Rhabdomyolysis in an HIV cohort: epidemiology, causes and outcomes.

BackgroundThe Literature on rhabdomyolysis in the HIV-positive population is sparse and limited. We aimed to explore the incidence, patient characteristics, etiologies and outcomes of rhabdomyolysis in a cohort of HIV-positive patients identified through the Johns Hopkins HIV clinical registry between June 1992 and April 2014.MethodsA retrospective analysis of 362 HIV-positive patients with non-cardiac CK elevation ≥1000 IU/L was performed. Both inpatients and outpatients were included. Incidence rate and potential etiologies for rhabdomyolysis were ascertained. The development of acute kidney injury (AKI, defined as doubling of serum creatinine), need for dialysis, and death in the setting of rhabdomyolysis were determined. Logistic regression was used to evaluate the association of peak CK level with the development of AKI.ResultsThree hundred sixty two cases of rhabdomyolysis were identified in a cohort of 7079 patients with a 38,382 person years follow-up time. The incidence rate was nine cases per 1000 person-years (95% CI: 8.5-10.5). Infection was the most common etiology followed by compression injury and drug/alcohol use. One-third of cases had multiple potential etiologies. AKI developed in 46% of cases; 20% of which required dialysis. Thirteen percent died during follow-up. After adjustment, AKI was associated with higher CK (OR 2.05 for each 1-log increase in CK [95% CI: 1.40-2.99]), infection (OR 5.48 [95% CI 2.65-11.31]) and higher HIV viral load (OR 1.22 per 1-log increase [95% CI: 1.03-1.45]).ConclusionRhabdomyolysis in the HIV-positive population has many possible causes and is frequently multifactorial. HIV-positive individuals with rhabdomyolysis have a high risk of AKI and mortality

Investigating the relationship between social support and durable return to work

The aim of the current study was to investigate the relationship between social support and durable return to work (RTW) post occupational injury. A total of 1,179 questionnaires were posted to clients previously receiving vocational rehabilitation services from the Return to Work Assist program in Queensland, Australia. Participants were asked to indicate their current RTW status, in addition to completing questionnaires measuring their relationship with their superior, relationships with colleagues, and social support external to the workplace. The statistical analysis included 110 participants. An ANOVA indicated that participants in the RTW group reported significantly better relationships with their superiors and colleagues than participants in the non-durable RTW group. No significant differences were observed between the RTW, non-durable RTW and no RTW groups on a measure of social support external to the workplace. Although the findings were limited by the low response rate, an evaluation of demographics indicated the respondents were representative of the original target sample. The findings suggested that providing support in the workplace is an important area for intervention and may be a means of increasing durable RTW outcomes.</jats:p

Dryland pasture yields and botanical composition over 5 years under sheep grazing in Canterbury

Annual dry matter (DM) production and botanical composition of six dryland pasture combinations, grown under sheep grazing at Lincoln University for 5 years, are presented. In 4 years, lucerne produced the highest DM yields (13.1-18.5 t/ha/yr) through higher daily growth rates, compared with grass based pastures, particularly during periods of water stress in summer and autumn. Of the grass based pastures, cocksfoot sown with subterranean clover produced yields of 9.9-12.9 t DM/ha/yr which were greater than, or similar to, all other pastures (8.0-12.9 t DM/ha/yr). Cocksfoot established with white clover produced >9.7 t DM/ha/yr in years with wetter than average summers. Over the 5 years the contribution of perennial ryegrass to total DM yield declined by ~0.7 t/ha/yr, from 70% in Year 1, to 44% in Year 5. It was replaced by unsown dicotyledonous weeds and grasses which increased from 4% in Year 1 to 24% by Year 5. Overall results show a dryland pastoral system that includes both lucerne and cocksfoot with subterranean clover pastures is likely to produce more feed in dry years than perennial ryegrass/white clover pastures. The inclusion of white clover with cocksfoot and subterranean clover may allow utilisation of variable and unpredictable rainfall in moist summers.A. Mills acknowledges financial assistance from Meat & Wool NZ through the FoRST Pastoral21 programme, Lincoln University and the Cocksfoot Growers Association

The Role of Domain Satisfaction in Explaining the Paradoxical Association Between Life Satisfaction and Age

Although aging is associated with declines in many life circumstances, overall life satisfaction does not appear to sharply decline with age. One explanation for this paradoxical finding is that several life domains improve with age such that increases in certain domains balance the decreases in others. Life and domain satisfaction data from eight years of the British Household Panel Study were analyzed to evaluate this hypothesis. Results showed that although domain satisfaction scores demonstrate distinct trajectories, the aggregate of these distinct trajectories resembled the overall life satisfaction trajectory. These findings have implications for top-down and bottom-up models of life satisfaction

