Nonsurgical Management of Severe Osteonecrosis of the Knee in an HIV-Positive Patient: A Case Report

Due to the life-prolonging effects of combination antiretroviral therapy, many people with HIV are living longer. However, this enhanced longevity is often mirrored by increased disability resulting from HIV and/or the adverse effects of medication. Management of HIV-positive patients is further complicated by comorbidities related to aging, including bone and joint disorders. In this paper, we describe the nonsurgical management of an HIV-positive patient with premature onset of severe osteonecrosis of the knee. A 50-year-old man who had been HIV-positive for 16 years and on combination antiretroviral therapy for 11 years presented to his family physician with extreme discomfort in his right knee. He was diagnosed with osteonecrosis of the right knee, but resisted total knee arthroplasty because of potential complications under anesthesia related to comorbid advanced liver disease. Instead, a successful combination of non-surgical management strategies was employed by the patient and his health care team

Cytotoxic Complexes of Sodium Oleate with β-Lactoglobulin

pre-printA complex of α-lactalbumin and oleic acid has previously been shown to induce apoptosis in cancer cells in a number of in vitro and in vivo trials. This complex is called HAMLET or BAMLET, depending on the origin of α-la (human/bovine alpha-lactalbumin made lethal to tumour cells). In the current study, it was shown that bovine β-lactoglobulin (β-lg), upon binding sodium oleate (NaOle), the salt of oleic acid, also acquires cytotoxicity towards tumour cells (human monocytic cells U937), analogously to HAMLET/BAMLET complexes. The properties of the complex were characterized using FIR spectroscopy, HPLC and SDS-PAGE. It was shown that the level of covalent oligomerization (dimers and trimers) of β-lg increased with increasing the molar ratio of sodium oleate NaOle:β-lg in the preparation procedure. At the same time, increasing the molar ratio of NaOle:β-lg increased the cytotoxicity of the complex. The increase in cytotoxicity appeared to be dependent on the amount of bound NaOle in the complex, but not on the content of multimeric forms of β-lg. The NaOle/β-lg complex also showed similarity with BAMLET in penetrating the cell membrane and co-localizing with the cell nucleus. Furthermore, DNA fragmentation studies suggested that tumour cells (U937) treated with the complex died by apoptosis, as in the case of BAMLET, and healthy cells appeared to be less affected by treatment, as shown with model rat adrenal pheochromocytoma cells PC12. In conclusion, β-lg and NaOle can form complexes with apoptosis-inducing qualities comparable to those of BAMLET.The work was funded by the Irish Dairy Research Trust and The Department of Agriculture (Food Institutional Research Measure – FIRM project 08RDTMFRC650) under the National Development Plan 2007-2013. K. Lišková was funded under the TeagascWalsh Fellowship Scheme

Patient experience of Guided self-help CBT intervention for VoicEs (GiVE) delivered within a pilot randomized controlled trial

Background: Access to cognitive behaviour therapy for those with psychosis (CBTp) remains poor. The most frequently endorsed barrier to implementation is a lack of resources. To improve access to CBTp, we developed a brief form of CBTp that specifically targets voice-related distress. The results of our pilot trial of guided self-help CBT for voices (GiVE) suggest the therapy is both acceptable and beneficial. Aims: The present study aims to explore the subjective patient experience of accessing GiVE in the context of a trial. Method: We interviewed 9 trial participants using the Change Interview and a mixed methods approach. Results: Most participants reported at least one positive change that they attributed to GiVE. We extracted five themes: (1) changes that I have noticed; (2) I am not alone; (3) positive therapy experiences; (4) I want more therapy; and (5) helping myself. The themes indicate that participating in the GiVE trial was generally a positive experience. The main areas in which participants experienced changes were improved self-esteem, and the ability to cope with voices. Positive changes were facilitated by embracing and enacting ‘self-help’ and having support both in and out of the therapy sessions. Conclusions: The findings support the use of self-help materials with those distressed by hearing voices, but that support both within and outside the clinical setting can aid engagement and outcomes. Overall, the findings support the continued investigation of GiVE

HIV in MOTION: a community of practice on physical rehabilitation for and by people living with HIV and their allies

