Little is known about the impact of comorbid psychiatric symptoms in persons with HIV. This study estimates the burden on health-related quality of life associated with comorbid psychiatric ...conditions in a nationally representative sample of persons with HIV.
The authors conducted a multistage sampling of urban and rural areas to produce a national probability sample of persons with HIV receiving medical care in the contiguous United States (N=2,864). Subjects were screened for psychiatric conditions with the short form of the Composite International Diagnostic Interview. Heavy drinking was assessed on the basis of quantity and frequency of drinking. Health-related quality of life was rated with a 28-item instrument adapted from similar measures used in the Medical Outcomes Study.
HIV subjects with a probable mood disorder diagnosis had significantly lower scores on health-related quality of life measures than did those without such symptoms. Diminished health-related quality of life was not associated with heavy drinking, and in drug users it was accounted for by presence of a comorbid mood disorder.
Optimization of health-related quality of life is particularly important now that HIV is a chronic disease with the prospect of long-term survival. Comorbid psychiatric conditions may serve as markers for impaired functioning and well-being in persons with HIV. Inclusion of sufficient numbers of appropriately trained mental health professionals to identify and treat such conditions may reduce unnecessary utilization of other health services and improve health-related quality of life in persons with HIV infection.
The successful construction of an immunosensor depends on having an effective procedure for immobilising the bio-recognition element to the transducer surface. In the present study, an ...amino-terminated 4-aminothiophenol (ATP) self-assembled monolayer (SAM) was modified with heterobifunctional crosslinker sulfosuccinimidyl 4-N-maleimidomethyl cyclohexane-1-carboxylate to couple reduced anti-myoglobin half-antibody fragments. The disulphide groups present in the hinge region of IgG molecules were selectively cleaved by 2-mercaptoethylamine to produce reduced half-antibody fragments with free sulphydryl groups. The maleimide terminated 4-ATP SAM modified surface was coupled to these reduced antibody fragments to produce highly oriented immobilization of the half-antibody via its Fc domain and to allow free access to the Fv bindings sites. This represents an improvement by comparison with biotin/avidin mediated IgG attachment which is essentially randomly oriented. Functional immunosensors were able to detect myoglobin in both phosphate buffered saline and whole serum over the range of concentrations from 10
−
13
M to 10
−
6
M, and order of magnitude better than avidin/biotin linked immunosensors. In addition, atomic force microscopy (AFM) was carried out to elucidate the nanotopology of the immunosensor surface at different stages of fabrication; the images demonstrate that half antibodies bind as described and show structural changes on subsequent antigen binding.
Commodity purchase tasks provide a useful method for evaluating behavioral economic demand in the human laboratory. Recent research has shown how responding to purchase tasks for blinded drug ...administration can be used to study abuse liability. This analysis uses data from a human laboratory study to highlight how similar procedures may be particularly useful for understanding momentary changes in drug valuation when screening novel interventions. Eight nontreatment-seeking participants with cocaine use disorder (one with partial data) were enrolled in a cross-over, double-blind, randomized inpatient study. Participants were maintained on the Food and Drug Administration-approved insomnia medication suvorexant (oral; 0, 5, 10, 20 mg/day) in randomized order with experimental sessions completed after at least 3 days of maintenance on each suvorexant dose. Experimental sessions included administration of a sample dose of 0, 10 and 30 mg/70 kg intravenous cocaine. Analyses focused on purchase tasks for the blinded sample dose as well as alcohol, cigarettes and chocolate completed 15 min after the sample dose. As expected based on abuse liability, near zero demand was observed for placebo with dose-related increases in cocaine demand. Suvorexant maintenance increased cocaine demand in a dose-related manner with the greatest increase observed for the 10 mg/kg cocaine dose. Increased demand under suvorexant maintenance was also observed for alcohol. No effect of cocaine administration was observed for alcohol, cigarette, or chocolate demand. These data support the validity of demand procedures for measuring blinded drug demand. Findings also parallel self-administration data from this study by showing increases in cocaine use motivation under suvorexant maintenance.
