated infection (1.2%) and 29 of 429 PICCs developed symptomatic venous thromboembolism (6.7%). Patients with PICCs whose primary service was in an ICU were independently at higher risk of early removal (OR 1.44, 95% CI 1.14, 1.83); weekday insertion was independently associated with a lower likelihood of early removal compared to weekend insertion (OR 0.60; 95% CI 0.49, 0.75).LimitationPICC removal after discharge was not assessed and paper records were likely incomplete and biased.ConclusionNearly one in five PICCs were removed within five days. Patients whose primary team was in an ICU and PICCs ordered on weekends were at independently higher risk of early removal

Transcriptomic changes in porcine articular cartilage one year following disruption of the anterior cruciate ligament.

To determine the transcriptomic changes seen in early- to mid-stage posttraumatic osteoarthritis (PTOA) development, 72 Yucatan minipigs underwent transection of the anterior cruciate ligament. Subjects were randomized to no further intervention, ligament reconstruction, or ligament repair, followed by articular cartilage harvesting and RNA-sequencing at three different postoperative timepoints (1, 4, and 52 weeks). Six additional subjects received no ligament transection and provided cartilage tissue to serve as controls. Differential gene expression analysis between post-transection cartilage and healthy cartilage revealed an initial increase in transcriptomic differences at 1 and 4 weeks followed by a stark reduction in transcriptomic differences at 52 weeks. This analysis also showed how different treatments genetically modulate the course of PTOA following ligament disruption. Specific genes (e.g., MMP1, POSTN, IGF1, PTGFR, HK1) were identified as being upregulated in the cartilage of injured subjects across all timepoints regardless of treatment. At the 52-week timepoint, 4 genes (e.g., A4GALT, EFS, NPTXR, ABCA3) that-as far as we know-have yet to be associated with PTOA were identified as being concordantly differentially expressed across all treatment groups when compared to controls. Functional pathway analysis of injured subject cartilage compared to control cartilage revealed overarching patterns of cellular proliferation at 1 week, angiogenesis, ECM interaction, focal adhesion, and cellular migration at 4 weeks, and calcium signaling, immune system activation, GABA signaling, and HIF-1 signaling at 52 weeks

Treatment of adult deformity surgery by orthopedic and neurological surgeons: trends in treatment, techniques, and costs by specialty.

BACKGROUND CONTEXT: Surgery to correct adult spinal deformity (ASD) is performed by both neurological surgeons and orthopedic surgeons. Despite well-documented high costs and complication rates following ASD surgery, there is a dearth of research investigating trends in treatment according to surgeon subspeciality. PURPOSE: The purpose of this investigation was to perform an analysis of surgical trends, costs and complications of ASD operations by physician specialty using a large, nationwide sample. STUDY DESIGN/SETTING: Retrospective cohort study using an administrative claims database. PATIENT SAMPLE: A total of 12,929 patients were identified with ASD that underwent deformity surgery performed by neurological or orthopedic surgeons. OUTCOME MEASURES: The primary outcome was surgical case volume by surgeon specialty. Secondary outcomes included costs, medical complications, surgical complications, and reoperation rates (30-day, 1-year, 5-year, and total). METHODS: The PearlDiver Mariner database was queried to identify patients who underwent ASD correction from 2010 to 2019. The cohort was stratified to identify patients who were treated by either orthopedic or neurological surgeons. Surgical volume, baseline characteristics, and surgical techniques were examined between cohorts. Multivariable logistic regression was employed to assess the cost, rate of reoperation and complication according to each subspecialty while controlling for number of levels fused, rate of pelvic fixation, age, gender, region and Charlson Comorbidity Index (CCI). Alpha was set to 0.05 and a Bonferroni correction for multiple comparisons was utilized to set the significance threshold at p ≤.000521. RESULTS: A total of 12,929 ASD patients underwent deformity surgery performed by neurological or orthopedic surgeons. Orthopedic surgeons performed most deformity procedures accounting for 64.57% (8,866/12,929) of all ASD operations, while the proportion treated by neurological surgeons increased 44.2% over the decade (2010: 24.39% vs. 2019: 35.16%; p CONCLUSIONS: This investigation of over 12,000 ASD patients demonstrates orthopedic surgeons continue to perform the majority of ASD correction surgery, although neurological surgeons are performing an increasingly larger percentage over time with a 44% increase in the proportion of surgeries performed in the decade. In this cohort, neurological surgeons more frequently operated on older and more comorbid patients, utilizing shorter-segment fixation with greater use of navigation and robotic assistance

Schematic of experimental design.

Schematic of experimental design.</p

Percent of animals with ECM-B material present in the tibiofemoral joint at the time of harvest.

Each ECM-B joint is seen in variable tones of gray and Week 8 control samples are black.</p

Comparison of histology scores between ECM-B and PBS-treated control animals at eight weeks after treatment.

Mean scores ± standard error are presented.</p

Hind limb BOS of ECM-B and control animals from pre-procedure to Week 8 post-injection.

Circles represent means of the control group and squares represent ECM-B group means. The error bars represent the standard error. Mean and standard error values can be seen in the table to the right of the graph. Significantly different means are denoted by an asterisk in the graph and bolded in the table.</p