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Introduction Nationally, women of African heritage die at higher rates from breast cancer than women of other races or ethnicities. We developed Breast Cancer Champions (BCC) a peer-to-peer education program, which recruited 12 women and deployed them into the community in August 2020 during the height of the COVID-pandemic. BCC aims to improve breast cancer screening rates for women of African heritage through peer-to-peer education, which has proven successful for addressing cancer-related health disparities. Methods BCC community experts, or “Champions,” are peer-to-peer educators that conduct awareness and screening events in their communities. Champion's education activities were tracked by bi-weekly check-in calls, which recorded the activity type, location, and the number of participants for each event. We used spatial and statistical analyses to determine the efficacy of the program at increasing screening rates for women within the area of Champion activity versus women outside of their activity area. Results Over 15 months, Champions conducted 245 in-person or online events to engage women in their community for screening. More women of African heritage were screened in areas champions were active during the intervention compared to historical data comparing areas outside of the Champion activity in the prior 15 months (X 2 = 3.0845, p = 0.079). Conclusion BCC successes could be attributed to pivoting to online community building when in-person events were restricted and enabling Champions to design and conduct their own events, which increased outreach possibilities. We demonstrate improved screening outcomes associated with an updated peer-to-peer education program.

HIV-1 persistence in different cell types presents the main obstacle to an HIV-1 cure. We have previously shown that the renal epithelium is a site of HIV-1 infection and that the kidney represents a separate viral compartment from blood. Whether renal cells can harbor latent virus that can be reactivated upon treatment with latency reversing agents (LRAs) is unknown. To address this question, we developed an in vitro HIV-1 latency model in renal tubule epithelial (RTE) cells using a dual color HIV-1 reporter virus, R7/E-/GFP/EF1a-mCherry (R7GEmC), and evaluated the effect of LRAs, both as single agents and in combination, on viral reactivation. Our data show that HIV-1 can establish latency in RTE cells early postinfection. While the pool of latently infected cells expanded overtime, the percentage of productively infected cells declined. Following LRA treatment only a small fraction of latently infected cells, both T cells and RTE cells, could be reactivated, and the drug combinations more effective in reactivating HIV transcription in RTE cells differed from those more active in T cells. Our study demonstrates that HIV can establish latency in RTE cells and that current LRAs are only marginally effective in inducing HIV-1 reactivation. This suggests that further study of LRA dynamics in non-T cells may be warranted to assess the suitability of LRAs as a sterilizing cure strategy. IMPORTANCE Anti-retroviral therapy (ART) has dramatically reduced HIV-related morbidity and mortality. Despite this success, a number of challenges remain, including the long-term persistence of multiple, clinically latent viral reservoirs capable of reactivation in the absence of ART. As efforts proceed toward HIV eradication or functional cure, further understanding of the dynamics of HIV-1 replication, establishment of latency and mechanisms of reactivation in reservoirs harboring the virus throughout the body is necessary. HIV-1 can infect renal epithelial cells and the expression of viral genes in those cells contributes to the development of HIV associated nephropathy (HIVAN) in untreated individuals. The significance of our work is in developing the first model of HIV-1 latency in renal epithelial cells. This model enhances our understanding of HIV-1 latency and persistence in the kidney and can be used to screen candidate latency reversing agents.

To investigate abnormal vaginal and suture-based bacterial flora for associations with spontaneous preterm birth in high-risk singleton pregnancies with an ultrasound-indicated or emergency cervical cerclage.A retrospective study of 196 singleton pregnancies with an ultrasound-indicated or emergency cerclage at the Royal Women's Hospital, Australia, from 2004 to 2018. High vaginal swabs were collected regularly between 14 and 26 weeks' gestation, including pre- and post-cerclage insertion, and sent for microscopy and culture. Cervical suture was cultured upon removal. Primary outcomes were spontaneous preterm birth37,34 and30 weeks.43.4% (85/196) of women delivered preterm. The acquisition and persistence of vaginalFor singleton pregnancies with an ultrasound-indicated or emergency cerclage, the presence of vaginal or suture-based

Objectives Preterm birth clinics provide dedicated obstetric care to women at high risk of spontaneous preterm birth (SPTB). There remains a lack of conclusive evidence to support the overall utility of such clinics, attributable to a paucity and heterogeneity of primary data. This study audits Australia’s largest and oldest dedicated preterm birth clinic with the aim to add primary data to the area and offer opportunities for similar clinics to align practice. Methods A retrospective audit of referrals to the Preterm Labour Clinic at the Royal Women’s Hospital, Melbourne, Australia, between 2004 and 2018 was conducted. 1,405 singleton pregnancies met inclusion criteria. The clinic’s key outcomes, demographics, predictive tests and interventions were analysed. The primary outcomes were SPTB before 37, 34 and 30 weeks’ gestation. Results The overall incidence of SPTB in the clinic was 21.2% (n=294). Linear regression showed reductions in the adjusted rates of overall SPTB and pre-viable SPTB (delivery Conclusions Dedicated preterm birth clinics can reduce rates of SPTB, particularly deliveries before 24 weeks’ gestation, and improve short-term neonatal outcomes in pregnant women at risk of preterm birth.

