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The predominant use of intravenous catheters as primary access type in the pediatric hemodialysis population is associated with an increased risk of catheter related blood stream infections. While strict adherence to catheter placement and long-term care guidelines have helped to decrease the incidence of these infections, blood stream infections remain an infection burden in pediatric patients with long term hemodialysis catheters. The formation of biofilms on the surfaces of these catheters has been shown to be a source of microbes causing blood stream infections. One of the strategies for preventing bacterial colonization, inhibiting microbial multiplication, and suppressing the seeding of these microbes from biofilms upon maturation, has been the use of antibiotic-based lock solutions in-between dialysis treatments. Although clinical guidelines for the use of antibiotic lock solutions are yet to be developed, available evidence suggests a beneficial role of antibiotic lock solutions in the management of catheter related blood stream infections. Additionally, a clear understanding of how biofilms are formed and their role in the pathogenesis of catheter related bloodstream infection will facilitate the development of solutions that can prevent biofilm formation and inhibit their multiplication, maturation and seeding into the bloodstream.

Judith J Stephenson,1 Jonathon Colby Gable,2 Rebekah Zincavage,1 Gregory L Price,2 Collin Churchill,2 Emily Zhu,2 Keri Stenger,2 Mukul Singhal,1 Bal Nepal,1 Michael Grabner,1 Michael J Fisch,3 David Debono,4 Amy R Geschwender,5 Gebra Cuyun Carter2 1HealthCore, Inc., Wilmington, DE, USA; 2Eli Lilly and Company, Indianapolis, IN, USA; 3AIM Specialty Health, Chicago, IL, USA; 4Anthem, Inc., Indianapolis, IN, USA; 5SWOG Cancer Research Network, San Antonio, TX, USACorrespondence: Judith J Stephenson Tel +1 302-547-5770Email JStephenson@healthcore.comPurpose: To describe patients’ perspectives on the use of and potential challenges and barriers with adherence/persistence to cyclin-dependent kinase 4 and 6 inhibitors (CDK4& 6i’s) to treat metastatic breast cancer (MBC).Methods: This qualitative study consisted of 60-minute semi-structured telephone interviews with patients with MBC in the US who were either current or recent CDK4& 6i users, identified from administrative claims of survey-eligible commercial and Medicare Advantage patients in the HealthCore Integrated Research Database between November 1, 2018 and November 1, 2019. Patients were recruited by email and/or mailed letter. The 60-minute telephone interviews were conducted by a trained facilitator using a study-developed interview discussion guide that included topics impacting treatment choice and adherence/persistence. Interviews were audio-recorded, transcribed, and thematically analyzed.Results: All 462 eligible patients were sent a recruitment email and/or letter to which 36 patients responded, consented to participate, and met study inclusion criteria; 25 patients scheduled interviews, and 24 completed them. Study participants were predominately white, non-Hispanic (96%) with a mean age of 59.5 years. Participants reported a largely positive experience and mentioned very few adherence/persistence issues. They further reported appreciating the ease and convenience of oral oncolytics, coped with side effects, had strong medical and social support, and experienced few cost issues.Conclusion: The few adherence/persistence issues reported by participants contrasts with other findings of suboptimal oral oncolytic use. Interview themes indicated several factors that likely contributed to the lack of adherence/persistence issues: trusted relationship with oncologist, belief in importance of medication, positive medication views, strong medical and social support, and minimal personal drug cost. Future research should focus on whether and how much these factors impact adherence/persistence in more diverse populations. If adherence/persistence issues are identified in these populations, then it would be appropriate to study the development of interventions that target factors associated with better adherence/persistence.Keywords: oral oncolytics, patient perspective, semi-structured interviews, adherence, persistence, CDK4& 6i users

