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Objective: Researchers and public health professionals have increased their attention to GPS-based social and sexual networking applications (apps) tailored to gay, bisexual, and other men who have sex with men (MSM) and transgender women. These populations continue to be disproportionately affected by HIV in the United States, therefore these apps, in particular Grindr, have become an important sampling venue for the recruitment of HIV-related research participants. As such, it is essential to identify differences among app users to avoid potential sampling bias. This paper seeks to identify differences in MSM and transgender women who use Grindr and those who use other similar apps. Methods: A community-based participatory research (CBPR) approach was used to recruit participants online who then completed a 25-item anonymous survey. Five domains were assessed: sociodemographics, HIV testing, sexual risk, substance abuse, and use of GPS-based social and sexual networking apps. Results: 457 participants completed surveys. There were significant differences in the sociodemographic characteristics by app use, including age, race/ethnicity, sexual orientation, and outness. After adjusting for the sociodemographic characteristics associated with app use, there were significant differences in HIV risk and substance use between the groups. Conclusion: This paper is the first to report on findings that compare MSM and transgender women who report using Grindr to MSM and transgender women who report using other similar apps. GPS-based social and sexual networking apps may offer a valuable recruitment tool for future HIV research seeking to recruit populations at increased risk for HIV or those living with HIV for therapeutic trials. Because of the differences identified across users of different apps, these findings suggest that if researchers recruited participants from just one app, they could end up with a sample quite different than if they had recruited MSM and transgender women from other apps.

The aim of this study was to obtain the diagnostic, therapeutic and prophylactic approach among Swiss veterinary practitioners in cows with parturient hypocalcemia. All members of the Association for Ruminant Health were contacted per e-mail. The survey was completed by 108 (28%) of 393 that were contacted. According to the questionnaire responses, the typical presentation of a parturient paresis cow is a pluriparous middle-yielding dairy cow one day post-partum in sternal recumbency with normal consciousness. The diagnosis is usually based upon the medical history. Therapy of parturient paresis consists of mixed infusions (with calcium, phosphorus, magnesium or glucose) as well as oral preparations with calcium. The veterinarians estimate that 25-50% of the cows treated for parturient paresis need more than one treatment and that one case of parturient paresis costs CHF 200-300. Prophylactic treatments are usually used for cows, which have suffered from parturient paresis in the previous lactation, elder cows (≥ 3 lactations) as well as cows with a high body condition score (3.25). Prophylactic measures used by the veterinarians are vitamin D3 injections and oral preparations with calcium. They recommended a special diet, for example a low calcium diet ante-partum.Ziel der Online-Umfrage war, die diagnostische, therapeutische und prophylaktische Vorgehensweise bei Milchkühen mit hypokalzämischer Gebärparese in der Praxis zu erfassen. Alle Mitglieder der Vereinigung für Wiederkäuergesundheit wurden per E-Mail kontaktiert. Von den 393 versandten Fragebögen wurden 108 (28%) vollständig ausgefüllt und ausgewertet. Im Vorbericht der an Gebärparese erkrankten Tiere wurden festliegende, pluripare Milchkühe mit mittlerer Milchleistung, ein Tag post partum, mit normalem Bewusstseinszustand genannt. Die Diagnose wird häufig an Hand der Vorgeschichte gestellt. Die betroffenen Milchkühe werden mit Mischinfusionen (Kalzium- und Phosphorpräparate, teilweise mit Magnesium sowie Glukose) und oralen Kalziumpräparaten behandelt. Die Tierärzte schätzten, dass 25–50% der erkrankten Kühe nachbehandelt werden müssen und sich die Gesamtkosten pro Kuh auf CHF 200–300 belaufen. Prophylaktisch werden vor allem Tiere behandelt, welche in der vorherigen Laktation schon eine Gebärparese hatten, sowie ältere Kühe (≥ 3. Laktation) und solche mit hoher Körperkonditionsbeurteilung (3.25). Für die Prophylaxe verwendeten Tierärzte Vitamin D3 Injektionen sowie orale Kalziumpräparate und/oder rieten den Landwirten zu kalziumarmer Fütterung ante partum.Le but de la présente enquête en ligne était de relever les méthodes de diagnostic, de traitement et de prophylaxie utilisées en pratique en matière de parésie puerpérale hypocalcémique. Tous les membres de l’Association suisse pour la santé des ruminants ont été contactés par courriel. Sur les 393 questionnaires envoyés, 108 (28%) ont été remplis complètement et exploités. L’anamnèse typique est un animal pluripare avec une production de parésie puerpérale, il est mentionné des animaux pluripares avec une production laitière moyenne, incapables de se lever un jour après le vêlage et présentant un état de conscience normal. Le diagnostic est fréquemment posé sur la base de l’anamnèse. Les vaches laitières concernées sont traitées avec des perfusions mixtes (produits à base de calcium et de phosphore, parfois avec du magnésium et du glucose) et des préparations de calcium orales. Les vétérinaires estiment que 25 à 50% des vaches nécessitent plusieurs traitements et que les coûts totaux par animal de l’ordre de CHF 200 à 300. Du point de vue prophylactique, ce sont principalement les animaux ayant déjà souffert d’une parésie lors de la lactation précédente ainsi que les vaches plus âgées (3ème lactation et plus) et celles présentant un indice de condition élevé (3.25) qui sont traitées. Les vétérinaires utilisent pour cette prophylaxie des injections de vitamine D3 ainsi que des préparations orales de calcium et/ou conseillent aux propriétaires une alimentation pauvre en calcium ante partum.Scopo del sondaggio online era di rilevare nei bovini affetti da paresi puerperale con ipocalcemia la procedura diagnostica, terapeutica e profilattica utilizzata negli studi veterinari. Tutti i membri dell’Associazione per la salute dei ruminanti sono stati contattati via e-mail. Dei 393 questionari inviati 108 (28%) sono stati completati e valutati. Gli stati degli animali affetti da paresi puerperale più nominati sono: bovini sdraiati, mucche da latte pluripare con media lattazione, un giorno dopo il parto, con normale stato di coscienza. La diagnosi è spesso stata posata in base al passato dell’animale. Le mucche da latte affette sono state trattate con infusioni costituite da integratori di calcio e fosforo e alcune con magnesio e glucosio e da integratori di calcio per via orale. I veterinari hanno stimato che il 25–50% delle bovine malate hanno dovuto essere trattate di nuovo per un costo totale per animale di CHF 200–300. In modo profilattico sono stati trattati soprattutto gli animali che già nella precedente lattazione avevano presentato una paresi puerperale, le mucche più anziane (≥ 3 lattazioni) e quelle con un alto valore di BCS (3.25). Per la profilassi, i veterinari hanno utilizzato iniezioni di vitamina D3 e integratori di calcio per via orale e/o hanno consigliato agli allevatori di alimentarle con mangime povero in calcio prima del parto.