The SARS-CoV-2 virus, or COVID-19, is responsible for the current global pandemic and has resulted in the death of over 100,000 in the United States. Interestingly, rates of venous thromboembolism have been noted to be much higher in those infected with COVID-19. Here we report a case-series of COVID-19 patients with diverse presentations of pulmonary embolism (PE) at our institution. We also briefly describe the pathophysiology and mechanisms for pulmonary embolism in COVID-19. These cases indicate a need to maintain a high index of suspicion for PE in patients with COVID-19, as well as the need to consider occult COVID-19 infection in patients with PE in the right clinical circumstance.

SummaryRecently more distributed acoustic sensing (DAS) data have been collected during hydraulic fracturing in shale. Low-frequency DAS signals show patterns that are intuitively consistent with the understanding of the strain field around hydraulic fractures. This study uses a fracture simulator combined with a finite element solver to further understand the various patterns of the strain field caused by hydraulic fracturing. The results can serve as a “type-curve” template for the further interpretation of cross-well strain field plots.Incorporating detailed pump schedule and fracturing fluid/proppant properties, we use a hydraulic fracture simulator to generate fracture geometries, which are then passed to a finite element solver as boundary conditions for elastic-static calculation of the strain field. Because the finite element calculated strain is a tensor, it needs to be projected along the monitoring well trajectory to be comparable with the DAS strain, which is uniaxial. Moreover, the calculated strain field is transformed into a time domain using constant fracture propagation velocity. Strain rate is further derived from the simulated strain field using differentiation along the fracture propagation direction.Scenarios including a single planar hydraulic fracture, a single fracture with a discrete fracture network (DFN), and multiple planar hydraulic fractures in both vertical and horizontal directions were studied. The scenarios can be differentiated in the strain patterns on the basis of the finite element simulation results. In general, there is a tensile heart-shaped zone in front of the propagating fracture tip shown along the horizontal strain direction on both strain and strain rate plots. On the sides, there are compressional zones parallel to the fracture. The strain field projects beyond the depth where the hydraulic fracture is present. Patterns from strain rate can be used to distinguish whether the fracture is intersecting the fiber. Along the vertical direction, the transition zone depicts the upper boundary of the fracture. A complex fracture network with DFN shows a much more complex pattern compared with a single planar fracture. Multiple planar fractures show polarity reversals in horizontal fiber because of interactions between fractures. Data from the Hydraulic Fracturing Test Site 2 (HFTS2) experiment were used to validate the simulated results.The application of the study is to provide a template to better interpret hydraulic fracture characteristics using low-frequency DAS strain-monitoring data. To our understanding, there are no comprehensive templates for engineers to understand the strain signals from cross-well fiber monitoring. The results of this study will guide engineers toward better optimization of well spacing and fracturing design to minimize well interference and improve efficiency.

The media has reported recent increases in nursing home closures. This study examined closures from 2011-2019, identified facility and market characteristics associated with closures, and assessed the impact of closures on quality and access. We identified closures using termination dates and gaps in certification surveys and conducted descriptive and multivariate analysis. We identified 1,220 closures, with large increases in closure rates in 2018 and 2019 and geographic clusters. Chain facilities, urban facilities and smaller facilities were more likely to close, as were facilities with higher percentages of non-white and Medicaid residents. Staffing and quality five-star ratings had a nonlinear relationship with closure, which suggests Medicaid funding may impact closures rates. We found both the number of beds per 1,000 elderly and occupancy rates decreased, including in high-quality facilities. Closures should be examined further in the context of the COVID-19 pandemic.

People living with HIV are at higher risk for acute and chronic kidney disease compared with uninfected individuals. Kidney disease in this population is multifactorial, with several contributors including HIV infection of kidney cells, chronic inflammation, genetic predisposition, aging, comorbidities, and coinfections. In this review, we provide a summary of recent advancements in the understanding of the mechanisms and implications of HIV infection and kidney disease, with particular focus on the role of direct HIV infection of renal cells.

We modeled cross-well strain/strain rate responses of fiber optic sensing, including distributed strain sensing (DSS) and low-frequency distributed acoustic sensing (DAS), to hydraulic stimulation. DSS and low-frequency DAS have been used to measure strain or the strain rate to characterize hydraulic fractures. However, the current application of DSS/DAS is limited to acquisition, processing, and qualitative interpretations. The lack of geomechanical models hinders the development of the technology toward quantitative interpretation and inversion. We have developed a strategy to use the displacement discontinuity method to model the strain field around kinematically propagating fractures. For a horizontal monitoring well, modeling results were able to explain the heart-shaped extending pattern before a fracture hit, the polarity flip due to fracture interaction during stimulation, and the V-shaped pattern when a fracture does not intersect with the monitoring well. For a vertical monitoring well, modeling shows the different characters of strain rate responses when a fracture is near and far away from a vertical monitoring well. We also investigated the effects of fractures with various geometries such as elliptic and layered fractures. We compared and verified the modeling with field data from the Hydraulic Fracturing Test Site 2, a research experiment performed in the Permian Basin. Our modeling work can be used to identify patterns in field observations. The results also help to improve acquisition design and lay the groundwork for quantitative interpretation and inversion.

