Cervical cancer mortality remains high in sub-Saharan Africa, especially among women living with HIV (WLWH). Characterization of prevalent high-risk human papillomavirus (hrHPV) types and immune ...function in WLWH with cervical abnormalities despite antiretroviral therapy (ART) can inform prevention strategies.
Kampala, Uganda.
From 2017 to 2020, we enrolled Ugandan women with cervical dysplasia detected with visual inspection with acetic acid (VIA). WLWH were required to be on ART >3 months with plasma HIV RNA <1000 copies/mL. Biopsies from VIA-positive lesions underwent histopathologic grading and cervical swab specimens were tested for hrHPV. Clinical correlations were evaluated with Poisson regression to estimate adjusted prevalence ratios (aPR).
One hundred eighty-eight WLWH and 116 HIV-seronegative women participated. Among WLWH, median ART duration was 6 years and median CD4 667 cells/µL. Cervical intraepithelial neoplasia (CIN) grade 2/3 was found in 29% of WLWH versus 9% of HIV-seronegative women. In women with CIN1 or without histopathology-confirmed dysplasia, hrHPV (aPR 95% confidence interval: 2.17 1.43 to 3.29) and multiple hrHPV (aPR 3.73 1.07 to 13.1) were more common in WLWH, as were vaccine-targeted and vaccine-untargeted hrHPVtypes. Differences in hrHPV prevalence by HIV serostatus were not observed in women with CIN2/3 (interaction P < 0.01). Among WLWH, low CD4/8 ratio was associated with hrHPV while detectable plasma HIV RNA (20-1000 copies/mL) was associated with CIN2/3 or invasive cancer.
Despite ART, WLWH with cervical VIA abnormalities remain at elevated risk for multiple hrHPV and high-grade dysplasia. Cervical cancer prevention and research tailored for WLWH are warranted in the ART era.
A vast amount of civil infrastructure is constructed using reinforced concrete, which can be susceptible to corrosion, posing significant risks. Corrosion of reinforced concrete has various causes, ...with chloride ingress known to be a major contributor. Monitoring this chloride ingress would allow for preventative maintenance to be less intrusive at a lower cost. Currently, chloride sensing methods are bulky and expensive, leaving the majority of concrete infrastructures unmonitored. This paper presents the design and fabrication of a miniature, low-cost device that can be embedded into concrete at various locations and depths. The device measures localized concrete resistance, correlating to the chloride ingress in the concrete using equations listed in this paper, and calculated results from two experiments are presented. The device benefits from a four-probe architecture, injecting a fixed frequency AC waveform across its outer electrodes within the cement block. Voltage across the internal electrodes is measured with a microcontroller and converted to a resistance value, communicated serially to an external computer. A final test showcases the ability of the device for three-dimensional mass deployment.
Purpose: This study compared the performance of three amplification devices hypothesized to improve speech communication in individuals with hypophonia (HP), as well as to identify individuals' ...device preferences. Method: Twenty-two individuals with HP and their primary communication partners participated in a cross-over design study comparing three different speech amplification devices--a wired portable amplifier (Device A), a wireless stationary amplifier (Device B), and a one-way personal communication system (Device C). Participants attended one laboratory visit followed by 1-week trial periods with each device. At the first visit, HP participants completed speech tasks with and without the devices, in quiet and in noise. Following the in-laboratory test period, participants trialed each device at home for approximately 1 week per device. Following completion of the study, participants indicated whether or not they would like to continue using a device. Results: Overall, in the presence of noise, all three devices demonstrated significant improvements in speech-to-noise levels and speech intelligibility compared to no device. A clear device hierarchy emerged such that the personal communication device (Device C) was associated with significantly better speech outcomes compared to the other two devices. The majority of participants elected to continue using a device at the completion of the study. Device preferences, however, did not clearly reflect the objective device hierarchy that was found for the objective speech measures. Each of the three devices was selected as a preferred device by at least three participants at the completion of the study. Conclusion: Results from this study demonstrated clear differences in device performance in three distinct forms of amplification devices for individuals with HP. Findings suggest that amplification device use may be beneficial for this clinical population and underscore the potential to improve device availability and device selection criteria in future research.
