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The impact of HIV on influenza-like illness (ILI) has been incompletely described in the era of combination antiretroviral therapy, particularly in the post-H1N1 pandemic period. This analysis informs on ILI in an otherwise healthy, predominantly outpatient cohort of adults with HIV in the USA. From September 2010 to March 2015, this multisite observational cohort study enrolled otherwise healthy adults presenting to a participating US military medical center with ILI, a subset of whom were HIV positive. Demographics, clinical data, and self-reported symptom severity were ascertained, and enrollees completed a daily symptom diary for up to 10 days. 510 men were included in the analysis; 50 (9.8%) were HIV positive. Subjects with HIV were older and less likely to be on active duty. Rhinovirus and influenza A were the most commonly identified pathogens. Moderate-severe diarrhea (p<0.001) and fatigue (p=0.01) were more frequently reported by HIV-positive men. HIV positivity was associated with higher gastrointestinal scores, but not other measures of ILI symptom severity, after controlling for age, race, military status, and influenza season. Few were hospitalized. HIV-positive subjects had more influenza B (p=0.04) and were more likely to receive antivirals (32% vs 6%, p<0.01). Antiviral use was not significantly associated with symptom scores when accounting for potential confounders. In this predominantly outpatient cohort of adult men, HIV had minimal impact on ILI symptom severity. Despite similar illness severity, a higher percentage of subjects with HIV reported undergoing antiviral treatment for ILI, likely reflecting differences in prescribing practices. Trial registration number: NCT01021098.

The impact of HIV on influenza-like illness (ILI) has been incompletely described in the era of combination antiretroviral therapy, particularly in the post-H1N1 pandemic period. This analysis informs on ILI in an otherwise healthy, predominantly outpatient cohort of adults with HIV in the USA. From September 2010 to March 2015, this multisite observational cohort study enrolled otherwise healthy adults presenting to a participating US military medical center with ILI, a subset of whom were HIV positive. Demographics, clinical data, and self-reported symptom severity were ascertained, and enrollees completed a daily symptom diary for up to 10 days. 510 men were included in the analysis; 50 (9.8%) were HIV positive. Subjects with HIV were older and less likely to be on active duty. Rhinovirus and influenza A were the most commonly identified pathogens. Moderate–severe diarrhea (p<0.001) and fatigue (p=0.01) were more frequently reported by HIV-positive men. HIV positivity was associated with higher gastrointestinal scores, but not other measures of ILI symptom severity, after controlling for age, race, military status, and influenza season. Few were hospitalized. HIV-positive subjects had more influenza B (p=0.04) and were more likely to receive antivirals (32% vs 6%, p<0.01). Antiviral use was not significantly associated with symptom scores when accounting for potential confounders. In this predominantly outpatient cohort of adult men, HIV had minimal impact on ILI symptom severity. Despite similar illness severity, a higher percentage of subjects with HIV reported undergoing antiviral treatment for ILI, likely reflecting differences in prescribing practices.Trial registration number: NCT01021098.

Ischemic colitis (IC) is a well-described complication of ruptured abdominal aortic aneurysms (rAAAs). The purpose of this study was to compare the incidence of IC in patients with rAAA undergoing open repair (OR) versus endovascular aneurysm repair (EVAR) at a single institution. In addition, we analyzed the incidence of IC before and after the implementation of a formal rupture AAA protocol (rEVAR protocol).

A key step in spatial transcriptomics is identifying genes with spatially varying expression patterns. We adopt an information theoretic perspective to this problem by equating the degree of spatial coherence with the Jensen-Shannon divergence between pairs of nearby cells and pairs of distant cells. To avoid the notoriously difficult problem of estimating information theoretic divergences, we use modern approximation techniques to implement a computationally efficient algorithm designed to scale with in situspatial transcriptomics technologies. In addition to being highly scalable, we show that our method, which we call maximization of spatial information (Maxspin), improves accuracy across several spatial transcriptomics platforms and a variety of simulations when compared with a variety of state-of-the-art methods. To further demonstrate the method, we generated in situspatial transcriptomics data in a renal cell carcinoma sample using the CosMx Spatial Molecular Imager and used Maxspin to reveal novel spatial patterns of tumor cell gene expression.

Upper respiratory tract infection (URI) is a well-documented cause of morbidity, extra expense, and lost training time among basic military trainees (BMTs). The goal of this study was to characterize the clinical presentation of influenza in the BMT population and to better understand how this presentation differs from that of the general Department of Defense (DoD) beneficiary population (non-BMTs).

