A Strategy for Building Spiritual Resilience in Marines Using the Twenty-Third Psalm

This ministry focus paper develops a strategy for building spiritual resilience in Marines affected by combat and operational stress. It employs a spiritual discipline training seminar designed to build the resilience attributes of contentment, peace, restoration, security, grace, and joy as illustrated in the twenty-third Psalm. The paper argues that Marines who understand and apply six selected spiritual disciplines will experience a measurable decrease in combat stress symptoms and a measurable increase in spiritual resilience. Furthermore, this spiritual resilience will provide a measure of healing from the destructive effects of current combat stress exposure and protect them against the effects of future exposure to combat stress. The thesis was tested on Marines assigned to Kaneohe Bay, Hawaii. Based on resilience research and a thorough examination of Scripture, this paper presents a theology of spiritual resilience with specific focus on the six spiritual resilience attributes of Psalm 23. These attributes have been paired with specific spiritual disciplines selected to develop the attributes based on theological conclusions drawn from this study. The disciplines include Scripture study for building contentment, meditation for developing peace, confession that leads to restoration, prayer that fosters security, service that inspires grace, and celebration that elicits joy. This strategy has employed these disciplines in a two-day seminar that includes pre-seminar and post-seminar assessments in order to analyze the effects of this approach. This paper concludes that the practice of spiritual disciplines reduces the symptoms of combat and operational stress and increases spiritual resilience. However, additional research may be required to determine the long-term effectiveness of this strategy particularly the preventative aspect of this approach for those in combat. Based on this study, the project has potential for wider application beyond the military community to civilian churches, particularly those who offer ministry to former military members and their families. Content Reader: Dr. Jeff Saville, DMi

Challenges and Opportunities to Updating Prescribing Information for Longstanding Oncology Drugs.

A number of important drugs used to treat cancer-many of which serve as the backbone of modern chemotherapy regimens-have outdated prescribing information in their drug labeling. The Food and Drug Administration is undertaking a pilot project to develop a process and criteria for updating prescribing information for longstanding oncology drugs, based on the breadth of knowledge the cancer community has accumulated with the use of these drugs over time. This article highlights a number of considerations for labeling updates, including selecting priorities for updating; data sources and evidentiary criteria; as well as the risks, challenges, and opportunities for iterative review to ensure prescribing information for oncology drugs remains relevant to current clinical practice

Potential for false positive HIV test results with the serial rapid HIV testing algorithm

Background: Rapid HIV tests provide same-day results and are widely used in HIV testing programs in areas with limited personnel and laboratory infrastructure. The Uganda Ministry of Health currently recommends the serial rapid testing algorithm with Determine, STAT-PAK, and Uni-Gold for diagnosis of HIV infection. Using this algorithm, individuals who test positive on Determine, negative to STAT-PAK and positive to Uni-Gold are reported as HIV positive. We conducted further testing on this subgroup of samples using qualitative DNA PCR to assess the potential for false positive tests in this situation. Results: Of the 3388 individuals who were tested, 984 were HIV positive on two consecutive tests, and 29 were considered positive by a tiebreaker (positive on Determine, negative on STAT-PAK, and positive on Uni-Gold). However, when the 29 samples were further tested using qualitative DNA PCR, 14 (48.2%) were HIV negative. Conclusion: Although this study was not primarily designed to assess the validity of rapid HIV tests and thus only a subset of the samples were retested, the findings show a potential for false positive HIV results in the subset of individuals who test positive when a tiebreaker test is used in serial testing. These findings highlight a need for confirmatory testing for this category of individuals

Design of the liraglutide effect and action in diabetes: evaluation of cardiovascular outcome results (LEADER) trial.

BACKGROUND: Diabetes is a multisystem disorder associated with a nearly twofold excess risk for a broad range of adverse cardiovascular outcomes including coronary heart disease, stroke, and cardiovascular death. Liraglutide is a human glucagon-like peptide receptor analog approved for use in patients with type 2 diabetes mellitus (T2DM). STUDY DESIGN: To formally assess the cardiovascular safety of liraglutide, the Liraglutide Effect and Action in Diabetes: Evaluation of cardiovascular outcome Results (LEADER) trial was commenced in 2010. LEADER is a phase 3B, multicenter, international, randomized, double-blind, placebo-controlled clinical trial with long-term follow-up. Patients with T2DM at high risk for cardiovascular disease (CVD) who were either drug naive or treated with oral antihyperglycemic agents or selected insulin regimens (human NPH, long-acting analog, or premixed) alone or in combination with oral antihyperglycemics were eligible for inclusion. Randomized patients are being followed for up to 5 years. The primary end point is the time from randomization to a composite outcome consisting of the first occurrence of cardiovascular death, nonfatal myocardial infarction, or nonfatal stroke. CONCLUSIONS: LEADER commenced in September 2010, and enrollment concluded in April 2012. There were 9,340 patients enrolled at 410 sites in 32 countries. The mean age of patients was 64.3 ± 7.2 years, 64.3% were men, and mean body mass index was 32.5 ± 6.3 kg/m2. There were 7,592 (81.3%) patients with prior CVD and 1,748 (18.7%) who were high risk but without prior CVD. It is expected that LEADER will provide conclusive data regarding the cardiovascular safety of liraglutide relative to the current standard of usual care for a global population of patients with T2DM

