Search

Abstract Next-generation sequencing (NGS) is becoming more relevant for medical diagnostics, especially for using cell-free DNA to monitor response to therapy in cancer management, as high sensitivity of NGS enables detection of rare events. Sequencing Library preparation is a time-consuming and complex process, and large-scale liquid handlers are often used for automation. However, for smaller labs and low-to-medium throughput samples, these liquid handlers are expensive and need experts for handling. This work presents a proof-of-concept for library preparation on a commercially available and open lab-on-a-chip platform, which provides an alternative automation for low-to-medium throughput requirements. It covers common library preparation steps optimized to a microfluidic environment that include customizable PCR for target enrichment, end-repair, adapter ligation, nucleic acid purification via magnetic beads, and an integrated quantification step. The functionality of the cartridge is demonstrated with reference cfDNA containing different allelic frequencies of seven known mutations. Processing the samples in the cartridge reveals highly comparable results to manual processing (Pearson r = 0.94) based on amplicon sequencing. Summarized, the proposed automated lab-on-a-chip workflow for customizable library preparation could further pave the way for NGS to evolve from a technology used for research purposes to one that is applied in routine cancer management.

Abstract [11C]Carfentanil ([11C]CFN) is the only selective carbon-11 labeled radiotracer currently available for positron emission tomography (PET) imaging of mu opioid receptors (MORs). Though used extensively in clinical research, [11C]CFN has not been thoroughly characterized as a tool for preclinical PET imaging. As we were occasionally observing severe vital sign instability in rat [11C]CFN studies, we set out to investigate physiological effects of CFN mass and to explore its influence on MOR quantification. In anesthetized rats (n = 15), significant dose-dependent PCO2 increases and heart rate decreases were observed at a conventional tracer dose range (IV, > 100 ng/kg). Next, we conducted baseline and retest [11C]CFN PET scans over a wide range of molar activities. Baseline [11C]CFN PET studies (n = 27) found that nondisplaceable binding potential (BPND) in the thalamus was positively correlated to CFN injected mass, demonstrating increase of MOR availability at higher injected CFN mass. Consistently, when CFN injected mass was constrained

Abstract Background Global longitudinal active strain energy density (GLASED) is an innovative method for assessing myocardial function and quantifies the work performed per unit volume of the left ventricular myocardium. The GLASED, measured using MRI, is the best prognostic marker currently available. This study aimed to evaluate the feasibility of measuring the GLASED using echocardiography and to investigate potential differences in the GLASED among athletes based on age and sex. Methods An echocardiographic study was conducted with male controls, male and female young athletes, and male and female veteran athletes. GLASED was calculated from the myocardial stress and strain. Results The mean age (in years) of the young athletes was 21.6 for males and 21.4 for females, while the mean age of the veteran athletes was 53.5 for males and 54.2 for females. GLASED was found to be highest in young male athletes (2.40 kJ/m3) and lowest in female veterans (1.96 kJ/m3). Veteran males exhibited lower values (1.96 kJ/m3) than young male athletes did (P

Background: In the United Kingdom, onsite religious services were halted during COVID-19 lockdowns, which were followed by various levels of restrictions on communal worship including social distancing, mandatory wearing of face masks, adequate ventilation and a ban on congregational singing and chanting. The aim of our study was to evaluate the impact of closures and changes within places of worship in response to the first lockdown in 2020, to assess the effect of the pandemic on religious practice and worshippers’ wellbeing and religious coping. Methods: Participants were regular worshippers in the UK, recruited through an online survey using convenience sampling. Respondents were asked about their attitudes to changes to places of worship in the UK and their wellbeing and mental health, including assessment of their risk of depression and anxiety using the Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder Assessment (GAD-7) measures. Questionnaires were completed August to November 2020. Findings: 939 participants were included in the analysis. Median age was 52.7 years and 66.1 % were female. 80.7 % identified as Christian. 165 (19.3 %) had mild, 45 (5.3 %) moderate, 25 (2.9 %) moderately severe and 10 (1.2 %) severe depression, and 192 (22.5 %) had mild, 55 (6.4 %) moderate and 27 (3.2 %) severe anxiety, according to PHQ-9 and GAD-7 scores, respectively. Nearly half (46.4 %) reported that their mood and anxiety levels had worsened and 16.6 % reported that they felt the things they were doing in their lives were not worthwhile. The vast majority of respondents (92.7 %) reported that prayer had helped them cope with the way they had felt during lockdown: 29.2 % and 47.0 % reported that it helped moderately and a great deal, respectively. This 76.2 % had significantly lower levels of moderate/severe depression and anxiety (adjusted odds ratio: depression 0.37 (95%CI 0.22–0.63), anxiety 0.52 (95%CI 0.31–0.88). Interpretation: Our study demonstrates the significant impact of COVID-19 on communal worshippers’ mental health and reinforces the benefits of positive religious coping during the first UK lockdown. Barriers to communal worship participation during lockdowns, including access to appropriate technology, need to be recognised and facilitators identified.

Abstract Introduction This prospective, longitudinal, community-based study, EpidemiologiCal POpulatioN STudy of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in Lake CounTy, Illinois (CONTACT), investigated coronavirus disease 2019 (COVID-19) immunity, occupational risks related to SARS-CoV-2 exposure, and long-term immunoglobulin G (IgG) seroconversion kinetics. Methods At baseline and follow up (3, 6, and 9 months), non-hospitalized adult participants provided nasal and blood serum specimens for molecular [reverse transcription polymerase chain reaction (RT-PCR)] and serological (IgG) testing (4 November 2020–30 October 2021). Results At baseline, 6.4% (65/1008) had evidence of current/prior SARS-CoV-2 infection. At 3, 6, and 9 months, positive PCR tests were obtained from 0.4% (3/781), 0.4% (3/733), and 0% (0/673) of participants, respectively. Positive IgG occurred at baseline and 3, 6, and 9 months in 4.5% (45/1008), 6.0% (48/799), 5.4% (39/733), and 2.8% (19/673) of participants, respectively. Of participants positive for IgG at baseline, 28 had a negative IgG test at a follow-up visit; of those 28, 21 had their first negative IgG test within 6 months. Participants were more likely to retain positive IgG if they were 18–29 years of age, were male, or had medium-high/high-risk occupations. A high vaccination rate (70% received ≥ 1 dose by 9 months) was observed. Influence of occupational status or characteristics on transmission and IgG, and COVID-19 vaccination trends, are shown. Conclusions This study expands on prior studies assessing COVID-19 immunity and IgG seroconversion by including both RT-PCR and serologic testing and longitudinal follow-up of study participants. We observed decreased infection rates over the 9 month follow-up period as well as a decline in IgG persistency after 6 months. The findings from this community-based study regarding vaccinate rates, infection rates by PCR, and IgG persistency over time can help improve our understanding of COVID-19 immunity, occupational risks related to SARS-CoV-2 exposure, and the kinetics of long-term IgG seroconversion, which is important to help guide local and national mitigation strategies. Clinical Trial Registration NCT04611230.

