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Objective In case of complex aortic aneurysmal disease, fenestrated or branched EVAR (b/f-EVAR) is considered as a valid and safe alternative to open surgery. However, one the main limitation is the time required for manufacture, limiting its use in emergent situations. The new off-the-shelf 4 inner branches E-nside (Jotec, Hechingen, Germany) has been developed to offer a solution in such circumstances. The aim of this study was to report our preliminary monocentric experience with this new device. Methods Retrospective analysis of prospective data retrieved from 1 center between November 2020 and January 2022 was done. Endpoints were technical success, postoperative morbidity, rate of endoleak and any aneurysm-related re-interventions during follow-up. Results In this study, 15 patients (mean age 73 years, range 59–90) were identified. There was a majority of male (9/15) and all of them but 3 were asymptomatic. The mean aneurysmal diameter was 60 mm (range 50–100). There were 3 cases of juxtarenal aortic aneurysms (20%), 1 Crawford type I (7%), 4 type II (27%), 4 type III (27%) and 3 type IV (20%) aneurysms. In 7 cases, a 2-steps procedure was done with a TEVAR first followed by Enside implantation. There was a technical success in 93% with 1 open conversion for a mesenterical bypass. There was no death in the post-operative period. During the post-operative period, 33% of patients (5/15) presented complications with 3 complications related to the femoral or iliac access and 2 cases of spinal cord ischemia (13%). One case occurred in an emergent setting of a type III aneurysm rupture. The other case was the open conversion and the patient also developed a colic ischemia and finally died 4 months alter. The mean length of stay was 9 days. During the follow-up, 2 reinterventions were necessary, 1 for a type Ic endoleak with distal prolongation of the stent and 1 renal stent occlusion treated by relining. The overall target vessel patency was 98%. Conclusion The use of the off-the-shelf 4 inner branches E-nside appears to be safe with good technical success for the treatment of complex aortic aneurysmal disease. It is associated with an acceptable rate of complications and allows for treatment of a wide variety of diseases in an emergent setting. Further patients and longer follow-up are required to better evaluate the exact role of this new device.

To explore the prevalence of intrauterine device self-removal practices before and during the COVID-19 pandemic among family planning clinics.This is a secondary analysis of data from a descriptive, longitudinal study using a clinic-based convenience sample from the Abortion Clinical Research Network assessing baseline and pandemic-adaptive family planning practices.Of the 63 sites that provided contraception, 5 (7.9%) reported providing guidance on intrauterine device self-removal at baseline. Sixteen sites (25.4%) provided guidance on self-removal by the end of the study period. Self-removal counseling was associated with being an academic center and reporting a median lower number of monthly contraceptive encounters.Endorsement of IUD self-removal increased to one-quarter of sites by the final timepoint.Twenty-five percent of family planning clinics reported provision of intrauterine device self-removal guidance by eight months into the COVID-19 pandemic, a three-fold increase from baseline; these findings suggest clinician support for patient autonomy in contraceptive self-management and limited concern for safety issues with self-removal during a public health emergency.

Background Sarcopenia was reported to be associated with poor clinical outcome, higher incidence of community-acquired pneumonia, increased risk of infections and reduced survival in different clinical settings. The aim of our work is to evaluate the prognostic role of sarcopenia in patients with the 2019 novel coronavirus disease (COVID-19). Materials and Methods 272 COVID-19 patients admitted to the University Hospital of Modena (Italy) from February 2020 to January 2021 were retrospectively studied. All included patients underwent a chest computed tomography (CT) scan to assess pneumonia during their hospitalization and showed a positive SARS-CoV-2 molecular test. Sarcopenia was defined by skeletal muscle area (SMA) evaluation at the 12th thoracic vertebra (T12). Clinical, laboratory data and adverse clinical outcome (admission to Intensive Care Unit and death) were collected for all patients. Results prevalence of sarcopenia was high (41,5%) but significantly different in each pandemic wave (57,9% vs 21,6% p

This case demonstrates a successful dilation and evacuation (DE) at 21 weeks gestation for a patient with abdominal cerclage without initial advanced dilation. We followed a 2-day protocol with placement of 5 laminaria and mifepristone for cervical preparation without complication.