BACKGROUND: Little is known about medical cannabis (MC)–related care for patients with cancer using MC. Methods: Semistructured telephone interviews were conducted in a convenience sample of individuals (n = 24) with physician-confirmed oncologic diagnoses and state/district authorization to use MC (Arizona, California, Florida, Illinois, Massachusetts, Oregon, New York, and Washington, DC) from April 2017 to March 2019. Standard qualitative techniques were used to assess the degree of MC-related health care oversight, MC practices, and key information sources. Results: Among 24 participants (median age, 57 years; range, 30–71 years; 16 women [67%]), MC certifications were typically issued by a professional new to a patient’s care after a brief, perfunctory consultation. Patients disclosed MCuse to their established medical teams but received little medical advice about whether and how to use MC. Patients with cancer used MC products as multipurpose symptom management and as cancer-directed therapy, sometimes in lieu of standard-of-care treatments. Personal experimentation, including methodical self-monitoring, was an important source of MC know-how. Absent formal advice from medical professionals, patients relied on nonmedical sources for MC information. Conclusions: Patients with cancer used MC with minimal medical oversight. Most received MC certifications through brief meetings with unfamiliar professionals. Participants desired but were often unable to access high-quality clinical information about MC from their established medical teams. Because many patients are committed to using MC, a product sustained by a growing industry, medical providers should familiarize themselves with the existing data for MM and its limitations to address a poorly met clinical need.

ObjectivesHIV-1 can infect and persist in different organs and tissues, resulting in the generation of multiple viral compartments and reservoirs. Increasing evidence supports the kidney as such a reservoir. Previous work demonstrated that HIV-1 infected CD4+ T-cells transfer virus to renal tubule epithelial (RTE) cells through cell-to-cell contact. In addition to CD4+ T-cells, macrophages represent the other major target of HIV-1. Renal macrophages induce and regulate inflammatory responses and are critical to homeostatic regulation of the kidney environment. Combined with their ability to harbor virus, macrophages may also play an important role in the spread of HIV-1 infection in the kidney.Design and MethodsMultiparametric histochemistry analysis was performed on kidney biopsies from individuals with HIV-1 associated nephropathy (HIVAN). Primary monocyte-derived macrophages were infected with a (GFP)-expressing replication competent HIV-1. HIV-1 transfer from macrophages to RTE cells was carried out in a co-culture system and evaluated by fluorescence-microscopy and flow-cytometry. Live imaging was performed to assess the fate of HIV-1 infected RTE cells over time.ResultsWe show that macrophages are abundantly present in the renal inflammatory infiltrate of individuals with HIVAN. We observed contact-dependent HIV-1 transfer from infected macrophages to both primary and immortalized renal cells. Live imaging of HIV-1 infected RTE cells revealed four different fates: proliferation, hypertrophy, latency and cell death.ConclusionsOur study suggests that macrophages may play a role in the dissemination of HIV-1 in the kidney and that proliferation of infected renal cells may contribute to HIV-1 persistence in this compartment.

Recently new Distributed Acoustic Sensing (DAS) data have been collected during hydraulic fracturing in shale. Low frequency DAS signals show patterns that are intuitively consistent with the understanding of the strain field around hydraulic fractures. This study utilizes a fracture simulator combined with a finite element solver to further understand the various patterns of the strain field caused by hydraulic fracturing. The results can serve as a "type-curve" template for the further interpretation of cross well strain field plots. Incorporating detailed pump schedule and frac fluid/proppant properties, we use a hydraulic fracture simulator to generate fracture geometries, which are then passed to a finite element (FE) solver as boundary conditions for elastic-static calculation of the strain field. Since the FE calculated strain is a tensor, it needs to be projected along the monitoring well trajectory to be comparable with the fiber strain, which is uniaxial. Moreover, the calculated strain field is transformed into time domain using constant fracture propagation velocity. Strain rate is further derived from the simulated strain field using differentiation along fracture length. Scenarios including a single planar hydraulic fracture, a single fracture with a discrete fracture network (DFN), and multiple planar hydraulic fractures, in both vertical and horizontal directions were studied. The scenarios can be differentiated in the strain patterns based on the finite element simulation results. In general, there is a tensile heart shaped zone in front of the propagating fracture tip. On the sides there are compressional zones parallel to the fracture. Multiple planar fracture show polarity reversals in horizontal fiber due to interactions between fractures. Strain field/strain rate show consistent patterns with what is observed from field cross well strain data. The application of the study is to provide a template to better interpret hydraulic fracture characteristics using low frequency fiber strain monitoring. To the author's understanding, there are no comprehensive templates for engineers to understand the strain signals from cross well fiber monitoring. The results of this study will guide engineers toward better optimization of well spacing and frac design to minimize well interference and improve efficiency.