Abstract Background The athlete’s heart (AH) defines the phenotypical changes that occur in response to chronic exercise training. Echocardiographic assessment of the AH is used to calculate LV mass (LVM) and determine chamber geometry. This is, however, interpreted using standard linear (ratiometric) scaling to body surface area (BSA) whereas allometric scaling is now widely recommended. This study (1) determined whether ratiometric scaling of LVM to BSA (LVMiratio) provides a size-independent index in young and veteran athletes of mixed and endurance sports (MES), and (2) calculated size-independent beta exponents for allometrically derived (LVMiallo) to BSA and (3) describes the physiological range of LVMiallo and the classifications of LV geometry. Methods 1373 MES athletes consisting of young ( 35 years old) (males n = 327 and females n = 220) were included in the study. LVMiratio was calculated as per standard scaling and sex-specific LVMiallo were derived from the population. Cut-offs were defined and geometry was classified according to the new exponents and relative wall thickness. Results LVMiratio did not produce a size independent index. When tested across the age range the following indexes LVMi/BSA0.7663 and LVMi/BSA0.52, for males and females respectively, were size independent (r = 0.012; P = 0.7 and r = 0.003; P = 0.920). Physiological cut-offs for LVMiallo were 135 g/(m2)0.7663 in male athletes and 121 g/(m2)0.52 in female athletes. Concentric remodelling / hypertrophy was present in 3% and 0% of young male and female athletes and 24% and 17% of veteran male and female athletes, respectively. Eccentric hypertrophy was observed in 8% and 6% of young male and female athletes and 9% and 11% of veteran male and female athletes, respectively. Conclusion In a large cohort of young and veteran male and female MES athletes, LVMiratio to BSA is not size independent. Sex-specific LVMiallo to BSA with LVMi/BSA0.77 and LVMi/BSA0.52 for male and female athletes respectively can be applied across the age-range. Population-based cut-offs of LVMiallo provided a physiological range demonstrating a predominance for normal geometry in all athlete groups with a greater percentage of concentric remodelling/hypertrophy occurring in veteran male and female athletes.

Consumption of fruits, vegetables, and nuts is essential for human health because of their minerals, vitamins, antioxidants and dietary fibre contents. Two types of beverages were prepared (tiger nut beverage and tiger nut/beetroot beverage). 200 g tiger nut was homogenized in 1 L of sterile water to prepare tiger nut beverage while 200 g of tiger nut with 20 g of beetroot to prepare tiger nut/beetroot beverage were homogenized with 1 L of sterile water. The prepared products were pasteurized at 80 °C for 5 min and left to ferment at room temperature (28±2 °C) for 4 days. The products were analyzed for chemical composition and microbial load. Results obtained showed no significant differences in the moisture, ash and protein content products. However, significant differences existed in fibre, fat and carbohydrate contents. Leuconostoc mesenteroides, Lactobacillus plantarum, Lactobacillus acidophilus, Streptococcus lactis, Saccharomyces cerevisiae, Saccharomyces exiguus, Saccharomyces stellatus and Candida pseudotropicalis were isolated from products. The number of bacteria in Tiger nut beverages increased from 0.85×103 to 1.83×107 and 0.97×103 to 1.78×107 in the Tiger/beetroot beverage. Mould and yeast counts in the tiger nut beverage increased from 0.32×102 to 1.06×104 while in the mixed product, the increase was from 0.30×102 to 1.18×104. There were no significant differences in pH and titratable acidity throughout days of fermentation. The tiger nut/beetroot beverage has high overall acceptability. The beverages could serve as a good material for the production of quality yoghurt in place of animal milk that is mostly used for yoghurt production.

Abstract Lattice and electronic structure interactions for f-electrons are fundamental challenges for lanthanide equation of state development. Difficulties in first-principles calculations, such as density functional theory (DFT), emphasize the need for well-characterized experimental data. Here, we measure in-situ x-ray diffraction of shocked samarium (Sm) and temperature along the Hugoniot for the first time, providing direct evidence for phase transitions. We report direct evidence of a distorted fcc (dfcc) phase at 23 GPa. Shocked samarium melts from the dfcc phase starting at 33 GPa (1333 K), with complete melt at 40 GPa (1468 K). Previous work indicated shock melt at 27 GPa (1200 K), underscoring the significance of x-ray measurements for detecting phase transitions. Interestingly, our observed melting is in sharp contrast with the melting reported by a diamond anvil cell study. These experimental data can tightly constrain first principles calculations and serve as key touchstones for equation of state modeling.

BackgroundRecommendations for the echocardiographic assessment of left ventricular (LV) mass in the athlete suggest the use of the linear method using a two-tiered classification system (2TC). The aims of this study were to compare the linear method and the area-length (A-L) method for LV mass in elite rugby football league (RFL) athletes and to establish how any differences impact the classification of LV geometry using 2TC and four-tier (4TC) classification systems.MethodsTwo hundred and twenty (220) male RFL athletes aged 25 ± 5 (14–34 years) were recruited. All athletes underwent echocardiography and LV mass was calculated by the American Society of Echocardiography (ASE) corrected Linear equation (2D) and the A-L method. Left ventricular mass Index (LVMi) was used with relative wall thickness to determine geometry in the 2TC and with concentricity and LV end diastolic volume index for the 4TC. Method specific recommended cut-offs were utilised.ResultsHigher values of absolute (197 ± 34 vs. 181 ± 34 g; p