Acute appendicitis (AA) is one of the most common causes of a surgical abdomen worldwide, occurring most frequently in those age 10 to 29 years. Adenovirus (ADV) is a rare but reported cause of AA in children and a well-recognized cause of intussusception in infants and young children. Annually, about 36,000 basic military trainees (BMTs) undergo initial training at Joint Base San Antonio Lackland, Texas. Before reintroduction of the ADV 4/7 vaccine in November 2011, one-third of BMTs developed an adenoviral upper respiratory tract infection (URI) during the 8.5 weeks of training. We hypothesized that ADV may be a common cause of AA in the BMT population given their young age and high incidence of adenoviral URIs. The objective of this study was to determine the frequency with which ADV, cytomegalovirus (CMV), Epstein-Barr virus (EBV), and enterovirus were associated with AA in a population of young adults.

Glioblastoma is a heterogeneous tumor for which effective treatment options are limited and often insufficient. Few studies have examined the intratumoral transcriptional and proteomic heterogeneity of the glioblastoma microenvironment to characterize the spatial distribution of potential molecular and cellular therapeutic immunooncology targets. We applied an integrated multimodal approach comprised of NanoString GeoMx Digital Spatial Profiling, single-cell RNA-seq (scRNA-seq), and expert neuropathologic assessment to characterize archival formalin-fixed paraffin-embedded glioblastoma specimens. Clustering analysis and spatial cluster maps highlighted the intratumoral heterogeneity of each specimen. Mixed cell deconvolution analysis revealed that neoplastic and vascular cells were the prominent cell types throughout each specimen, with macrophages, oligodendrocyte precursors, neurons, astrocytes, and oligodendrocytes present in lower abundance and illustrated the regional distribution of the respective cellular enrichment scores. The spatial resolution of the actionable immunotherapeutic landscape showed that robust B7H3 gene and protein expression was broadly distributed throughout each specimen and identified STING and VISTA as potential targets. Lastly, we uncovered remarkable variability in VEGFAexpression and discovered unanticipated associations between VEGFA, endothelial cell markers, hypoxia, and the expression of immunoregulatory genes, indicative of regionally distinct immunosuppressive microdomains. This work provides an early demonstration of the ability of an integrated panel-based spatial biology approach to characterize and quantify the intrinsic molecular heterogeneity of the glioblastoma microenvironment.

To uncover underlying mechanisms associated with failure of indoleamine 2,3-dioxygenase 1 (IDO1) blockade in clinical trials, we conducted a pilot, window-of-opportunity clinical study in 17 patients with newly diagnosed advanced high-grade serous ovarian cancer before their standard tumor debulking surgery. Patients were treated with the IDO1 inhibitor epacadostat, and immunologic, transcriptomic, and metabolomic characterization of the tumor microenvironment was undertaken in baseline and posttreatment tumor biopsies. IDO1 inhibition resulted in efficient blockade of the kynurenine pathway of tryptophan degradation and was accompanied by a metabolic adaptation that shunted tryptophan catabolism toward the serotonin pathway. This resulted in elevated nicotinamide adenine dinucleotide (NAD+), which reduced T cell proliferation and function. Because NAD+metabolites could be ligands for purinergic receptors, we investigated the impact of blocking purinergic receptors in the presence or absence of NAD+on T cell proliferation and function in our mouse model. We demonstrated that A2a and A2b purinergic receptor antagonists, SCH58261 or PSB1115, respectively, rescued NAD+-mediated suppression of T cell proliferation and function. Combining IDO1 inhibition and A2a/A2b receptor blockade improved survival and boosted the antitumor immune signature in mice with IDO1 overexpressing ovarian cancer. These findings elucidate the downstream adaptive metabolic consequences of IDO1 blockade in ovarian cancers that may undermine antitumor T cell responses in the tumor microenvironment.