With the rapid ageing of the Australian population, dementia has emerged as a major health and economic challenge. Consensus exists that the number of people with dementia will grow significantly because the prevalence is strongly correlated with age. However, there are substantial gaps in our understanding of the impacts on the dementia 'epidemic' of changes in non-demographic risk factors and of our knowledge of the economic implications. Only a few prevalence-based studies have been conducted to examine the health economics of dementia in Australia. These studies have suggested that considerable resources are absorbed by dementia care, yet there is a lack of integrated models that simultaneously explore epidemiologic and economic perspectives incorporating the impact of preventive and early intervention initiatives. This study reviews the current evidence on the economic implications of dementia in Australia and approaches taken to project the future costs of dementia. [ABSTRACT FROM AUTHOR]

Introduction: Lower limb amputation significantly impacts individuals' quality of life, with prostheses playing a crucial role in rehabilitation and mobility restoration. In Nepal, where access to advanced medical care is limited, understanding the factors affecting the well-being of prosthesis users is essential for optimizing rehabilitation services. This study investigates the sociodemographic and health-related variables influencing the quality of life among lower-limb amputees using prostheses in Nepal., Methods: A cross-sectional study was conducted at a super-specialized disability care center within a tertiary care hospital. The study included 43 amputees who had received prostheses at least five years prior and were regular users. The sample was drawn from patients at the same hospital. The study collected data on sociodemographic characteristics, health components, and pain experiences. Health-related quality of life (HrQoL) was assessed using the SF-12 tool, with scores above 50 indicating high HrQoL on the Mental Component Summary (MCS) and Physical Component Summary (PCS). Scores below 50 indicated low HrQoL. Factors associated with these variables were analyzed using Chi-square (χ²) at a 95% confidence interval., Results: Our study assessed the health-related quality of life among lower limb amputees, finding that 76.74% of participants scored high in mental health and 81.40% in physical health. Significant associations were identified between age and marital status with the Mental Component Summary (MCS) and Physical Component Summary (PCS). Additionally, the reason for amputation and the experience of the Phantom pain were linked to the MCS. Factors like treatment for stump pain, perceived effectiveness of stump pain treatment, and residual stump pain were associated with both the PCS and MCS, while actions taken for stump pain and extremity dominance were associated significantly with the PCS. The level of amputation and treatment for phantom pain also showed significant association. All associations were significant (p > 0.05) at a 95% confidence interval., Conclusion: These findings indicate that age, marital status, extremity dominance, reason for amputation, stump pain treatment, and pain management are critical factors influencing the quality of life among lower limb amputees. The study underscores the need for comprehensive rehabilitation programs incorporating effective pain management, spouse support, and tailored interventions based on individual demographic and clinical characteristics., (© 2024. The Author(s).)

HIV-1-associated neurocognitive disorders (HAND) are a major comorbidity of HIV-1 infection, marked by impairment of executive function varying in severity. HAND affects nearly half of people living with HIV (PLWH), with mild forms predominating since the use of anti-retroviral therapies (ART). The HIV-1 transactivator of transcription (Tat) protein is found in the cerebrospinal fluid of patients adherent to ART, and its administration or expression in animals causes cognitive symptoms. Studies of Tat interaction with the N-methyl-D-aspartate receptor (NMDAR) suggest that glutamate toxicity contributes to Tat-induced impairments. To identify changes in regional glutamatergic circuitry underlying cognitive impairment, we injected recombinant Tat86 or saline to medial prefrontal cortex (mPFC) of male Sprague-Dawley rats. Rats were assessed with behavioral tasks that involve intact functioning of mPFC including the novel object recognition (NOR), spatial object recognition (SOR), and temporal order (TO) tasks at 1 and 2 postoperative weeks. Following testing, mPFC tissue was collected and analyzed by RT-PCR. Results showed Tat86 in mPFC-induced impairment in SOR, and upregulation of Grin1 and Grin2a transcripts. To further understand the mechanism of Tat toxicity, we assessed the effects of full-length Tat101 on gene expression in mPFC by RNA sequencing. The results of RNAseq suggest that glutamatergic effects of Tat86 are maintained with Tat101, as Grin2a was upregulated in Tat101-injected tissue, among other differentially expressed genes. Spatial learning and memory impairment and Grin2a upregulation suggest that exposure to Tat protein drives adaptation in mPFC, altering the function of circuitry supporting spatial learning and memory., (© 2024. The Author(s).)