Risk of cardiovascular events from current, recent, and cumulative exposure to abacavir among persons living with HIV who were receiving antiretroviral therapy in the United States: a cohort study.

BackgroundThere is ongoing controversy regarding abacavir use in the treatment of HIV infection and the risk of subsequent development of cardiovascular disease. It is unclear how the risk varies as exposure accumulates.MethodsUsing an administrative health-plan dataset, risk of cardiovascular disease events (CVDe), defined as the first episode of an acute myocardial infarction or a coronary intervention procedure, associated with abacavir exposure was assessed among HIV-infected individuals receiving antiretroviral therapy across the U.S. from October 2009 through December 2014. The data were longitudinal, and analyzed using marginal structural models.ResultsOver 114,470 person-years (n = 72,733) of ART exposure, 714 CVDe occurred at an incidence rate (IR) (95% CI) of 6·23 (5·80, 6·71)/1000 person-years. Individuals exposed to abacavir had a higher IR of CVDe of 9·74 (8·24, 11·52)/1000 person-years as compared to 5·75 (5·30, 6·24)/1000 person-years for those exposed to other antiretroviral agents. The hazard (HR; 95% CI) of CVDe was increased for current (1·43; 1·18, 1·73), recent (1·41; 1·16, 1·70), and cumulative [(1·18; 1·06, 1·31) per year] exposure to abacavir. The risk for cumulative exposure followed a bell-shaped dose-response curve peaking at 24-months of exposure. Risk was similarly elevated among participants free of pre-existing heart disease or history of illicit substance use at baseline.ConclusionCurrent, recent, and cumulative use of abacavir was associated with an increased risk of CVDe. The findings were consistent irrespective of underlying cardiovascular risk factors

A close call: does the location of incision at cesarean delivery matter in patients with vasa previa? A case report.

We present here a case of vasa previa in a multipara, diagnosed at the time of her late second trimester ultrasonogram. The patient subsequently underwent an elective cesarean section after 37 weeks gestation, giving birth to a healthy child with an uneventful post-partum, neonatal and infant course. At the time of cesarean section, the incision was gradually deepened in layers through the myometrium by utmost care allowing the amniotic sac to protrude through the uterine incision hereby avoiding laceration of the vasa previa and its branches. Fetal exsanguination and a need for blood transfusion as well as a possible adverse neonatal course were therefore avoided

Indoor residual spraying of insecticide and malaria morbidity in a high transmission intensity area of Uganda.

BackgroundRecently the use of indoor residual spraying of insecticide (IRS) has greatly increased in Africa; however, limited data exist on the quantitative impacts of IRS on health outcomes in highly malaria endemic areas.Methodology/principal findingsRoutine data were collected on more than 90,000 patient visits at a single health facility over a 56 month period covering five rounds of IRS using three different insecticides. Temporal associations between the timing of IRS and the probability of a patient referred for microscopy having laboratory confirmed malaria were estimated controlling for seasonality and age. Considering patients less than five years of age there was a modest decrease in the odds of malaria following the 1(st) round of IRS using DDT (OR = 0.76, p<0.001) and the 2(nd) round using alpha-cypermethrin (OR = 0.83, p = 0.002). Following rounds 3-5 using bendiocarb there was a much greater decrease in the odds of malaria (ORs 0.34, 0.16, 0.17 respectively, p<0.001 for all comparisons). Overall, the impact of IRS was less pronounced among patients 5 years or older.Conclusions/significanceIRS was associated with a reduction in malaria morbidity in an area of high transmission intensity in Uganda and the benefits appeared to be greatest after switching to a carbamate class of insecticide

‘I didn’t even recognise myself’: Survivors’ experiences of altered appearance and body image distress during and after treatment for head and neck cancer