INTRODUCTION: Uterine anomalies occur in an estimated 5% of women and have been shown to confer a higher risk of spontaneous preterm birth (SPTB). A sonographically short cervix (

We investigated how dimensions of sexual perfectionism (i.e., self-directed, partner-directed, partner-prescribed, and socially-prescribed), which reflect expectations to be a perfect sexual partner, related to sexual assertiveness in women. Women (n = 202) in the United States recruited from Amazon Mechanical Turk, who self-reported having previously engaged in sexual activity, served as participants and completed the Multidimensional Sexual Perfectionism Questionnaire and the Sexual Assertiveness Scale. Results revealed that all four dimensions of sexual perfectionism related to lower levels of assertiveness around refusal of unwanted sexual activity and accounted for approximately 19% of its variance. When controlling for shared variance across dimensions of sexual perfectionism, only partner-prescribed sexual perfectionism uniquely related to lower levels of refusal assertiveness. In addition, partner-prescribed sexual perfectionism related to lower levels of assertiveness around initiation of desired sexual activity (i.e., initiation assertiveness) when holding levels of sexual perfectionism on other dimensions constant. In contrast, partner-directed sexual perfectionism related to higher levels of initiation assertiveness when holding constant the other dimensions of sexual perfectionism. We conclude that sexual perfectionism (particularly perceived perfectionistic expectations from sexual partners) appears to be a salient concept in understanding what may hinder women from sexually asserting themselves.

Background Preterm birth continues to be a major cause of infant morbidity and mortality worldwide, but advances have recently been made in its prediction and prevention. A short cervix (

Background Multiple Myeloma (MM) is a plasma cell neoplasm causing a proliferation of monoclonal immunoglobulins that causes end organ damage in the form of hypercalcemia, renal insufficiency, anemia, and lytic bone lesions. Specifically, patients with MM are at risk for developing significant bone disease eventually leading to development of skeletal related events (SRE) (pathological fractures, spinal cord compression, and/or need for radiotherapy or surgery to bone). It is well established that the use of anti-resorptive agents (i.e. Bisphosphonates, Denosumab) lead to fewer bony lesions, less severe bone disease, and fewer SREs. However, while anti-resorptive therapy is recommended for all MM patients undergoing treatment, it is common for initiation of anti-resorptive therapy to be delayed due to the need for dental clearance, clinician preference, or relative contraindications to the medications. Current studies show that this therapy is overall underutilized, likely for similar reasons. However, the effect on SRE with regards to time to initiation of anti-resorptive agent has not been well studied. Herein, we conducted a retrospective analysis to determine if time to anti-resorptive agent has an effect on incidence of SREs. Methods: We performed a retrospective cohort study using our Electronic Health Record system to identify and analyze data of patients with newly diagnosed Multiple Myeloma from July 1st, 2016 until June 30th, 2019 to determine whether time to anti-resorptive therapy affects the incidence of SRE. Patients previously treated with bisphosphonates, and patients not treated with anti-resorptive therapy were excluded. The study's primary endpoint was probability of developing SRE based on time to anti-resorptive therapy. The relationship between incidence of SREs and time to anti-resorptive therapy, sex, age, ISS stage at diagnosis, Area Deprivation Index (ADI), and prior SRE present at diagnosis was analyzed by multivariable Cox proportional hazards model. The cutoff point of anti-resorptive therapy delay was based on the recursive partitioning of univariable Cox model. Results: Three hundred and seventy-five patients with newly diagnosed multiple myeloma patients were identified. In total, 237 patients were included in the final analysis. Demographic information is detailed in the table provided. Of these, 208 patients (88%) used bisphosphonates and 29 (12%) used a RANK ligand inhibitor as their anti-resorptive agent. The median time to therapy was 55 days (IQR 135 days). One hundred twenty four (55%) patients had an SRE present at diagnosis. Forty-one (15.2%) patients developed a new SRE after initiation of anti-resorptive therapy. The model showed that patients who had a delay to anti-resorptive therapy of 31 days or greater had a higher risk of developing SRE after diagnosis (HR 2.49, 95% CI 0.95-6.55, p=0.064). In addition, when comparing ISS II to ISS I, patients with ISS II disease had a higher risk of developing SRE (HR 2.78, 95% CI 1.02-7.57, p=0.045). Conclusions: Patients with longer delays to anti-resorptive therapy had higher risk of developing SRE after diagnosis, however the difference was not statistically significant. One explanation for this may be that starting anti-resorptive therapy at any time point may be more important than time it takes to start therapy in the setting of effective anti-myeloma treatment. However, the rate of SRE in this study was lower than initially predicted based on previous studies, and therefore, our sample size may have been too small to detect a significant outcome related to time to initiation of anti-resorptive agents. Ongoing efforts to increase the sample size through multi-institutional initiatives are underway. Disclosures Binder: Janssen: Membership on an entity's Board of Directors or advisory committees; Sanofi: Consultancy.

