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A correct injection technique is essential in order to ensure the effectiveness of insulin and to achieve good metabolic control, and the use of suitable needles is fundamental. Today, technological evolution has transformed insulin needles into innovative tools able to guarantee an effective and safe administration of insulin, to reduce local complications, such as lipodystrophies that are an obstacle to the effectiveness of the treatment itself, and to minimize the pain of the injection, a crucial factor in the acceptance of therapy and for compliance. The steering committee of the scientific society SIMDO has commissioned the scientific committee and some members of the board to draw up an official SIMDO point of view/consensus on the use of insulin needles. In this way, a group that has combined the experience gained in their field of expertise—diabetologists operating in the public and private sectors, nurses, psychologists, and patients—was set up. The aim is to give indications regarding insulin injection techniques, combining themes such as technology innovation, education in self-management, and psychological support for the patient into a unified approach based on the priority area of patient quality of life. The document will provide operational recommendations that integrate the directions regarding the standards of care for diabetes resulting from the most recent scientific acquisitions with the concept of quality at 360°, as it emerged from the point of view of all the operators involved, but with the patient’s interests as a central focal point.

PurposeThis study aims to describe the cohort of Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) research program participants and evaluate whether the ATN's recently completed 5-year cycle recruited study participants who parallel the populations most impacted by HIV in the United States.MethodsHarmonized measures across ATN studies collected at baseline were aggregated for participants aged 13-24 years. Pooled means and proportions stratified by HIV status (at risk for or living with HIV) were calculated using unweighted averages of study-specific aggregate data. Medians were estimated using a weighted median of medians method. Public use 2019 Centers for Disease Control and Prevention surveillance data for state-level new HIV diagnoses and HIV prevalence among US youth aged 13-24 years were obtained for use as reference populations for ATN at-risk youth and youth living with HIV (YLWH), respectively.ResultsData from 3,185 youth at-risk for HIV and 542 YLWH were pooled from 21 ATN study phases conducted across the United States. Among ATN studies tailored to at-risk youth, a higher proportion of participants were White and a lower proportion were Black/African American and Hispanic/Latinx compared to youth newly diagnosed with HIV in the United States in 2019. Participants in ATN studies tailored to YLWH were demographically similar to YLWH in the United States.DiscussionThe development of data harmonization guidelines for ATN research activities facilitated this cross-network pooled analysis. These findings suggest the ATN's YLWH are representative, but that future studies of at-risk youth should prioritize recruitment strategies to enroll more participants from African American and Hispanic/Latinx populations.

Resumen Este artículo es un ejercicio de reflexividad sobre investigaciones etnográficas propias de la infección por SARS-CoV-2 realizadas en 2020-2021. Se analizan aquí experiencias, narrativas y políticas de diagnóstico y control de la circulación del virus en tres ciudades de diferente escala urbana de Argentina. Realizado en la postpandemia, nuestro análisis se propone aportar al estudio del fenómeno sanitario desde la antropología social, ofreciendo recomendaciones para la planificación y gestión de futuros y probables confinamientos. Concluimos que nuestra contribución como científicas sociales es la comprensión del fenómeno sanitario en el marco de desigualdades estructurales, emergiendo la necesidad de planificar la prevención por confinamiento a escalas micro, meso y macro sociales.

Pursuing sustainable energy solutions has prompted researchers to focus on optimizing energy extraction from renewable sources. Control laws that optimize energy extraction require accurate modeling, often resulting in time-varying, nonlinear differential equations. An energy-maximizing optimal control law is derived for time-varying, nonlinear, second-order, energy harvesting systems. We demonstrate that sustaining periodic motion under this control law when subjected to periodic disturbances necessitates identifying appropriate initial conditions, inducing the system to follow a limit cycle. The general optimal solution is applied to two point absorber wave energy converter models: a linear model where the analytical derivation of initial conditions suffices and a nonlinear model demanding a numerical approach. A stable limit cycle is obtained for the latter when the initial conditions lie within an ellipse centered at the origin of the phase plane. This work advances energy-maximizing optimal control solutions for nonautonomous nonlinear systems with application to point absorbers. The results also shed light on the significance of initial conditions in achieving physically realizable periodic motion for periodic energy harvesting systems.