Summary: Background: The Invasive Respiratory Infection Surveillance (IRIS) Consortium was established to assess the impact of the COVID-19 pandemic on invasive diseases caused by Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, and Streptococcus agalactiae. We aimed to analyse the incidence and distribution of these diseases during the first 2 years of the COVID-19 pandemic compared to the 2 years preceding the pandemic. Methods: For this prospective analysis, laboratories in 30 countries and territories representing five continents submitted surveillance data from Jan 1, 2018, to Jan 2, 2022, to private projects within databases in PubMLST. The impact of COVID-19 containment measures on the overall number of cases was analysed, and changes in disease distributions by patient age and serotype or group were examined. Interrupted time-series analyses were done to quantify the impact of pandemic response measures and their relaxation on disease rates, and autoregressive integrated moving average models were used to estimate effect sizes and forecast counterfactual trends by hemisphere. Findings: Overall, 116 841 cases were analysed: 76 481 in 2018–19, before the pandemic, and 40 360 in 2020–21, during the pandemic. During the pandemic there was a significant reduction in the risk of disease caused by S pneumoniae (risk ratio 0·47; 95% CI 0·40–0·55), H influenzae (0·51; 0·40–0·66) and N meningitidis (0·26; 0·21–0·31), while no significant changes were observed for S agalactiae (1·02; 0·75–1·40), which is not transmitted via the respiratory route. No major changes in the distribution of cases were observed when stratified by patient age or serotype or group. An estimated 36 289 (95% prediction interval 17 145–55 434) cases of invasive bacterial disease were averted during the first 2 years of the pandemic among IRIS-participating countries and territories. Interpretation: COVID-19 containment measures were associated with a sustained decrease in the incidence of invasive disease caused by S pneumoniae, H influenzae, and N meningitidis during the first 2 years of the pandemic, but cases began to increase in some countries towards the end of 2021 as pandemic restrictions were lifted. These IRIS data provide a better understanding of microbial transmission, will inform vaccine development and implementation, and can contribute to health-care service planning and provision of policies. Funding: Wellcome Trust, NIHR Oxford Biomedical Research Centre, Spanish Ministry of Science and Innovation, Korea Disease Control and Prevention Agency, Torsten Söderberg Foundation, Stockholm County Council, Swedish Research Council, German Federal Ministry of Health, Robert Koch Institute, Pfizer, Merck, and the Greek National Public Health Organization.

Cardiac tamponade is a medical emergency requiring prompt recognition and intervention to avoid potentially fatal consequences. We present a case series of ventricular dysfunction and cardiogenic shock following pericardiocentesis in 3 patients with pericardial effusions at The Ottawa Hospital between 2014 and 2020. This report highlights the need for monitoring post-pericardiocentesis and raises awareness of this phenomenon, particularly in patients with malignancy. We propose a novel pressure-monitoring protocol to guide drainage and prevent development of pericardial decompression syndrome. The novel teaching points include limiting drainage to prevent development of pericardial decompression syndrome and a protocol for intra-pericardial pressure monitoring. RÉsumÉ: La tamponnade cardiaque est une urgence médicale qui, à défaut d’une reconnaissance et d’une intervention rapides, peut avoir des conséquences potentiellement fatales. Nous présentons une série de cas sur des dysfonctions ventriculaires et des chocs cardiogéniques survenus après une péricardiocentèse chez trois patients présentant des épanchements péricardiques traités à l’Hôpital d’Ottawa entre 2014 et 2020. Notre article souligne la nécessité de surveiller les patients au cours de la période suivant la péricardiocentèse et met en lumière le phénomène de la tamponnade cardiaque, en particulier chez les patients atteints de cancer. Nous proposons un nouveau protocole de surveillance des pressions conçu pour guider le drainage et prévenir le syndrome de décompression péricardique. Les nouveautés à enseigner comprennent la limitation du drainage afin de prévenir le syndrome de décompression péricardique et un protocole de surveillance des pressions intrapéricardiques.

Abstract Bicontinuous cubic (Q) lyotropic liquid crystal (LLC)‐derived polymer networks possess periodic, uniform‐size, 3D‐interconnected nanopores that make them highly desirable organic materials for selective molecular separation and uptake applications. To date, there are no reported examples of a Q‐phase network with additional functional properties, such as catalytic reactivity, response to external stimuli, or gated transport, that would expand the usefulness of this class of porous materials. Here, a functionalized gyroid‐type Q polymer network material that can be used for potential gated transport or adaptive uptake applications is presented. This material contains a novel spiropyran‐containing dopant monomer that upon blending and cross‐linking with a gyroid‐forming LLC monomer, yields a gyroid polymer material that retains its phase architecture while reversibly responding to changes in external solution and vapor pH. Studies also demonstrate that this system is capable of strongly binding to aq. Pb2+ ions when activated by UV light, allowing it to function as a potential colorimetric sorbent or gated‐response material.

The Tasmanian emu (Dromaius novaehollandiae diemenensis) persisted alongside Aboriginal people for ∼40,000 years, for the last ∼14,000 years of which Tasmania was a large, continental island. This population of emus was extirpated soon after European colonization in the 19th century. Is hunting by people sufficient to explain the rapid demise of the emu or should we look to a synergy of pressures? Could wild emus be reintroduced to Tasmania? We investigated the distribution, hunting, and extinction of emus in Tasmania, before and after colonization, using population simulations, species distribution modelling, and land use analysis. We also evaluated the potential for rewilding with emus in present Tasmanian landscapes. The Tasmanian emu was a generalist with respect to vegetation and was widespread in the lowlands of eastern Tasmania. Prior to colonization, the maximum sustainable yield of adult emus was low, less than one per person per year. Following colonization, hunting rates quickly increased to a level that can account for rapid extinction. Large parts of Tasmania have both habitat and land uses suitable for an introduction of Australian mainland emus (D. n. novaehollandiae). This putative reintroduction of emus to Tasmania could reinstate several ecological and cultural roles but successful rewilding would require support from the wider community. We recommend field trial experiments, with methodologies co-designed by local community members.

This study highlighted the school collaboration and process involved in implementing Tier 1 reading instruction in a rural school in New Mexico and measured the efficacy of this model on student outcomes. Our participants included seven elementary grade teachers, two special educators, one principal, and 106 students in Grades K-6. Our process involved adding more reading time to the schedule, providing teachers with pacing guides and fidelity checklists to maintain teacher accountability with reading instruction, leading biweekly professional learning communities for teachers, and using individually administered curriculum-based measures to track student outcomes in reading. Our results depicted student growth in reading outcomes across elementary grades and a reduction in risk for reading difficulties from the beginning to the end of the school year, which in part could be attributed to our model of Tier 1 reading instruction.

Aims: To compare (1) conventional left ventricular (LV) functional parameters, (2) LV peak strain and strain rate and (3) LV temporal strain and strain rate curves in age, ethnicity and sport-matched athletes with concentric, eccentric and normal LV geometry. Methods: Forty-five male athletes were categorised according to LV geometry including concentric remodelling/hypertrophy (CON), eccentric hypertrophy (ECC) or normal (NORM). Athletes were evaluated using conventional echocardiography and myocardial speck tracking, allowing the assessment of myocardial strain and strain rate; as well as twist mechanics. Results: Concentric remodelling was associated with an increased ejection fraction (EF) compared to normal geometry athletes (64% (48–78%) and 56% (50–65%), respectively; p < 0.04). No differences in peak myocardial strain or strain rate were present between LV geometry groups including global longitudinal strain (GLS; CON −16.9% (−14.9–20.6%); ECC −17.9% (−13.0–22.1%); NORM −16.9% (−12.8–19.4%)), global circumferential strain (GCS; CON −18.1% (−13.5–24.5%); ECC −18.7% (−15.6–22.4%); NORM −18.0% (−13.5–19.7%)), global radial strain (GRS; CON 42.2% (30.3–70.5%); ECC 50.0% (39.2–60.0%); NORM 40.6 (29.9–57.0%)) and twist (CON 14.9° (3.7–25.3°); ECC 12.5° (6.3–20.8°); NORM 13.2° (8.8–24.2°)). Concentric and eccentric remodelling was associated with alterations in temporal myocardial strain and strain rate as compared to normal geometry athletes. Conclusion: Physiological concentric and eccentric remodelling in the athletes heart is generally associated with normal LV function; with concentric remodelling associated with an increased EF. Physiological concentric and eccentric remodelling in the athletes heart has no effect on peak myocardial strain but superior deformation and untwisting is unmasked when assessing the temporal distribution.