The 2018 Report Card on Physical Activity for Children and Youth reported that only 24% of U.S. children and youth ages 6 to 17 meet the national recommendation of 60 minutes of daily physical acti...

According to research and theory, the construct of perfectionism may apply to specific life domains, including being a perfect sexual partner. We extended the research on sexual perfectionism (SP) by examining the relationships between its various dimensions (i.e., self-directed, partner-directed, socially prescribed, partner-prescribed) and communication about sex, sexual functioning, and appearance self-consciousness during sex. Women (N = 208) of ages 19-50 were recruited online to respond to the Multidimensional Sexual Perfectionism Questionnaire and measures of communication about sex, sexual functioning, and physical appearance self-consciousness during sex. Dimensions of SP demonstrated a mixed pattern of relationships with measures of adaptive functioning. Partner-prescribed SP was related to greater appearance self-consciousness during sex, indicating an unfavorable role of this dimension of SP. An indirect effect of socially prescribed and partner-prescribed SP on sexual functioning through poor dyadic communication about sex and greater appearance self-consciousness was also found. Self-directed SP was less clearly problematic and uniquely related to better dyadic communication, whereas partner-directed SP was uniquely related to fewer concerns about the body appearance during sex. In conclusion, with respect to personal functioning, higher standards directed towards sexual partners may be less problematic but perceptions that romantic partners expect one to be a perfect sexual partner may have deleterious effects. Overall, SP may relate to sexual experiences of women beyond the college-age group with some aspects of SP being more problematic than others.

Supplemental Digital Content is available in the text, HIV-1 persists indefinitely in multiple cellular reservoirs despite antiretroviral therapy. We previously demonstrated HIV-1 compartmentalization in kidney and urine. Here, we further characterized viruses in urine and when available, compared them to those present in semen from HIV-1 positive participants with detectable plasma viremia to further understand the viral dynamics in the upper and lower genitourinary tract. Blood and urine samples were obtained from 19 HIV-1 positive participants. Simultaneous semen samples were obtained from 16 of the 19 participants. HIV-1 envelope (env) gene sequences were obtained by single-genome amplification (SGA) and neighbor-joining trees were constructed using the Kimura 2-parameter model. HIV-1 env gene sequences were amplified from blood in 19/19 (100%) participants, urine in 18/19 (95%) participants, and semen in 12/16 (75%). In individuals from which both urine and semen samples were obtained, differences in viral shedding between the 2 sources were observed, where HIV-1 env sequences could only be amplified from either urine or semen. Longitudinal phylogenetic analysis of urine-derived env sequences from 1 participant demonstrated that urine clusters distinct from blood are maintained over time (20 weeks), consistent with viral compartmentalization and local replication. Comparison of urine and semen derived sequences demonstrated either virus compartmentalization or equilibration. Our results demonstrate that when present, viral compartmentalization in urine persists over time. Comparison of timing of viral shedding in urine and semen samples from our cohort suggest different viral kinetics between the upper and lower genitourinary tract and sequence analysis suggests that HIV-1 populations in urine and semen can either be imported from blood or produced locally.