In vitro and animal data suggest that cadmium, a heavy metal that contaminates some foods and tobacco plants, is an estrogenic endocrine disruptor. Elevated estrogen exposure is associated with ...breast, endometrial, and ovarian cancer risk.
We examined the association between dietary cadmium intake and risk of these cancers in the large, well-characterized Women's Health Initiative (WHI).
A total of 155,069 postmenopausal women, 50-79 years of age, who were enrolled in the WHI clinical trials or observational study, participated in this study. We estimated dietary cadmium consumption by combining baseline food frequency questionnaire responses with U.S. Food and Drug Administration data on food cadmium content. Participants reported incident invasive breast, endometrial, or ovarian cancer, and WHI centrally adjudicated all cases through August 2009. We applied Cox regression to estimate adjusted hazard ratios (HRs) and 95% CIs for each cancer, comparing quintiles of energy-adjusted dietary cadmium intake.
Over an average of 10.5 years, 6,658 invasive breast cancers, 1,198 endometrial cancers, and 735 ovarian cancers were reported. We observed no statistically significant associations between dietary cadmium and risk of any of these cancers after adjustment for potential confounders including total dietary energy intake. Results did not differ in any subgroup of women examined.
We found little evidence that dietary cadmium is a risk factor for breast, endometrial, or ovarian cancers in postmenopausal women. Misclassification in dietary cadmium assessment may have attenuated observed associations.
Background Prior studies have shown the association of low serum magnesium levels with adverse health outcomes in patients undergoing hemodialysis. There is a paucity of such studies in patients ...undergoing peritoneal dialysis (PD). Study Design Cohort study. Setting & Participants 10,692 patients treated with PD from January 1, 2007, through December 31, 2011, in facilities operated by a single large dialysis organization in the United States. Predictor Baseline serum magnesium levels, examined as 5 categories (<1.8, 1.8-<2.0, 2.0-<2.2 reference, 2.2-<2.4, and ≥2.4 mg/dL). Outcomes Time to first hospitalization and time to death using competing-risks regression models. Results The distribution of baseline serum magnesium levels in the cohort was <1.8 mg/dL, 1,928 (18%); 1.8 to <2.0 mg/dL, 2,204 (21%); 2.0 to <2.2 mg/dL, 2,765 (26%); 2.2 to <2.4 mg/dL, 1,765 (16%); and ≥2.4 mg/dL, 2,030 (19%). Of 10,692 patients, 6,465 (60%) were hospitalized at least once and 1,392 (13%) died during follow-up (median, 13; IQR, 7-23 months). Baseline serum magnesium level < 1.8 mg/dL was associated with higher risk for hospitalization and all-cause mortality after adjustment for demographic and clinical characteristics (adjusted HRs of 1.23 95% CI, 1.14-1.33 and 1.21 95% CI, 1.03-1.42, respectively). The higher risk for hospitalization persisted upon adjustment for laboratory variables, whereas that for all-cause mortality was attenuated to a nonsignificant level. The greatest risk for hospitalization was in patients with low serum albumin levels (<3.5 g/dL; P for interaction < 0.001). Limitations Possibility of residual confounding by unmeasured variables cannot be excluded. Conclusions Lower serum magnesium levels may be associated with higher risk for hospitalization in incident PD patients, particularly those with hypoalbuminemia. Additional studies are needed to confirm these findings and investigate whether correction of hypomagnesemia reduces these risks.
