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Winner of the 2022-2023 James B. M. Schick Pittsburg State University Graduate Best Essay Prize When considering the primary romance in Jane Austen's Pride and Prejudice, new readers and faithful [...]

Despite effective antiretroviral therapy (ART), persons living with HIV harbor reservoirs of persistently infected [CD4.sup.+] cells, which constitute a barrier to cure. Initiation of ART during acute infection reduces the size of the HIV reservoir, and we hypothesized that in addition, it would favor integration of proviruses in HIV- specific [CD4.sup.+] T cells, while initiation of ART during chronic HIV infection would favor relatively more proviruses in herpesvirus-specific cells. We further hypothesized that proviruses in acute ART initiators would be integrated into antiviral genes, whereas integration sites (ISs) in chronic ART initiators would favor genes associated with cell proliferation and exhaustion. We found that the HIV DNA distribution across HIV-specific versus herpesvirus-specific [CD4.sup.+] T cells was as hypothesized. HIV ISs in acute ART initiators were significantly enriched in gene sets controlling lipid metabolism and HIF-1[alpha]-mediated hypoxia, both metabolic pathways active in early HIV infection. Persistence of these infected cells during prolonged ART suggests a survival advantage. ISs in chronic ART initiators were enriched in a gene set controlling EZH2 histone methylation, and methylation has been associated with diminished long terminal repeat transcription. These differences that we found in antigen specificities and IS distributions within HIV- infected cells might be leveraged in designing cure strategies tailored to the timing of ART initiation., Introduction Antiretroviral therapy (ART) can effectively suppress HIV replication, but maintenance of virologic suppression requires that persons living with HIV adhere to the prescribed medicines over their lifetime, as current [...]

Editor's Note: As part of our continued effort to highlight innovative approaches to improve the health and environment of communities, the Journal is pleased to publish regular columns from the [...]

The purpose of this paper was to determine whether recommendations made by King & Murphy (Journal of Autism and Developmental Disorders 44:2717-2733, 2014) in their review of the evidence on autistic people in contact with the criminal justice system (CJS) have been addressed. Research published since 2013 was systematically examined and synthesised. The quality of 47 papers was assessed using the Mixed Methods Appraisal Tool. Findings suggest a limited amount of good quality research has been conducted that has focused on improving our understanding of autistic people in contact with the CJS since 2013. Methodological limitations make direct comparisons between autistic and non-autistic offenders difficult. Autistic people commit a range of crimes and appear to have unique characteristics that warrant further exploration (i.e., vulnerabilities, motivations for offending)., Author(s): J. Collins [sup.1] , K. Horton [sup.1] , E. Gale-St. Ives [sup.1] , G. Murphy [sup.1] , M. Barnoux [sup.1] Author Affiliations: (1) grid.9759.2, 0000 0001 2232 2818, Tizard [...]

