Pharmacological treatment of painful HIVassociated sensory neuropathy

Background. HIV-associated sensory neuropathy (HIV-SN) is a common and frequently painful  complication of HIV infection and its treatment. However, few data exist describing the frequency, type and dosage of pain medications patients are receiving in the clinic setting to manage the painful symptoms of HIV-SN.Objective. To report on analgesic prescription for painful HIV-SN and factors influencing that prescription in adults on combination antiretroviral therapy.Methods. Using validated case ascertainment criteria to identify patients with painful HIV-SN, we  recruited 130 HIV-positive patients with painful HIV-SN at Chris Hani Baragwanath Hospital,  Johannesburg, South Africa. Demographic and clinical data (including current analgesic use) were collected on direct questioning of the patients and review of the medical files.Results. We found significant associations, of moderate effect size, between higher pain intensity and lower CD4 T-cell counts with prescription of analgesic therapy. Factors previously identified as predicting analgesic treatment in HIV-positive individuals (age, gender, level of education) were not associated with analgesic use here. Consistent with national guidelines, amitriptyline was the most commonly used agent, either alone or in combination therapy. Importantly, we also found that despite the relatively high analgesic treatment rate in this setting, the majority of patients described their current level of HIV-SN pain as moderate or severe.Conclusion. Our findings highlight the urgent need for both better analgesic options for HIV-SN pain  treatment and ongoing training and support of clinicians managing this common and debilitating condition

Lithic technological responses to Late Pleistocene glacial cycling at Pinnacle Point Site 5-6, South Africa

There are multiple hypotheses for human responses to glacial cycling in the Late Pleistocene, including changes in population size, interconnectedness, and mobility. Lithic technological analysis informs us of human responses to environmental change because lithic assemblage characteristics are a reflection of raw material transport, reduction, and discard behaviors that depend on hunter-gatherer social and economic decisions. Pinnacle Point Site 5-6 (PP5-6), Western Cape, South Africa is an ideal locality for examining the influence of glacial cycling on early modern human behaviors because it preserves a long sequence spanning marine isotope stages (MIS) 5, 4, and 3 and is associated with robust records of paleoenvironmental change. The analysis presented here addresses the question, what, if any, lithic assemblage traits at PP5-6 represent changing behavioral responses to the MIS 5-4-3 interglacial-glacial cycle? It statistically evaluates changes in 93 traits with no a priori assumptions about which traits may significantly associate with MIS. In contrast to other studies that claim that there is little relationship between broad-scale patterns of climate change and lithic technology, we identified the following characteristics that are associated with MIS 4: increased use of quartz, increased evidence for outcrop sources of quartzite and silcrete, increased evidence for earlier stages of reduction in silcrete, evidence for increased flaking efficiency in all raw material types, and changes in tool types and function for silcrete. Based on these results, we suggest that foragers responded to MIS 4 glacial environmental conditions at PP5-6 with increased population or group sizes, 'place provisioning', longer and/or more intense site occupations, and decreased residential mobility. Several other traits, including silcrete frequency, do not exhibit an association with MIS. Backed pieces, once they appear in the PP5-6 record during MIS 4, persist through MIS 3. Changing paleoenvironments explain some, but not all temporal technological variability at PP5-6.Social Science and Humanities Research Council of Canada; NORAM; American-Scandinavian Foundation; Fundacao para a Ciencia e Tecnologia [SFRH/BPD/73598/2010]; IGERT [DGE 0801634]; Hyde Family Foundations; Institute of Human Origins; National Science Foundation [BCS-9912465, BCS-0130713, BCS-0524087, BCS-1138073]; John Templeton Foundation to the Institute of Human Origins at Arizona State Universit

The effect of density and feature size on mechanical properties of isostructural metaffic foams produced by additive manufacturing

Simple models describing the relationship between basic mechanical properties and the relative density of various types of porous metals (such as foams, sponges and lattice structures) are well established. Carefully evaluating these relationships experimentally is challenging, however, because of the stochastic structure of foams and the fact that it is difficult to systematically isolate density changes from variations in other factors, such as pore size and pore distribution. Here a new method for producing systematic sets of stochastic foams is employed based on electron beam melting (EBM) additive manufacturing (AM). To create idealised structures, structural blueprints were reverse-engineered by inverting X-ray computed tomographs of a randomly packed bed of glass beads. This three-dimensional structure was then modified by computer to create five foams of different relative density ρr, but otherwise consistent structure. Yield strength and Young’s modulus have been evaluated in compression tests and compared to existing models for foams. A power of 3 rather than a squared dependence of stiffness on relative density is found, which agrees with a recent model derived for replicated foams. A similar power of 3 relation was found for yield strength. Further analysis of the strength of nominally fully dense rods of different diameters built by EBM AM suggest that surface defects mean that the minimum size of features that can be created by EBM with similar strengths to machined samples is ∼1 mm