INTRODUCTION: With the FDA approval of CPX-351 (Vyxeos; Jazz Pharmaceuticals, Inc.; Palo Alto, CA), the prospect of inducing select patients with acute myeloid leukemia (AML) with a regimen that does not require continuous intravenous in the outpatient (OP) setting became a reality. With the recognition that an OP-induction strategy has the potential benefits of reduced healthcare resource utilization (HRU),1,2 improved quality of life3 and decreased risk of nosocomial infections, some centers have opted to administer Vyxeos in the OP setting and to admit patients only if complications which necessitate inpatient (IP) management occur. The safety and decreased HRU of this approach during consolidation has been demonstrated4 in the study population treated on the pivotal phase III trial (NCT01696084).5 We present the first real-world experience of OP AML induction with Vyxeos without planned hospital admission. METHODS: We performed a retrospective analysis of all patients at our institution treated with OP-Vyxeos without planned admission (OP-Vyxeos) between August, 2017 and June, 2020. Patients were deemed safe for OP induction if they met the criteria outlined in Table 1 at diagnosis or could be stabilized in the hospital and discharged when these criteria were met. Primary and secondary objectives were to evaluate the safety and HRU, respectively, of this approach. The primary endpoint was 30-day mortality. Secondary endpoints included 60-day mortality, rate of adverse effects (AEs), number of hospitalizations, number of hospital days, number of intensive care (ICU) days, and number of days receiving intravenous (IV) antibiotics. When possible, primary and secondary endpoints were compared to patients who received Vyxeos induction in the inpatient setting (IP-Vyxeos) on the phase III trial.5,6 RESULTS: Twenty-five patients received OP-Vyxeos at our institution between August, 2017 and June, 2020 and all were evaluable for the primary endpoint. Baseline characteristics of the OP- and IP-Vyxeos populations are presented in Table 2. The mean age of OP-Vyxeos patients was less than IP-Vyxeos patients (65.4 years vs. 67.7 years) and a higher proportion of OP-Vyxeos patients were Clinical efficacy and safety outcomes are presented in Table 3. Complete response (CR) rate for Vyxeos was similar between the OP- and IP-Vyxeos groups (48% vs. 37%), as was time to neutrophil recovery (34 vs. 35 days). There were no early deaths (before 30 days) in the OP-Vyxeos group compared to 9 (5.9%) in the IP-Vyxeos group. Sixty-day mortality was similar between the two groups (4.5% vs. 13.7%). The cause of death in the one OP-Vyxeos patient who died was fungal pneumonia in the setting of presumed refractory leukemia. Febrile neutropenia (FN) with or without documented infection and bleeding (any grade) were the most common AEs in both groups, however, the rates varied significantly between OP- and IP-groups (FN: 88% vs. 68%; bleeding: 28% vs. 74.5%). FN was by far the most common AE in the OP-Vyxeos group and was the admission diagnosis for 91% (32/35) of admissions. HRU-metrics are presented in Table 4. The majority of OP-Vyxeos patients required hospitalization (88%); however, despite an increased mean number of hospitalizations (1.4 vs. 1.0), the median total number of hospital days in the OP group was decreased (22 vs. 28). Three patients (12%) never required hospitalization during OP-Vyxeos induction. The median days spent OP prior to first admission was 8 and 18% (4/22) of patients remained OP for >14 days. CONCLUSIONS: Outpatient Vyxeos induction without planned admission for select patients was safe and resulted in decreased healthcare resource utilization in our cohort of patients. There were no early deaths in the OP-Vyxeos group. Despite an increased mean number of hospitalizations, patients who received OP-Vyxeos had a decreased number of total hospital days. Limitations of this analysis include that this is a small, single-center, retrospective analysis. In the future, we hope to validate our criteria for OP-induction in a larger, multi-institution patient cohort. Disclosures Palmisiano: AbbVie: Research Funding; Genentech: Research Funding. Kasner:Jazz Pharmaceuticals: Membership on an entity's Board of Directors or advisory committees, Research Funding; Otsuka Pharmaceutical: Research Funding.

Type D personality has been associated with minor health complaints in the general population and dysregulation of basal cortisol secretion in coronary patients. The aims of the present study were to investigate (i) whether there is an association between Type D personality and basal cortisol secretion in the general population, and (ii) whether subjective measures of stress and anxiety, as well as indices of basal cortisol secretion, mediate the relationship between Type D personality and self-reported physical symptoms in this group. Self-report measures of stress, trait anxiety and physical symptoms were provided by 101 individuals aged 18-45 years. Saliva samples were also provided over two consecutive "typical" days, to enable indices of the cortisol awakening response and diurnal cortisol profile to be determined. There was a significant relationship between Type D personality and self-reported physical symptoms, which was fully mediated by subjective stress and anxiety. However, there were no significant relationships between Type D personality and the basal cortisol indices. These findings suggest that the association between Type D personality and minor health complaints in the general population can be explained by feelings of stress and anxiety, but a precise biological mechanism for this link is yet to be elucidated.

Relationships among bully victimization, bully perpetration, ethnic identity, and subjective well-being (i.e., life satisfaction, positive affect, and negative affect) were examined in a group of urban, ethnically diverse early adolescents. Indices of subjective well-being correlated with participants' scores on bully victimization and perpetration measures but bully perpetration was not significantly related to negative affect. The authors used cluster analysis to determine participants' status as either bully-victims, perpetrators, non-participants, or victim-perpetrators. They found significant analysis of variance differences on the variables of interest between bully participants vs. non-participants. This article discusses implications for bully prevention efforts with ethnic minority youth.

This study tested a conceptual model of religiousness/spirituality (R/S) and hedonic well-being (HWB; measured by life satisfaction and positive affect) by including eudaimonic well-being (EWB; measured by meaning in life) as a mediator. Given the multidimensionality of R/S, we examined whether and how the magnitudes of direct and indirect relationships varied for various aspects of R/S: organizational religious practices, private religious practices, daily religious/spiritual experiences, and subjective spirituality. Web survey data of 450 US American adults were analyzed using structural equation modeling. Results showed that EWB partially mediated the relation of daily religious/spiritual experiences and HWB; however, the other three aspects of R/S had no indirect relationships with HWB. Additionally, private religious practices and subjective spirituality indicated negative direct relationships with HWB. Approximately 68% of the variance in HWB was accounted for by the variables included in this model...

