Addressing Social and Structural Determinants Affecting HIV Medical Care Among Adolescents Aged 13-24 in Georgia, 2013

BACKGROUND: Adolescents aged 13-24 account for a substantial number of new HIV infections every year in the United States. Timely linkage to care and continuous engagement is very imperative for effective medical interventions and overall improved health outcomes for HIV positive young adults. This thesis addresses and evaluates the factors affecting linkage to and retention in care for the newly diagnosed HIV positive adolescents in Georgia in 2013 and potential solutions to address the disparities. METHODS: The analysis assessed quantitative and qualitative data extracted from Georgia’s HIV Surveillance-Electronic HIV/AIDS Reporting System (eHARS), Grady Infectious Disease Program (IDP), Ryan White CAREWare, and Georgia HIV Testing Data System. The data analysis was carried out using MS Excel and SAS 9.4. A univariate analysis was used by cross tabulating variables such as linked to care, any care, retention in care, and stratified by race/ethnicity, age, and risk factors. Inferential data was obtained from narrative reports of de-identified client-level from the Anti-Retroviral Treatment Access to Services (ARTAS) Intervention. Descriptive statistics analysis and logistic regression were performed using SAS version 9.4 with significance set at p\u3c0.05. RESULTS: Of the total 2,555 newly diagnosed HIV infected persons in Georgia in 2013, 601 were adolescents aged 13-24 years old. In comparison to other age groups, adolescents had the second highest newly diagnosed rate. Of the HIV infected adolescents, only 58% were linked to care and 47% were retained in care. HIV infection was found prominently among Black MSM populations. CONCLUSION: The results of this study indicated differences in factors and barriers that are associated with HIV positive adolescents and linkage to medical care and retention in medical care provide evidence for developing public health interventions. Public health intervention programs that address sex education, effect of IV drug use, and the importance of health insurance may help curb the prevalence of both HIV and sexually transmitted diseases in at-risk groups

Synthesis and Characterization of N-Substituted Tetrahydroiso-quinoline Derivatives via a Pictet-Spengler Condensation

Synthesis of N-substituted 1,2,3,4 –tetrahydroisoquinoline derivatives and bis-isoquinoline has been carried out via a Pictet-Spengler condensation. Tetrahydroisoquinolines were obtained from 2-(3',4'-dimethoxyphenyl) ethylamine in four steps. The entire synthesized compounds were characterized by IR, 1H NMR and mass spectral data

Evaluation of peripheral lymphadenopathy by fine needle aspiration cytology: a one year study at tertiary centre

Background: Lymphadenopathy is common presenting features in various non-neoplastic and neoplastic lesions. Fine needle aspiration cytology (FNAC) is simple, quick, inexpensive and minimally invasive technique that can be used as an outpatient procedure to diagnose them. The present study was undertaken to assess the various causes of lymphadenopathy through FNAC, and to see the distribution of lesions with respect to age and gender. To assess the diagnostic accuracy of lymph node fine needle aspiration (FNA) cytology in various non-neoplastic and neoplastic conditions.Methods: Total 555 cases of the lymph node FNAC were studied from January 2014 to December 2014 in Cytopathology department of Government Medical College, Surat .The cytomorphologic features seen in the aspirates were analyzed and correlated with their etiology.Results: In this study 555 cases of cervical lymphadenopathy were analysed. The age of the patients ranged from 5 months to 90 years of which 60.2% were males and 39.8% were females. Maximum numbers of cases 147(26.4%) were in the age group of 21- 30 years. The most common lesion encountered was tuberculous lymphadenitis 44.8% followed by metastatic tumors 31.3%, reactive lymph node 16.7%, acute lymphadenitis 5.4% and lymphoma 1.8%. Male showed predominance of metastatic carcinoma and lymphoma while chronic reactive hyperplasia and tuberculous lymphadenitis were equally distributed in both male & female.Conclusions: FNAC is safe, rapid and cost effective method in establishing the diagnosis in large number of cases of lymphadenopathy. It can differentiate a neoplastic from a non-neoplastic process and therefore influence patient management preventing patient from being subjected to unnecessary surgery

Listening as medicine: A thematic analysis

Realizations of the importance of “the art of medicine” in trust-building and patient satisfaction have resulted in the incorporation of narrative medicine programs into training curricula. By learning how to respond to patient stories as well as communicate their own, healthcare providers can ensure that their patients feel heard and respected. This study seeks to define what constitutes empathetic listening through a qualitative analysis of personal narratives collected from patients, caregivers, and providers across an urban academic healthcare system. Stories (n=41) underwent thematic analysis to note common experiences related to listening during a health system encounter. Eighteen grounded codes were identified which were abstracted to the following five themes: (1) connection and trust, (2) emotion and vulnerability, (3) objectives and experiences, (4) interaction and opportunity, and (5) challenges of listening. The most common theme of “connection and trust” indicated that active listening and person-centered care were key drivers of patient satisfaction and medical adherence. Encouraging patients and providers to become more comfortable verbalizing vulnerability also provided emotional relief. Taking the time to listen to patient needs and values advanced shared-decision making and facilitated the establishment of care objectives. Storytellers also conveyed the challenges inherent to the listening process. By helping to define empathetic listening, these results may enable the development of healthcare training programs centered on improving clinician communication and patient experience. We hope this study encourages future research devoted to quantifying subjective features such as “connection and trust” and “emotion and vulnerability” utilizing psychometrically validated instruments. Experience Framework This article is associated with the Patient, Family & Community Engagement lens of The Beryl Institute Experience Framework (https://www.theberylinstitute.org/ExperienceFramework). Access other PXJ articles related to this lens. Access other resources related to this lens

Quantifying how post-transcriptional noise and gene copy number variation bias transcriptional parameter inference from mRNA distributions

Transcriptional rates are often estimated by fitting the distribution of mature mRNA numbers measured using smFISH (single molecule fluorescence in situ hybridization) with the distribution predicted by the telegraph model of gene expression, which defines two promoter states of activity and inactivity. However, fluctuations in mature mRNA numbers are strongly affected by processes downstream of transcription. In addition, the telegraph model assumes one gene copy but in experiments, cells may have two gene copies as cells replicate their genome during the cell cycle. While it is often presumed that post-transcriptional noise and gene copy number variation affect transcriptional parameter estimation, the size of the error introduced remains unclear. To address this issue, here we measure both mature and nascent mRNA distributions of GAL10 in yeast cells using smFISH and classify each cell according to its cell cycle phase. We infer transcriptional parameters from mature and nascent mRNA distributions, with and without accounting for cell cycle phase and compare the results to live-cell transcription measurements of the same gene. We find that: (i) correcting for cell cycle dynamics decreases the promoter switching rates and the initiation rate, and increases the fraction of time spent in the active state, as well as the burst size; (ii) additional correction for post-transcriptional noise leads to further increases in the burst size and to a large reduction in the errors in parameter estimation. Furthermore, we outline how to correctly adjust for measurement noise in smFISH due to uncertainty in transcription site localisation when introns cannot be labelled. Simulations with parameters estimated from nascent smFISH data, which is corrected for cell cycle phases and measurement noise, leads to autocorrelation functions that agree with those obtained from live-cell imaging

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

The Dangers of Hydraulic Fracturing

Our goal is to reduce the risk that results from hydraulic fracturing. We implore the oil and gas industry to cooperate with government in researching the procedure and technique.Spring 201