Background
Peritoneal carcinomatosis, from a variety of gastrointestinal and gynecological malignancies, has been historically challenging to treat and there remains a wide range of biologic ...aggressiveness in these patients. Malignancies commonly associated with PC include those of colorectal, appendiceal, gastric, ovarian, sarcoma, small intestinal, and primary peritoneal origin among others. Advances in our understanding of this unique disease process have led to significant interest in cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS-HIPEC) as an emerging treatment option. The goal of CRS-HIPEC is to remove all visible macroscopic disease while preserving organ function, and then treat microscopic disease through perfusion of the peritoneal cavity with heated chemotherapy.
Purpose
Although recent reviews have focused on the management of peritoneal carcinomatosis secondary to colorectal cancer given the publication of several recent randomized controlled trials, the purpose of the current review is to summarize the evidence on CRS-HIPEC for non-colorectal peritoneal surface malignancies, including appendiceal neoplasms, malignant peritoneal mesothelioma, gastric cancer, and ovarian cancer.
Results
While retrospective studies have clarified the importance of prognostic factors such as the peritoneal carcinomatosis index, completeness of cytoreduction, histopathological characteristics, and lymph node positivity, the lack of convincing level 1 evidence for the use of CRS-HIPEC has led to it remaining a highly controversial topic.
Conclusion
The decision to utilize CRS-HIPEC should involve a multidisciplinary team approach and evaluation of prognostic factors to balance the short-term morbidity of the operation with maximum long-term benefits. Large, multi-institutional groups and ongoing trials hold promise for clarifying the role of CRS-HIPEC in peritoneal surface malignancies.
We present the detections of 18 solar flares detected in high-energy gamma-rays (above 100 MeV) with the Fermi Large Area Telescope (LAT) during its first 4 yr of operation. This work suggests that ...particle acceleration up to very high energies in solar flares is more common than previously thought, occurring even in modest flares, and for longer durations. We then describe the detailed temporal, spatial, and spectral characteristics of the first two long-lasting events; the 2011 March 7 flare, a moderate (M3.7) impulsive flare followed by slowly varying gamma-ray emission over 13 hr, and the 2011 June 7 M2.5 flare. We compare the Fermi LAT data with X-ray and proton data measurements from GOES and RHESSI. We argue that the gamma-rays are more likely produced through pion decay than electron bremsstrahlung, and we find that flic energy spectrum of the proton distribution softens during the extended emission of the 2011 March 7 flare.
Goal:
Research has highlighted psychological distress resulting from the COVID-19 pandemic on healthcare workers (HCWs), including the development of posttraumatic stress symptoms (PTSS). However, ...the degree to which these conditions have endured beyond the pandemic and the extent to which they affect the entire healthcare team, including both clinical and nonclinical workers, remain unknown. This study aims to identify correlates of PTSS in the entire healthcare workforce with the goal of providing evidence to support the development of trauma-informed leadership strategies.
Methods:
Data were collected from June to July 2022 using a cross-sectional anonymous survey in a large academic medical center setting. A total of 6,466 clinical and nonclinical employees completed the survey (27.3% response rate). Cases with at least one missing variable were omitted, for a total sample size of 4,806, the evaluation of which enabled us to understand individual, organizational, and work-related and nonwork-related stressors associated with PTSS. Data were analyzed using ordinal logistic regression and dominance analyses to identify predictors of PTSS specific to clinical and nonclinical workers.