Persevering with home rehabilitation exercise is a struggle for millions of people in the US each year. A key factor that may influence motivation to engage with rehabilitation exercise is the challenge level of the assigned exercises, but this hypothesis is currently supported only by subjective, self-report. Here, we studied the relationship between challenge level and perseverance using long-term, self-determined exercise patterns of a large number of individuals (N = 2,581) engaging in home rehabilitation with a sensor-based exercise system without formal supervision. FitMi is comprised of two puck-like sensors and a library of 40 gamified exercises for the hands, arms, trunk, and legs that are designed for people recovering from a stroke. We found that individuals showed the greatest perseverance with the system over a 2-month period if they had (1) a moderate level of motor impairment and (2) high but not perfect success during the 1st week at completing the exercise game. Further, a steady usage pattern (vs. accelerating or decelerating use) was associated with more overall exercise, and declines in exercise amount over time were associated with exponentially declining session initiation probability rather than decreasing amounts of exercise once a session was initiated. These findings confirm that an optimized challenge level and regular initiation of exercise sessions predict achievement of a greater amount of overall rehabilitation exercise in a group of users of commercial home rehabilitation technology and suggest how home rehabilitation programs and exercise technologies can be optimized to promote perseverance.

As e-commerce drives the packaging growth, consumers are pushing for more sustainable packaging solutions. Considering the current societal needs, we have been able to engineer a new pathway for sustainable packaging solutions by developing lignin-containing micro- and nano-fibrillated cellulosic (LMNFCs) materials to strengthen the recycled fibers. LMNFCs from unbleached softwood pulp containing 14.4% lignin at high and low fibrillation levels were produced. Packaging papers from recycled old-corrugated containers were strengthened with LMNFCs with varying addition levels of 1 wt% to 3 wt% at two basis weights. The results show 2 wt% addition of LMNFC can enhance strength at low levels of fibrillation, and that basis weight can be reduced by 16.7%, from 150 gsm to 125 gsm, while maintaining a burst strength of 49-53 lbf. Reduction in basis weight and high lignin content of LMNFC also enhanced dewatering during sheet formation with the lowest increase in drainage time, 9%, relative to the 150 gsm with no LMNFC. The techno-economic analysis supports the feasibility of using LMNFC to produce lightweight and sustainable packaging materials at industrial scale with an 8% reduction in fiber cost.

Introduction/objectives: Diabetic Kidney Disease (DKD) is the leading cause of end-stage kidney disease. Despite optimal glycemic control and blood pressure management, progression to DKD cannot be halted in some patients. We aimed to find the association of modifiable and non-modifiable risk factors and comorbid conditions in patients with DKD. Methods: Retrospective medical record review of adult patients with diabetes mellitus (DM) was performed who visited our internal medicine office between January 1, 2020 and December 31, 2020. Results: Among 728 patients with DM, 471 (64.7%) patients had DKD, and 257 (35.3%) patients were without DKD. Among the group of patients with DKD, the majority were in CKD stage G1A2 (34.6%), followed equally by G2A2 and G3aA1 (16.8% each). Mean age of the patients with DKD was significantly greater than the patients without DKD (69.4 years vs 62.2 years; P

Commercially available conventional drugs have been used to adulterate herbal products. Considering the rapid growth of herbal products’ market, it is essential to screen herbal products for the presence of conventional drugs. Simple analytical methods are needed for the rapid screening of conventional drugs that are likely to be adulterated in herbal products. Thin layer chromatography (TLC) methods for screening twelve conventional drugs in herbal products have been developed and applied. The analytes were extracted from herbal products using acetonitrile:methanol:acetic acid:water (4:4:1:1, v/v). Solvent mixture of dichloromethane:ethyl acetate:methanol (75:15:10, v/v) separated well trimethoprim, sildenafil, paracetamol, and sulfamethoxazole while pyrimethamine, metronidazole, and sulfadoxine were well separated by dichloromethane:ethyl acetate:methanol (77.5:12.5:10, v/v). In addition, acetyl salicylic acid, ibuprofen, diclofenac, quinine, and lumefantrine were well separated by ethyl acetate:methanol:30% ammonia (75:22.5:2.5, v/v). Chromatographic separations were found to be highly reproducible, and more than 10 samples can be analysed in one run. The method was applied in the screening of 229 herbal products. Consequently, 24.0% of the samples contained one adulterant, while 21.4% contained at least two adulterants. All conventional drugs detected in herbal products were not mentioned on the labels and therefore the consumers are kept unaware of their side effects and health problems. Further studies for confirming and quantitatively determining the adulterants in a wide range of products as well as a systematic toxicological analysis of the adulterants in herbal products are recommended.

OBJECTIVES/GOALS: Perioperative surgical care is team-based with close partnership between surgeons, residents, advanced practice professionals (APPs), and others. The objective is to develop an understanding of the current state and implementation needs required for APPs to engage surgical patients in advanced care planning (ACP) to promote goal concordant care. METHODS/STUDY POPULATION: We will conduct a mixed methods evaluation of ACP knowledge, attitudes, and beliefs amongst surgical APPs to identify barriers and facilitators of APPs engaging in a team-based approach to engaging surgical patients in ACP. We will conduct an online survey and qualitative interviews in the following 4 domains: 1) knowledge, skills, and attitudes about engaging in ACP with a patient or their surrogate decision maker during their perioperative care; 2) prior ACP-specific education; 3) experiences conducting ACP discussions with patients; and 4) perceived training needs to increase ACP uptake and documentation. The findings will provide the foundations to design team-based interventions focused on addressing the barriers and inform training and coaching needs to develop expertise and comfort in the ACP process. RESULTS/ANTICIPATED RESULTS: We expect variability in the knowledge, skills, attitudes, and experiences with the ACP process. We anticipate gaining a better understanding of the educational materials best suited to support APPs as they begin engaging patients in ACP. Possible barriers to APP-led ACP discussions include inconsistent role delineation, uncertainty about the value of pre-operative vs. post-operative ACP discussions, lack of experience engaging in ACP discussion, and lack of familiarity with electronic health records ACP tools. Possible facilitators of APP-led ACP discussions may be related to past work experience settings, exposure to ACP in educational preparation, hands-on observation of value of ACP in surgical patients and influences from attending and residents. DISCUSSION/SIGNIFICANCE: While current ACP research in surgery focuses on physician-led patient engagement in ACP discussions, there is a paucity of research focusing on how to develop a team-based approach to ACP discussions in surgery. This study will provide information necessary for the development of interventions that increase team-based ACP for surgical patients.