Wave energy holds significant promise as a renewable energy source due to the consistent and predictable nature of ocean waves. However, optimizing wave energy devices is essential for achieving competitive viability in the energy market. This paper presents the application of a nonlinear model predictive controller (MPC) to enhance the energy extraction of a heaving point absorber. The wave energy converter (WEC) model accounts for the nonlinear dynamics and static Froude–Krylov forces, which are essential in accurately representing the system’s behavior. The nonlinear MPC is tested under irregular wave conditions within the power production region, where constraints on displacement and the power take-off (PTO) force are enforced to ensure the WEC’s safety while maximizing energy absorption. A comparison is made with a linear MPC, which uses a linear approximation of the Froude–Krylov forces. The study comprehensively compares power performance and computational costs between the linear and nonlinear MPC approaches. Both MPC variants determine the optimal PTO force to maximize energy absorption, utilizing (1) a linear WEC model (LMPC) for state predictions and (2) a nonlinear model (NLMPC) incorporating exact Froude–Krylov forces. Additionally, the study analyzes four controller configurations, varying the MPC prediction horizon and re-optimization time. The results indicate that, in general, the NLMPC achieves higher energy absorption than the LMPC. The nonlinear model also better adheres to system constraints, with the linear model showing some displacement violations. This paper further discusses the computational load and power generation implications of adjusting the prediction horizon and re-optimization time parameters in the NLMPC.

Although evidence of the benefits of breastfeeding is widespread, there are several challenges to initiate and sustain it. Infant formula companies use marketing strategies that violate existing regulations, contributing to its early abandonment. We explore the digital marketing exposure of infant formulas in Argentina by analyzing people’s interactions with brands and the traces of these interactions in conversations engaged in Facebook groups during 2022, from a qualitative approach based on digital ethnography. Results show that companies deploy regulatory avoidance tactics and seek contact with mothers. Users do not interact with the accounts but are exposed to their strategies given the correlation between product attributes present in advertising with their motivations and aspirations. The mediators between marketing and mothers are medical professionals, used as marketing resources. We conclude that authorities should promote new agreements on the practices of medical professionals and develop regulations taking into account digital environments.

In the face of declining vaccination coverage and the dissemination of health-related information, conversations in the public/mediatic digital sphere constitute a relevant study area for the field of health communication. Through a qualitative study based on the analysis of government publications, digital press, and social media, we characterize the public conversation on vaccines – in terms of topics, moments, axes, and framings in Argentina during the 2020-2021 period – marked by the debate on covid-19 vaccines. The results show that public conversation focused on covid-19 vaccination, structured in two distinct moments (vaccine production and vaccination campaign), and under moral framings grounded in vaccination as a care practice and science as an authoritative voice. Simultaneously, doubts about the safety and efficacy of vaccines shaped arguments of vaccine hesitancy, which we understand as part of extended practices associated with distrust towards institutions and reinterpretations of scientific knowledge and care.

High Temperature Hydrogen Attack (HTHA) is a wellknown phenomenon that impacts the design, operation, and maintenance for syngas production facilities (e.g., hydrogen and carbon monoxide plants). Recommendations regarding material selection and inspection are given by API 941 and API RP 586 [1], that is currently under revision after Tesoro accident. The new rules have highlighted the need to adapt inspection with more advanced NDT methodology, improving the detection of early stage HTHA damage, then supporting a Fitness for Service approach. This paper makes an overview of various projects funded by Materials Technology Institute (MTI) regarding the assessment and improvement of the performance of such UT advanced NDT for HTHA detection, by means of CIVA UT simulations after a detailed metallographic review and statistical modeling of material inclusions and HTHA damage distributions of field samples. HTHA damage inputs and comparisons between experimental and simulated UT images are consistent for different damaged samples (different levels and types of damage, especially for welded samples), different UT acquisition settings and different inspection frequencies. The unprecedented use of HTHA damage distribution laws and NDT simulations of nonmetallic defects and HTHA damage are promising tools which may then used to assess the limits of existing NDT and to define optimized probes and procedures relying on advanced ultrasonic examinations.