Most artificial intelligence (AI) studies have focused primarily on adult imaging, with less attention to the unique aspects of pediatric imaging. The objectives of this study were to (1) identify ...all publicly available pediatric datasets and determine their potential utility and limitations for pediatric AI studies and (2) systematically review the literature to assess the current state of AI in pediatric chest radiograph interpretation. We searched PubMed, Web of Science and Embase to retrieve all studies from 1990 to 2021 that assessed AI for pediatric chest radiograph interpretation and abstracted the datasets used to train and test AI algorithms, approaches and performance metrics. Of 29 publicly available chest radiograph datasets, 2 datasets included solely pediatric chest radiographs, and 7 datasets included pediatric and adult patients. We identified 55 articles that implemented an AI model to interpret pediatric chest radiographs or pediatric and adult chest radiographs. Classification of chest radiographs as pneumonia was the most common application of AI, evaluated in 65% of the studies. Although many studies report high diagnostic accuracy, most algorithms were not validated on external datasets. Most AI studies for pediatric chest radiograph interpretation have focused on a limited number of diseases, and progress is hindered by a lack of large-scale pediatric chest radiograph datasets.
Ultrasound imaging is an essential component of healthcare services. This study sought to explore perceptions of access, and factors which shape access, to ultrasound imaging in two northern, remote, ...Indigenous communities in Canada. Using interpretive description as a methodological approach and a multi-dimensional conceptualisation of access to care as a theoretical framework, 15 semi-structured interviews were conducted in the northern Canadian communities of Stony Rapids and Black Lake, Saskatchewan. All participants had an obstetrical or non-obstetrical ultrasound exam performed in the past 10 years. Interviews were audio recorded and interview transcripts were analysed using constant comparative analysis. Geographic isolation from imaging facilities was a central barrier to participants accessing ultrasound imaging. Other barriers became apparent when participants had to travel for ultrasound, including fear of air travel, isolation from family, financial means, and unfamiliarity with larger cities. Barriers such as family and work responsibilities were exacerbated by the barrier of geography. Participants overcame these barriers as they were motivated by potential diagnostic benefits of ultrasound imaging. This study highlights disparities in access to ultrasound for northern, remote, Indigenous populations. Future efforts to improve access to imaging should consider barriers of distance to imaging facilities and strategies to bridge these barriers.
Cadmium production has risen 1000-fold in the past 100 years, from under 20 to over 20,000 tons per year, causing anthropogenically-mobilized Cd to overwhelm natural sources in global cycling. ...Cadmium has no known biological function in humans, yet has biochemical behaviors similar to zinc and manganese, making exposure detrimental to human health. Identifying and quantifying the sources of Cd for human sub-populations is key to reducing exposures. Cadmium stable isotopes may provide a method for tracing Cd sources throughout the environment and the human body, but at present the limited database for high precision Cd isotopic compositions is inadequate to support such an analysis. Here, we provide new Cd isotope data on dietary sources, cigarette smoking components, and environmentally relevant standard reference materials. Results indicated that minor but significant variations are observed in food products (e.g., peanuts, sunflower seeds, spinach, kale, lettuce, cocoa powder; ~0.9‰ at 4 amu) that may be useful for tracing contamination in agricultural soils. In contrast, Cd isotope fractionation during smoking is larger (~6‰ at 4 amu) and has implications for tracing cadmium sources from tobacco combustion in the environment and throughout the human body. The primary inhaled component of cigarette smoke contains highest delta values (δ116/112Cd or δ114/110Cd ~5.2‰), while the second-hand smoke and cigarette ash have the lowest delta values (δ116/112Cd or δ114/110Cd ~−0.9‰). Used cigarette butts have δ114/110Cd ~2.4‰, in between the values measured in ash/s hand smoke and the inhaled smoke components. The high delta values of the inhaled smoke indicate that Cd isotopes may be used to determine the extent of Cd exposure due to smoking in human biological samples. This study provides new data for previously uncharacterized isotopic reservoirs that can be included in future studies of Cd source-exposure tracing.
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•Cd isotopes may provide a method for tracing human exposure to different sources.•Cd isotopic compositions of dietary sources show a narrow but measurable range.•Cd isotopic compositions of cigarette smoking components exhibit large variation.•Inhaled cigarette smoke had δ114/110Cd ~5.2 ‰ the heaviest signature measured.•Large fractionation during cigarette combustion allows for identifying exposure.