Scope and limitations of the irreversible thermodynamics and the solution diffusion models for the separation of binary and multi-component systems in reverse osmosis process

YesReverse osmosis process is used in many industrial applications ranging from solute-solvent to solvent-solvent and gaseous separation. A number of theoretical models have been developed to describe the separation and fluxes of solvent and solute in such processes. This paper looks into the scope and limitations of two main models (the irreversible thermodynamics and the solution diffusion models) used in the past by several researchers for solute-solvent feed separation. Despite the investigation of other complex models, the simple concepts of these models accelerate the feasibility of the implementation of reverse osmosis for different types of systems and variety of industries. Briefly, an extensive review of these mathematical models is conducted by collecting more than 70 examples from literature in this study. In addition, this review has covered the improvement of such models to make them compatible with multi-component systems with consideration of concentration polarization and solvent-solute-membrane interaction

SPECIAL ISSUE HIV and CHRONIC PAIN (The Global Task Force for Chronic Pain in People with HIV (PWH): Developing a research agenda in an emerging field)

Chronic pain is a common comorbidity in people with HIV (PWH), with prevalence estimates of 25-85%. Research in this area is growing, but significant gaps remain. A Global Task Force of HIV experts was organized to brainstorm a scientific agenda and identify measurement domains critical to advancing research in this field. Experts were identified through literature searches and snowball sampling. Two online questionnaires were developed by Task Force members. Questionnaire 1 asked participants to identify knowledge gaps in the field of HIV and chronic pain and identify measurement domains in studies of chronic pain in PWH. Responses were ranked in order of importance in Questionnaire 2, which was followed by a group discussion. 29 experts completed Questionnaire 1, 25 completed Questionnaire 2, and 21 participated in the group. Many important clinical and research priorities emerged, including the need to examine etiologies of chronic pain in PWH. Pain-related measurement domains were discussed, with a primary focus on domains that could be assessed in a standardized manner across various cohorts that include PWH in different countries. We collaboratively identified clinical and research priorities, as well as gaps in standardization of measurement domains, that can be used to move the field forward

Utilisation of an operative difficulty grading scale for laparoscopic cholecystectomy

Background A reliable system for grading operative difficulty of laparoscopic cholecystectomy would standardise description of findings and reporting of outcomes. The aim of this study was to validate a difficulty grading system (Nassar scale), testing its applicability and consistency in two large prospective datasets. Methods Patient and disease-related variables and 30-day outcomes were identified in two prospective cholecystectomy databases: the multi-centre prospective cohort of 8820 patients from the recent CholeS Study and the single-surgeon series containing 4089 patients. Operative data and patient outcomes were correlated with Nassar operative difficultly scale, using Kendall’s tau for dichotomous variables, or Jonckheere–Terpstra tests for continuous variables. A ROC curve analysis was performed, to quantify the predictive accuracy of the scale for each outcome, with continuous outcomes dichotomised, prior to analysis. Results A higher operative difficulty grade was consistently associated with worse outcomes for the patients in both the reference and CholeS cohorts. The median length of stay increased from 0 to 4 days, and the 30-day complication rate from 7.6 to 24.4% as the difficulty grade increased from 1 to 4/5 (both p < 0.001). In the CholeS cohort, a higher difficulty grade was found to be most strongly associated with conversion to open and 30-day mortality (AUROC = 0.903, 0.822, respectively). On multivariable analysis, the Nassar operative difficultly scale was found to be a significant independent predictor of operative duration, conversion to open surgery, 30-day complications and 30-day reintervention (all p < 0.001). Conclusion We have shown that an operative difficulty scale can standardise the description of operative findings by multiple grades of surgeons to facilitate audit, training assessment and research. It provides a tool for reporting operative findings, disease severity and technical difficulty and can be utilised in future research to reliably compare outcomes according to case mix and intra-operative difficulty

Esophageal and Gastric Malignancies After Bariatric Surgery: a Retrospective Global Study