BackgroundThis paper describes the design, implementation, and evaluation of a community of practice (CoP), HIV in MOTION (HIM), to advance physical activity rehabilitation interventions with adults living with HIV, clinicians, researchers, and representatives from community-based organizations. We attracted a diverse audience of geographically dispersed people living with HIV, clinicians, exercise personnel, and trainees to eight HIM community of practice events that featured the clinical, research, and lived experience of people living with HIV. HIV in MOTION had (a) a domain related to physical rehabilitation, exercise, and social participation for people living with HIV; (b) a community of diverse individuals; and (c) a practice, that is, a series of sustained interactions online and offline, synchronous, and asynchronous. Our team included six diverse people living with HIV, two coordinators, and three academic researchers who planned, prepared, implemented, and evaluated each online session. To evaluate the HIV in MOTION CoP, we employed an evaluation framework composed of five criteria: Goals and Scope, Context and Structure, Process and Activities, Outcomes, and Impact. We collected quantitative and qualitative evaluative data using online evaluation, audiovisual archiving, and participant observations during the debriefing with all members of our team.ResultsWe widened the Goals and Scope of the HIV in MOTION CoP to include the HIV narrative of lived experiences, including autopathography, and participant storytelling. In matters of Context and Structure, we received explicit satisfaction with our governance and leadership. Also, being flexible to fit online formats was a productive strategy that made the HIV in MOTION CoP sessions agile and amenable to audiovisual archiving. Our indicators of success in Process, Activities, and Outcomes included participant retention online, elicited verbal interventions and comments in the chat room, and a rate of three repeat visits online. The indicators of success of Impact were the presence of voluntary and unscripted autopathography, the patient storytelling and how it reportedly caused changes in the participants, and the “legitimate peripheral participation” of emerging research and clinical students. In conclusion, we recommend our form of CoP for mixing the knowledge of diverse persons in this area. However, we recommend considering budget and burnout as serious challenges to sustainability

Farm management factors associated with bulk tank total bacterial count in Irish dairy herds during 2006/07

Research has shown that total bacterial count (TBC), which is the bacterial growth per ml of milk over a fixed period of time, can be decreased by good hygiene and farm management practices. The objective of the current study was to quantify the associations between herd management factors and bulk tank TBC in Irish spring calving, grass-based dairy herds. The relationship between bulk tank TBC and farm management and infrastructure was examined using data from 400 randomly selected Irish dairy farms where the basal diet was grazed grass. Herd management factors associated with bulk tank TBC were identified using linear models with herd annual total bacterial score (i.e., arithmetic mean of the natural logarithm of bulk tank TBC) included as the dependent variable. All herd management factors were individually analysed in a separate regression model, that included an adjustment for geographical location of the farm. A multiple stepwise regression model was subsequently developed. Median bulk tank TBC for the sample herds was 18,483 cells/ml ranging from 10,441 to 130,458 cells/ml. Results from the multivariate analysis indicated that the following management practices were associated with low TBC; use of heated water in the milking parlour; participation in a milk recording scheme; and tail clipping of cows at a frequency greater than once per year. Increased level of hygiene of the parlour and cubicles were also associated with lower TBC. Herd management factors associated with bulk tank TBC in Irish grazing herds were generally in agreement with most previous studies from confinement systems of milk production

How do existing HIV-specific instruments measure up? Evaluating the ability of instruments to describe disability experienced by adults living with HIV

Background: Despite the multitude of health challenges faced by adults living with HIV, we know of no HIV-specific instrument developed for the purpose of describing the health-related consequences of HIV, a concept known as disability. In a previous phase of research, adults living with HIV conceptualized disability as symptoms/ impairments, difficulties carrying out day-to-day activities, challenges to social inclusion, and uncertainty that may fluctuate on a daily basis and over the course of living with HIV. In this paper, we describe the extent to which existing HIV-specific health-status instruments capture the experience of disability for adults living with HIV. Methods: We searched databases from 1980 to 2006 for English language, HIV-specific, self-reported questionnaires consisting of at least two items that were tested for reliability and validity. We then conducted a content analysis to assess how well existing questionnaires describe disability as defined by the Episodic Disability Framework, a framework that conceptualizes this experience from the perspective of adults living with HIV. We matched items of the instruments with categories of the framework to evaluate the extent to which the instruments capture major dimensions of disability in the framework. Results: We reviewed 4274 abstracts, of which 30 instruments met the inclusion criteria and were retrieved. Of the four major dimensions of disability, symptoms/impairments were included in all 30 instruments, difficulties with day-to-day activities in 16, challenges to social inclusion in 16, and uncertainty in 9. Seven instruments contained at least 1 item from all 4 dimensions of disability (breadth) however, the comprehensiveness with which the dimensions were represented (depth) varied among the instruments. Conclusions: In general, symptoms/impairments and difficulties carrying out day-to-day activities were the disability dimensions characterized in greatest depth while uncertainty and challenges to social inclusion were less well represented. Although none of the instruments described the full breadth and depth of disability as conceptualized by the Episodic Disability Framework, they provide a foundation from which to build a measure of disability for adults living with HIV

