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Purpose: To better understand what is most important to people living with human immunodeficiency virus (PLWH) when choosing their treatment. We assessed how PLWH trade off the potential risks and benefits of oral and long acting injectable (LAI) treatments., Participants and Methods: Firstly, in-depth interviews were conducted with 11 PLWH to develop a holistic understanding of experiences and determine attributes that contribute to treatment decision-making. Secondly, a discrete choice experiment (DCE) was used to understand the treatment preferences for PLWH with n = 99 PLWH aged 18 years or over with a diagnosis of human immunodeficiency virus (HIV) and who were currently using anti-retroviral therapy (ART). Study participants were presented with 12 scenarios and asked to select their preferred treatment among two hypothetical injectable treatment alternatives, "injection 1" and "injection 2" and their current oral ART treatment. The DCE data were modelled using a latent class model (LCM)., Results: The model revealed significant heterogeneity in preferences for treatment attributes among study participants. Two segments/classes of PLWH were identified. The first segment expressed a strong preference for their current oral treatment; the second segment showed strong preference for the injection treatment and for it to be administered in a GP clinic. Overall, out-of-pocket cost was the most important attribute for participants. One-third of PLWH were willing to switch to an LAI., Conclusion: Not all PLWH valued the same treatment attributes equally. Overall, out-of-pocket costs for treatments were considered by respondents as the most determining factor in making treatment choices. Results have important implications for healthcare policy and will serve to better inform patients and stakeholders involved in the treatment decision-making process about the treatment preferences of PLWH. Clinicians are encouraged to consider shared decision-making to establish the treatment course that best aligns with PLWH's treatment goals., Competing Interests: SF and TK are employed by CaPPRe. CaPPRe has consulted to AbbVie, Amgen, AstraZeneca, Celgene, CSL Behring, Edwards, GSK, Ipsen, Janssen, Novo Nordisk, Roche, Sanofi, Shire and UCB, outside of the submitted work. MT is an employee of GSK. FD is an employee of ViiV Healthcare. The authors report no other conflicts of interest in this work., (© 2023 Fifer et al.)

Background: Patients with lesions suspicious for skin cancer often present to primary care physicians (PCPs), who may have limited training in skin cancer diagnosis., Objective: To measure the impact of an adjunctive handheld device for PCPs that employs elastic scattering spectroscopy (ESS) on the diagnosis and management of skin cancer., Methods: Fifty-seven PCPs evaluated 50 clinical images of skin lesions (25 malignant and 25 benign), first without and then with knowledge of the handheld ESS device output, and in each case indicated if a lesion was likely to be benign or malignant., Results: The diagnostic sensitivity of the PCPs with and without the use of the ESS device was 88% (95% CI, 84%-92%) and 67% (95% CI, 62%-72%), respectively ( P  < .0001). In contrast, no significant difference was observed in the diagnostic specificity. The management sensitivity of the physicians with and without the use of the ESS device was 94% (95% CI, 91%-96%) and 81% (95% CI, 77%-85%), respectively ( P  = .0009). Similarly, no significant difference was observed in the management specificity., Conclusion: The use of the ESS device may have the potential to help improve skin cancer diagnosis and confidence in management decision-making in a primary care setting., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Todd Thames and Thomaz de Campos Silva are advisors for DermaSensor, Inc. Laura Korb Ferris is a consultant for DermTech and an investigator for Castle Biosciences, SkinAnalytics, and DermTech.

Background: The Connect through Positive Leisure Activities for Youth (Connect through PLAY) trial is a prospective, randomized controlled trial implemented within pre-existing afterschool programs (ASPs) comparing a staff-based social development physical activity (PA) program to a health curriculum active control. The efficacy trial aims to improve staff capacity for implementing effective physical activity (PA) programming within ASPs serving underserved youth (minority, low-income) through enhancing the influence of ASP staff as key change agents and addressing the social development needs of adolescents., Design and Setting: The 5-year cluster randomized trial will involve 30 ASPs that are randomized to either the Connect through PLAY intervention or the active health curriculum control., Intervention: The Connect through PLAY intervention employs a novel theoretical framework that targets three key social mechanisms for increased and sustained PA of staff and youth including youth-peer connections/friendships, group belonging, and staff-youth connections. All components of the intervention are designed to improve staff capacity for facilitating a PA context that supports these social mechanisms and increases the influence of ASP staff as positive PA role models and agents of change. Compared to control sites, ASPs receiving Connect through PLAY are expected to show greater improvements from baseline to post- and 6-month follow-up on youth PA, staff PA, and social mechanisms., Implications: The results of the Connect through PLAY trial will demonstrate the efficacy of the intervention and will assist in developing a model of training, motivating, and empowering ASP staff to address social mechanisms that promote youth PA., (Copyright © 2022 Elsevier Inc. All rights reserved.)