Fulfilling the current pass-by noise regulation is a challenge for the original equipment manufacturers and their suppliers. And it's not going to improve over time. Any possible ways to reduce the exterior noise can happen to be beneficial. In this context, simulations are natural alternatives to costly and long measurement campaigns to quantify the benefits of acoustic treatments. Nevertheless, modelling procedures to tackle this type of issues are far from being well-established, even though the literature is rich with studies describing the complex processes involved in the tyre–road contact. Very often, when it comes to full-vehicle modelling, tyre sources are replaced by simple sources as monopoles, thus introducing a physical simplification. This paper is concerned with the tyre noise modelling in finite element simulation in the perspective to assess the pass-by noise of a car. For that, the sound radiated by validated velocity maps from a tyre–road noise simulation model at different speeds and for different loads is compared with the noise radiated by monopoles in the close vicinity of the tyres. The aim is to define the limitation related to the use of the monopoles in order to correctly capture the relevant physics in the simulation.

Acute hypoxemic respiratory failure (AHRF) is severe arterial hypoxemia that is refractory to supplemental oxygen and could be caused by pneumonia, cardiogenic pulmonary edema, ARDS, and chronic obstructive pulmonary disease (COPD). ARDS is an important syndrome of noncardiogenic edema in which the most common risk factors include pneumonia, nonpulmonary sepsis, and aspiration (Stefan et al., J Hosp Med, 8:79–82, 2013).

Habitat destruction, hydrologic alteration, and nonnative species introductions have greatly altered the composition of North American stream fish assemblages. In the western United States, intermediate-elevation transition-zone stream reaches––those located between higher-elevation mountain and lower-elevation plains areas––historically supported native fish assemblages that included sensitive species and peripheral or isolated populations of more widespread taxa. We compiled historical records and conducted sampling to examine changes to the fish assemblage in the transition-zone reach of South Boulder Creek, Colorado, USA. Because human development of transition zones altered stream and riparian ecosystems prior to sampling, we developed a historical timeline of human activities to formulate hypotheses regarding factors that influenced fish assemblage change through time. Native fish species richness declined by 60% from the likely historical assemblage, and we hypothesize that widespread alteration of stream and riparian habitat in the mid-1800s caused a first wave of species losses, especially taxa with specific habitat or life history requirements. The remaining coolwater native fishes dominated through the mid-1990s, but more recently, the coldwater-tolerant, nonnative Brown Trout Salmo trutta has greatly expanded and is implicated in additional native species loss. Possible management actions to restore native fish assemblages in transition-zone streams include the following: increasing habitat diversity, particularly off-channel backwaters suited to lentic-adapted native fishes; providing refuges from predators or reducing predator abundance; restoring sinuosity to straightened reaches to improve channel function; improving stream connectivity via installation of fish passages; reintroducing beaver or installing beaver dam analogs; provisioning of suitable flow; and eventually, identifying native stocks for reintroduction. Management of other western United States transition-zone stream reaches may benefit from these insights, especially if conservation of the locally distinct native fish assemblages and their scarce habitat is a priority in the face of rapid human population growth and expanding invasive species.

Background Men who have sex with men (MSM) in Europe are most affected by HIV disparities. Complex systems theory proposes that many health behaviors and risks arise from numerous cascading and interacting processes. Our aim was to explore how stigmatizing policies at the European country-level create pathways to HIV risk and disparities among MSM in Europe. Methods We used data from the 2017 European Men Who Have Sex with Men Internet Survey (EMIS-2017). The anonymous online survey recruited 126,090 European MSM. We assessed condom use with steady & non-steady partners as the outcome. Condom use was categorized from zero to 10 (10 or more partners). Abuse was scored zero to three and internalized homonegativity from zero to six. We used the International Gay and Lesbian Association's Rainbow Index as the main predictor, which ranks European countries' laws and policies regarding LGBTQ+ legal protections from zero (worst) to 100 (best). We used structural equation and multi-level modeling for analyses. Results The mean Rainbow Index score was 50.8 with a range from 6 to 88. The Rainbow Index scores were the highest in Western European (mean=62.5), then Central European (mean=45.9), then Eastern Europe (mean=21.4) (p Conclusions The policy context influences HIV risk, especially through the policies' effects on condom use. HIV research and prevention efforts must recognize that structural determinants can shape people's risk for HIV and that the best individual and local efforts may be undermined by structural factors such as policies.

