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Rationale: Foreign-born persons traveling on a student visa are not currently screened for tuberculosis on entry into the United States, despite residing in the United States for up to several years., Objectives: To characterize the risk of tuberculosis in international students entering the United States and to identify strategies for early diagnosis and prevention in this population., Methods: Data were collected in 18 tuberculosis control jurisdictions in the United States. A cohort of 1,268 foreign-born patients of known visa status, diagnosed with active tuberculosis between 2004 and 2007, was used for analysis. Incidence rates were estimated on the basis of immigration data from study jurisdictions., Measurements and Main Results: Tuberculosis was diagnosed in 46 student residents, providing an annual estimate of 308 cases nationally. The estimated tuberculosis case rate in student residents was 48.1 cases per 100,000 person-years (95% confidence interval, 35.6-64.8), more than twice that of the general foreign-born population. Students identified by tuberculosis screening programs were more likely to be diagnosed within 6 months of U.S. arrival (75 vs. 6%; P < 0.001), and those with pulmonary disease were less likely to have a positive sputum smear for acid-fast bacilli compared with those not screened (18 vs. 63%; P = 0.05). In unscreened students, 71% were diagnosed more than 1 year after U.S. arrival and only 6% were previously treated for latent tuberculosis infection., Conclusions: The tuberculosis case rate in foreign-born students is significantly higher than in other foreign-born individuals. Screening this group after arrival to the United States is an effective strategy for earlier diagnosis of active tuberculosis.

Background: The pemphigus group is characterized by the presence of circulating immunoglobulins against desmosomes. IgG/IgA pemphigus is defined by the presence of IgG and IgA cell surface deposits upon direct immunofluorescence (DIF) and/or circulating IgG and IgA autoantibodies upon indirect immunofluorescence. Previous reports of patients with IgG/IgA pemphigus are sparse. Whether IgG/IgA pemphigus is best classified as a subtype of IgG (classic) pemphigus or IgA pemphigus, or as a distinct entity, has yet to be determined., Objectives: We compared the features of patients with IgG/IgA pemphigus to those of IgG pemphigus and IgA pemphigus., Methods: Retrospective clinicopathologic study of patients with IgG, IgG/IgA, and IgA pemphigus evaluated at our clinic (1993-2013)., Results: We included 26, 13, and seven patients with IgG, IgG/IgA, and IgA pemphigus, respectively. Patients with IgG/IgA pemphigus did not differ significantly from patients with IgG pemphigus in terms of clinical and microscopic features, DIF findings, anti-desmoglein antibody values, and treatments required. However, patients with IgG/IgA pemphigus were significantly different from patients with IgA pemphigus regarding intertriginous distribution (P = 0.038) and pustular lesions (P < 0.001), acantholysis (P = 0.043), and presence of intercellular C3 deposits on DIF (P < 0.001)., Conclusion: Comparative clinicopathologic data imply that IgG/IgA pemphigus may best be regarded as a variant of IgG pemphigus and distinct from IgA pemphigus., (© 2015 The International Society of Dermatology.)

Treatment of hepatitis C virus with potent, interferon-free, direct-acting antiviral regimens with no activity against hepatitis B virus (HBV) may increase the risk for HBV reactivation in coinfected patients. We present 2 cases of HBV reactivation during treatment with an all-oral regimen of simeprevir and sofosbuvir and discuss strategies to prevent HBV flare., (© The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Terra firma-forme dermatosis is a benign dermatologic condition that presents as dirt-colored patches and plaques, mainly affecting children and adolescents. It is resistant to conventional washing with soap and water but is easily treated with isopropyl alcohol. Clinical awareness of this condition provides a quick, simple resolution. Here we present two cases involving 14-year-old girls with uncommon presentations of terra firma-forme dermatosis. One case involved an upper extremity and the other presented with a history of knee brace occlusion. After diagnosis, both patients were successfully treated with weekly isopropyl alcohol applications., (© 2015 Wiley Periodicals, Inc.)

Introduction: Despite recommendations by the Centers for Disease Control (CDC) that all adults be offered non-targeted HIV screening in all care settings, screening in acute-care settings remains unacceptably low. We performed an observational study to evaluate an HIV screening pilot in an academic-community partnership health center urgent care clinic., Methods: We collected visit data via encounter forms and demographic and laboratory data from electronic medical records. A post-pilot survey of perceptions of HIV screening was administered to providers and nurses. Multivariable analysis was used to identify factors associated with completion of testing., Results: Visit provider and triage nurse were highly associated with both acceptance of screening and completion of testing, as were younger age, male gender, and race/ethnicity. 23.5% of patients completed tests, although 36.0% requested screening; time constraints as well as risk perceptions by both the provider and patient were cited as limiting completion of screening. Post-pilot surveys showed mixed support for ongoing HIV screening in this setting by providers and little support by nurses., Conclusions: Visit provider and triage nurse were strongly associated with acceptance of testing, which may reflect variable opinions of HIV screening in this setting by clinical staff. Among patients accepting screening, visit provider remained strongly associated with completion of testing. Despite longstanding recommendations for non-targeted HIV screening, further changes to improve the testing and results process, as well as provider education and buy-in, are needed to improve screening rates.