Purpose: Preparation for head and neck cancer treatment is focused on practicalities of treatment. Little or no time is spent prior to treatment discussing aesthetic results of treatment or the psychosocial impact of living with an altered appearance after treatment. The objective of this study was to explore the experiences of survivors of head and neck cancers, with a focus on the psychosocial impact of altered appearance. Methods: A qualitative research approach based on social constructionist theory was used. Twenty-one semi-structured interviews were conducted with survivors of head and neck cancer who had been diagnosed in the previous six years. Thematic analysis was used to identify themes. Results: People diagnosed with HNC reported feeling rushed into treatment, with adequate procedural preparation but little or no preparation related to appear-ance. The main themes included: Preparation (sub-themes: Decision-making; and Preparation for Altered Appearance); Altered Appearance (sub-themes: Weight Loss; Face, Skin and Hair Changes; and Reconstructive Surgery); and Consequences (sub-themes Reactions from Others; Adapting to Altered Appearance). Conclusions: Body image distress related to altered appearance, contributed to psychosocial issues for many people diagnosed with head and neck cancer. Current practice provides information pre-treatment about many aspects of coping; however, the subject of appearance is not routinely addressed. Communication skills training for health professionals that improves their comfort and sensitivity in discussing and conveying compassion around issues of altered appearance, body image, and trauma, is needed to decrease suffering for survivors, support healthy adaptation to living with altered appearance, and increase their satisfaction with health care

HTR2008-58015 ROTOR SCALE MODEL TESTS FOR POWER CONVERSION UNIT OF GT-MHR

ABSTRACT A power-generating unit with the high-temperature helium reactor (GT-MHR) has a turbomachine (TM) that is intended for both conversion of coolant thermal energy into electric power in the direct gas-turbine cycle, and provision of helium circulation in the primary circuit. The vertically oriented TM is placed in the central area of the power conversion unit (PCU). TM consists of a turbocompressor (TC) and a generator. Their rotors are joined with a diaphragm coupling and supported by electro-magnetic bearings (EMB). The complexity and novelty of the task of the full electromagnetic suspension system development requires thorough stepwise experimental work, from small-scale physical models to full-scale specimen. On this purpose, the following is planned within the framework of the GT-MHR Project: investigations of the "flexible" rotor small-scale mockup with electro-magnetic bearings ("Minimockup" test facility); tests of the radial EMB; tests of the position sensors; tests of the TM rotor scale model; tests of the TM catcher bearings (CB) friction pairs; tests of the CB mockups; tests of EMB and CB pilot samples and investigation of the full-scale electromagnetic suspension system as a part of full-scale turbocompressor tests. The rotor scale model (RSM) tests aim at investigation of dynamics of rotor supported by electromagnetic bearings to validate GT-MHR turbomachine serviceability. Like the full-scale turbomachine rotor, the RSM consist of two parts: the generator rotor model and the turbocompressor rotor model that are joined with a coupling. Both flexible and rigid coupling options are tested. Each rotor is supported by one axial and two radial EMBs. The rotor is arranged vertically. The RSM rotor length is 10.54 m, and mass is 1171 kg. The designs of physical model elements, namely of the turbine, compressors, generator and exciter, are simplified and performed with account of rigid characteristics, which are identical to those of the full-scale turbomachine elements. INTRODUCTION A power-generating unit with the high-temperature helium reacto