1. Chemical characterisation of an extract of Solanum glaucophyllum (SG) leaves affirmed the predominant presence of 1,25-dihydroxycholecalciferol (1,25(OH)2D3) glycosides. The compound 1-(s-D-glucopyranosyl)-1α,25-dihydroxycholecalciferol was isolated for the first time from a natural source. 2. Vitamin D activity of the extract was confirmed by the calcaemic properties shown in a quail eggshell bioassay. The results suggested a 1,25(OH)2D3 bioavailability of approximately 15%. 3. A broiler feeding experiment replicated in time was carried out with 6 treatments. A basic control diet containing 25 μg cholecalciferol/kg was supplemented with 2.5 and 5 μg free 1,25(OH)2D3/kg, with a product based on dried SG leaves (Panbonis) providing 10 μg of 1,25(OH)2D3-glycosides/kg, with two concentrations of an SG extract providing 8.8 and 37.8 μg of 1,25(OH)2D3-glycosides/kg. 4. Tibia breaking strength and stiffness were numerically greater in all treatment groups with free 1,25(OH)2D3 and with SG products compared to controls, though the overall treatment effects only had probabilities in the range of P = 0.07 to P = 0.1. Values for both characteristics increased progressively, with additions of synthetic 1,25(OH)2D3; values with the dried SG product were similar to those with 5 μg synthetic 1,25(OH)2D3/kg. 5. Plasma calcium was mildly elevated (P < 0.05) in treatment groups. The SG extract treatment containing 37.8 μg 1,25(OH)2D3/kg gave the highest plasma calcium concentration and lowest bodyweight, signs of marginal hypervitaminosis D. Plasma 1,25(OH)2D3 concentrations were in the normal range for all treatments. 6. Tibial dyschondroplasia occurred in only one replicate. The incidences were 31% in controls but considerably lower or zero with all other treatments. 7. Bioavailability of 1,25(OH)2D3 in the SG product seemed to be higher in broiler chickens than in Japanese quails. 8. It is concluded that the inclusion of the dried SG product as a source of vitamin D3 in broiler diets at a dietary concentration of 1 g/kg, providing 10 μg 1,25(OH)2D3/kg, is safe and efficacious.

Field and petrographic studies of recent supratidal sabkhas and ponds, and a solar salt works, in Saudi Arabia and Egypt have documented the formation of distinctive surface sedimentary structures that have resulted from microbial activity and abiological physical processes. Microbially induced sedimentary structures (MISS) dominate the permanent and ephemeral parts of supratidal ponds of Al Zeeb sabkha, Saudi Arabia and halite crystallization ponds in salt works, west of Alexandria, Egypt. They are varied and include gas bubbles, blisters, wrinkles, pinnacles, cones, and polygonal folds (petees) induced by epibenthic microbial mats. Physically induced sedimentary structures dominate the emergent areas surrounding the ponds, as well as the supratidal sabkhas in Al Zeeb and Ras Shukeir areas. They include polygonal cracks and different types of tepees. The sediments of the microbial-induced structures are composed of green and brown microbial filaments that entrap and bind lenticular and clastic gypsum, or form nucleation sites for halite and/or grass-like gypsum crystals. The sediments of the physically induced structures are composed of halite-cemented siliciclastic sand and mud, or bottom-nucleated chevron and cornet halite crystals. The results of this study indicate that microbial and physical structures co-exist due to local factors, especially topography, brine recharge, salinity, microbial activity, and history of the supratidal sabkha and pond. The importance of the local interplay of these conditions indicates that it will be difficult to interpret sedimentary successions in fossil sabkhas and their general depositional environment if only limited sections are available for study.