Scoping studies: advancing the methodology

Abstract Background Scoping studies are an increasingly popular approach to reviewing health research evidence. In 2005, Arksey and O'Malley published the first methodological framework for conducting scoping studies. While this framework provides an excellent foundation for scoping study methodology, further clarifying and enhancing this framework will help support the consistency with which authors undertake and report scoping studies and may encourage researchers and clinicians to engage in this process. Discussion We build upon our experiences conducting three scoping studies using the Arksey and O'Malley methodology to propose recommendations that clarify and enhance each stage of the framework. Recommendations include: clarifying and linking the purpose and research question (stage one); balancing feasibility with breadth and comprehensiveness of the scoping process (stage two); using an iterative team approach to selecting studies (stage three) and extracting data (stage four); incorporating a numerical summary and qualitative thematic analysis, reporting results, and considering the implications of study findings to policy, practice, or research (stage five); and incorporating consultation with stakeholders as a required knowledge translation component of scoping study methodology (stage six). Lastly, we propose additional considerations for scoping study methodology in order to support the advancement, application and relevance of scoping studies in health research. Summary Specific recommendations to clarify and enhance this methodology are outlined for each stage of the Arksey and O'Malley framework. Continued debate and development about scoping study methodology will help to maximize the usefulness and rigor of scoping study findings within healthcare research and practice

Hydrographic Changes in Nares Strait (Canadian Arctic Archipelago) in Recent Decades Based on δ18O Profiles of Bivalve Shells

Nares Strait is one of three main passages of the Canadian Archipelago that channel relatively fresh seawater from the Arctic Ocean through Baffin Bay to the Labrador Sea. Oxygen isotopic profiles along the growth axis of bivalve shells, collected live over the 5 – 30 m depth range from the Greenland and Ellesmere Island sides of the strait, were used to reconstruct changes in the hydrography of the region over the past century. The variability in oxygen isotope ratios is mainly attributed to variations in salinity and suggests that the northern end of Nares Strait has been experiencing an increase in freshwater runoff since the mid 1980s. The recent changes are most pronounced at the northern end of the strait and diminish toward the south, a pattern consistent with proximity to the apparently freshening Arctic Ocean source in the north and mixing with Baffin Bay waters as the water progresses southward. This increasing freshwater signal may reflect changes in circulation and ice formation that favor an increased flow of relatively fresh waters from the Arctic Ocean into Nares Strait.Le détroit de Nares est l’un des trois principaux passages de l’archipel canadien qui canalise de l’eau de mer relativement fraîche de l’océan Arctique jusqu’à la mer du Labrador en passant par la baie de Baffin. Les profils de la composition isotopique de l’oxygène le long de l’axe de développement des coquillages bivalves recueillis en vie à une profondeur variant entre 5 à 30 m des côtés du détroit à la hauteur du Groenland et de l’île d’Ellesmere ont servi à reconstruire les changements ayant caractérisé l’hydrographie de la région au cours du dernier siècle. La variabilité en matière de ratio d’isotope de l’oxygène est principalement attribuable aux variations de salinité, ce qui laisse entendre que l’extrémité nord du détroit de Nares connaît une augmentation de l’écoulement d’eau douce depuis le milieu des années 1980. Les changements récents sont plus prononcés à l’extrémité nord du détroit et diminuent en arrivant vers le sud, ce qui constitue une tendance conforme à la proximité de la source de l’océan Arctique en dessalure apparente dans le nord et qui se mélange avec les eaux de la baie de Baffin au fur et à mesure que l’eau progresse vers le sud. Cette augmentation de la présence d’eau douce peut être le reflet de changements en matière de circulation et de formation de la glace qui favorisent un écoulement accru d’eaux relativement douces en provenance de l’océan Arctique et se jettent dans le détroit de Nares

CV16022

This report provides the main results and findings of the fifteenth annual underwater television on the Aran, Galway Bay and Slyne head Nephrops grounds, ICES assessment area; Functional Unit 17. The survey was multi-disciplinary in nature collecting UWTV, fishing, CTD and other ecosystem data. In 2016 a total of 45 UWTV stations were successfully completed, 34 on the Aran Grounds, 7 on Galway Bay and 4 on Slyne Head patches. The mean burrow density observed in 2016, adjusted for edge effect, was medium at 0.29 burrows/m². The final krigged burrow abundance estimate for the Aran Grounds was 343 million burrows with a CV (or relative standard error) of 3 %. The final abundance estimate for Galway Bay and Slyne Head was 25 and 11 million burrows with CVs of 7% and 3% respectively. The total abundance estimates have fluctuated considerably over the time series. The 2016 combined abundance estimate was 32% lower than in 2015 and at 379 million and is below the MSY Btrigger (540 million). Using the 2016 abundance estimate and updated stock data implies catch of 489 tonnes and landings of 456 tonnes in 2017 when MSY approach is applied (assuming that discard rates and fishery selection patterns do not change from the average of 2013–2015). Virgilaria mirabilis was the only sea-pen species observed on the UWTV footage. Trawl marks were present at 20% of the Aran stations surveyed