High-resolution, H band Spectroscopy of Be Stars with SDSS-III/APOGEE: I. New Be Stars, Line Identifications, and Line Profiles

APOGEE has amassed the largest ever collection of multi-epoch, high-resolution (R~22,500), H-band spectra for B-type emission line (Be) stars. The 128/238 APOGEE Be stars for which emission had never previously been reported serve to increase the total number of known Be stars by ~6%. We focus on identification of the H-band lines and analysis of the emission peak velocity separations (v_p) and emission peak intensity ratios (V/R) of the usually double-peaked H I and non-hydrogen emission lines. H I Br11 emission is found to preferentially form in the circumstellar disks at an average distance of ~2.2 stellar radii. Increasing v_p toward the weaker Br12--Br20 lines suggests these lines are formed interior to Br11. By contrast, the observed IR Fe II emission lines present evidence of having significantly larger formation radii; distinctive phase lags between IR Fe II and H I Brackett emission lines further supports that these species arise from different radii in Be disks. Several emission lines have been identified for the first time including ~16895, a prominent feature in the spectra for almost a fifth of the sample and, as inferred from relatively large v_p compared to the Br11-Br20, a tracer of the inner regions of Be disks. Unlike the typical metallic lines observed for Be stars in the optical, the H-band metallic lines, such as Fe II 16878, never exhibit any evidence of shell absorption, even when the H I lines are clearly shell-dominated. The first known example of a quasi-triple-peaked Br11 line profile is reported for HD 253659, one of several stars exhibiting intra- and/or extra-species V/R and radial velocity variation within individual spectra. Br11 profiles are presented for all discussed stars, as are full APOGEE spectra for a portion of the sample.Comment: accepted in A

Comparison of routine health management information system versus enhanced inpatient malaria surveillance for estimating the burden of malaria among children admitted to four hospitals in Uganda.

The primary source of malaria surveillance data in Uganda is the Health Management Information System (HMIS), which does not require laboratory confirmation of reported malaria cases. To improve data quality, an enhanced inpatient malaria surveillance system (EIMSS) was implemented with emphasis on malaria testing of all children admitted in select hospitals. Data were compared between the HMIS and the EIMSS at four hospitals over a period of 12 months. After the implementation of the EIMSS, over 96% of admitted children under 5 years of age underwent laboratory testing for malaria. The HMIS significantly overreported the proportion of children under 5 years of age admitted with malaria (average absolute difference = 19%, range = 8-27% across the four hospitals) compared with the EIMSS. To improve the quality of the HMIS data for malaria surveillance, the National Malaria Control Program should, in addition to increasing malaria testing rates, focus on linking laboratory test results to reported malaria cases

The Open Cluster Chemical Analysis and Mapping Survey: Local Galactic Metallicity Gradient with APOGEE using SDSS DR10

The Open Cluster Chemical Analysis and Mapping (OCCAM) Survey aims to produce a comprehensive, uniform, infrared-based dataset for hundreds of open clusters, and constrain key Galactic dynamical and chemical parameters from this sample. This first contribution from the OCCAM survey presents analysis of 141 members stars in 28 open clusters with high-resolution metallicities derived from a large uniform sample collected as part of the SDSS-III/Apache Point Observatory Galactic Evolution Experiment (APOGEE). This sample includes the first high-resolution metallicity measurements for 22 open clusters. With this largest ever uniformly observed sample of open cluster stars we investigate the Galactic disk gradients of both [M/H] and [alpha/M]. We find basically no gradient across this range in [alpha/M], but [M/H] does show a gradient for R_{GC} < 10 kpc and a significant flattening beyond R_{GC} = 10 kpc. In particular, whereas fitting a single linear trend yields an [M/H] gradient of -0.09 +/- 0.03$ dex/kpc --- similar to previously measure gradients inside 13 kpc --- by independently fitting inside and outside 10 kpc separately we find a significantly steeper gradient near the Sun (7.9 <= R_{GC} <= 10) than previously found (-0.20 +/- 0.08 dex/kpc) and a nearly flat trend beyond 10 kpc (-0.02 +/- 0.09 dex/kpc).Comment: 6 pages, 4 figures, ApJ letters, in pres