Restoration action effectiveness: employing the concept of net ecosystem improvement

The mission statement of the Northwest Straits Initiative includes ‘improving ecosystem health’ of the Strait of Juan de Fuca and Northern Puget Sound by restoring and protecting natural habitats and resources. For the Initiative, and many other programs, defining ‘ecosystem health’ and developing relevant and measureable health metrics is problematic, and yet critical to both assessing program action effectiveness as well as justifying investments. The Initiative is exploring utilizing the concept of net ecosystem improvement (NEI) to summarize results of actions and couch the results in a broader ecosystem perspective. Net improvement is defined as following development; there is an increase in the size and natural functions of an ecosystem or natural components of the ecosystem (Thom et al. 2005. Restoration Ecol. v. 13). Conceptual models are used to summarize knowledge and guide actions to improve the ecosystem. NEI is calculated by estimating the change in function times the change in area over which this change in function occurred including both temporal and spatial aspects. For example, the anchor out zone project managed by the Jefferson County Marine Resources Committee in Port Townsend protects 21.6ha (52 acres) of eelgrass. Without this protection most if not all of the eelgrass would be lost. Using data from other areas, we estimated that 3,998 - 66,077 Dungeness crab (primarily juveniles) and net production by eelgrass of 2,083 metric tons wet wt y-1, are protected. Based on WDNR monitoring (Christiaen et al. 2017), this area of eelgrass protected amounts to 0.5 – 0.8% of the total eelgrass area in the Straits, and 0.5% of the Puget Sound Partnership 2020 eelgrass recovery goal of ~4000ha. Estimating NEI and placing the results in a broader ecosystem perspective is possible for many actions taken by the Initiative’s Marine Resource Committees, and may be appropriate for other programs

Land Use and Land Cover Change Dynamics across the Brazilian Amazon: Insights from Extensive Time-Series Analysis of Remote Sensing Data

Throughout the Amazon region, the age of forests regenerating on previously deforested land is determined, in part, by the periods of active land use prior to abandonment and the frequency of reclearance of regrowth, both of which can be quantified by comparing time-series of Landsat sensor data. Using these time-series of near annual data from 1973–2011 for an area north of Manaus (in Amazonas state), from 1984–2010 for south of Santarém (Pará state) and 1984–2011 near Machadinho d’Oeste (Rondônia state), the changes in the area of primary forest, non-forest and secondary forest were documented from which the age of regenerating forests, periods of active land use and the frequency of forest reclearance were derived. At Manaus, and at the end of the time-series, over 50% of regenerating forests were older than 16 years, whilst at Santarém and Machadinho d’Oeste, 57% and 41% of forests respectively were aged 6–15 years, with the remainder being mostly younger forests. These differences were attributed to the time since deforestation commenced but also the greater frequencies of reclearance of forests at the latter two sites with short periods of use in the intervening periods. The majority of clearance for agriculture was also found outside of protected areas. The study suggested that a) the history of clearance and land use should be taken into account when protecting deforested land for the purpose of restoring both tree species diversity and biomass through natural regeneration and b) a greater proportion of the forested landscape should be placed under protection, including areas of regrowth

Hydrodynamic limit of multiscale viscoelastic models for rigid particle suspensions

We study the multiscale viscoelastic Doi model for suspensions of Brownian rigid rod-like particles, as well as its generalization by Saintillan and Shelley for self-propelled particles. We consider the regime of a small Weissenberg number, which corresponds to a fast rotational diffusion compared to the fluid velocity gradient, and we analyze the resulting hydrodynamic approximation. More precisely, we show the asymptotic validity of macroscopic nonlinear viscoelastic models, in form of so-called ordered fluid models, as an expansion in the Weissenberg number. The result holds for zero Reynolds number in 3D and for arbitrary Reynolds number in 2D. Along the way, we establish several new well-posedness and regularity results for nonlinear fluid models, which may be of independent interest.Comment: 64 page

Effect of Electrically Mediated Intratumor and Intramuscular Delivery of a Plasmid Encoding IFN α on Visible B16 Mouse Melanomas

Interferon α may be used as a single agent therapy for metastatic malignant melanoma or as an adjuvant to chemotherapy. Delivery of interferon α by gene therapy offers an alternative to recombinant protein therapy. Electrically mediated delivery enhances plasmid expression in a number of tissues, for instance skin, liver, muscle and tumors including melanomas. Here we compare the effect of delivery of a plasmid encoding mouse interferon α on growth of visible B16 mouse melanomas following electrically mediated delivery to muscle or directly to the tumor. Intratumoral delivery of interferon α plasmid not only slows melanoma growth, but induces complete, long term, regression. This effect was not observed after intramuscular delivery