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

Clinical Characteristics and Outcomes Among Individuals With Spinal Implant Infections: A Descriptive Study.

Little is known about the clinical presentation and outcomes associated with spinal implant infections. Here, we describe a single center's experience in a retrospective cohort of 109 individuals with spinal implant infections, including clinical, microbiological, therapeutic, and outcome data

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

Melatonin protects against alterations in hippocampal cholinergic system, trace metals and oxidative stress induced by gestational and lactational exposure to cadmium

Dietary exposure to cadmium, even at lower doses, can lead to free radical induced neurotoxicity, neurobehavioral changes and alteration in neurotransmitters. Such changes are likely to be more pronounced in the developing brain due to incompleteness of blood brain barrier (BBB). Hippocampus being the seat of intelligence has a role in learning and cognitive behavior and any damage to hippocampus during developmental stage is likely to result in neurodegenerative changes in later life. To this end, fetal and neonatal exposure to cadmium was induced by exposing pregnant dams of Swiss albino strain throughout the period of gestation and following parturition up till 5th day post partum (pp) through drinking water (3ppm/animal/day). The neonates were sacrificed on day 6 pp and indices of oxidative stress, levels of trace elements and changes in cholinergic system were evaluated in the hippocampus. Increased lipid peroxidation, surge in reactive oxygen species (ROS), depressed antioxidant defense, increased accumulation of cadmium, differential alterations in trace elements and decreased activity of AChE were the features of cadmium toxicity. Simultaneous administration of melatonin to cadmium challenged animals offset these detrimental changes. The results suggest that melatonin co-administration can effectively protect against the adverse effects of cadmium on endogenous antioxidant status, changes in trace metal concentrations and compromised hippocampal cholinergic system

‘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