Abnormal cell membrane metabolism is associated with many neuropsychiatric disorders. Free phosphomonoesters and phosphodiesters, which can be detected by in vivo 31P magnetic resonance spectroscopy (MRS), are important cell membrane building blocks. However, the quantification of phosphoesters has been highly controversial even in healthy individuals due to overlapping signals from macromolecule membrane phospholipids (MP). In this study, high signal-to-noise ratio (SNR) cerebral 31P MRS spectra were acquired from healthy volunteers at both 3 and 7 Tesla. Our results indicated that, with minimal spectral interference from MP, the [phosphocreatine (PCr)]/[phosphocholine (PC) + glycerophosphocholine (GPC)] ratio measured at 7 Tesla agreed with its value expected from biochemical constraints. In contrast, the 3 Tesla [PCr]/[PC+GPC] ratio obtained using standard spectral fitting procedures was markedly smaller than the 7 Tesla ratio and than the expected value. The analysis suggests that the commonly used spectral model for MP may fail to capture its complex spectral features at 3 Tesla, and that additional prior knowledge is necessary to reliably quantify the phosphoester signals at low magnetic field strengths when spectral overlapping is significant.

Background Evaluation of multiple breath washout (MBW) set-up including staff training, certification and central “over-reading” for data quality control is essential to determine the feasibility of MBW in future bronchiectasis studies. Aims To assess the outcomes of a MBW training, certification and central over-reading programme. Methods MBW training and certification was conducted in European sites collecting lung clearance index (LCI) data in the BronchUK Clinimetrics and/or i-BEST-1 studies. The blended training programme included the use of an eLearning tool and a 1-day face-to-face session. Sites submitted MBW data to trained central over-readers who determined validity and quality. Results Thirteen training days were delivered to 56 participants from 22 sites. Of 22 sites, 18 (82%) were MBW naïve. Participant knowledge and confidence increased significantly (p

Background: The identification of coronary artery calcification (CAC) detected coincidentally on chest CT exams could assist in cardiovascular risk assessment but may not be reported consistently on clinical studies. Cardiovascular risk factor stratification is important to predict short term cardiac events during cancer therapy and long term cardiac event free survival in cancer patients. We sought to determine the prevalence of CAC and clinical reporting rates in a cohort of cancer patients at high risk of cancer therapy related cardiac events. Methods: 408 Breast cancer patients who were referred to a cardiac oncology clinic were screened. Inclusion criteria included having had a CT chest and the absence of known coronary disease. Among those screened 263 patients were included in the study. Results: CAC was identified in 70 patients (26%). CAC was reported in 18% of studies. The reporting rates of CAC increased with the extent of coronary calcification (p

The next generation of devices for personal healthcare monitoring will comprise molecular sensors to monitor analytes of interest in the skin compartment. Transdermal devices based on microneedles offer an excellent opportunity to explore the dynamics of molecular markers in the interstitial fluid, however good acceptability of these next generation devices will require several technical problems associated with current commercially available wearable sensors to be overcome. These particularly include reliability, comfort and cost. An essential pre-requisite for transdermal molecular sensing devices is that they can be fabricated using scalable technologies which are cost effective.We present here a minimally invasive microneedle array as a continuous monitoring platform technology. Method for scalable fabrication of these structures is presented. The microneedle arrays were characterised mechanically and were shown to penetrate human skin under moderate thumb pressure. They were then functionalised and evaluated as glucose, lactate and theophylline biosensors. The results suggest that this technology can be employed in the measurement of metabolites, therapeutic drugs and biomarkers and could have an important role to play in the management of chronic diseases. Keywords: Microneedles, Minimally invasive sensors, Continuous glucose monitoring (CGM), Continuous lactate monitoring (CLM), Interstitial therapeutic drug monitoring (iTDM)

The growing number of security breaches has become a major concern in organisations. Most often, such security breaches are related to internal employees due to their indirect or direct actions leading to information security policy (ISP) violations. Therefore, understanding employees’ security behaviour and intrinsic motivation towards ISP compliance with respect to autonomy is critical. This study aims to find out whether the autonomy intrinsic motivator can be influenced by the Decisions and Disruptions (D-D) table-top game to enhance security awareness and, in turn, reinforce behavioural intention towards ISP compliance. We developed pre- and post-assessment tests on intrinsic motivation to find out whether there is a significant improvement in test scores after participants experience D-D gameplay. Thirty postgraduate students participated in the study. Overall results confirmed that the autonomy intrinsic motivator is positively influenced by the game and has a positive effect on the behavioural intention to comply with ISPs.

Strain imaging provides an accessible, feasible and non-invasive technique to assess cardiac mechanics. Speckle tracking echocardiography (STE) is the primary modality with the utility for detection of subclinical ventricular dysfunction. Investigation and adoption of this technique has increased significantly in both the research and clinical environment. It is therefore important to provide information to guide the sonographer on the production of valid and reproducible data. The focus of this review is to (1) describe cardiac physiology and mechanics relevant to strain imaging, (2) discuss the concepts of strain imaging and STE and (3) provide a practical guide for the investigation and interpretation of cardiac mechanics using STE.

PurposeThe principal excitatory neurotransmitter glutamate plays an important role in many central nervous system disorders. Because glutamate resides predominantly in glutamatergic neurons, its relaxation properties reflect the intracellular environment of glutamatergic neurons. This study developed an improved echo time-independent technique for measuring transverse relaxation time and demonstrated that this radio frequency (RF)-driven longitudinal steady state technique can reliably measure glutamate transverse relaxation in the frontal cortex, where structural and functional abnormalities have been associated with psychiatric symptoms.MethodBloch and Monte Carlo simulations were performed to improve and optimize the RF-driven, longitudinal, steady-state (MARzss) technique to significantly shorten scan time and increase measurement precision. Optimized four-flip angle measurements at 0°,12°, 24°, and 36° with matched repetition time were used in nine human subjects (6F, 3M; 27-49 years old) at 7 Tesla. Longitudinal and transverse relaxation rates for glutamate were measured from a 2 x 2 x 2 cm3 voxel placed in three different brain regions: gray matter-dominated medial prefrontal lobe, white matter-dominated left frontal lobe, and gray matter-dominated occipital lobe.ResultsCompared to the original MARzss technique, the scan time per voxel for measuring glutamate transverse relaxation was shortened by more than 50%. In the medial frontal, left frontal, and occipital voxels, the glutamate T2 was found to be 117.5±12.9 ms (mean ± standard deviation, n = 9), 107.3±12.1 (n = 9), and 124.4±16.6 ms (n = 8), respectively.ConclusionsThe improvements described in this study make the MARZSS technique a viable tool for reliably measuring glutamate relaxation from human subjects in a typical clinical setting. It is expected that this improved technique can be applied to characterize the intracellular environment of glutamatergic neurons in a variety of brain disorders.