Introduction: To evaluate the mobility of the current gas-pressurized glove of the extravehicular mobility unit (G-glove) and the elastic counterpressure glove (E-glove), we investigated range of motion (ROM) and indices of fatigue during grip endurance with both gloves using a bare hand as a control. Methods: In nine healthy male right-handed subjects, ROM of the proximal interphalangeal joint of the left middle finger was measured. The median frequency of electromyography (EMG) of the left flexor carpi radialis during grip with 25% of maximum strength was measured with the bare hand, G-glove, and E-glove. Using Borg's scale, discomfort was assessed during each grip test. Results: ROM of the E-glove was similar to that of the bare hand (91 ± 3° and 97 ± 1° for the G-glove and bare hand, respectively) and significantly higher than that of the G-glove (74 ± 2°). The change in the median frequency of the EMG, which is correlated with Borg's scale, was significantly smaller using the G-glove at marker time points of 1/4 and 1/2 of the total endurance time (-3.5 ± 1.5 and -10.4 ± 1.2 Hz) compared to those for the G-glove (-10.1 ± 1.1 and -16.7 ± 1.9 Hz). Thus, the G-glove had faster onset of fatigue than the G-glove. Conclusion: These results suggest the G-glove has better mobility and is more suitable for fine motor tasks as compared to the G-glove. [ABSTRACT FROM AUTHOR]

The efficacy of an antibiotic support team (AST) has been demonstrated in both large teaching hospitals and smaller community hospitals. The usefulness of an AST in a medium-sized military hospital was investigated in the present study. Patients at least 18 years old hospitalized at the David Grant USAF Medical Center (DGMC) and receiving > or =1 of 17 specified antibiotics for > or =3 consecutive days were randomized to an educational intervention group or control group. Primary endpoints included antibiotic defined daily dose (DDD) per patient treatment course and days of antibiotic therapy (DOT) per patient. Fifty-two patients were analyzed from March to August 2006. DDD per patient treatment course was significantly lower in the intervention group, (6.7 +/- 7.6 vs. 12.9 +/- 16.3, p = 0.05). A trend toward fewer DOT per patient was seen in the intervention vs. control group. Implementation of an AST decreased the intensity of exposure to antibiotics.

AbstractThis paper deploys Denzin’s (1994) four “Writing Issues” as an interrogative lens for evaluating the appropriateness and utility of the design of a recent doctoral study of the educational aspirations and opportunities of Australian mobile show people (Danaher, 2001a). The deployment of that lens highlights a number of dilemmas and tensions that the researcher encountered in writing about a community traditionally subject to exoticisation and marginalisation in ways that were as ‘true’ as possible to the participants and that also fulfilled the taken-for-granted assumptions about doctoral research. The paper presents the argument that Denzin’s “Writing Issues” constitute one among several potentially useful frameworks for reflecting on the planning and conduct of an educational research project, as well as for navigating the specific challenges and opportunities involved in designing doctoral educational research.

AbstractLearner-centredness is a key element of the contemporary dominant discourse pertaining to pedagogies and learning. Yet enacting learner-centredness is far from easy in the increasingly massified higher education system. The authors contend that it is in the intersection between this philosophy and practice that meaning emerges and personal pedagogies can be researched.This paper deploys the authors’ experiences as higher educators covering a diversity of disciplines, encompassing pre-undergraduate, undergraduate and postgraduate domestic and international students and including face-to-face, distance and online delivery modes in two Australian universities. Learner-centredness is interrogated in relation to three key sites:exploring transformative learning with previously educationally marginalized pre-undergraduate students in face-to-face and external modesenhancing self-efficacy with face-to-face undergraduate teacher education students in relation to their mathematical competenceexperiencing social presence with online postgraduate students learning about educational research methods and ethics.The paper reports examples from each site where learner-centredness is successfully engaged and hence where the meaning emerging in practice is fulfilling and productive. At the same time, interpersonal and structural factors sometimes obstruct the attainment of such positive outcomes. These findings have important implications for the authors’ ongoing research into their personal pedagogies as well as for policy and practice in contemporary higher education more broadly.

Objective.To compare the ability of 2 types of dressings to contain vaccinia virus after smallpox vaccination.Design.Prospective, nonrandomized trial.Setting.The smallpox vaccination clinic in a medium-sized military hospital.Participants.Ninety-seven active-duty military members who received smallpox vaccination in accordance with US Department of Defense and Centers for Disease Control and Prevention guidelines.Methods.The first 40 participants enrolled were instructed to cover their vaccination sites with a semipermeable membrane placed over a separate gauze pad, and the subsequent 57 participants were given a semipermeable membrane bonded to an absorbent pad. Swab samples of the external surface of the dressing were collected 7 and 21 days after vaccination. Real-time quantitative polymerase chain reaction was used to detect vaccinia DNA in the samples.Results.The rate of vaccinia DNA detection was significantly higher for samples obtained from vaccinees who were using the separate gauze and semipermeable membrane, compared with the vacinees who were using the gauze-impregnated semipermeable membrane (22% vs 2.2%; P= .008; odds ratio, 12.3 [95% confidence interval, 1.4-567.4]).Conclusion.A gauze-impregnated semipermeable membrane more effectively reduced viral passage to the external surface of the dressing than did a semipermeable membrane placed over a separate gauze pad. Routine use of such dressings following smallpox vaccination might reduce the incidence of autoinoculation and secondary transmission.