Brief periods of cardiac ischemia and reperfusion exert a protective effect against subsequent longer ischemic periods, a phenomenon coined ischemic preconditioning. Similarly, repeated brief episodes of coronary occlusion and reperfusion at the onset of reperfusion, called post-conditioning, dramatically reduce infarct sizes. Interestingly, both effects can be achieved by the administration of any volatile anesthetic. In fact, cardio-protection by volatile anesthetics is an older phenomenon than ischemic pre- or post-conditioning. Although the mechanism through which anesthetics can mimic ischemic pre- or post-conditioning is still unknown, adenosine generation and signaling are the most redundant triggers in ischemic pre- or post-conditioning. In fact, adenosine signaling has been implicated in isoflurane-mediated cardioprotection. Adenosine acts via four receptors designated as A1, A2a, A2b, and A3. Cardioprotection has been associated with all subtypes, although the role of each remains controversial. Much of the controversy stems from the abundance of receptor agonists and antagonists that are, in fact, capable of interacting with multiple receptor subtypes. Recently, more specific receptor agonists and new genetic animal models have become available paving way towards new discoveries. As such, the adenosine A2b receptor was shown to be the only one of the adenosine receptors whose cardiac expression is induced by ischemia in both mice and humans and whose function is implicated in ischemic pre- or post-conditioning. In the current review, we will focus on adenosine signaling in the context of anesthetic cardioprotection and will highlight new discoveries, which could lead to new therapeutic concepts to treat myocardial ischemia using anesthetic preconditioning.

Polycomb-mediated chromatin repression modulates gene expression during development in metazoans. Binding of multiple sequence-specific factors at discrete Polycomb response elements (PREs) is thought to recruit repressive complexes that spread across an extended chromatin domain. To dissect the structure of PREs, we applied high-resolution mapping of nonhistone chromatin proteins in native chromatin of Drosophila cells. Analysis of occupied sites reveal interactions between transcription factors that stabilize Polycomb anchoring to DNA, and implicate the general transcription factor ADF1 as a novel PRE component. By comparing two Drosophila cell lines with differential chromatin states, we provide evidence that repression is accomplished by enhanced Polycomb recruitment both to PREs and to target promoters of repressed genes. These results suggest that the stability of multifactor complexes at promoters and regulatory elements is a crucial aspect of developmentally regulated gene expression.

Dental nurse Kelly Hughes considers the key components

Posttraumatic stress disorder (PTSD) has been associated with neuropsychological impairments across multiple domains, but consensus regarding the cognitive profile of PTSD has not been reached. In this study of women with PTSD related to intimate partner violence (n = 55) and healthy, demographically similar comparison participants (NCs; n = 20), we attempted to control for many potential confounds in PTSD samples. All participants were assessed with a comprehensive neuropsychological battery emphasizing executive functioning, including inhibition, switching, and abstraction. NCs outperformed PTSD participants on most neuropsychological measures, but the differences were significant only on speeded tasks (with and without executive functioning components). The PTSD group’s mean performance was within the average range on all neuropsychological tests. Within the PTSD group, more severe PTSD symptoms were associated with slower processing speed, and more severe dissociative symptoms were associated with poorer reasoning performance. These results suggest that women with PTSD related to intimate partner violence demonstrate slower than normal processing speed, which is associated with the severity of psychiatric symptoms. We speculate that the cognitive slowing seen in PTSD may be attributable to reduced attention due to a need to allocate resources to cope with psychological distress or unpleasant internal experiences. (JINS, 2009, 15, 879–887.)

To evaluate the anti-inflammatory and anti-oxidant activity of Glyco-Flex ® III (GFIII), inflammation was induced using IL- 1 β in canine chondrocytes. Anti - oxidant capacity was measured using the ABTS method. GFIII whole tablet and separate active constituents (grape seed extract, glucosamine HCl, MSM, DMG, Perna canaliculus) and deracoxib (Deramaxx®) were tested at concentrations 0-1000 μg mL1. Nitric oxide (NO), soluble collagen (Sircol), sulphated glycosaminoglycan (sGAG), prostaglandin E2 (PGE2), interleukin-6 (IL-6), tumor necrosis factor-α (TNF - α) and matrix metalloproteinase-3 (MMP-3) were measured using previously established analysis techniques. The anti-oxidant activity of GFIII and constituents was concentration-dependent. GFIII exhibited similar reduction in nitrite, nitrate, soluble collagen, MMP-3 and TNF-α levels than deracoxib at some concentrations, while it has greater potency in reducing PGE2, sGAG and IL-6 at specific concentration ranges. Perna canaliculus has similar potency in reducing nitrite, nitrate, MMP-3 and TNF-α levels than deracoxib, while demonstrating attenuated potency in reducing sGAG, soluble collagen and IL-6 at specific concentration ranges. The other individual constituents exhibited similar pharmacological activity. Glyco-Flex® III whole tablet and components have potent anti-oxidant properties and inhibit cytokine-induced NO and PGE2 production and may ameliorate proteoglycan degradation after an inflammatory insult in vitro.