Supplemental Digital Content is Available in the Text., Background: HPTN 067 assessed the feasibility of daily and non-daily dosing of open-label emtricitabine/tenofovir disoproxil fumarate (FTC/TDF)-based pre-exposure prophylaxis (PrEP). Methods: Factors associated with sex-related PrEP adherence were assessed among men who have sex with men (MSM) randomized to one of 3 PrEP dosing arms in HPTN 067 in New York City. Sex-related PrEP adherence was defined per protocol as at least 1 PrEP tablet taken within 4 days pre-sex and at least 1 additional PrEP tablet taken within 24 hours post-sex, assessed via electronic drug monitoring and weekly interviews. Demographic data and behavioral measures were evaluated for association with sex-related PrEP adherence. Logistic regression for clustered data was used to estimate the unadjusted and adjusted odds ratios. Results: Of 176 randomized MSM participants, 59% were Black, 10% White, 25% Hispanic, and 6% other; median age was 31 years. In the multivariable analyses, higher sex-related PrEP adherence was significantly associated with daily dosing arm, older age, employment, and higher PrEP adherence behavioral skills. Lower sex-related PrEP adherence was significantly associated with identifying as Black or Hispanic (compared with White), opiate use, and reporting “I forgot” as an adherence barrier. Conclusions: This analysis identified populations of MSM who might benefit from additional support to optimize PrEP adherence, including those who are younger, unemployed, or opiate users. MSM with lower PrEP behavioral skills may benefit from targeted interventions. Further study is needed to assess racial and ethnic disparities in PrEP adherence, which may reflect broader social and economic inequalities not captured in this study.

Background:Wireless vital parameter continuous monitoring (WVPCM) is compared to regular nurse monitoring in order to provide data on the clinical and economic impact of critically ill patients (CIPs) in Internal Medicine Units (IMU). Study Design:Pilot prospective randomized controlled open-label multi-center study with WIN@Hospital wearable wireless system creating alerts on portable devices (ipad). Experimental Arm:CIPs with MEWS (Modified Early Warning Score) ≥ 3 and/or NEWS (National Early Warning Score) ≥ 5 at admission underwent WCPCM over the first 72 h. Active Comparator:CIPs with MEWS ≥ 3 and/or NEWS ≥ 5 at admission undergoing regular nurse monitoring. Primary outcomes:Reduction of major complications (MC) from 15% to 5%. Secondary outcomes:One day reduction in length of stay (LOS); reduced nurse monitoring time; accurate patient stratification and definition of end stage disease. Statistical methods:According to the preliminary study (Manerbio, 2016), 27% of hospitalized patients, of which 15% have MC, are critical (MEWS ≥3), and require monitoring. Clinical significance is set at 5% relative reduction in MCs in the experimental arm. 148 patients shall be recruited per arm (total 296; calculated by setting the alpha error at 5%, beta error at 20%, 80% test power, 5% loss). Preliminary results:Enrolled 95 and evaluable 89 patients (35 M/54 F), mean age 80.5 years, Comorbidity: Cumulative Illness Rating Scale CIRS-CI: 4, CIRS SI: 1.8. About 38% scored a BRASS (Blaylock Risk Assessment Screening Score) ≥20 indicating need for discharge planning requiring step-down care. More than 50% of patients present IIA index >3 indicating high dependency from nursing assistance. Nurses saved a minimum of 49,6 minutes to a maximum of 58,1 minutes on time spent monitoring each patient per day. Conclusions:WVPCM, detecting early deterioration in CIPs, may facilitate timely response in at-risk patients, increasing safety and reducing costs.

Driven by more and more stringent CO2 [1] and noise emission regulations [2], the need for advanced engineering in the engine bay has significantly increased over the last few years. One of the most effective solutions involves engine encapsulation, which consists in enclosing as much as possible the engine into a capsule-like assembly. On the one hand, this allows retention of heat and reduced CO2 emission, and, on the other hand, decreasing both interior and exterior vehicle noise [3][4].