Abstract Background The management of sub-totally resected sporadic vestibular schwannoma (VS) may include observation, re-resection or irradiation. Identifying the optimal choice can be difficult due to the disease’s variable progression rate. We aimed to define an immune signature and associated transcriptomic fingerprint characteristic of rapidly-progressing VS to elucidate the underpinnings of rapidly progressing VS and identify a prognostic model for determining rate of progression. Methods We used multiplex immunofluorescence to characterize the immune microenvironment in 17 patients with sporadic VS treated with subtotal surgical resection alone. Transcriptomic analysis revealed differentially-expressed genes and dysregulated pathways when comparing rapidly-progressing VS to slowly or non-progressing VS. Results Rapidly progressing VS was distinctly enriched in CD4+, CD8+, CD20+, and CD68+ immune cells. RNA data indicated the upregulation of anti-viral innate immune response and T-cell senescence. K − Top Scoring Pair analysis identified 6 pairs of immunosenescence-related genes (CD38-KDR, CD22-STAT5A, APCS-CXCR6, MADCAM1-MPL, IL6-NFATC3, and CXCL2-TLR6) that had high sensitivity (100%) and specificity (78%) for identifying rapid VS progression. Conclusion Rapid progression of residual vestibular schwannoma following subtotal surgical resection has an underlying immune etiology that may be virally originating; and despite an abundant adaptive immune response, T-cell immunosenescence may be associated with rapid progression of VS. These findings provide a rationale for clinical trials evaluating immunotherapy in patients with rapidly progressing VS.

Soft tissue sarcomas (STS) invading the skull base are rare with little data to guide surgical management. Here we aimed to determine the factors affecting tumor control rates and survival in patients with T4 stage head and neck STS involving the skull base. A retrospective review of STS patients, surgically treated at our institution between 1994 and 2017 was conducted. Variables were collected and assessed against progression-free survival. Tumors were graded using the Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC) system. A total of 51 patients (mean age of 35) were included, of whom 17 (33.3%) patients were FNCLCC grade 1, 8 (15. 7%) were FNCLCC grade 2 and 26 (51%) were FNCLCC grade 3. The median PFS was 236.4 months while the 5- and 10-year PFS rates were 44% and 17%, respectively. Recurrence occurred in 17 (33.3%) patients. Local recurrence occurred in 10 (58.8%). Univariate analysis revealed R0 resection had a near-significant impact on tumor control in radiation-naïve patients. Otherwise, prior radiation (HR 6.221, CI 1.236–31.314) and cavernous sinus involvement (HR 14.464, CI 3.326–62.901) were negative predictors of PFS. The most common cause of treatment failure was local recurrence. In T4 stage head and neck STS with skull-base involvement, FNCLCC grade, radiation status, and anatomic spread should be considered in determining the overall treatment strategy.

Objective Spinal reconstruction after resection of invasive craniocervical junction malignancies is fraught with technical and management considerations as well as a paucity of data in the existing literature. In this study, we describe our experience with craniocervical junction malignancies, especially the influence of radiation on the need for revision spinal instrumentation. Methods We performed a retrospective chart review of all patients who underwent occipitocervical fixation between 2011 and 2019 at The University of Texas MD Anderson Cancer Center. Results Twenty-five patients had primary malignancies and 12 (30%) had metastatic tumors. Thirteen (33%) underwent a staged resection in multiple operations during their hospital stay. Tumor resection was performed in 19 patients (48%), while only stabilization was performed in 21 patients (52%). Nine patients (23%) underwent expanded endoscopic transclival approaches for tumor resection, 10 patients (25%) an extreme lateral approach, and 2 patients (5%) an anterior open approach. Eleven patients underwent early postoperative radiation therapy (within 3 months) and 8 underwent delayed radiation therapy (between 3 months and 1 year in 7 patients). The revision rate was 8%, with a median time to revision surgery of 42 months. The administration and timing of adjuvant radiation therapy relative to surgery had no significant effect on the need for instrumentation revision on log-rank and Cox regression analyses (p < 0.05). Conclusion Revision surgery was needed infrequently in our patients. Postoperative radiation therapy was not associated with hardware failure, indicating that the timing of radiation therapy should be dictated by the diagnosis and can be initiated postoperatively without delay.

