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Using a mobile research facility, we enrolled 141 opioid users from a neighborhood of Philadelphia, an urban epicenter of the opioid epidemic. Nearly all (95.6%) met DSM-5 criteria for severe opioid use disorder. The prevalence of HIV infection (8.5%) was more than seven times that found in the general population of the city. Eight of the HIV-positive participants (67.0%) reported receiving antiretroviral treatment but almost all of them had unsuppressed virus (87.5%). The majority of participants (57.4%) reported symptoms consistent with major depressive disorder. Severe economic distress (60.3%) and homelessness were common (57%). Polysubstance use was nearly universal, 72.1% had experienced multiple overdoses and prior medication for opioid use disorder (MOUD) treatment episodes (79.9%), but few currently engaged in addiction care. The prevalence, multiplicity and severity of chronic health and socioeconomic problems highlight consequences of the current opioid epidemic and underscore the urgent need to develop integrated models of treatment.Utilizando un Centro de Investigación Móvil, inscribimos a 141 usuarios de opioides del vecindario de Filadelfia, un epicentro urbano de la epidemia de opioides. Casi todos (95,6%) cumplieron con los criterios del DSM-5 para el trastorno del uso severo del consumo de opioides. La prevalencia de la infección de VIH (8,5%) fue másﹶ de 7 veces superior a las encontrada en la población general de la ciudad. Ocho de los participantes con VIH positivo (67,0%) reportaron haber recibido tratamiento antirretroviral pero casi todos tuvieron virus no suprimido (87,5%). La mayoría de los participantes (57,4%) informaron síntomas compatibles con el Desorden Depresivo Mayor. La angustia severa por lo económico (60,3%) y las personas sin hogar fueron comunes (57%). El uso de múltiples sustancias fue casi universal, el 721% había experimentado múltiples sobredosis y previos medicamentos para el tratamiento del trastorno por consumo de opioides (MOUD) (79,9%), pero muy pocos estaban comprometidos con la atención a las adicciones. La prevalencia, la multiplicidad y la seriedad de los problemas de salud crónica y los problemas socioeconómicos destacan las consecuencias de la actual epidemia de opioides y subrayan la urgente necesidad de desarrollar nuevos modelos de tratamiento integrados.

The human papillomavirus (HPV) vaccine was recently approved for use in males. Certain groups, such as men who have sex with men (MSM), are at increased risk of HPV infection. The purpose of the study was to understand perceptions of HPV and the vaccine among adolescent and young adult males, both heterosexual and MSM. Seventy-six males (45 heterosexual, 31 MSM) completed a questionnaire and participated in a focus group. Overall, 42% had heard of HPV and 39% had heard of the HPV vaccine. Males had moderate to favorable attitudes toward vaccination, although intentions to vaccinate were more neutral. MSM were more knowledgeable, aware, and in control of the decision to vaccinate than heterosexual males. Increasing awareness and knowledge about HPV and the vaccine may be necessary to encourage vaccination; certain subgroups of males may be more receptive to HPV vaccination than others.

Welcome to the fourth edition of Architectural Science Review for 2013. Seven papers have been selected which address the aims and fit within the breadth of scope in the journal. In addition Peter ...

Objective: The objectives of this study were to determine myocardial injury in patients with septic shock by measuring serum cardiac troponin I (cTnI), to evaluate relationship between elevated cTnI and myocardial dysfunction and to determine if cTnI is a predictor of outcome in these patients. Methods: Thirty-seven consecutive patients with septic shock were included in the study. Serum cTnI was measured at study entry and after 24 and 48 h. Transthoracic echocardiogram, electrocardiogram and regular biochemical and hemodynamic assessments were performed. Results: Sixteen (43%) patients had elevated serum cTnI. These patients had higher need for inotropic/vasopressor support (94% vs. 53%, p =0.018), higher APACHE II score (28 vs. 20, p =0.004), higher incidence of regional wall motion abnormalities on echocardiography (56% vs. 6%, p =0.002), lower ejection fraction (46% vs. 62%, p =0.04) and higher mortality (56% vs. 24%, p =0.04) compared to normal cTnI patients. By multiple logistic regression analysis, serum cTnI and APACHE II score were independent predictor of death and length of stay in intensive care unit. Serum cTnI, APACHE II score, anion gap and serum lactate were independent predictor of need for inotropic/vasopressor support. Receiver-operating characteristics of serum cTnI as a predictor of death in septic shock were significant. The elevated serum level of cTnI correlated with the lower left ventricular ejection fraction ( p Conclusions: Myocardial injury can be determined in patients with septic shock by serum cTnI. Serum cTnI concentration correlates with myocardial dysfunction in septic shock. High serum cTnI predicts increased severity of sepsis and higher mortality. A close monitoring of patients with septic shock and elevated levels cTnI is warranted.