[(18)F]fallypride was synthesized in a batch microfluidic chip with a radiochemical yield of 65 ± 6% (n = 7) and an average specific activity of 730 GBq μmol(-1) (20 Ci μmol(-1)) (n = 4). Specific activity was ~2-fold higher than [(18)F]fallypride synthesized in a macroscale radiosynthesizer, despite starting with significantly less radioactivity, and thus safer conditions, in the microchip.

Background: Automated radiosynthesizers are vital for routine production of positron-emission tomography tracers to minimize radiation exposure to operators and to ensure reproducible synthesis yields. The recent trend in the synthesizer industry towards the use of disposable kits aims to simplify setup and operation for the user, but often introduces several limitations related to temperature and chemical compatibility, thus requiring reoptimization of protocols developed on non-cassette-based systems. Radiochemists would benefit from a single hybrid system that provides tremendous flexibility for development and optimization of reaction conditions while also providing a pathway to simple, cassette-based production of diverse tracers., Methods: We have designed, built, and tested an automated three-reactor radiosynthesizer (ELIXYS) to provide a flexible radiosynthesis platform suitable for both tracer development and routine production. The synthesizer is capable of performing high-pressure and high-temperature reactions by eliminating permanent tubing and valve connections to the reaction vessel. Each of the three movable reactors can seal against different locations on disposable cassettes to carry out different functions such as sealed reactions, evaporations, and reagent addition. A reagent and gas handling robot moves sealed reagent vials from storage locations in the cassette to addition positions and also dynamically provides vacuum and inert gas to ports on the cassette. The software integrates these automated features into chemistry unit operations (e.g., React, Evaporate, Add) to intuitively create synthesis protocols. 2-Deoxy-2-[18F]fluoro-5-methyl-β-l-arabinofuranosyluracil (l-[18F]FMAU) and 2-deoxy-2-[18F]fluoro-β-d-arabinofuranosylcytosine (d-[18F]FAC) were synthesized to validate the system., Results: l-[18F]FMAU and d-[18F]FAC were successfully synthesized in 165 and 170 min, respectively, with decay-corrected radiochemical yields of 46% ± 1% (n = 6) and 31% ± 5% (n = 6), respectively. The yield, repeatability, and synthesis time are comparable to, or better than, other reports. d-[18F]FAC produced by ELIXYS and another manually operated apparatus exhibited similar biodistribution in wild-type mice., Conclusion: The ELIXYS automated radiosynthesizer is capable of performing radiosyntheses requiring demanding conditions: up to three reaction vessels, high temperatures, high pressures, and sensitive reagents. Such flexibility facilitates tracer development and the ability to synthesize multiple tracers on the same system without customization or replumbing. The disposable cassette approach simplifies the transition from development to production.

With current trends in legislation around the delivery of patient care, the role of a community health worker (CHW) is gaining growing and much deserved attention. However, a system needs to be built for any CHW program to be successful and sustainable. This article describes a unique approach to community health work at the Massachusetts General Hospital Chelsea HealthCare Center where a well-integrated CHW model provides support for everyone involved in patient care: patients, providers, the community at large, and the internal CHW staff.

N-[(11)C]-methyl-hydroxyfasudil was synthesized as a new potential radiotracer for rho-kinases (ROCKs) via a two-step one-pot radiosynthesis. The first step was the methylation of the precursor N-Boc-hydroxyfasudil-sodium salt/benzo-15-crown-5 complex with [(11)C]methyl iodide. The second step involved deprotection of the tert-butoxycarbonyl protecting group. The radiochemical and chemical purities of N-[(11)C]-methyl-hydroxyfasudil were >95% and specific radioactivity was 1565-2565mCi/mumol at the end of the synthesis., (Copyright (c) 2009 Elsevier Ltd. All rights reserved.)

The aim of the study was to compare the coordination of hand grip (G) and load force (a force that tends to cause slippage of a grasped object; L) in static bimanual manipulation tasks with the same data obtained from the similar dynamic tasks. Based on the previous findings obtained from dynamic tasks, it was hypothesized that an increase in the rate of L change would be predominantly associated with a decrease in the coordination of the within limb forces (coordination of G and L of each hand as assessed through the correlation coefficients), while a decrease in coordination of interlimb forces (between two G and two L) will be less pronounced. Regarding the pattern of modulation of G, the same increase in L frequency was also expected to be associated with a decrease in G gain and an increase in G offset (as assessed by slope and intercept of the regression lines obtained from G to L diagrams, respectively), as well as with an increase in average G/L ratio. Subjects exerted oscillatory isometric L profiles by simultaneous pulling out two handles of an externally fixed device under an exceptionally wide range of L frequencies (0.67-3.33 Hz). The results demonstrated relatively high correlation coefficients between both the interlimb and within limb forces that were only moderately affected under sub-maximal L frequencies. Furthermore, the hypothesized changes in G gain and offset appeared only under the highest L frequency, while the G/L ratio remained unaffected. We conclude that, when compared with the dynamic tasks based on the unconstrained movements of hand-held objects that produce similar pattern of L change, the static manipulation tasks demonstrate a consistent and highly coordinated pattern of bilateral G and L under a wide range of frequencies. However, the neural mechanisms that play a role in the revealed differences need further elucidation.