Innovative strategies are needed to assist providers with delivering secondary HIV prevention in the primary care setting. This longitudinal HIV clinic-based study conducted from 2004-2007 in a Birmingham, Alabama HIV primary care clinic tested a computer-assisted, provider-delivered intervention designed to increase condom use with oral, anal and vaginal sex, decrease numbers of sexual partners and increase HIV disclosure among HIV-positive men-who-have-sex-with-men (MSM). Significant declines were found for the number of unprotected insertive anal intercourse acts with HIV+ male partners during the intervention period (p = 0.0003) and with HIV-/UK male partners (p = 0.0007), as well as a 47% reduction in the number of male sexual partners within the preceding 6 months compared with baseline (p = 0.0008). These findings confirm and extend prior reports by demonstrating the effectiveness of computer-assisted, provider-delivered messaging to accomplish risk reduction in patients in the HIV primary care setting.

Sexual health is an important facet of comprehensive HIV care delivery. Additionally, patients with sexually transmitted infections (STIs) are commonly encountered in the HIV primary care setting. To better understand the level of patient risk for STI acquisition and HIV transmission, tailor counseling, and implement optimal screening strategies, an understanding of the components of a thorough sexual history is imperative. Given the limited number of point-of-care diagnostic tests for STIs, knowledge of key STI syndromes and the associated etiologies facilitates effective management of symptomatic patients presenting to the HIV primary care setting.

The safety of supplementing broiler feed with a standardised herbal extract, Solanum Glaucophyllum Standardised Leaves (SGSL) containing glycosylated 1a,25-dihydroxyvitamin D3 (1,25(OH)2D3) and standardised to contain 10 µg/g 1,25(OH)2D3 equivalent, was examined in two studies. In a first study, we examined the potential of SGSL to substitute vitamin D3 (VD3) and the tolerated dose range of SGSL when applied without concomitant VD3 by analyzing performance and blood chemical parameters after 14, 25 and 38 days on diets containing two doses of SGSL (1 and 10 g/kg feed) as source of 1,25(OH)2D3. In the second study, the no adverse effect level of SGSL was determined by analyzing the same parameters after 35 days on diets containing basic VD3 supply and in addition 0.2, 1.0, 2.0 and 4.0 g of SGSL/kg feed. We showed that SGSL was able to substitute VD3 in broilers as far as the performance parameters were concerned. Also, we found that the no adverse effect level is at least 4 g SGSL/kg feed when used with moderate doses of VD3. This is 20 times higher than the upper limit of the commercially recommended dose. We concluded that SGSL is a safe feed additive to use in broiler chicken.Die Sicherheit des standardisierten Pflanzenextrakts, Solanum Glaucophyllum Standardised Leaves (SGSL) als Futterzusatz bei Masthühnern wurde anhand von zwei Studien überprüft. SGSL enthält standardisiert 10 µg/g 1,25(OH)2D3 in glykosylierter Form. In der ersten Studie wurde das Potential, als Vitamin D3 (VD3)-Ersatz zu wirken und der tolerierte Dosisbereich von SGSL untersucht, indem SGSL ohne Zugabe von VD3 gegeben wurde. Hierzu wurden Leistung und laborchemische Blutparameter nach 14, 25 und 38 Tagen Fütterung mit zwei unterschiedlichen Dosierungen SGSL (1 und 10 g/kg Futter) als 1,25(OH)2D3-Quelle untersucht. In der zweiten Studie wurde der No Adverse Effect Level anhand der gleichen Parameter nach 35 Tagen bei einer Fütterung, welche nebst einer moderaten Menge an VD3 0.2, 1.0, 2.0 und 4.0 g SGSL/kg enthielt. Es konnte gezeigt werden, dass SGSL Vitamin D3 bei Masthühnern ersetzen kann, was die untersuchten Leistungsparameter betrifft. Der No Adverse Effect Level lag bei mindestens 4 g SGSL/kg Futter wenn SGSL begleitend zu moderaten VD3-Mengen gegeben wurde. Diese Dosis ist zwanzigmal höher als die kommerziell empfohlene Höchstdosis. Wir schliessen daraus, dass SGSL ein sicheres Futterzusatzmittel bei Masthühnern ist.Dans la cadre de deux études, on a examiné la sécurité de l’extrait de plante standardisé Solanum Glaucophyllum Standardised Leaves (SGSL) comme complément alimentaire chez les poulets d’engraissement. Le SGSL contient de façon standardisée 10 µg/g de 1,25(OH)2D3 sous forme glycolysée. Dans la première étude, on a examiné le potentiel d’action en tant que remplaçant de la vitamine D3 (VD3) et le domaine de dose de SGSL toléré, ceci en ne donnant que du SGSL sans addition de VD3 . On a examiné la performance et les paramètres de chimie sanguine après 14, 25 et 38 jours d’affouragement de deux doses différentes (1 et 10 g/kg d’aliment) de SGSL comme source de 1,25(OH)2D3. Dans la seconde étude, on a recherché le No Adverse Effect Level sur la base des mêmes paramètres après 35 jours avec une alimentation contenant, outre une quantité modérée de VD3, 0.2, 1.0, 2.0 et 4.0 g de SGSL/kg. On a pu démontrer que le SGSL peut remplacer la vitamine D3 chez les poulets d’engraissement en ce qui concerne les performances étudiées. Le No Adverse Effect Level se situait aux environs d’au moins 4g de SGSL/kg d’aliment lorsqu’il était associé avec des quantités modérées de Vitamine D3. Cette dose est vingt fois supérieure à la dose maximale recommandée par le fabriquant. Nous en déduisons que le SGSL est un complément alimentaire sûr pour les poulets d‘engraissement.Si è voluto dimostrare, sulla base di due studi, la sicurezza dell’estratto vegetale standardizzato delle foglie di Solanum glaucophyllum (Solanum Glaucophyllum Standardised Leaves SGSL) come additivo per mangimi per polli da carne. SGSL contiene 10 µg/g di 1,25 (OH)2D3 sotto forma glicosilata standardizzata. Nel primo studio, è stato esaminato il potenziale della sua azione come sostituto della vitamina D3 (VD3) e l’intervallo della dose tollerata di SGSL, nel quale SGSL è stato incorporato senza aggiungere VD3. A questo scopo le prestazioni e i parametri biochimici del sangue sono stati esaminati dopo 14, 25 e 38 giorni di alimentazione con due dosaggi diversi di SGSL (1 e 10 g/kg di mangime) come 1,25 (OH)2D3. Nel secondo studio è stata esaminata la dose priva di effetto avverso (NOAEL), sulla base dei medesimi parametri, dopo 35 giorni con un’alimentazione che assieme ad una moderata quantità di VD3 0.2, 1.0, 2.0 contiene 4.0g SGSL/kg. È stato dimostrato che la vitamina D3 di SGSL può essere sostituita nei polli da carne, per quanto riguarda i parametri di performance studiati. La dose priva di affetto avverso si situava al minimo a 4g SGSL/kg di mangime quando SGSL veniva somministrato in concomitanza con moderate quantità di VD3. Questa dose è di venti volte superiore alla dose massima raccomandata in commercio. Concludiamo che SGSL è un additivo alimentare sicuro per i polli da carne.