Metastatic carcinoma involving the paranasal sinuses is uncommon. One hundred-sixty seven cases have been published in the literature since 1951. Symptoms, signs, and rhinoscopic and imaging findings are often nonspecific, and the diagnosis may be missed for considerable time. Therefore, a high level of suspicion is warranted in patients with known malignancies presenting with persistent or recurrent rhinosinusitis or facial complaints.

A pre-distortion by amplitude modulate (PDAM) method is evaluated for use in linear frequency modulated (LFM) coded harmonic imaging. LFM coded signals are known to boost the SNR of the low amplitude harmonics, but due to the nature of harmonic imaging, are located at inefficient regions of the transducer's bandwidth. As a consequence, the LFM signal is subjected to transducer-induced tapering which is particularly severe at the start or end of the signal. The motivation for this work is to investigate whether compensating for this tapering effect results in improved compression of the harmonic signal. PDAM signals are designed using an inverse filter method. Hydrophone measurements show successful transducer compensation of the fundamental signal. Fundamental and second harmonic images of a tissue mimicking phantom indicate minimal improvement when compared with non pre-distorted LFM signals (N-PDAM). A discussion is provided as to why this result can be attributed to the use of a sub-optimal compression filter.

The high velocities encountered in major vessels impede potential drug-free thombolysis treatments such as Histotripsy by lowering the gas concentration that is known to promote inertial cavitation and soft tissue fragmentation. The ”ultrasonic tap” can retain microbubbles in a highly localised region, against the vessel wall. Phospholipid microbubbles flowing through a 4 mm wall less vessel at a depth of 30 mm within a tissue mimicking phantom were successfully accumulated at a single location. The same ultrasound medical probe was used to emit the acoustic field required to trap the microbubbles, acquire B-Mode frames and induce inertial cavitation for concentrations of 106 and 107 MB/ml. Inertial cavitation was measured through 17 mm of tissue mimicking material with similar frequency dependent attenuation to human tissue.

This paper provides a simulation study into the use of a novel method of ultrasound array excitation referred to as randomized excitation. This technique provides a solution for temporal ultrasound power/intensity control across an ultrasound array. This technique particularly differs from other previously reported solutions as elements are randomly switched, spatially across the array and temporally in time. Simulations show this excitation scheme to be capable of producing fine temporal control of the transmitted ultrasound power at the focal region. This paper covers the basics of randomized excitation implementation, simulation results and future potential applications of randomized excitation.

In an ultrasound system, a digital beamformer is a critical component, which beamforms the data in a desired direction. A 96 channel parameterized beamforming system is designed using VHDL tools. Incoming sampled signals are delayed using FIFO chains and receive apodization is applied using a single multiplier on a sample by sample basis. Each delayed channel data is then summed using a pipelined adder tree to give a beamformed line. The design is evaluated using a 96 channel hardware research platform (UARP), but can easily be extended to more than 96 channels for different imaging techniques. It supports variable channel count, aperture sizes and delays. It increases system frame rate as compared to PC based beamforming with just another 15% logic utilization and 3% memory resources using custom FPGA board, making it viable for real-time processing and measurements.

Sarcoidosis was first described by a British dermatologist, Jonathan Hutchison in 1869. Since then it has been seen in almost every part of the world and continues to engender considerable interest and concern amongst scientists and medical providers alike because 1) the cause is unknown, 2) it may involve any organ system in the body, 3) the course and prognosis vary from spontaneous resolution to progressive disability and death, and 4) there is no truly satisfactory treatment. Just as there are many unknowns about the illness in general, its diagnosis remains problematic despite extensive study and voluminous reporting in the scientific literature. Our objective in this chapter is to provide an overview of current knowledge on the diagnostic approach in sarcoidosis.