Peritoneal Equilibration Test and Patient Outcomes Mehrotra, Rajnish; Ravel, Vanessa; Streja, Elani ...
Clinical journal of the American Society of Nephrology,
11/2015, Letnik:
10, Številka:
11
Journal Article
Recenzirano
Odprti dostop
Although a peritoneal equilibration test yields data on three parameters (4-hour dialysate/plasma creatinine, 4- to 0-hour dialysate glucose, and 4-hour ultrafiltration volume), all studies have ...focused on the prognostic value of dialysate/plasma creatinine for patients undergoing peritoneal dialysis. Because dialysate 4- to 0-hour glucose and ultrafiltration volume may be superior in predicting daily ultrafiltration, the likely mechanism for the association of peritoneal equilibration test results with outcomes, we hypothesized that they are superior to dialysate/plasma creatinine for risk prediction.
We examined unadjusted and adjusted associations of three peritoneal equilibration test parameters with all-cause mortality, technique failure, and hospitalization rate in 10,142 patients on peritoneal dialysis treated between January 1, 2007 and December 31, 2011 in 764 dialysis facilities operated by a single large dialysis organization in the United States, with a median follow-up period of 15.8 months; 87% were treated with automated peritoneal dialysis.
Demographic and clinical parameters explained only 8% of the variability in dialysate/plasma creatinine. There was a linear association between dialysate/plasma creatinine and mortality (adjusted hazards ratio per 0.1 unit higher, 1.07; 95% confidence interval, 1.02 to 1.13) and hospitalization rate (adjusted incidence rate ratio per 0.1 unit higher, 1.05; 95% confidence interval, 1.03 to 1.06). Dialysate/plasma creatinine and dialysate glucose were highly correlated (r=-0.84) and yielded similar risk prediction. Ultrafiltration volume was inversely related with hospitalization rate but not with all-cause mortality. None of the parameters were associated with technique failure. Adding 4- to 0-hour dialysate glucose, ultrafiltration volume, or both did not result in any improvement in risk prediction with dialysate/plasma creatinine alone.
This analysis from a large contemporary cohort treated primarily with automated peritoneal dialysis validates dialysate/plasma creatinine as a robust predictor of outcomes in patients treated with peritoneal dialysis.
We present a mid-infrared (IR) sample study of nearby ultraluminous X-ray sources (ULXs) using multiepoch observations with the Infrared Array Camera (IRAC) on the Spitzer Space Telescope. ...Spitzer/IRAC observations taken after 2014 were obtained as part of the Spitzer Infrared Intensive Transients Survey. Our sample includes 96 ULXs located within 10 Mpc. Of the 96 ULXs, 12 have candidate counterparts consistent with absolute mid-IR magnitudes of supergiants, and 16 counterparts exceeded the mid-IR brightness of single supergiants and are thus more consistent with star clusters or non-ULX background active galactic nuclei. The supergiant candidate counterparts exhibit a bimodal color distribution in a Spitzer/IRAC color-magnitude diagram, where "red" and "'blue" ULXs fall in IRAC colors 3.6 - 4.5 ∼ 0.7 and 3.6 - 4.5 ∼ 0.0, respectively. The mid-IR colors and absolute magnitudes of four "red" and five "blue" ULXs are consistent with those of supergiant Be (sgBe) and red supergiant (RSG) stars, respectively. Although "blue," RSG-like mid-IR ULX counterparts likely host RSG mass donors; we propose that "red" counterparts are ULXs exhibiting the "Be phenomenon" rather than hosts of sgBe mass donors. We show that the mid-IR excess from the "red" ULXs is likely due to thermal emission from circumstellar or circumbinary dust. Using dust as a probe for total mass, we estimate mass-loss rates of M ˙ ∼ 1 × 10 − 4 M yr−1 in dust-forming outflows of red ULXs. Based on the transient mid-IR behavior and its relatively flat spectral index, = −0.19 0.1, we suggest that the mid-IR emission from Holmberg IX X-1 originates from a variable jet.
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