To provide a miniature review of recent literature surrounding a brief history of syphilis, to discuss the recently increasing incidence of syphilis, to discuss recent United State Preventative Service Task Force recommendations for syphilis screening, and to discuss congenital syphilis. The literature review was conducting using PubMed with the following search terms: syphilis, congenital syphilis, MSM and syphilis, prenatal syphilis, neurosyphilis, and other related terms. Treponema pallidum has been a constant, and unwanted, companion of humankind since antiquity. This sexually transmitted infection (STI) has the potential to affect virtually every rung of society—young and old, rich and poor, but it has a proclivity for the most vulnerable groups among us. Since record high rates of infection in the World War II era, tremendous progress has been made in effectively controlling the infection, and this has been largely mediated by the efficacy of penicillin on the causative spirochete. However, 2014 data from the Centers for Disease Control and Prevention demonstrated a sharp increase in the rate of new cases of syphilis, predominantly in men who have sex with men. Additionally, the numbers of newly diagnosed cases of congenital syphilis are on the rise as well. In effect, a burgeoning crisis has come to the doorstep of the medical community. We are faced with changing attitudes regarding sexual interactions. The authors believe that geolocation dating and sex applications for smart phones increase the availability of sexual encounters. Pre-exposure prophylaxis may be leading to more laissez-faire attitudes toward unprotected intercourse, and with increased opportunities for sexual encounters, co-infected states with other diseases may be altering the landscape of STIs. In 2016, in response to increasing rates of newly diagnosed syphilis, the United States Preventative Health Services Task Force reaffirmed the need for syphilis screening in at-risk populations. However, primary care physicians and advanced practice providers may not always be aware of which patients fall into that category. Due to the highly personal nature of discussing sexuality, sexual behavior may not be explored at all. Numerous challenges lie ahead of the infectious diseases, primary care, and public health communities in attempting to bend the curve of the ascendant rise in syphilis. To adequately combat this infection, sufficient funding will need to be provided to public health departments, adequate access to health care resources will be needed to allow for the necessary screening of patients, and primary care practitioners will need thoroughly engage with their patients to understand their sexual practices and to offer the necessary interventions.