Summary A self-diverting-acid based on viscoelastic surfactant (SDVA) has been successfully used recently on numerous stimulation treatments of carbonate formations in various fields. The decrease of acid concentration during the spending process viscosifies the fluid through the transformation from spherical micelles to an entangled wormlike micellar structure while penetrating the carbonate rock. The highly viscous fluid acts as a temporary barrier and diverts the fluid into the remaining lower-permeability treating zones. After treatment, the SDVA barrier breaks when contacted either by formation hydrocarbons or pre- and postflush fluids. Quantifying diversion, fluid efficiency, and cleanup are important factors for successful candidate selection and job design. Laboratory tests defining these key factors are presented in this paper. This paper demonstrates the diverting ability of the acid as a function of permeability, characterized by introducing the concept of maximum pressure ratio (dPmax/dP0) supported by core-flow and acid conductivity tests using limestone and dolomite cores. Results demonstrate high dPmax/dP0 in high-permeability cores and low dPmax/dP0 in low-permeability cores. Retained permeability measurements are presented that assess the level of cleanup. Flow-initiation experiments of spent acid systems with gas and brine were performed to illustrate the cleanup behavior of SDVA in comparison to gelled acid systems under conditions encountered in gas and oil wells. The results indicate that SDVA systems clean up easily and that SDVA provides higher regained permeability than conventional gelled acid systems. Background The purpose of matrix stimulation in limestone and dolomite reservoirs is the formation of wormholes, which can bypass the damaged areas and increase the effective wellbore area. When acid enters the formation with the highest injectivity it creates highly conductive flow channels, called wormholes, by dissolving the carbonate-containing minerals. Consequently, the injectivity will be further increased. The other zones are left untreated by the acid. To overcome this problem, a diverting agent is used. Mechanical diverters such as ball sealers, degradable ball sealers, rock salt, and benzoic acid flakes are used alone or in conjunction with chemical diverters based on foams or polymeric gels (Williams et al. 1979; Economides and Nolte 1989). These materials can work effectively only in a narrow permeability contrast and may result in residual damage (Lynn and Nasr-El-Din 2001). These characteristics are highly undesirable, particularly in low-pressure gas wells, and in long vertical and horizontal sections. Polymer-based systems such as in-situ crosslinked gelled acids (XLGA) have been used in the field as self-diverting fluids. These systems rely on a pH-triggered increase of viscosity during the acid spending process. Essentially, the pH change activates a metallic reagent that crosslinks the polymer chains, and the resulting viscosity increase causes a higher flow resistance (Mukherjee and Gudney 1993; Saxon et al. 1997). Further increase of the pH deactivates the metallic crosslinker and breaks the fluid down to the original linear gel with dissociated polymer chains. However, because of the nature of the long polymer chains, potential damage of the formation may occur (Lynn and Nasr-El-Din 2001). Recently, a new polymer-free self-diverting acid system was developed with a fluid stability in temperatures greater than 300°F (Taylor et al. 2003; Chang et al. 2001). The fluid system has been applied successfully in both matrix (Al-Mutawa et al. 2001) and acid-fracturing (Al-Muhareb et al. 2003; Artola et al. 2004) treatments. It causes rapid viscosity development throughout the spending process. The reduction in acid concentration, together with the simultaneous release of ions in solution, promotes the transformation from spherical micelles into worm-like micelles, resulting in increased viscosity of the fluid. The highly viscous fluid subsequently diverts the remaining acid treatment fluid into zones of lower injectivity by reducing the acid loss into wormholes, resulting in an improved zonal coverage of the treatment interval. Diversion tests using multiple parallel cores with varying permeabilities showed effective stimulation in all cores (Taylor et al. 2003; Chang et al. 2001). This paper presents new data providing further insight into the understanding of the unique properties of this SDVA based on laboratory studies. Specifically described are the chemical and physical properties of the SDVA fluid, including cleanup efficiency that is relevant to low-pressure reservoirs.

The effect that treatment with stimulant medication has on the intellectual performance of children with attention deficit hyperactivity disorder (ADHD) was examined. Thirty-one children diagnosed with ADHD were given a WISC-III before any treatment was implemented. At least 1 year later, children were retested. At this time, 24 of the children were taking stimulant medications. Children receiving medications had significant increases in IQ scores, but no changes were found for those not taking medications. Changes in IQ scores were moderately related to parents’ perceived efficacy of the medication and parent-reported compliance with medication but were not strongly related to changes in parent-reported ADHD symptoms.

Previous research investigating the influence of Type D personality on cardiovascular reactivity to stress in healthy young adults is somewhat mixed. The present study sought to investigate this question using an ecologically valid laboratory stressor. Beat-to-beat blood pressure and heart rate were measured in 77 healthy young adults during exposure to multitasking stress. Mood and background stress were both associated with Type D personality when Type D was conceptualised as a dimensional construct, with less robust findings observed using the traditional dichotomous typological approach. However, the continuous Type D construct added limited predictive value of the self-report measures above that of its constituent components, negative affectivity (NA) and social inhibition (SI). Further, an inverse relationship between the continuous Type D construct and blood pressure reactivity to multitasking stress was observed. In summary, our findings suggest that Type D personality is predictive of blunted cardiovascular reactivity to stress in healthy individuals when Type D is considered as a dimensional construct and the independent influence of NA and SI is controlled for. Further, our findings suggest that Type D does not predict additional variance in mood and background stress above that of NA and SI when these constituent factors are considered independently.