We investigated the accuracy of Automated Breast Volume Scanner (ABVS) compared to handheld ultrasound (HHUS) for monitoring tumor response to neoadjuvant treatment (NAT) in breast cancer (BC).All the patients submitted to biopsy in our Institution, from January 2017 to May 2017, proven invasive BC and eligible for NAT, were enrolled in this prospective study. The participants underwent ABVS, HHUS, dynamic contrast-enhanced Magnetic Resonance Imaging (DCE-MRI) and mammography at the beginning of NAT and ABVS, HHUS and DCE-MRI at the halfway point of therapy and before the surgery. DCE-MRI was considered the standard of reference. Two breast radiologists (R1, R2), with fifteen and five years of experience in breast imaging, independently assigned a visibility score (ordinal 5-point scale) to ABVS, HHUS, and DCE-MRI. Diagnostic performance of ABVS and HHUS as measured by sensitivity, specificity, positive and negative predictive values (PPV and NPV) was calculated. Correlations between ABVS and MRI, and between HHUS and MRI were analyzed using Pearson's correlation test.A total of 21 patients were enrolled. 189 examinations were performed. The comparison between ABVS and DCE-MRI was similar for the both readers: ABVS had a sensitivity of 63,16%, specificity of 83,58%, PPV of 76,60%, NPV of 72,73%, accuracy of 74,19% (R1) and a sensitivity of 54.54%, specificity of 85.51%, PPV of 75%, NPV of 70,24%, accuracy of 71.77% (R2). The comparison between HHUS and DCE-MRI showed that HHUS had a sensitivity of 63,16 %, specificity of 83,58%, PPV of 76,60%, NPV of 72,73%, accuracy of 74,19% (R1) and a sensitivity of 36.84%, specificity of 85.07%, PPV of 67.74%, NPV of 61.29%, accuracy of 62.90% (R2). The calculated Pearson's correlation coefficient r values were 7.8 for HHUS vs. DCE-MRI and 28.5 for ABVS vs. DCE-MRI (R1) and 7.8 for HHUS vs. DCE-MRI and 22.4 for ABVS vs. DCE-MRI (R2). Statistical significance of ABVS and HHUS was p0.0001 and 0.005p0.01, respectively (R1, R2).DCE-MRI is recommended for the tumor response assessment. ABVS, a product of the biotechnology development, providing reproducible images, in addition to DCE-MRI, can be a potentially useful tool for the monitoring of response to NAT.

Background Despite intensive efforts to engage people living with HIV in the United States, less than half of the youth aged 13 to 24 years achieve viral suppression. There is a clear and continued need for innovative behavioral programs that support optimizing adherence among young persons with HIV. Objective There are 3 phases of this project. Phase 1 involves conducting focus groups to obtain feedback from youth about an existing technology-based antiretroviral therapy (ART) adherence intervention. Phase 2 will be used to conduct beta testing with youth to refine and finalize the YouTHrive (YT) intervention. Phase 3 is a randomized controlled trial (RCT) to test the efficacy of the YT intervention among youth living with HIV (YLWH). Methods In phase 1, we will conduct 6 focus groups with approximately 8 youths (aged 15-19 years) and young adults (aged 20-24 years), each in 3 US cities to obtain (1) feedback from YLWH about the look and feel and content of an existing adult-focused Web-based ART adherence intervention and (2) suggestions for adapting the intervention for YLWH similar to themselves. Phase 2 will involve updating the existing intervention to include features and functionality recommended by YLWH in phase 1; it will conclude with beta testing with 12 participants to gain feedback on the overall design and ensure proper functionality and ease of navigation. For phase 3, we will enroll 300 YLWH in 6 US cities (Atlanta, Chicago, Houston, New York City, Philadelphia, and Tampa) into a 2-arm prospective RCT. Participants will be randomized 1:1 to YT intervention or control group. The randomization sequence will be stratified by city and use random permuted blocks of sizes 2 and 4. Participants randomized to the control condition will view a weekly email newsletter on topics related to HIV, with the exception of ART adherence, for 5 months. Participants randomized to the YT intervention condition will be given access to the YT site for 5 months. Study assessments will occur at enrollment and 5, 8, and 11 months post enrollment. The primary outcome that will be assessed is sustained viral load (VL), defined as the proportion of participants in each study arm who have suppressed VL at both the 5- and 11-month assessment; the secondary outcome that will be assessed is suppressed VL at both the 5- and 11-month assessment between drug-using and nondrug-using participants assigned to the YT intervention arm. Results Participant recruitment began in May 2017 for phase 1 of the study. The data collection for aim 3 is anticipated to end in April 2020. Conclusions The efficacy trial of the YT intervention will help to fill gaps in understanding the efficacy of mobile interventions to improve ART adherence among at-risk populations. Trial Registration ClinicalTrials.gov NCT03149757; https://clinicaltrials.gov/ct2/show/NCT03149757 (Archived by WebCite at http://www.webcitation.org/73pw57Cf1) International Registered Report Identifier (IRRID) DERR1-10.2196/11502