Um die Arzneimitteltherapiesicherheit (AMTS) im Alter zu erhohen sind mittels Expertenkonsens Listen mit potenziell inadaquater Medikation (PIM) entwickelt worden. In Deutschland entstand 2010 die PRISCUS-Liste, in der 83 Medikamente als PIM kategorisiert wurden. Daneben wurden 46 Medikamente mit nicht eindeutiger Bewertung als fragliche PRISCUS-Medikamente eingestuft. Im Gegensatz zur sehr popularen PRISCUS-Liste werden die fraglichen PRISCUS nicht diskutiert. Ziel ist es die Pravalenz von PRISCUS- und fraglichen PRISCUS-Medikamenten zu schatzen. Unter Berucksichtigung der Ergebnisse einer ausfuhrlichen Literaturrecherche soll der Stellenwert der fraglichen PRISCUS im Vergleich zu den PRISCUS aufgezeigt werden. Daten von n=4504 Probanden (45-75 Jahre, Manner 49,8%) aus der Erst- und Zweiterhebung der populationsbezogenen Heinz Nixdorf Recall Studie (Ruhrgebiet, 2000-2008) wurden eingeschlossen. Zur Studie gehorte die Erfassung der in den letzten 7 Tagen vor der Untersuchung eingenommenen Medikation. Diese umfasste Verordnungen aus der ambulanten arztlichen Versorgung und die Selbstmedikation, nebst Nahrungserganzungsmitteln und Phytotherapeutika. Die Pravalenz von PRISCUS-Medikamenten bei ≥65-Jahrigen (n=1066) liegt bei 18% (Manner 16%, Frauen 20%). Nach funf Jahren Follow-up zeigt sich uber alle Altersgruppen keine Anderung der Pravalenz. Der PRISCUS-Anteil an allen Medikamenteneinnahmen sinkt von 5,8% auf 4,3%. Kardiovaskulare (Nifedipin, Sotalol) und psychotrope PRISCUS (Benzodiazepine, Antidepressiva) sind am haufigsten (107 respektive 60 Einnahmen). Die Rangfolge andert sich nach funf Jahren (78 respektive 88 Einnahmen). Die Pravalenz von fraglichen PRISCUS liegt bei 23% und steigt auf 31 %. Haufige und steigende fragliche PRISCUS sind Diclofenac (60 Einnahmen Ersterhebung +37 Einnahmen Follow-up), Acetylsalicylsaure (15 +17), Ginkgo Biloba (39 +37), Glibenclamid (24 +1), Moxonidin (19 +6), Theophyllin (16 +1) und Opipramol (5 +9 Einnahmen). Die Ergebnisse zeigen, dass fragliche PRISCUS durch eine haufigere Einnahme bezuglich unerwunschter Arzneimittelwirkungen bedeutsamer sein konnten, als PRISCUS-Medikamente selbst. Die Bedeutung wird durch die Entwicklung nach 5 Jahren mit einem klaren Anstieg der fraglichen PRISCUS und einer Stagnation der PRISCUS noch unterstutzt. Deshalb sollten fragliche PRISCUS in weitergehenden Analysen zur AMTS im Alter mit eingeschlossen werden. Es sollten weitere Studien erfolgen, die das Risiko und den Nutzen der in dieser Arbeit diskutierten fraglichen PRISCUS-Medikamente bei alteren Menschen untersuchen. Die PIM-Listen durfen nicht daruber hinwegtauschen, dass randomisiert-kontrollierte Arzneimittelstudien bei Alteren fehlen.

Syphilis continues to be a burden on the public health system. While men who have sex with men and HIV-infected individuals are the most affected populations, syphilis rates have also increased in reproductive-aged women, resulting in concurrent increases in congenital syphilis. Prompt diagnosis and treatment are requisite components of syphilis control.

Background Persistent human papillomavirus infection in human immunodeficiency virus (HIV)-infected individuals has been strongly associated with anal squamous cell carcinoma. The incidence of anal squamous cell carcinoma continues to increase in this population despite advances in HIV therapy. There are few studies describing the prevalence of anal cancer precursors, treatment outcomes, and associated factors among HIV-infected populations in the southern United States. Methods A retrospective chart review was performed on 355 HIV-infected patients from a Southern HIV clinic who were 18 years or older and had received at least one anal Pap smear. Demographic and clinical variables were collected. Descriptive statistics, single variable, and multivariate logistic regression analysis were performed to evaluate for predictors of high-grade squamous intraepithelial lesion (HSIL). Odds ratios and 95% confidence intervals were constructed for independent measures. Results After the first anal Pap smear, 38.3% (70/183) of patients with abnormal results were lost to follow-up. Comparing patients with biopsy proven HSIL versus low-grade squamous intraepithelial lesions, patients were less likely to have HSIL if they had a higher CD4 count (odds ratio, 0.81; 95% confidence interval, 0.72-0.93; P = 0.0022). Treatment success after the first round of treatment for topical and infrared coagulation therapy was 36.7% (18/49, all therapy types), and of those who achieved biopsy proven treatment success at follow-up screening, 94.4% (17/18) required subsequent therapy. Conclusions Patients with a higher CD4 count were less likely to have HSIL. CD4 nadir, number of sexual partners, and race/ethnicity were not significantly associated with the presence of HSIL.

Background: The aim of the study was to evaluate the impact of preoperative breast MRI on primary surgical treatment in a specialized multidisciplinary breast cancer clinic. The diagnostic tools routinely used are conventional mammography, ultrasound with core needle biopsy, and clinical examination including palpation of breast and axillary nodes. If indicated, the examination includes ultrasound examination and fine needle biopsy of axillary glands. We offer all patients selected for breast-conserving surgery preoperative breast MRI. Material and methods: We included consecutively 145 breast cancer lesions in 143 women (two had bilateral cancer) aged 35–75 in a prospective study, collecting data from January 2009 to December 2010. The patients were all selected for breast-conserving surgery based on the criteria recommended by the Norwegian Breast Cancer Group. That is, tumor ≤ 4 cm, or acceptable tumor:breast ratio, and age > 35. Multifocal lesions, defined as more than one tumor > 1 cm apart, size of tumor > 4 cm, or a large tumor:breast ratio, extensive ductal carcinoma in situ (DCIS), or known genetic disposition for breast cancer, indicates mastectomy according to these criterias. In addition, when postoperative radiation therapy is contraindicated, mastectomy is indicated. If the patients filled the criteria for breast-conserving surgery, they were offered preoperative breast MRI and included in the study. Patients who either choose mastectomy, or did not get a breast MRI for technical reasons, were excluded from the study. Two experienced breast radiologists evaluated the breast MRIs, and three experienced breast radiologists studied the mammographies and did the ultrasound examinations and biopsies. All additional MRI findings were examined by ultrasound-guided biopsy and given a histological diagnose before it influenced the surgical method. Results: We excluded 28 patients from the study; 10 patients choose mastectomy, 13 patients were excluded due to problems with the MRI technology, and 5 patients were excluded for other reasons. Among the remaining 117 patients, 96 were treated by breast-conserving surgery, and 21 by mastectomy. The change of operative method was induced by the preoperative breast MRI in 16 patients, because of multifocality in 11 patients, and because of a more extensive tumor than discovered by conventional diagnostic tools, in 5 patients. Five patients had a secondary mastectomy, due to histopathological findings in the lump. In one patient preoperative MRI revealed cancer in the contralateral breast, and in one patient the additional findings on MRI resulted in preoperative systemic chemotherapy. The multifocality diagnosed on the preoperative MRI was confirmed on histopathological examination of the breast in 10/11 patients. In one patient who received preoperative systemic chemotherapy, the removed breast was without sign of malignant cells on microscopic examination. Discussion: In this prospective study preoperative breast MRI give additional information that have impact on the primary surgical treatment in 16/117 or 13,7% of the patients selected for breast-conserving surgery. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-08-09.