Principal Findings:
While previous studies have shown that HCWs in different job roles experience unique stressors, our data indicate that the top correlates of PTSS among both clinical and nonclinical HCWs are the same: burnout, moral distress, and compassion fatigue. These three factors alone explained 45% and 44.4% of the variance in PTSS in clinical and nonclinical workers, respectively. PTSS was also associated with a lower sense of recognition and feeling mistreated by other employees at work in the clinical workforce. Concerningly, women and sexual minorities in the clinical sample exhibited a higher incidence of PTSS. In nonclinical workers, social isolation or loneliness and lower trust and confidence in senior leadership were associated with PTSS. Nonwork-related factors, such as exhaustion from caregiving responsibilities and financial strain, were also significantly associated with PTSS. Even after controlling for discrimination at and outside of work in both samples, we found that non-White populations were more likely to experience PTSS, highlighting a deeply concerning issue in the healthcare workforce.
Practical Applications:
The primary objective of this article is to help healthcare leaders understand the correlates of PTSS across the entire healthcare team as organizations recover from the COVID-19 pandemic. Understanding which factors are associated with PTSS will help healthcare leaders develop best practices that aim to reduce HCW distress and strategies to circumvent trauma derived from future crises. Our data indicate that leaders must address the correlates of PTSS in the workforce, focusing attention on both those who work on the frontlines and those who work behind the scenes. We urge leaders to adopt a trauma-informed leadership approach to ensure that the entire healthcare workforce is recognized, supported, and cared for as each HCW plays a unique role in the care of patients.
The living arrangements of older persons play a key role in their use of formal and informal care, as well as in their health and well‐being. Nurses engaged in primary care, discharge planning, and ...home care are strategically positioned to contribute to an optimal fit between older persons and their home environment. This article describes the demographic significance of late‐life living arrangements and proposes a model for organizing the complex web of factors associated with household composition and late‐life migration. The article then summarizes qualitative and quantitative evidence in support of the proposed model. Key areas for nursing research and strategies for applying available research are identified.
Knowledge of the spatial distribution of populations is fundamental to management plans for any species. When tracking data are used to describe distributions, it is sometimes assumed that the ...reported locations of individuals delineate the spatial extent of areas used by the target population.
Here we examine existing approaches to validate this assumption, highlight caveats, and propose a new method for a more informative assessment of the number of tracked animals (i.e. sample size) necessary to identify distribution patterns. We show how this assessment can be achieved by considering the heterogeneous use of habitats by a target species using the probabilistic property of a utilisation distribution. Our methods are compiled in the r package SDLfilter.
We illustrate and compare the protocols underlying existing and new methods using conceptual models and demonstrate an application of our approach using a large satellite tracking dataset of flatback turtles Natator depressus tagged with accurate Fastloc‐GPS tags (n = 69).
Our approach has applicability for the post hoc validation of sample sizes required for the robust estimation of distribution patterns across a wide range of taxa, populations and life‐history stages of animals.
Background
The relationship between inflammation and corrected QT (QTc) interval prolongation is currently not well defined in patients with COVID-19.
Objective
This study aimed to assess the effect ...of marked interval changes in the inflammatory marker C-reactive protein (CRP) on QTc interval in patients hospitalized with COVID-19.
Methods
In this retrospective cohort study of hospitalized adult patients admitted with COVID-19 infection, we identified 85 patients who had markedly elevated CRP levels and serial measurements of an ECG and CRP during the same admission. We compared mean QTc interval duration, and other clinical and ECG characteristics between times when CRP values were high and low. We performed mixed-effects linear regression analysis to identify associations between CRP levels and QTc interval in univariable and adjusted models.
Results
Mean age was 58 ± 16 years, of which 39% were women, 41% were Black, and 25% were White. On average, the QTc interval calculated
via
the Bazett formula was 15 ms higher when the CRP values were “high” vs. “low” 447 ms (IQR 427–472 ms) and 432 ms (IQR 412–452 ms), respectively. A 100 mg/L increase in CRP was associated with a 1.5 ms increase in QTc interval β coefficient 0.15, 95% CI (0.06–0.24). In a fully adjusted model for sociodemographic, ECG, and clinical factors, the association remained significant (β coefficient 0.14, 95% CI 0.05–0.23).
Conclusion
An interval QTc interval prolongation is observed with a marked elevation in CRP levels in patients with COVID-19.
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