During the maturation step, the retroviral capsid proteins (CAs) assemble into polymorphic capsids. Their acute curvature is largely determined by 12 pentamers inserted into the hexameric lattice. However, how the CA switches its conformation to control assembly curvature remains unclear. We report the high-resolution structural model of the Rous sarcoma virus (RSV) CA T = 1 capsid, established by molecular dynamics simulations combining solid-state NMR and prior cryoelectron tomography restraints. Comparing this with our previous model of the RSV CA tubular assembly, we identify the key residues for dictating the incorporation of acute curvatures. These residues undergo large torsion angle changes, resulting in a 34° rotation of the C-terminal domain relative to its N-terminal domain around the flexible interdomain linker, without substantial changes of either the conformation of individual domains or the assembly contact interfaces. This knowledge provides new insights to help decipher the mechanism of the retroviral capsid assembly.

As part of a clinical practice which aims to alleviate the psychological suffering of children in situations of migration and/or uprooting, a discussion can be undertaken regarding the cultural aetiologies of migrant families whose children present autism spectrum disorders. The transcultural context enables families to travel between worlds as well as share their collective imagination regarding psychological suffering using graphic expression and narrative elements., (Copyright © 2020 Elsevier Masson SAS. All rights reserved.)

Sustainability assessment is a fundamental step to support decisions towards sustainable development, and several procedures to assess the sustainability of antrophic production systems have been suggested. However, most of them lack a scientific-based construct supporting their conceptual model of sustainability, which usually results in a choice of indicator(s) without criterion that can best represent a fraction of the larger and deeper concept of sustainability. This work proposes a novel framework, named Sustainability Assessment Procedure for Operations and Production Processes (SUAPRO), supported by the PDCA four-step management method (plan, do, check, and act) and the five sectors sustainability (5SEnSU) model. Grounded on scientific bases, SUAPRO provides the steps for a sustainability assessment, including its contextualization (objectives, functional unit, boundaries, energy diagram), the choice of indicators based on the 5SEnSU model, the quantification step including goal programming as a multicriteria tool, and conclude the first cycle with a sensitivity analysis. To illustrate an application of SUAPRO, the road and railroad transportation options for soybean in Brazil are considered as a case study. Results show that the railroad mode has better performance as for the Sustainability Synthetic Indicator (SSIS of 3.6 ± 0.4) than the road mode (SSIS of 4.0 ± 0.3). Towards a SSIS improvement, the sensitivity analysis highlights that public policies or even private actions should be mainly focused on reducing the emergy invested in the railroad system, while the road transportation option claims effort in reducing its global warming and acidification potentials. SUAPRO is the main contribution in this work, as it tries to overcome shortcomings as usually found in scientific papers aiming to assess the sustainability of antrophic systems. The subjectivity inherent in any multicriteria method is present as the main limitation, thus all criteria used in choosing weights must be clearly presented., (Copyright © 2019. Published by Elsevier B.V.)

Infection of mice with Mycobacterium avium or immunization with a novel PE gene expressed by M. avium (MaPE) showed that a dominant T-cell immune response was elicited. Immunization with an MaPE DNA vaccine protected mice against an aerosol challenge with Mycobacterium tuberculosis, suggesting that mycobacteria express PE antigens with cross-protective T-cell epitopes.