Background: Little is known about access to medicine among immigrant Latinos in the United States (US). This study explored access to, and use of, prescription drugs obtained from nonmedical sources among recently arrived, Spanish-speaking immigrant Latinos in rural North Carolina (NC). Methods: Our community-based participatory research partnership collected, analyzed, and interpreted data from individual in-depth interviews with Latino community members and rural health service providers. A purposive sample of 30 community members, including traditional healers, religious leaders, transgender Latinos, heterosexual Latino men and women, and Latino gay men, were interviewed to gain emic (“insider”) perspectives on use of nonmedical sources of prescription drugs. Six local Latino health service providers also were interviewed to gain etic (“outsider”) perspectives on use. Results: Participants described the roles of tiendas (grocers), family, and social networks in accessing treatment advice and prescription drugs. They described health care expectations among immigrants and contingencies for accessing prescription drugs in the US. Prescription medicines (eg, antibiotics, hormones, Viagra, analgesics), injection equipment (eg, syringes), and medical advice were identified as readily available from nonmedical sources. Conclusions: Increased access to formalized health care and effective health education initiatives are needed to meet the challenges facing immigrant Latinos.

It is uncertain which methods for the diagnosis of rectal gonococcal and chlamydial infection are optimal. This study evaluated the performance of culture and nucleic acid amplification tests (NAATs) for rectal chlamydial and gonococcal diagnosis. From July 2003 until February 2007, 441 rectal test sets were collected from individuals attending a sexually transmitted disease clinic and three HIV clinics who gave a history of anal intercourse or were women at high risk for Neisseria gonorrhoeae or Chlamydia trachomatis infections. Rectal swab specimens were tested using culture and commercial NAATs employing transcription-mediated amplification (TMA), strand displacement amplification (SDA), and PCR amplification. Test performance was evaluated using a rotating standard by which patients were classified as infected if either two or three comparator tests were positive. Test sensitivities for the detection of N. gonorrhoeae ranged from 66.7% to 71.9% for culture to 100% for TMA. Specificities were 99.7% to 100% for culture and greater than 95.5% for all three NAATs. Test sensitivities for C. trachomatis ranged from 36.1% to 45.7% for culture and among NAATS from 91.4% to 95.8% for PCR to 100% for TMA. Specificities of the NAATs ranged from 95.6% to 98.5% (two-of-three standard) and from 88.8% to 91.8% (three-of-three standard). Over 60% and 80% of gonococcal and chlamydial infections, respectively, among men who have sex with men and over 20% of chlamydial infections in women would have been missed if the rectal site had not been tested. Currently available NAATs are more sensitive for the detection of chlamydial and gonococcal infection at the rectal site than is culture.

The Middle Carnian Wet Intermezzo (MCWI) of the Stuttgart Formation (Schilfsandstein) and age-equivalent strata of the northwestern Tethys occurred entirely within equivalents of the upper subzone of the Austrotrachyceras austriacum ammonoid zone of the late Julian. Its duration is estimated to be only about 0.7–0.8 myr. In both the Germanic Basin and the northwestern Tethys, the warm climate during the MCWI was characterized by a rate of precipitation that exceeded somewhat the evaporation but was not so great as to be pluvial. The MCWI was related to the atmospheric circulation of a megamonsoonal system that was characterized by strong, moisture-laden, northwesterly flowing trade winds that rose as they reached the estimated 2000–3000 m high eastern shoulder uplift of a huge rift causing them to drop an extraordinary amount of rain. This eastern shoulder uplift lay within the Caledonides of modern day western Scandinavia. This region only, between 30 and 50°N palaeolatitude, had a truly pluvial climate, and the huge amounts of fresh water dropped there transported large amounts of siliciclastics from this rift-shoulder uplift southward into the Germanic Basin. Before deposition of the siliciclastics an early Julian eustatic sea-level fall caused widespread erosion in the Germanic Basin. In the later part of late Julian, a transgression from the eastern gates with the concurrent strong fresh water influx from the north flooded the centre of the northern Germanic Basin with a shallow brackish sea in which the Osterhagen Horizon (Basisschichten) of the lower Stuttgart Formation was deposited. In the upper Osterhagen Horizon the salinity rapidly decreased from mesohaline through mio- and oligohaline to fresh water levels. In southern Germany the Basisschichten formed entirely within fresh water or very low salinity brackish environments . Later, a slight subsidence of the southwestern Germanic Basin shifted the main outflow of fresh water toward the southwestern end of the basin, creating local brackish conditions in the northern marginal part of the northwestern Tethys (e.g. in the Lunz Beds). During this time interval, tidal influence also can be found in the Stuttgart Formation deposited in palaeoestuaries of the southwestern Germanic Basin adjacent to the Tethys. The very strong fresh water influx from the north, however, prevented these estuaries from developing a strongly elevated salt content, so that only fresh water to oligohaline brackish faunas are found there such as the Eberstadt bivalve–conchostracan fauna. At the base of the Tuvalian, the megamonsoonal system either disintegrated or else the trade winds shifted their principal flow direction. This caused the climate within the Germanic Basin and in the nearby northwestern Tethys Sea to become arid again as it had been before the deposition of the Stuttgart Formation. These changes in the atmospheric circulation patterns also terminated the pluvial climatic regime to the north along the Scandinavian eastern rift-shoulder uplift. This in turn ended the transport of huge amounts of siliciclastics from this region southward into the Germanic Basin and ended the deposition of the Schilfsandstein. After this, the hypersaline sabkha and playa sedimentation of the Weser Formation began, which was accompanied by some minor marine ingressions in the southwestern Germanic Basin.