Background: Current national guidelines on caring for hip fractures recommend early mobilization. However, this recommendation does not account for time spent immobilized waiting for surgery. We sought to determine timing of mobilization following hip fracture, beginning at hospital admission, and evaluate its association with medical complications and length of hospital stay (LOS). Methods: We performed a retrospective review of prospectively collected data for 470 consecutive patients who underwent surgery for a hip fracture between September 2019 and August 2020 at an academic, tertiary-referral hospital. Outcomes of interest included time from hospital admission to mobilization, complication rate and LOS. We used a binary regression analysis to determine the effect of different surgical and patient factors on the risk of a postoperative medical complication. Results: The mean time from admission to mobilization was 2.8 [+ or -] 2.3 days (range 3 h-14 d). There were 125 (26.6%) patients who experienced at least 1 complication. The odds of developing a complication began to increase steadily once a patient waited more than 3 days from admission to mobilization (odds ratio 2.15, 95% confidence interval 1.42-3.25). Multivariate regression analysis showed that prefracture frailty ((3 = 0.276, p = 0.05), and timing from hospital admission to mobilization ((3 = 0.156, p < 0.001) and from surgery to mobilization ((3 = 1.195, p < 0.001) were associated with complications. The mean LOS was 12.2 [+ or -] 10.7 days (range 1-90 d). Prolonged wait to mobilization was associated with longer LOS (p = 0.01). Conclusion: Comprehensive guidelines on timing of mobilization following hip fracture should account for cumulative time spent immobilized. Contexte : Les lignes directrices nationales actuelles en matière de prise en charge des fractures de la hanche recommandent une mobilisation précoce. Cependant, le temps d'immobilisation en attente de la chirurgie n'est pas pris en compte. Nous avons cherché à déterminer le temps écoulé de l'hospitalisation à la mobilisation après une fracture de la hanche et à évaluer les effets de ce délai sur les complications médicales et la durée de séjour à l'hôpital. Méthodes : Nous avons réalisé une revue rétrospective de données recueillies prospectivement auprès de 470 patients consécutifs ayant subi une chirurgie pour fracture de la hanche entre septembre 2019 et août 2020 dans un centre hospitalier universitaire de soins tertiaires. Les paramètres d'intérêt comprenaient le temps écoulé entre l'hospitalisation et la mobilisation, le taux de complications et la durée de séjour. Nous avons utilisé une analyse par régression binaire pour évaluer l'effet de différents facteurs liés à l'intervention et au patient sur le risque de complication postopératoire. Résultats : Le temps moyen entre l'hospitalisation et la mobilisation s'élevait à 2,8 [+ or -] 2,3 jours (3 h-14 j). Parmi les patients, 125 (26,6%) ont rencontré au moins 1 complication. Le risque d'apparition d'une complication augmentait progressivement à partir de 3 jours d'attente entre l'hospitalisation et la mobilisation (rapport de cotes 2,15, intervalle de confiance à 95% 1,42-3,25). L'analyse de régression multivariable a montré qu'une fragilité préexistante ([beta] = 0,276, p = 0,05) et le temps écoulé entre l'hospitalisation et la mobilisation ([beta] = 0,156, p < 0,001) et entre l'intervention et la mobilisation ([beta] = 1,195, p < 0,001) étaient liés à des complications. La durée de séjour moyenne s'élevait à 12,2 [+ or -] 10,7 jours (1-90 j). Une attente prolongée avant la mobilisation était associée à une plus longue durée de séjour (p = 0,01). Conclusion : Des lignes directrices exhaustives sur le moment de mobilisation après une fracture de la hanche devraient tenir compte du temps d'immobilisation cumulatif., Hip fracture is a leading cause of disability and morbidity worldwide. (1-4) It is estimated that the annual global number of hip fractures will increase from 1.26 million in 1990 [...]

Transthoracic echocardiography is commonly used to identify structural and functional cardiac abnormalities that can be prevalent in childhood chronic kidney failure (KF). Left ventricular mass (LVM) increase is most frequently reported and may persist post-kidney transplant especially with hypertension and obesity. While systolic dysfunction is infrequently seen in childhood chronic KF, systolic strain identified by speckle tracking echocardiography has been frequently identified in dialysis and it can also persist post-transplant. Echocardiogram association with long-term outcomes has not been studied in childhood KF but there are many adult studies demonstrating associations between increased LVM, systolic dysfunction, strain, diastolic dysfunction, and cardiovascular events and mortality. There has been limited study of interventions to improve echocardiogram status. In childhood, improved blood pressure has been associated with better LVM, and conversion from hemodialysis to hemodiafiltration has been associated with better diastolic and systolic function. Whether long-term cardiac outcomes are also improved with these interventions is unclear. Echocardiography is a well-established technique, and regular use in childhood chronic KF seems justified. A case can be made to extend screening to include speckle tracking echocardiography and intradialytic studies in high-risk populations. Further longitudinal studies including these newer echocardiogram modalities, interventions, and long-term outcomes would help clarify recommendations for optimal use as a screening tool., Author(s): Amelia K. Le Page [sup.1] [sup.2] , Naganandini Nagasundaram [sup.1] , Ari E. Horton [sup.2] [sup.3] [sup.4] , Lilian M. Johnstone [sup.1] [sup.2] Author Affiliations: (1) grid.460788.5, Department of [...]