In ultrasound harmonic imaging with chirp coded excitation, the axial resolution can be improved by increasing the excitation signal bandwidth. However, increasing the bandwidth will cause overlapping between the received nonlinear second harmonic chirp component (SHCC) and the fundamental component. For the spectrally overlapping harmonics, signal decoding using the second harmonic matched filter (SHMF) typically produces higher range sidelobes level (RSLL), which reduces the image contrast. A multi-pulse detection scheme such as pulse inversion can be used to extract the overlapped SHCC; however it is susceptible to motion artifacts and reduced system frame-rate. In this study, the fractional Fourier transform (FrFT) is proposed with chirp coded excitation for the extraction of the overlapped SHCC. The experimental results indicate at least a 13 dB improvement in the RSLL of the FrFT filtered compressed SHCC when compared with the unfiltered compressed SHCC.

Acoustic radiation force has become a significant factor in the research to enhance the targeting of microbubbles for molecular imaging and drug delivery. In this study microbubbles are flown through an opposing radiation force funnel and the impact on their path is compared to the theory. The experiments demonstrate that the behavior of the lipid microbubbles is in accordance with the simulation. Although the force required to stop microbubbles flowing at 10 mm/s is in the order of 100s of nN, large clusters are successfully held against the flow.

4702This book consists of an introductory part of four interviews, followed by eight parts comprising of a total of 30 chapters by various authors, generally of the younger generation of architects...

4701Simon Unwin has long experience of teaching architecture students, and of writing about the subject in an engaging, easy-to-read style. His previous books Analysing Architecture and Twenty Buil...

This series of nine essays on the relationship between climate and architectural design, is an initiative of the Royal Danish Academy of Fine Arts. Its emphasis is on the challenges, and the opport...

The influence of climate on building design has assumed such importance in recent decades that it is often considered to be a recent development. An alternative argument is that the principles of d...

Diagnostic testing in community-acquired pneumonia (CAP) serves three functions: firstly, to confirm the presence of CAP; secondly, to assess severity; and thirdly, to identify the causative pathogen. Available techniques are satisfactory to fulfill the first two roles but are seriously inadequate as regards the third. Accordingly, antibiotic therapy for CAP must be empirical, at least initially. This article reviews current diagnostic methods and provides suggestions for appropriate use of diagnostic tests in CAP. The shortcomings of the available methods for microbiologic diagnosis are discussed. The potential for PCR to become the much sought after 'ideal' test for microbiologic diagnosis in CAP is explored.

Diagnostic tests are used to confirm the presence of community-acquired pneumonia (CAP), assess severity, and identify the responsible pathogen. At present, there is no study or combination of studies that can consistently provide a microbiologic diagnosis, and controversy continues as to what tests should be performed. This article reviews each of the roles of diagnostic testing in CAP and focuses on the issue of microbiologic diagnosis. Based on available evidence, recommendations are provided for use of diagnostic studies in CAP.

A patient with ovarian cystadenocarcinoma developed respiratory insufficiency due to bilateral endobronchial metastases, 6.5 years after treatment of the primary tumor. Ovarian cancers frequently metastasize to the pleura and lung parenchyma. Clinically significant bronchial metastases are rare. Only three cases have been reported previously. As in our patient, bronchial metastases tend to occur after a relatively long interval from diagnosis of the primary tumor, and survival may be prolonged after their appearance.

A 78-year-old man presented with acute lupus pleuritis due to procainamide. The pleural fluid was a turbid, yellow exudate with a WBC count of 53,200/cu mm (70 percent polymorphonuclear leucocytes), LDH of 4,296 IU/L, and pH of 7.195. Although these fluid characteristics suggested pleural space infection, they were due to pleural inflammation from drug-induced lupus. LE cells were present in the fluid and results of microbiologic studies were negative. Clinical and roentgenographic improvement followed discontinuation of procainamide.

Thirty patients known to have or suspected of having acquired immunodeficiency syndrome (AIDS) were evaluated for opportunistic pulmonary infection using a double lumen lavage catheter (DLL). Lavage specimens obtained were cytocentrifuged and initially stained by the Papanicolaou technique as a means of rapid evaluation for Pneumocystis carinii. If no opportunistic organism was identified, the patient underwent further diagnostic investigations. In 18 patients receiving mechanical ventilatory support, the procedure was performed via the endotracheal tube. Twelve patients who were less severely ill underwent the procedure via the transnasal route. In 43 percent (13/30), opportunistic infections were diagnosed by DLL. Twelve had P carinii, one of whom had cytomegalovirus and another of whom had Herpes simplex viruses, and one with Toxoplasma gondii. Thus, the sensitivity for all opportunistic infections was 86 percent (12/14). The volume of fluid recovered averaged 93 percent of that instilled. There was no significant difference between prelavage and postlavage PaO2. In this group of patients, double lumen lavage obviated the need for more invasive and expensive procedures.