Black shales of the lower member of the Carnian Xiaowa Formation (previously known as the Wayao Member of the Falang Formation or as the Wayao Formation) in the Guanling area, Guizhou Province, south-west China, are yielding a rich marine reptile fauna and exceptional remains of pelagic crinoids. The black shales represent deposition on the drowned southern margin of the Yangtze Platform during a Maximum Flooding Interval. The relatively reduced sedimentation rates led to the formation of the Lagerstatte through the accumulation of fossils in the anoxic bottom sediments over a prolonged period of time. Invertebrate fossils represent almost exclusively pelagic forms, such as a diverse ammonite fauna and halobiid bivalves. The spectacular finds of colonies of large (stem lengths > 11 m) crinoids of the genus Traumatocrinus attached to driftwood prove that this crinoid was the first to evolve a pseudoplanktonic life style. The other crinoid is the planktonic roveacrinid Osteocrinus. The marine reptile fauna, represented by probably hundreds of skeletons, is numerically dominated by three species of ichthyosaurs and four species of thalattosaurs. The thalattosaurs fill a palaeobiogeographic gap between the Alpine thalattosaur faunas and those from western North America. Two species of placodonts are rare finds. As for the thalattosaurs, the placodont occurrences greatly expand the geographic range of the group because placodonts have been known previously only from the Mediterranean region, the Alps and the Muschelkalk Basin. The unique abundance of thalattosaurs contrasts with a scarcity of fishes. Although we suggest that the fauna is authochthonous and inhabited surface waters, it must have represented an unusual ecosystem. However, the possibility remains that both the marine reptiles and the Traumatocrinus colonies were concentrated in the region by currents and do not reflect the biocoenosis.

Long-haul truck driving has been associated with HIV risk in developing countries but little research to date has considered whether truckers in the USA may also be at elevated risk for HIV and other STIs. This multi-method qualitative study explored HIV-risk factors among regional and cross-country truck drivers who were based in the southeastern USA. Data collection methods included focus groups conducted at company hubs and over Citizen's Band (CB) radio, and key informant interviews. Results indicated that sexual opportunities and risks are greater for long-haul drivers who often travel for long periods without returning home and who may engage in 'highway sex' in the absence of a regular home-life. Structural factors that have reduced drivers' autonomy, sexual risk taking and free time while traveling include recent trucking regulations, electronic surveillance and industry-wide trends emphasizing speed and efficiency. Other factors, such as age, experience, type of employment and type of route also play a role. Further research is needed to determine if these qualitative findings can be quantified in population-based studies that also include biomarker and incidence data.

Multivariate analysis including Estrogen and Her2 receptor status. This additional file comprises 3 sub-tables in total. In Table 1, risk of death is calculated by multivariate -652 6N del Cox-regression analyses including Estrogen receptor and Her2 receptor status. In Table 2, risk of death is calculated by multivariate Asp302His Cox-regression analyses including Estrogen receptor and Her2 receptor status. In Table 3, risk of death is calculated by CASP8 diplotypes multivariate Cox-regression including Estrogen receptor and Her2 receptor status. (DOCX 22 kb)

Adequate supply of vitamin D(3) is not sufficient for the prevention of post-menopausal osteoporosis, because of a tightly regulated critical step in formation of the most active vitamin D metabolite 1,25-dihydroxyvitamin D(3). Direct application of 1,25(OH)(2)D(3), however, was effective in reducing fracture rate and increasing bone mineral density as has been shown in large clinical studies. Extracts from Solanum glaucophyllum and Trisetum flavescens plants containing 1,25(OH)(2)D(3)-glycosides were characterized by their vitamin D-activity in a quail eggshell bioassay and applied in an osteoporosis model in ovariectomized rats. An extract from the grass T. flavescens and a purified extract from S. glaucophyllum were characterized by the absence of alkaloids and the analytically determined content of 1,25(OH)(2)D(3). In the ovariectomized rat model after 6 months duration, the bone metabolism relevant markers serum calcium, 1,25(OH)(2)D(3), urinary crosslinks and calcium were measured. At termination tibial mineral content was determined and as imaging procedure micro-computerized tomography was applied. The bisphosphonate alendronate was used as a positive standard. While alendronate reduced bone resorption, as seen in a reduced urinary crosslink excretion, both vitamin D metabolite-containing extracts were able to improve bone mineral density by an enhanced calcium turnover.