Day-to-day fasting glycaemic variability in DEVOTE: associations with severe hypoglycaemia and cardiovascular outcomes (DEVOTE 2)

AIMS/HYPOTHESIS: The Trial Comparing Cardiovascular Safety of Insulin Degludec vs Insulin Glargine in Patients with Type 2 Diabetes at High Risk of Cardiovascular Events (DEVOTE) was a double-blind, randomised, event-driven, treat-to-target prospective trial comparing the cardiovascular safety of insulin degludec with that of insulin glargine U100 (100 units/ml) in patients with type 2 diabetes at high risk of cardiovascular events. This paper reports a secondary analysis investigating associations of day-to-day fasting glycaemic variability (pre-breakfast self-measured blood glucose [SMBG]) with severe hypoglycaemia and cardiovascular outcomes. METHODS: In DEVOTE, patients with type 2 diabetes were randomised to receive insulin degludec or insulin glargine U100 once daily. The primary outcome was the first occurrence of an adjudicated major adverse cardiovascular event (MACE). Adjudicated severe hypoglycaemia was the pre-specified secondary outcome. In this article, day-to-day fasting glycaemic variability was based on the standard deviation of the pre-breakfast SMBG measurements. The variability measure was calculated as follows. Each month, only the three pre-breakfast SMBG measurements recorded before contact with the site were used to determine a day-to-day fasting glycaemic variability measure for each patient. For each patient, the variance of the three log-transformed pre-breakfast SMBG measurements each month was determined. The standard deviation was determined as the square root of the mean of these monthly variances and was defined as day-to-day fasting glycaemic variability. The associations between day-to-day fasting glycaemic variability and severe hypoglycaemia, MACE and all-cause mortality were analysed for the pooled trial population with Cox proportional hazards models. Several sensitivity analyses were conducted, including adjustments for baseline characteristics and most recent HbA1c. RESULTS: Day-to-day fasting glycaemic variability was significantly associated with severe hypoglycaemia (HR 4.11, 95% CI 3.15, 5.35), MACE (HR 1.36, 95% CI 1.12, 1.65) and all-cause mortality (HR 1.58, 95% CI 1.23, 2.03) before adjustments. The increased risks of severe hypoglycaemia, MACE and all-cause mortality translate into 2.7-, 1.2- and 1.4-fold risk, respectively, when a patient's day-to-day fasting glycaemic variability measure is doubled. The significant relationships of day-to-day fasting glycaemic variability with severe hypoglycaemia and all-cause mortality were maintained after adjustments. However, the significant association with MACE was not maintained following adjustment for baseline characteristics with either baseline HbA1c (HR 1.19, 95% CI 0.96, 1.47) or the most recent HbA1c measurement throughout the trial (HR 1.21, 95% CI 0.98, 1.49). CONCLUSIONS/INTERPRETATION: Higher day-to-day fasting glycaemic variability is associated with increased risks of severe hypoglycaemia and all-cause mortality. TRIAL REGISTRATION: ClinicalTrials.gov NCT01959529

Controlled in vitro delivery of voriconazole and diclofenac to the cornea using contact lenses for the treatment of Acanthamoeba keratitis

Acanthamoeba keratitis is caused by a protozoal infection of the cornea, with 80% of cases involving the improper use of contact lenses. The infection causes intense pain and is potentially blinding. However, early diagnosis improves treatment efficacy and the chances of healing. Despite the apparent accessibility of the cornea, patients do not always respond well to current eye drop treatments largely due to rapid dose loss due to blinking and nasolacrimal drainage. Here, the topical drug delivery of voriconazole alone and in combination with diclofenac via drug-loaded contact lenses, were investigated in vitro. The contact lenses were applied onto excised porcine eyeballs and maintained at 32°C under constant irrigation, with simulated tear fluid applied to mimic in vivo conditions. The drug delivered to the corneas was quantified by HPLC analysis. The system was further tested in terms of cytotoxicity and a scratch wound repopulation model, using corneal epithelial cells. Sustained drug delivery to the cornea was achieved and for voriconazole, the MIC against Acanthamoeba castellanii was attained alone and in combination with diclofenac. MTT and scratch wound data showed reasonable cell proliferation and wound repopulation at the drug doses used, supporting further development of the system to treat Acanthamoeba keratitis