Background: Cardiotoxicity from anthracycline-based chemotherapy is an important cause of early and late morbidity and mortality in breast cancer patients. Left ventricular (LV) function is assessed for patients receiving anthracycline-based chemotherapy to identify cardiotoxicity. However, animal studies suggest that right ventricular (RV) function may be a more sensitive measure to detect LV dysfunction. The purpose of this pilot study was to determine if breast cancer patients undergoing anthracycline-based chemotherapy experience RV dysfunction. Methods: Forty-nine breast cancer patients undergoing anthracycline-based chemotherapy at the Ottawa Hospital between November 2007 and March 2013 and who had 2 echocardiograms performed at least 3 months apart were retrospectively identified. Right atrial area (RAA), right ventricular fractional area change (RV FAC) and RV longitudinal strain of the free wall (RV LSFW) were evaluated according to the American Society of Echocardiography guidelines. Results: The majority (48/49) of patients were females with an average age of 53.4 (95% CI: 50.1–56.7 years). From baseline to follow-up study, average LV ejection fraction (LVEF) decreased from 62.22 (95% CI: 59.1–65.4) to 57.4% (95% CI: 54.0–60.9) (P = 0.04). During the same time period, the mean RAA increased from 12.1 cm2 (95% CI: 11.1–13.0 cm2) to 13.8 cm2 (95% CI: 12.7–14.9 cm2) (P = 0.02), mean RV FAC decreased (P = 0.01) from 48.3% (95% CI: 44.8–51.74) to 42.1% (95% CI: 38.5–45.6%), and mean RV LSFW worsened from −16.2% (95% CI: −18.1 to −14.4%) to −13.81% (95% CI: −15.1 to −12.5%) (P = 0.04). Conclusion: This study demonstrates that breast cancer patients receiving anthracycline-based chemotherapy experience adverse effects on both right atrial size and RV function. Further studies are required to determine the impact of these adverse effects on right heart function and whether this represents an earlier marker of cardiotoxicity.

Multiple projects within the rail industry across different regions have been initiated to address the issue of over-population. These expansion plans and upgrade of technologies increases the number of intersections, junctions, and level crossings. A level crossing is where a railway line is crossed by a road or right of way on the level without the use of a tunnel or bridge. Level crossings still pose a significant risk to the public, which often leads to serious accidents between rail, road, and footpath users and the risk is dependent on their unpredictable behavior. For Great Britain, there were three fatalities and 385 near misses at level crossings in 2015–2016. Furthermore, in its annual safety report, the Rail Safety and Standards Board (RSSB) highlighted the risk of incidents at level crossings during 2016/17 with a further six fatalities at level crossings including four pedestrians and two road vehicles. The relevant authorities have suggested an upgrade of the existing sensing system and the integration of new novel technology at level crossings. The present work addresses this key issue and discusses the current sensing systems along with the relevant algorithms used for post-processing the information. The given information is adequate for a manual operator to make a decision or start an automated operational cycle. Traditional sensors have certain limitations and are often installed as a “single sensor”. The single sensor does not provide sufficient information; hence another sensor is required. The algorithms integrated with these sensing systems rely on the traditional approach, where background pixels are compared with new pixels. Such an approach is not effective in a dynamic and complex environment. The proposed model integrates deep learning technology with the current Vision system (e.g., CCTV to detect and localize an object at a level crossing). The proposed sensing system should be able to detect and localize particular objects (e.g., pedestrians, bicycles, and vehicles at level crossing areas.) The radar system is also discussed for a “two out of two” logic interlocking system in case of fail-mechanism. Different techniques to train a deep learning model are discussed along with their respective results. The model achieved an accuracy of about 88% from the MobileNet model for classification and a loss metric of 0.092 for object detection. Some related future work is also discussed.

Category: Ankle Introduction/Purpose: The Internet has drastically changed how patients access health-related information. There are several ways the public can access online health-related information such as search engines, blogs, support groups and webinars. A recent study found that 45% of orthopedic patients searched for information online regarding their injury. Also, 78% believed they had better understanding of their condition after visiting these websites; furthermore, 41% felt the Internet supplied them with questions and concerns to discuss with their physicians. While most patients experience favorable outcomes after proper management of an isolated ankle sprain, inadequate treatment can lead to chronic ankle instability. The aim of our study is to evaluate the accuracy, quality and readability of online available information using the search terms “ankle sprain” and “ankle instability”. Methods: Three websites [Google, Bing, and Yahoo] were searched for the terms “ankle sprain” and “ankle instability”. The first 25 websites from each search were collected. After removal of duplicates, 65 websites were left for evaluation. Nine websites were excluded: contained video links only (n=3), lacked information (n=3), presented unrelated information (n=2), or was not written in English (n=1). A total of 56 websites met the inclusion criteria. Each website was assessed for quality, accuracy, and readability by three orthopedic residents blinded to the search term utilized. The quality was evaluated using a previously developed grading rubric containing 25 points pertaining to relevant anatomy, diagnosis, treatment, and complications of ankle sprains. The accuracy of the websites was assessed using a scale from 1-4. The Flesch-Kincaid (F-K) scale was used to evaluate readability of the websites. Lastly, websites were evaluated for any commercial bias and whether written by physicians or not. Results: Table 1 displays the quality results of all websites. The mean quality of websites written >7th grade level was statistically significantly higher than those written at =7th grade (p=0.01). A summary of the accuracy results is depicted in Table 2. The mean accuracy of websites written >7th grade level was statistically higher than websites written at =7th grade level (p=0.01). Only six websites (10.7%) included in this study were written at a 7th grade level or below. Multivariable regression analysis revealed the accuracy of websites was significantly associated with the F-K score and absence of commercial bias. Furthermore, the quality of websites was positively correlated with the F-K score, use of the search term “ankle instability”, websites written by physicians, and absence of commercial bias. Conclusion: The current study highlights the poor quality and accuracy of online information related to ankle sprains, especially those with commercial bias. Furthermore, while websites written by or under supervision of physicians were found of superior quality, a majority of sites were found to have an unacceptably high reading level. As the importance of health literacy becomes more apparent, it is critical to remember the physician’s role in guiding patients to high quality and accurate resources written at an appropriate level.