Urinary tract infections (UTI) are among the most common bacterial infections in infants and children. The early diagnosis of a pyelonephritis and its rapid, calculated antibacterial therapy are decisive for the prognosis. Urogenital anomalies, renal damage and bladder dysfunction may influence the risk of recurrences of UTI and pyelonephritic scarring. Diagnostic strategies therefore should focus on their early recognition. Pediatricians, urologists and infectiologists are cooperating in diagnostic, therapy and prophylaxis of UTI. The aim of the interdisciplinary consensus presented was to work out a concept which may help to manage childhood UTI in daily practice.

HIV prevention efforts are often difficult to emphasize in settings delivering comprehensive HIV care due to factors such as time constraints and differing priorities about the use of clinical time. To assist clinicians within dedicated HIV clinics to offer prevention strategies, investigators at two universities in the United States (Johns Hopkins University and the University of Alabama at Birmingham) have developed and implemented similar, audio-computerized-assisted, self-interviewing systems that have been programmed to assess individual patient risk factors and identify based on the patient's self-assessment, the patient's behavioral stage or, readiness for changing, each identified target behavior. Following the assessment, the systems provide printouts of key elements of this information along with individualized, theory-based intervention strategies to the medical provider. This paper will describe our efforts in developing provider-delivered, individualized, stage-based interventions intended to reduce high-risk behaviors among HIV-infected persons.

An approximately 1 m thick gypsum bed and its underlying < 45 cm dolomite bed with variable soft-sediment deformation structures are described from the Grundgips Member of the Grabfeld Formation (Middle Keuper, Ladinian) in southwestern Germany. The deformation structures are mainly convolutions, folds, cusps, domes and off-shooting dykes and, less common, brecciation or faulting. These deformation structures are interpreted to be caused by liquefaction and/or fluidization of the semiconsolidated sediments by a seismic shock of approximately magnitude 6–7. Palaeoseismicity is thought to be related with a nearby wrench fault system associated with a major suture zone of the Variscan basement.

Objectives: Public health sexually transmitted disease (STD) clinics play a central role in STD control efforts. This study addressed the perceived quality of client services at two STD clinics in Alabama. Goal: The goal of this study was to evaluate and develop tools for assessment of client satisfaction at STD clinics. Study: Four focus groups of staff (N = 16) and clients (N = 15) at the clinics were conducted between June and November 2003. Results: Staff and client assessments of respect, privacy protections, and friendliness at the clinics differed in substantial ways. Clients were concerned with visibility, being stigmatized or disrespected, and about a breach of confidentiality. Concerns about being stigmatized focused mainly on nonclinical staff. The staff did not perceive these concerns to be warranted. Quality of medical care was rated high by both groups. Conclusion: Staff-client interactions are an important element of STD care, and front desk actions set the tone at public STD clinics. Nonclinicians should receive training to improve body language and other behaviors to alleviate the stigma concerns of clients who are anxious, fearful, and sometimes distrustful of the health system.

Objective: HIV primary care clinics offer an environment in which to deliver prevention messages and to conduct sexually transmitted disease (STD) screening. Determination of the prevalence and factors associated with risk-taking behaviors among HIV clinic attendees is needed. Goal: The goal of this study was to describe risk behaviors and STD prevalence in males receiving HIV primary care. Study: Participants underwent an interviewer-administered survey and STD testing during this cross-sectional study. Results: Over two thirds of study participants reported sexual activity within the prior 6 months of which 6% were infected with gonorrhea or chlamydia. Men performing insertive rectal sex were 5 times less likely to use condoms when the partner was HIV-positive (odds ratio [OR], 5.14; 95% confidence interval [CI], 1.90-13.91), whereas patients with higher CD4 counts were more likely to engage in unprotected receptive rectal sex (OR, 1.20; 95% CI, 1.02-1.42). Conclusion: HIV primary care clinics provide access to patients in need of HIV prevention intervention and are appropriate sites for these activities.

The objectives of this study were to assess the prevalence and incidence of curable sexually transmitted infections (STI), i.e., gonorrhea, chlamydial infection, or trichomoniasis, in a cohort of HIV-infected women. The study population was derived from women seeking primary care at an outpatient university HIV clinic who were participants in a women's natural history study. Enrollees (n = 225) were predominantly African-American, heterosexually infected, with mean age 35 years. Mean entry CD4+ T cell count was 405 cells/mm3. Over 6% were STI positive at initial screening. Subsequently, the combined curable STI incidence was 4.82/1000 woman-months over a median of 33 months of observation. Of 36 incident STIs, trichomoniasis was most common (n = 32). Predictors for acquisition of a curable STI included absenteeism at scheduled clinic appointments, RR = 1.99 (1.28, 3.08), and a higher CD4+ T cell count, RR = 1.15 (1.0028, 1.3115) for 100 cells. Interventions to prevent curable STI in HIV-infected women are warranted in primary care settings.

TO THE EDITOR—We read with great interest the letter by Tucker et al [1] regarding our report outlining the outcomes from our social media intervention designed to increase human immunodeficiency virus (HIV) testing among men who have sex with men (MSM) and transgender persons [2]. Tucker et al suggest that our study is not unique given research that has been conducted using mass media and social marketing approaches. What made our study unique was that our intervention was implemented within 4 well-established social media websites (ie, dating or “hook-up” sites) that are commonly used for social and sexual networking among some MSM and transgender persons and not designed for intervention delivery, our evaluation included a rigorous randomized community trial, and our outcomes were favorable.