Background: Treatment for dural recurrence of olfactory neuroblastoma (ONB) is not standardized. We assess the outcomes of stereotactic body radiotherapy (SBRT) in this population. Methods: ONB patients with dural recurrences treated between 2013 and 2022 on a prospective registry were included. Tumor control, survival, and patient‐reported quality of life were analyzed. Results: Fourteen patients with 32 dural lesions were evaluated. Time to dural recurrence was 58.3 months. Thirty lesions (94%) were treated with SBRT to a median dose of 27 Gy in three fractions. Two patients (3 of 32 lesions; 9%) developed in‐field radiographic progression, five patients (38%) experienced progression in non‐contiguous dura. Two‐year local control was 85% (95% CI: 51–96%). There were no >grade 3 acute toxicities and 1 case of late grade 3 brain radionecrosis. Conclusion: In this largest study of SBRT reirradiation for ONB dural recurrence to date, high local control rates with minimal toxicity were attainable. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to investigate the safety of induction chemotherapy (IC) for patients with sinonasal malignancies with brain invasion or a neurological deficit. Methods We conducted a retrospective analysis of patients who underwent IC for sinonasal malignancies with intracranial invasion or a neurological deficit at a single tertiary cancer center from 1992 to 2020. Results In total, 460 patients with sinonasal malignancies were included in the study. Of the patients reviewed, 341 underwent IC and within this group 40 had brain invasion (BI) and 31 had a neurological deficit (ND) at presentation. The most prevalent malignancy was sinonasal undifferentiated carcinoma (BI 40%, ND 41.9%), followed by esthesioneuroblastoma (BI 27.5%, ND 9.7%). All tumors were stage T4 with the majority lacking nodal metastases (BI N0: 72.5%, ND N0: 77.5%). All patients completed at least two cycles of IC. Partial or complete response to IC was seen in 80% of BI and 71% of ND patients. No patients had cessation of treatment due to neurologic decline and none required urgent surgery. Five patients (12.5%) with BI and 2 (6.5%) with ND had interruption of IC for reasons other than neurological decline. In patients with ND, IC led to improvement of 54.5% NDs. Conclusion In patients with sinonasal malignancies with BI or ND who underwent IC, no patients had cessation of treatment due to neurologic decline. In contrast, most patients had improvement of neurologic symptoms with IC. IC was safely administered without interruption due to neurological decline or symptom progression. [ABSTRACT FROM AUTHOR]

Chronic pain is an important and understudied comorbidity in people living with HIV (PLWH). We conducted a pilot trial of Skills TO Manage Pain (STOMP), an innovative social cognitive theory-based pain self-management intervention tailored to PLWH, to assess feasibility, acceptability, and preliminary efficacy. Eligibility criteria included being HIV+, ≥ moderate pain for ≥ 3 months and a score of ≥ 4 on the three-item PEG pain severity and interference scale. Participants were randomized in a 1:1 fashion to STOMP or a usual care comparison. Among 22 participants randomized to STOMP, median session attendance was 9/12 (75%). Of 19 STOMP participants surveyed, 13 reported being "much better" overall since beginning treatment. Brief pain inventory-total scores decreased by 2 points in the intervention group and 0.9 in the control group (p = 0.11). STOMP is feasible, acceptable, and shows preliminary evidence of efficacy and promise for a full-scale trial.