DESIGN, FABRICATION, INSTALLATION, TESTING AND INITIAL RESULTS OF IN-VESSEL CONTROL COILS FOR DIII-D

OAK-B135 Since 1995, DIII-D has performed correction of magnetic field imperfections using a set of six external picture frame coils located on the vessel mid-plane. In 2000, these coils also demonstrated benefits when used for feedback of the resistive wall mode, an instability that limits the plasma performance at high beta. Modeling has shown that substantial performance improvements could be achieved by installing new coils inside the vessel and expanding the poloidal coverage above and below the mid-plane. Two prototype internal coils were installed in 2001 and were power tested successfully after several bakes to 350 C. A full set of twelve internal coils and related magnetic sensors are now operational in the DIII-D tokamak. The design requirements for the new coil system was to maximize the magnetic field at the plasma edge, operate with a frequency range of dc to 1000 Hz, and fit behind the existing graphite wall tiles. The coil design adopted and installed is a water-cooled hollow copper conductor insulated with polyamide and housed inside a stainless steel tube that forms a vacuum boundary. The coil is rigidly mounted to the inside of the vacuum vessel. The primary challenge in the design of these coils wa sin joining of both the copper conductor and the stainless tube without overheating the polyamide insulator. Elastic-plastic analysis was used to demonstrate acceptable thermal stresses during baking conditions. Analysis determined the optimum water cooling channel diameter. The coils were tested in high toroidal field to the limit of the power supply of 4.5 kA DC with inductance-limited current for frequencies between 300 Hz and 1000 Hz. Recent results are presented

Protecting children from secondhand smoke: a mixed-methods feasibility study of a novel smoke-free home intervention

Background: Globally, 40 % of children under 14 years are regularly exposed to secondhand smoke (SHS), typically in their homes. There is limited evidence of the effectiveness of interventions to reduce children’s SHS exposure,and so the aim of this study was to test the feasibility and acceptability of a novel intervention to help parents and carers (caregivers) to reduce their children’s exposure to SHS at home. Methods: A novel multi-component intervention to support caregivers to reduce their children’s SHS exposure athome was tested in a two-phase feasibility study. The 12-week intensive intervention delivered in the homeconsisted of three components: behavioural support, nicotine replacement therapy (NRT) for temporary abstinenceand feedback on levels of SHS exposure in the form of children’s salivary cotinine (phase 1) or home air quality (PM2.5) (phase 2). Participants were caregivers who smoked inside their homes and had at least one child under the age of 5 years living with them the majority of the time. Mixed-methods were used to explore the acceptability and feasibility of the intervention as well as processes, particularly around recruitment and retention, for an exploratory efficacy trial. Results: Twelve caregivers completed the study, all received personalised feedback on SHS exposure and behavioural support to help them to make their homes smoke-free and the majority at least tried NRT. Saliva cotinine results were variable in phase 1, and therefore, measures of PM2.5 were used for feedback in phase 2.Behavioural support was well received with personalised feedback reported as being the key motivator for initiating and maintaining behaviour change. Conclusions: Recruiting disadvantaged caregivers was labour intensive, but once recruited, this novel intervention was both feasible and acceptable in supporting caregivers to reduce their children’s exposure to SHS at home. It is appropriate to test the efficacy of this novel intervention in an exploratory randomised controlled trial

Design and analysis of the DII-D radiative divertor water-cooled structures

The Radiative Divertor is a major modification to the divertor of DIII-D and is being designed and fabricated for installation in late 1996. The Radiative Divertor Program (RDP) will enhance the dissipative processes in the edge and divertor plasmas to reduce the heat flux and plasma erosion at the divertor target. This approach will have major implications for the heat removal methods used in future devices. The divertor is of slot-type configuration designed to minimize the flow of sputtered and injected impurities back to the core plasma. The new divertor will be composed of toroidally continuous, Inconel 625 water-cooled rings of sandwich construction with an internal water channel, incorporating seam welding to provide the water-to-vacuum seal as well as structural integrity. The divertor structure is designed to withstand electromagnetic loads as a result of halo currents and induced toroidal currents. It also accommodates the thermal differences experienced during the 400 {degrees}C bake used on DIII-D. A low Z plasma-facing surface is provided by mechanically attached graphite tiles. Water flow through the rings will inertially cool these tiles which will be subjected to 38 MW, 10 second pulses. Current schedules call for detailed design in 1996 with installation completed in March 1997. A full size prototype, one-quarter of one ring, is being built to validate manufacturing techniques, machining, roll-forming, and seam welding. The experience and knowledge gained through the fabrication of the prototype is discussed. The design of the electrically isolated (5 kV) vacuum-to-air water feedthroughs supplying the water-cooled rings is also discussed