AbstractGroups and organisations are not automatically sites of effective and transformative pedagogy and learning; such outcomes are most likely to occur when entities become communities of practice (Wenger, McDermott & Snyder, 2002). One conception of community focused explicitly on the facilitation of pedagogy and learning is cooperative community, centred on five principles (Johnson & Johnson, 1998). Another productive notion of community is as a symbolic construction, centred on members’ shared consciousness and boundary maintenance (Cohen, 1985).One community that demonstrates the pedagogical and learning potential of cooperative and symbolic communities of practice is the Australian show people (Danaher, 1998, 2001). Following generations of educational marginalisation, this community participated in a specialised program within the Brisbane School of Distance Education between 1989 and 1999, and since 2000 its members have benefited from having their own Queensland School for Travelling Show Children, established under Education Queensland’s auspices.This paper maps and portrays enactments of the cooperative and symbolic communities of practice in the school and on the show circuits. It identifies specific strategies that underpin the pedagogies and learning made possible in those communities of practice, and it considers possible implications of such pedagogies and learning for other educational contexts and groups.

AbstractThis paper focuses on the discourse among academics with a shared interest in the relationship between vocational education and training (VET) and higher education within the University of Southern Queensland’s Faculty of Education. The authors endeavour to make sense of how VET pedagogies and praxis are currently envisaged and enacted within the faculty, how they respond to present-day influences and developments in the VET sector and how they will in turn shape teaching, learning and research activity.In the paper, the authors put their personal and professional ideologies under the microscope in a dialectic that aims to inform the development of a shared set of meanings that will serve as a platform from which to move forward in their practice. This dialectic examines the nuances of practices from the perspectives of a reflective (Schön, 1983, 1987) and a reflexive (Usher, 1987) practitioner. Theoretical lenses drawn upon in this reflective and reflexive dialectic include critical theory (Habermas, 1972, 1973), criticality (Barnett, 1997) and the humanist tradition in education (Dewey, 1916, 1938).The results of this dialectic are then used to engage pedagogies that relate to further education and training (fet) within the faculty. To guide this situated engagement, several questions are asked. The conclusions drawn confirm that the convergence of these personal and professional ideologies is helpful in shaping the contributions of fetto the existing and emerging needs of the faculty’s lifelong learners.

Abstract

Danaher: NanoString Technologies: Current Employment, Current holder of individual stocks in a privately-held company.

This article considers the pedagogical benefits of a state-of-the-art language laboratory for learning Japanese. The article argues that, although many believe the language laboratory is anachronistic, it deserves its rightful place as one of the 'new' technologies which can enhance foreign language learning. The benefits, however, are subject to the teacher's ability to encourage within students feelings of confidence and control about using this technology.

AbstractSituated ethics (Piper & Simons 2005; Simons & Usher 2000) provides a potentially powerful conceptual lens for reflecting on the research significance and researcher subjectivities entailed in contemporary educational research projects. This is the idea that research ethics is most appropriately understood and enacted in the specific contexts of such projects, rather than by reference to timeless and universal codes. This proposition is helpful in drawing attention to the crucial networks of aspirations and interests that bind and separate stakeholders in those projects.The authors illustrate this argument through a reflexive interrogation of their respective empirical doctoral studies (Danaher 2003; Danaher 2001). One study focused on multiple and conflicting constructions of wildlife preservation as a site of Japanese environmental politics and policy-making; the other examined educational provision for mobile show communities as a case of Australian Traveller Education.Both projects required the researchers to negotiate tentative and sometimes uneasy relations with research participants that veered between impartial and disinterested observers and partial and interested advocates. In engaging in those negotiations, the researchers enacted situated and provisional ethical positions derived from increasingly explicit assumptions about both the significance of their particular research and the importance of acknowledging their own subjectivities in making claims about that significance. Thus situated ethics is a vital element of evaluating the value as much as the values of conducting research with non-government organisations and on showgrounds.