Category: Ankle Introduction/Purpose: The Centers for Medicare and Medicaid services (CMS) have implemented initiatives to improve post-discharge care and reduce unnecessary readmissions. Readmissions within 30-days are frequent and represent an economic burden on patients and the healthcare system alike. A recent study reported a 3.17% readmission rate after open reduction and internal fixation (ORIF) of ankle fractures. While readmission implies inpatient-discharge to inpatient-readmission, patients may present to urgent care facilities and receive medical treatment without being admitted. This too has socioeconomic implications. The incidence and reasons for urgent care visits following ankle fracture surgery has not been studied. The aim of this study is to evaluate the frequency and causes for urgent care visits within 30-days of discharge after ankle ORIF and determine factors correlated with such visits. Methods: This was a retrospective analysis of prospectively collected data. All patients who underwent ankle ORIF at our institution between 7/1/2016 and 6/30/2017 were included. Patients were identified using CPT codes for ankle ORIF ((27814, 27822, 27823, 27792, 27766, and 27829). Patients less than 18 years of age, with open fractures or with other appendicular or axial skeleton injuries were excluded. Patients’ demographics including age, sex, race, BMI, occupation, insurance payer and comorbidities were documented. The primary outcome of our study was to determine the frequency of urgent care visits within 30-days of discharge after ankle ORIF. Our secondary goals were to evaluate the association between urgent care visits and demographics, and identify the reason for post-operative urgent care utilization. Results: A total of 333 patients met the inclusion criteria. Fifty four percent of our cohort were males. Thirty five patients (10.51%) had urgent care visits with 30-days of discharge. Patients presented at a mean of 11.83 days from the day of surgery. Sixteen patients (45.71%) had cast/splint related issues, seven (20%) presented with pain and seven (20%) with increased surgical site drainage (Fig 1). Univariable analysis demonstrated a statistically significant association between post-operative urgent care utilization and patients with diabetes (p=0.03) and underlying psychiatric disorders (p=0.03). Conclusion: In this population study of patients undergoing ankle fracture surgery who underwent ankle ORIF, we found that the rate of urgent care visits within 30-days of discharge exceeds the rate of inpatient readmission. Additionally, patients with diabetes and psychiatric disorders are significantly more likely to present to an urgent care facility post-operatively. This is an important finding, as there are large costs to the healthcare system associated with this. Future studies must identify additional risk factors and means of reducing such added costs to our already stressed healthcare system.

Microarrays are a powerful tool for studying differential gene expression. However, lists of many differentially expressed genes are often generated, and unraveling meaningful biological processes from the lists can be challenging. For this reason, investigators have sought to quantify the statistical probability of compiled gene sets rather than individual genes. The gene sets typically are organized around a biological theme or pathway. We compute correlations between different gene set tests and elect to use Fisher's self-contained method for gene set analysis. We improve Fisher's differential expression analysis of a gene set by limiting the p-value of an individual gene within the gene set to prevent a small percentage of genes from determining the statistical significance of the entire set. In addition, we also compute dependencies among genes within the set to determine which genes are statistically linked. The method is applied to T-ALL (T-lineage Acute Lymphoblastic Leukemia) to identify differentially expressed gene sets between T-ALL and normal patients and T-ALL and AML (Acute Myeloid Leukemia) patients.

The advantages of using 2H2O to quantify cholesterol synthesis include i) homogeneous precursor labeling, ii) incorporation of 2H via multiple pathways, and iii) the ability to perform long-term studies in free-living subjects. However, there are two concerns. First, the t1/2 of tracer in body water presents a challenge when there is a need to acutely replicate measurements in the same subject. Second, assumptions are made regarding the number of hydrogens (n) that are incorporated during de novo synthesis. Our primary objective was to determine whether a step-based approach could be used to repeatedly study cholesterol synthesis a subject. We observed comparable changes in the 2H-labeling of plasma water and total plasma cholesterol in African-Green monkeys that received five oral doses of 2H2O, each dose separated by one week. Similar rates of cholesterol synthesis were estimated when comparing data in the group over the different weeks, but better reproducibility was observed when comparing replicate determinations of cholesterol synthesis in the same nonhuman primate during the respective dosing periods. Our secondary objective was to determine whether n depends on nutritional status in vivo; we observed n of ∼25 and ∼27 in mice fed a high-carbohydrate (HC) versus carbohydrate-free (CF) diet, respectively. We conclude that it is possible to acutely repeat studies of cholesterol synthesis using 2H2O and that n is relatively constant.

Focusing on the faculty of intuition, my essay considers different ways that Aby Warburg (1866-1929) and Erwin Panofsky (1892-1968) interpret the late Renaissance cosmographer, Giordano Bruno. It argues that Warburg, in the last year of his life and with the help of Ernst Cassirer (1874-1945), appropriates the concept of synderesis from Bruno not only to rethink the Nachleben der Antike but also to inscribe himself in the history of word and image, a history that admits the irrational and the mystical as much as the rational. By contrast, Panofsky's Bruno is ultimately a more dialectical, prudential figure. Over the course of several decades, Bruno for Panofsky becomes symbolic of the possibility of "synthesis," the aim of his iconological method. This, however, diminishes the dynamism of Bruno's imagery, even as it gives intuition a more systematic role.

This study estimated the proportions and numbers of heterosexuals in the United States (U.S.) to calculate rates of heterosexually acquired human immunodeficiency virus (HIV) infection. Quantifying the burden of disease can inform effective prevention planning and resource allocation.Heterosexuals were defined as males and females who ever had sex with an opposite-sex partner and excluded those with other HIV risks: persons who ever injected drugs and males who ever had sex with another man. We conducted meta-analysis using data from 3 national probability surveys that measured lifetime (ever) sexual activity and injection drug use among persons aged 15 years and older to estimate the proportion of heterosexuals in the United States population. We then applied the proportion of heterosexual persons to census data to produce population size estimates. National HIV infection rates among heterosexuals were calculated using surveillance data (cases attributable to heterosexual contact) in the numerators and the heterosexual population size estimates in the denominators.Adult and adolescent heterosexuals comprised an estimated 86.7% (95% confidence interval: 84.1%-89.3%) of the U.S. population. The estimate for males was 84.1% (CI: 81.2%-86.9%) and for females was 89.4% (95% CI: 86.9%-91.8%). The HIV diagnosis rate for 2013 was 5.2 per 100,000 heterosexuals and the rate of persons living with diagnosed HIV infection in 2012 was 104 per 100,000 heterosexuals aged 13 years or older. Rates of HIV infection were >20 times as high among black heterosexuals compared to white heterosexuals, indicating considerable disparity. Rates among heterosexual men demonstrated higher disparities than overall population rates for men.The best available data must be used to guide decision-making for HIV prevention. HIV rates among heterosexuals in the U.S. are important additions to cost effectiveness and other data used to make critical decisions about resources for prevention of HIV infection.