Photoconducting antennas have been demonstrated which are capable of generating and coherently detecting subpicosecond electrical pulses. These antennas, when illuminated with femtosecond optical pulses, radiate electrical pulses which have frequency spectra that extend from 2 THz. Microscope dipoles measuring 50, 100, and 200 mu m have been fabricated and tested. Integrated photoconductors of radiation-damaged silicon-on-sapphire were used both for impulsive current excitation of the transmitting antennas as well as for gating the receiving antennas. >

Terbutaline, a new bronchodilator drug reported to have selective affinity for beta 2-adrenergic receptors, was compared with epinephrine in the treatment of 49 adult subjects with acute bronchial asthma. Under double-blind conditions, 24 subjects received 1.0 mg of terbutaline sulfate, and 25 subjects received 0.5 mg of epinephrine hydrochloride subcutaneously. Spirometric measurements, heart rate, and blood pressure, as well as subjective responses, were recorded prior to, and then at 5, 15, 30, 60, and 120 minutes after administration of the drug. The results indicate that terbutaline is an effective bronchodilator drug in subjects with acute asthma; however, the heart rate rose significantly after administration of terbutaline, with a maximal increase of 25 percent above control. Review of the literature reveals that tachycardia is a consistent finding when subcutaneous doses of terbutaline in excess of 0.25 mg are administered. Stimulation of beta 1-adrenergic receptors in the heart appears to be the most important factor involved in this response. A lesser cardioaccelerator effect was observed after administering epinephrine in a dose producing an equivalent degree of bronchodilatation.

Cavitation is an unusual manifestation of legionnaires' pneumonia. Mortality rates range from 24 to 58 percent with effective therapy. Antibiotic therapy is not standardized and is largely based on anecdotal reports. This report has described nosocomially acquired cavitary legionnaires' pneumonia in five renal transplant recipients. The diagnosis was made by seroconversion and immunofluorescent staining of lung tissue or transtracheal aspirates. Frequently seen associated symptoms were not present. All patients were successfully treated with 2 to 4 g of erythromycin for at least 4 weeks.

Mediastinal emphysema developed in a 13-year-old boy with diffuse interstitial pulmonary disease, later proved to be sarcoid. No previous report was found.

The authors present the roentgenological findings and response to treatment of 10 patients with tuberculous mediastinal lymphadenitis (TML). The clinical presentation is usually non specific except for the positive tuberculin skin test. The roentgenographic appearance varies but very often includes right tracheobronchial involvement. Tissue diagnosis is often necessary to establish the diagnosis. Since the epidemiology of tuberculosis is shifting, TML will be encountered more frequently in the adult.

In order to routinely monitor the fetal electrocardiogram (FECG), during labor, in an on-line real-time situation, the following processes need to be undertaken: The FECG signal must be recovered from noise. The recovered signal or waveform must be measured with a high degree of precision in order to generate the timing intervals, areas and parameters that are of interest to the clinician. The FECG and measured parameters must be presented to the clinician in a meaningful and simple format. Control of the machine and its processing should be a user friendly operation. In the current work, a system is described that uses digital filtering to recover the FECG waveform from low frequency biological noise and associated artifacts. A linear model of the FECG waveform is used to evaluate some 18 different timing intervals of the FECG. The enhanced waveform and accompanying parameters are displayed upon an intelligent graphics terminal to achieve a user friendly operation of the system by clinical staff.

The application of femtosecond optics to the measurement and characterization of the electronic properties of materials and devices is reviewed with emphasis on new approaches to the generation and detection of extremely fast electromagnetic transients. Specific topics discussed are: (i) the use of the inverse electro-optic effect for electrical pulse generation, (ii) the intrinsic speed of response of electro-optic materials, and (iii) a new approach to far-infrared spectroscopy which uses time-domain measurements of single-cycle pulses.

Pulmonary tuberculosis has long been associated with the formation of cavities in the lung. Many reports in the literature indicate that the occurrence of air-fluid levels in tuberculosis is unusual. The authors present 18 cases of proved active cavitary tuberculosis where air-fluid levels occurred during the active phase of the disease. The consideration of tuberculosis in the differential diagnosis of an air-fluid containing pulmonary cavity is emphasized and the pathogenesis of cavity formation is discussed.

We describe a degenerate four-wave mixing technique for measuring optical Kerr coefficients. This technique permits discrimination between fast and slow (thermal) nonlinearities. We report results for a number of long-chain organic materials.