AbstractThis inaugural theme issue of the International Journal of Pedagogies and Learning has been divided into three parts. Parts 2 and 3 will be introduced separately in the next two issues of the journal. Here we provide a brief overview of the articles that compose Part 1. While the articles in Parts 2 and 3 relate to primary and secondary schooling as well as to higher education settings, the articles in Part 1 engage with some of the issues entailed in university programs preparing graduates for different kinds of careers: as early childhood, primary and vocational educators and as members of defence forces. The articles in Part 1 also reflect the journal's consciously international focus, by canvassing the perspectives on pedagogies and learning held by researchers working in Australia, Malaysia and Pakistan.

AbstractThis paper focuses on the discourse among academics with a shared interest in the relationship between vocational education and training (VET) and higher education within the University of Southern Queensland's Faculty of Education. The authors endeavour to make sense of how VET pedagogies and praxis are currently envisaged and enacted within the faculty, how they respond to present-day influences and developments in the VET sector and how they will in turn shape teaching, learning and research activity.In the paper, the authors put their personal and professional ideologies under the microscope in a dialectic that aims to inform the development of a shared set of meanings that will serve as a platform from which to move forward in their practice. This dialectic examines the nuances of practices from the perspectives of a reflective (Schön 1983; 1987) and a reflexive (Usher 1987) practitioner. Theoretical lenses drawn upon in this reflective and reflexive dialectic include critical theory (Habermas 1972; 1973), criticality (Barnett 1997) and the humanist tradition in education (Dewey 1916; 1938).The results of this dialectic are then used to engage pedagogies that relate to further education and training (fet) within the faculty. To guide this situated engagement, several questions are asked. The conclusions drawn confirm that the convergence of these personal and professional ideologies is helpful in shaping the contributions of fet to the existing and emerging needs of the faculty's lifelong learners.

Septic arthritis is a serious, life and limb threatening infection. If suspected, empiric treatment must begin immediately and account for the most likely pathogens. Eight days following left knee arthroscopic surgery, a 51-year-old active duty male spent approximately 1 hour driving a personal watercraft on Okaloosa Bay near the Gulf of Mexico. Eight days later, he presented to the emergency room with septic arthritis of that knee. Fluid aspirated from the joint yielded Aeromonas hydrophila. The infection resolved with surgical drainage and 21 days of levofloxacin. A. hydrophila is a rare cause of septic arthritis, and reported cases have involved exposure to water after trauma to the affected joint. Many U.S. military bases are located in coastal areas and military members frequently participate in activities which compromise skin integrity and place them at increased risk for contracting waterborne infections. We present the ninth case of A. hydrophila septic arthritis described in the English language literature, highlight the importance of considering this pathogen in at-risk populations, and review the diagnosis and management of septic arthritis.

We describe a patient who developed dilated cardiomyopathy and clinical congestive heart failure after 2 months of therapy with amphotericin B (AmB) for disseminated coccidioidomycosis. His echocardiographic abnormalities and heart failure resolved after posaconazole was substituted for AmB. It is important to recognize the rare and potentially reversible toxicity of AmB.

Therapeutic strategies in patients with acute myeloid leukemia (AML) have remained relatively unchanged over the last 30 years. AML is only cured in 35-40% of patients <60 years of age and in 5-15% of patients >60 years of age. Elderly patients who are unfit to receive intensive salvage regimens can only be offered low-intensity therapy or best supportive care. In children, AML accounts for 20% of leukemias. Although intensive multi-agent chemotherapy in conjunction with improved supportive care has increased survival rates to 60-70%, 30-40% of children with AML relapse and only one-third of them will survive to adulthood. The development and delivery of new therapeutic strategies for high-risk AML, including immunotherapy, therefore remains a priority.

Chen: NanoString Technologies, Inc.: Employment, Other: Stock option. Dennis:NanoString Technologies, Inc.: Employment, Other: Stock option. Danaher:NanoString Technologies, Inc.: Employment, Other: Stock option. Wallden:NanoString Technologies, Inc.: Employment. Hood:NanoString Technologies, Inc.: Employment, Other: Stock option. Ren:NanoString Technologies, Inc.: Employment, Other: Stock option. Liu:NanoString Technologies, Inc.: Employment, Other: Stock option. Dowidar:NanoString Technologies, Inc.: Employment, Other: Stock option. Sullivan:NanoString Technologies, Inc.: Employment, Other: Stock option. Haffner:NanoString Technologies, Inc.: Employment, Other: Stock option. Cesano:NanoString Technologies, Inc.: Employment, Other: Stock option. Ferree:NanoString Technologies, Inc.: Employment, Other: Stock option, Patents & Royalties: NanoString Technologies, Inc.. Storhoff:NanoString Technologies, Inc.: Employment, Other: Stock option.