Background: Exposure to environmental metals has been consistently associated with attention and behavioral deficits in children, and these associations may be modified by coexposure to other metals or iron (Fe) status. However, few studies have investigated Fe status as a modifier of a metal mixture, particularly with respect to attention-related behaviors. Methods: We used cross-sectional data from the Public Health Impact of Metals Exposure study, which included 707 adolescents (10-14 years of age) from Brescia, Italy. Manganese, chromium, and copper were quantified in hair samples, and lead was quantified in whole blood, using inductively coupled plasma mass spectrometry. Concentrations of Fe status markers (ferritin, hemoglobin, transferrin) were measured using immunoassays or luminescence assays. Attention-related behaviors were assessed using the Conners Rating Scales Self-Report Scale- Long Form, Parent Rating Scales Revised-Short Form, and Teacher Rating Scales Revised-Short Form. We employed Bayesian kernel machine regression to examine associations of the metal mixture with these outcomes and evaluate Fe status as a modifier. Results: Higher concentrations of the metals and ferritin were jointly associated with worse self-reported attention-related behaviors: metals and ferritin set to their 90th percentiles were associated with 3.0% [[beta] = 0.03; 95% credible interval (CrI): -0.01, 0.06], 4.1% ([beta] = 0.04; 95% CrI: 0.00, 0.08), and 4.1% ([beta] = 0.04; 95% CrI: 0.00, 0.08) higher T-scores for self-reported attention deficit/hyperactivity disorder (ADHD) index, inattention, and hyperactivity, respectively, compared with when metals and ferritin were set to their 50th percentiles. These associations were driven by hair manganese, which exhibited nonlinear associations with all self-reported scales. There was no evidence that Fe status modified the neurotoxicity of the metal mixture. The metal mixture was not materially associated with any parent- reported or teacher-reported scale. Conclusions: The overall metal mixture, driven by manganese, was adversely associated with self-reported attention-related behavior. These findings suggest that exposure to multiple environmental metals impacts adolescent neurodevelopment, which has significant public health implications. https://doi.org/10.1289/EHP12988, Introduction Children living in proximity to steel-producing ferroalloy industry are commonly exposed to exogenous metals through inhalation or ingestion, including lead (Pb), manganese (Mn), chromium (Cr), and copper (Cu), through [...]

After a chemical fire, an investigation assessed health effects by using syndromic surveillance to monitor emergency department (ED) visits, a general health survey to assess the general public, and a first responders health survey to assess first responders. A total of four separate multivariable logistic regression models were developed to examine associations between reported exposure to smoke, dust, debris, or odor with any reported symptom in the general public. Syndromic surveillance identified areas with increased ED visits. Among general health survey respondents, 45.1% (911 out of 2,020) reported at least one symptom. Respondents reporting exposure to smoke, dust, debris, or odor had 4.5 (95% confidence interval (CI) [3.7, 5.5]), 4.6 (95% CI [3.6, 5.8]), 2.0 (95% CI [1.7, 2.5]), or 5.8 (95% CI [4.7, 7.3]) times the odds of reporting any symptom compared with respondents not reporting exposure to smoke, dust, debris, or odor, respectively. First responders commonly reported contact with material and being within 1 mi of the fire [greater than or equal to] 5 hr; 10 out of 31 of first responders reported at least one symptom. There was high symptom burden reported after the fire. Results from our investigation might assist the directing of public health resources to effectively address immediate community needs and prepare for future incidents., Introduction On the morning of June 14, 2021, a fire ignited and spread rapidly through an industrial chemical facility owned by the largest industrial grease manufacturer in the U.S. and [...]