People with dementia are not dying; they are experiencing changes in the brain. This paper utilizes a symbolic interaction theoretical perspective to outline communicative alternatives to polypharmacy. There is a growing interest in sociological interventions to untangle the “disordered discourses” associated with dementia. Such practices challenge common stigmas attached to dementia as an “ongoing funeral” or “death certificate.” Changing the expectations, attitudes and communication patterns of family care partners can positively impact them and the person living with dementia at the end of life. This paper delineates multiple non-verbal communication interventions (e.g., the trip back in time, dementia citizenship and sensory engagement modalities) to explore techniques to engage persons with advanced dementia.

The study discussed in this investigation is part of a larger collaborative initiative between Laureate Education and Cambridge University Press (LEP-CUP collaboration). This second phase of the research, completed in 2013, aimed to further explore the conclusions from phase 1 and set out to identify effective and appropriate best practice blended learning models within the network. A study was set up with 36 teachers, all experienced ELT teachers with differing levels of experience in blended language teaching, who took part in extended focus groups discussions sessions prompted by a series of questions. Responses from these groups of teachers indicated that a flipped classroom model is beginning to develop. The authors of this study found evidence of changing approaches to language teaching, changes that are not without their challenges, but for a number of the teachers who participated in this research sample these changes are bringing considerable benefit to their teaching experience. This study offered teachers another opportunity to become change managers for students who need to acquire the autonomous, life-long learning skills of the 21st as they transition into professional life. The scope of this study cannot address and solve all of the issues involved in this process, but it provides a step towards that end. DOI: 10.18870/hlrc.v4i3.213

Objectives: To determine the prevalence of prevention counseling discussions between HIV care providers and their patients who are newly linked to care and to assess factors that facilitate such discussions. Methods: In 2009, a probability sample of HIV care providers in 582 outpatient settings in the United States and Puerto Rico was surveyed regarding provider’s HIV prevention discussions with HIV-infected patients newly linked to HIV medical care. Results: A majority of providers reported consistently discussing HIV transmission risk reduction (76%), sexually transmitted disease risk (66%), and adherence to antiretroviral regimens (87%). Only 35% of providers reported consistently discussing partner counseling services. Conclusion: The proportion of providers engaged in HIV prevention counseling with patients newly linked to HIV care is generally high, but more work is needed to encourage providers to fully participate as partners in prevention, which is central to preventing onward transmission of HIV.

A 49-year-old patient with metastatic carcinoma of the bladder and no prior history of heart disease presented with diffuse ST elevation, elevated troponins, and biventricular dysfunction requiring intensive care unit admission and inotropic support after receiving her first course of infusional 5-fluorouracil (5-FU). Over the course of several days, the patient’s cardiac function and clinical status returned to baseline. A follow-up echocardiogram performed 5 days after initial presentation revealed an ejection fraction of 59 percent, with no evidence of wall motion abnormalities. Subsequent 5-FU chemotherapy was discontinued, and the patient went on to receive second-line chemotherapy.

BACKGROUND: Injection drug use provides an efficient mechanism for transmitting bloodborne viruses, including human immunodeficiency virus (HIV) and hepatitis C virus (HCV). Effective targeting of resources for prevention of HIV and HCV infection among persons who inject drugs (PWID) is based on knowledge of the population size and disparity in disease burden among PWID. This study estimated the number of PWID in the United States to calculate rates of HIV and HCV infection. METHODS: We conducted meta-analysis using data from 4 national probability surveys that measured lifetime (3 surveys) or past-year (3 surveys) injection drug use to estimate the proportion of the United States population that has injected drugs. We then applied these proportions to census data to produce population size estimates. To estimate the disease burden among PWID by calculating rates of disease we used lifetime population size estimates of PWID as denominators and estimates of HIV and HCV infection from national HIV surveillance and survey data, respectively, as numerators. We calculated rates of HIV among PWID by gender-, age-, and race/ethnicity. RESULTS: Lifetime PWID comprised 2.6% (95% confidence interval: 1.8%-3.3%) of the U.S. population aged 13 years or older, representing approximately 6,612,488 PWID (range: 4,583,188-8,641,788) in 2011. The population estimate of past-year PWID was 0.30% (95% confidence interval: 0.19 %-0.41%) or 774,434 PWID (range: 494,605-1,054,263). Among lifetime PWID, the 2011 HIV diagnosis rate was 55 per 100,000 PWID; the rate of persons living with a diagnosis of HIV infection in 2010 was 2,147 per 100,000 PWID; and the 2011 HCV infection rate was 43,126 per 100,000 PWID. CONCLUSION: Estimates of the number of PWID and disease rates among PWID are important for program planning and addressing health inequities.

The aim of this case study is to describe the implementation of the Laureate English Program (LEP), the consequent decision to roll out blended learning across the network, and the Laureate-Cambridge University Press research partnership. Phase 1 of the research was completed in September 2012. The goal of this first phase was to gain a general understanding of student profile, computer literacy and competence, student levels of achievement, and student feedback on their blended learning experience. Six hundred and forty-eight students and 35 teachers responded to a questionnaire, which included multiple choice questions and open ended questions requiring extended comment. The questionnaires revealed that less than 25% of the Laureate student group had ever learned a language online before, which impacted significantly on student perception and use of online learning content. Furthermore, the first phase of research has revealed the impact that a complex interplay of different factors has on the relative effectiveness of these blended programs, and it has acknowledged that research is central to informed decision making in order to provide for effective blended learning. DOI: 10.18870/hlrc.v3i1.103

Background. We established a dedicated cardiac oncology clinic in 2008 for the rapid diagnosis and treatment of cardiotoxicity related to cancer therapy. In this retrospective observational study, we report on clinical outcomes in women with early-stage breast cancer (EBC) referred to this clinic. Methods. Patients with EBC treated with chemotherapy/trastuzumab and referred between October 2008 and December 2010. Data included patient demographics, staging, cancer treatment/completion, dose delays, left ventricular ejection fraction (LVEF) and cardiac treatment. Results. Forty eight patients: median age 55.5 years, stage I/II disease (77%) and HER-2 positive (98%). The majority of women (n=32) were referred for decreases in LVEF (from baseline). Overall, 37 (77%) patients experienced at least one drop in LVEF while on treatment, of which 22 patients (59%) experienced a ≥10 percentage point drop. The majority of patients (30/37; 81%) experienced declines in LVEF while on trastuzumab. Interventions included trastuzumab delays (n=16/48; 33%) and cardiac medication (12/48: 25%). A total of 81% of patients completed ≥90% of trastuzumab therapy and 15% of patients discontinued therapy due to cardiotoxicity. Conclusion. The majority of patients referred to our clinic completed therapy. Further studies are needed to determine the impact of this multidisciplinary approach on treatment completion and cardiac outcomes.