Background: Bariatric surgery can influence the presentation, diagnosis, and management of gastrointestinal cancers. Esophagogastric (EG) malignancies in patients who have had a prior bariatric procedure have not been fully characterized. Objective: To characterize EG malignancies after bariatric procedures. Setting: University Hospital, United Kingdom. Methods: We performed a retrospective, multicenter observational study of patients with EG malignancies after bariatric surgery to characterize this condition. Results: This study includes 170 patients from 75 centers in 25 countries who underwent bariatric procedures between 1985 and 2020. At the time of the bariatric procedure, the mean age was 50.2 ± 10 years, and the mean weight 128.8 ± 28.9 kg. Women composed 57.3% (n = 98) of the population. Most (n = 64) patients underwent a Roux-en-Y gastric bypass (RYGB) followed by adjustable gastric band (AGB; n = 46) and sleeve gastrectomy (SG; n = 43). Time to cancer diagnosis after bariatric surgery was 9.5 ± 7.4 years, and mean weight at diagnosis was 87.4 ± 21.9 kg. The time lag was 5.9 ± 4.1 years after SG compared to 9.4 ± 7.1 years after RYGB and 10.5 ± 5.7 years after AGB. One third of patients presented with metastatic disease. The majority of tumors were adenocarcinoma (82.9%). Approximately 1 in 5 patients underwent palliative treatment from the outset. Time from diagnosis to mortality was under 1 year for most patients who died over the intervening period. Conclusion: The Oesophago-Gastric Malignancies After Obesity/Bariatric Surgery study presents the largest series to date of patients developing EG malignancies after bariatric surgery and attempts to characterize this condition.info:eu-repo/semantics/publishedVersio

Neanderthal Use of Fish, Mammals, Birds, Starchy Plants and Wood 125-250,000 Years Ago

Neanderthals are most often portrayed as big game hunters who derived the vast majority of their diet from large terrestrial herbivores while birds, fish and plants are seen as relatively unimportant or beyond the capabilities of Neanderthals. Although evidence for exploitation of other resources (small mammals, birds, fish, shellfish, and plants) has been found at certain Neanderthal sites, these are typically dismissed as unusual exceptions. The general view suggests that Neanderthal diet may broaden with time, but that this only occurs sometime after 50,000 years ago. We present evidence, in the form of lithic residue and use-wear analyses, for an example of a broad-based subsistence for Neanderthals at the site of Payre, Ardèche, France (beginning of MIS 5/end of MIS 6 to beginning of MIS 7/end of MIS 8; approximately 125–250,000 years ago). In addition to large terrestrial herbivores, Neanderthals at Payre also exploited starchy plants, birds, and fish. These results demonstrate a varied subsistence already in place with early Neanderthals and suggest that our ideas of Neanderthal subsistence are biased by our dependence on the zooarchaeological record and a deep-seated intellectual emphasis on big game hunting

Effect of density and unit cell size grading on the stiffness and energy absorption of short fibre-reinforced functionally graded lattice structures

Architectured structures, particularly functionally graded lattices, are receiving much attention in both industry and academia as they facilitate the customization of the structural response and harness the potential for multi-functional applications. This work experimentally investigates how the severity of density and unit cell size grading as well as the building direction affects the stiffness, energy absorption and structural response of additively manufactured (AM) short fibre-reinforced lattices with same relative density. Specimens composed of tessellated body-centred cubic (BCC), Schwarz-P (SP) and Gyroid (GY) unit cells were tested under compression. Compared to the uniform lattices of equal density, it was found, that modest density grading has a positive and no effect on the total compressive stiffness of SP and BCC lattices, respectively. More severe grading gradually reduces the total stiffness, with the modulus of the SP lattices never dropping below that of the uniform counterparts. Unit cell size grading had no significant influence on the stiffness and revealed an elastomer-like performance as opposed to the density graded lattices of the same relative density, suggesting a foam-like behaviour. Density grading of bending-dominated unit cell lattices showcased better energy absorption capability for small displacements, whereas grading of the stretching-dominated counterparts is advantageous for large displacements when compared to the ungraded lattice. The severity of unit cell size graded lattices does not affect the energy absorption capability. Finally, a power-law approach was used to semi-empirically derive a formula that predicts the cumulative energy absorption as a function of the density gradient and relative density. Overall, these findings will provide engineers with valuable knowledge that will ease the design choices for lightweight multi-functional AM-parts