The heparin-binding hemagglutinin (HBHA) of Mycobacterium tuberculosis is a surface-expressed adhesin that can affect binding to host cells via a unique, methylated, carboxyl-terminal, lysine-, alanine-, and proline-rich repeat region. It has been implicated in extrapulmonary dissemination of M. tuberculosis from the lung following the initial infection of the host. To assess the vaccine potential of this protein, purified preparations of HBHA were emulsified in a dimethyldioctadecylammonium bromide-monophosphoryl lipid A adjuvant and tested for the ability to reduce M. tuberculosis infection in the mouse aerosol challenge model for tuberculosis. The HBHA-containing vaccine gave a approximately 0.7-log reduction in CFU in both mouse lungs and spleens compared to adjuvant controls 28 days following challenge. Although a notable level of serum antibody to HBHA was elicited after three immunizations and the antibodies were able to bind to the surface of M. tuberculosis, passive immunization with monoclonal antibodies directed against HBHA did not protect in the challenge model. Compared to adjuvant controls, an elevated gamma interferon response was generated by splenic and lymph node-derived T cells from immunized mice in the presence of macrophages pulsed with purified HBHA or infected with live M. tuberculosis, suggesting that the effective immunity may be cell mediated. Efforts to construct effective recombinant HBHA vaccines in fast-growing Mycobacterium smegmatis have been unsuccessful so far, which indicates that distinctive posttranslational modifications present in the HBHA protein expressed by M. tuberculosis are critical for generating effective host immune responses. The vaccine studies described here demonstrate that HBHA is a promising new vaccine candidate for tuberculosis.

Although post-translational modifications of protein antigens may be important componenets of some B cell epitopes, the determinants of T cell immunity are generally nonmodified peptides. Here we show that methylation of the Mycobacterium tuberculosis heparin-binding hemagglutinin (HBHA) by the bacterium is essential for effective T cell immunity to this antigen in infected healthy humans and in mice. Methylated HBHA provides high levels of protection against M. tuberculosis challenge in mice, whereas nonmethylated HBHA does not. Protective immunity induced by methylated HBHA is comparable to that afforded by vaccination with bacille Calmette et Guérin, the only available anti-tuberculosis vaccine. Thus, post-translational modifications of proteins may be crucial for their ability to induce protective T cell-mediated immunity against infectious diseases such as tuberculosis.

Laparoscopic cholecystectomy has been developed as an alternative to open cholecystectomy for the treatment of symptomatic cholelithiasis. A collaborative study of 261 patients undergoing laparoscopic cholecystectomy at three Texas institutions was performed to determine the effectiveness and safety of this technique. There were 65 males and 196 females with a mean age of 49 years (range 17-94 years). Acute cholecystitis was present in 38 patients and chronic cholecystitis in 223 patients. Mean length of surgery was 80 minutes (20 min to 4 hr). Fifteen patients were converted to the open technique intraoperatively due to bleeding, adhesions, or difficulty of dissection. There were no perioperative deaths and morbidity was 3% including urinary retention, small bowel obstruction, arrhythmia, wound infection, and bile leakage. There were no common duct injuries. Hospitalization ranged from outpatient surgery to 7 postoperative days with a mean of 1.2 days. We conclude that laparoscopic cholecystectomy can be performed safely and with low morbidity and offers shorter hospitalization and postoperative recovery.

This study was conducted to test the accuracy of a commercially available forecasting system in predicting the effects of growth and orthodontic treatment. The pretreatment cephalograms and wax bites of mandibular casts of thirty-three consecutively treated Class II patients with high mandibular plane angles, along with twenty-six criteria related to treatment preference, were submitted for analysis. All patients had already been treated on a nonextraction basis by a single practitioner using high-pull face-bow headgear. The computer-generated posttreatment predictions or visual treatment objectives (VTO's) were compared to the actual posttreatment cephalograms, using twenty-one linear and nine angular measurements. Fifteen of the thirty parameters evaluated showed statistically significant (P less than 0.01) differences between the actual posttreatment result and the computer prediction. The computer was found to be accurate in predicting the effects of growth and treatment on maxillary position and rotation, mandibular length, upper face height, and incisor positions. It was found to be inaccurate in predicting the effects of growth and treatment on maxillary length, mandibular rotation, lower anterior and posterior face heights, the horizontal and vertical positions of the molars, and over 50% of the soft-tissue parameters.