Chronic pain is an important comorbidity among individuals with HIV. Behavioral interventions are widely regarded as evidence-based, efficacious non-pharmacologic interventions for chronic pain in the general population. An accepted principle in behavioral science is that theory-based, systematically-developed behavioral interventions tailored to the unique needs of a target population are most likely to be efficacious. Our aim was to use Intervention Mapping to systematically develop a Social Cognitive Theory (SCT)-based intervention for chronic pain tailored to individuals with HIV that will improve pain intensity and pain-related functional impairment. Our Intervention Mapping process was informed by qualitative inquiry of 24 patients and seven providers in an HIV primary care clinic. The resulting intervention includes group and one-on-one sessions and peer and staff interventionists. We also developed a conceptual framework that integrates our qualitative findings with SCT-based theoretical constructs. Using this conceptual framework as a guide, our future work will investigate the intervention's impact on chronic pain outcomes, as well as our hypothesized proximal mediators of the intervention's effect.

Objetivos. Se describen y analizan las prácticas alimentarias de sectores medios del Área Metropolitana de Buenos Aires durante el confinamiento, identificando cambios, continuidades y argumentos en función de representaciones sobre alimentación saludable que han estructurado esas prácticas en la prepandemia. Métodos. Metodológicamente se apeló a datos cuantitativos y cualitativos de fuentes primarias en el marco de diseños exploratorio/descriptivos. Resultados y conclusiones. Los resultados muestran la centralidad adquirida por la alimentación cotidiana durante el confinamiento, guiada por un patrón de prácticas y representaciones preexistente asociado con la tensión entre la salud y el placer, que se traduce en la vigilancia del peso corporal.

The decline in vaccination coverage associated with the population’s mistrust of vaccines has been defined as a global health threat. Adopting a qualitative approach centered on the social significance of vaccines, we conducted semi-structured interviews with mothers and fathers in the City of Buenos Aires between July and December 2020. We describe and analyze their knowledge and the arguments used to justify their acceptance or reluctance to vaccinate their children in the context of COVID-19. The results show that the studied population possesses knowledge about vaccines and accepts them as a preventive practice. Nonetheless, it was possible to identify a broad spectrum of attitudes towards vaccination, including more reticent positions based on concerns regarding their safety, adverse effects, and the need to apply them for eradicated diseases, proposing vaccination as an optional and complementary practice to other care practices. Arguments are organized under the assumption of individual and moral responsibility for health care, an expression of the current sociocultural and health backdrop.

Abstract Background Chronic low back pain (cLBP) is the leading cause of disability among older adults and one of the top reasons for seeking healthcare, resulting in significant decrements in physical functioning. Because older adults are among the fastest growing cohorts in the USA, both the incidence and burden of cLBP are expected to increase considerably, rendering geriatric pain management a top health priority. Resilience is defined as a process allowing individuals to adapt and recover from adverse and stressful conditions, and it has been highlighted as a crucial factor in positive health-related functioning. While a growing body of literature supports the use of resilience-based interventions in chronic pain, research examining their effectiveness in older adults with cLBP remains limited. The primary aims of the study are to assess the feasibility and acceptability of a psychologically oriented resilience intervention among aging adults with cLBP. Methods In this article, we describe the rationale and design of the Adaptability and Resilience in Aging Adults (ARIAA) study, a single-arm intervention in which 60 participants (ages ≥ 60 years) with cLBP will be recruited to participate in a 7-week group-based program aimed at enhancing psychological resilience. Intervention sessions will target positive psychology concepts (e.g., positive affect, pain acceptance, hopeful thinking, pain self-efficacy) and cognitive behavioral techniques that have established benefits in pain management. Primary study outcomes include intervention feasibility and acceptability as measured by treatment engagement, intervention credibility and satisfaction, ability to meet recruitment and retention metrics, and the feasibility of questionnaire and home activity completion. Outcomes will be assessed at baseline, immediately at posttreatment, and at the 3-month follow-up period. Discussion This study will establish the feasibility and acceptability of a novel intervention aimed at enhancing positive, psychological functioning, and resilience in older adults with cLBP. Achievement of these aims will provide a rich platform for future intervention research targeting improvements in pain and disability among geriatric populations and will serve as a foundation for a fully powered trial to examine treatment efficacy of the proposed intervention. Trial registration Clinicaltrials.gov, identifier NCT04068922 . Registered 28 August 2019.