Background The introduction of Bedaquiline, the first new antimycobacterial drug in over 40 years, has highlighted the critical importance of medication adherence in drug-resistant tuberculosis (DR-TB) treatment to prevent amplified drug-resistance and derive sustained benefit. Real-time electronic dose monitoring (EDM) accurately measures adherence and allows for titration of adherence support for anti-retroviral therapy (ART). The goal of this study was to evaluate the accuracy and acceptability of a next-generation electronic pillbox (Wisepill RT2000) for Bedaquiline-containing TB regimens. Methods Eligible patients were DR-TB/HIV co-infected adults hospitalized for the initiation of Bedaquiline-containing treatment regimens in KwaZulu-Natal, South Africa. A one-way crossover design was used to evaluate levels of adherence and patient acceptance of EDM. Each patient was given a Wisepill device which was filled with ART, Levofloxacin or Bedaquiline over three consecutive weeks. Medication adherence was measured using Wisepill counts, patient-reported seven-day recall, and weekly pill count. An open-ended qualitative questionnaire at the end of the study evaluated participant acceptability of the Wisepill device. Results We enrolled 21 DR-TB/HIV co-infected inpatients admitted for the initiation of Bedaquiline from August through September 2016. In aggregate patients were similarly adherent to Bedaquiline (100%) compared to Levofloxacin (100%) and ART (98.9%) by pill count. Wisepill was more sensitive (100%) compared to seven-day recall (0%) in detecting non-adherence events (p = 0.02). Patients reported positive experiences with Wisepill and expressed willingness to use the device during a full course of DR-TB treatment. There were no concerns about stigma, confidentiality, or remote monitoring. Conclusion In this pilot study patients were highly adherent to Bedaquiline by all adherence measures. However, there was lower adherence to ART by pill count and Wisepill suggesting a possible challenge for adherence with ART. The use of EDM identified significantly more missed doses than seven-day recall. Wisepill was highly acceptable to DR-TB/HIV patients in South Africa, and is a promising modality to support and monitor medication adherence in complex treatment regimens.

During the initial year of HIV diagnosis, while patients are often overwhelmed adjusting to this life changing diagnosis, they must develop self-care behaviors for attending regular medical care visits and antiretroviral therapy (ART) adherence to achieve and sustain viral suppression (VS). Maintaining "HIV adherence" and integrating it into one's daily life is required to sustain VS over time. The HIV care continuum or "treatment cascade," an epidemiological snapshot of the national epidemic in the United States (US), indicates that a minority of persons living with HIV (PLWH) have achieved VS. Little evidence exists regarding the effects of interventions focusing on PLWH newly initiating outpatient HIV care. An intervention that focuses on both retention in care and ART adherence skills delivered during the pivotal first year of HIV care is lacking. To address this, we developed a theory-based intervention evaluated in the Integrating Engagement and Adherence Goals upon Entry (iENGAGE) study, a National Institute of Allergy and Infectious Diseases (NIAID) funded randomized behavioral intervention trial. Here we present the study objectives, design and rationale, as well as the intervention components, targeting rapid and sustained VS through retention in HIV care and ART adherence during participants' first year of HIV care. The primary outcome of the study is 48-week VS (200 c/mL). The secondary outcomes are retention in care, including HIV visit adherence and visit constancy, as well as ART adherence.

KwaZulu-Natal, South Africa, is the epicenter of an epidemic of drug-resistant tuberculosis (DR-TB) and human immunodeficiency virus (HIV) co-infection, characterized by low rates of medication adherence and retention in care. Social workers may have a unique role to play in improving DR-TB-HIV outcomes. We designed, implemented and evaluated a model-based pilot training course on patient-centered care, treatment literacy in DR-TB and HIV coinfection, patient support group facilitation, and self-care. Ten social workers participated in a 1-day training course. Post-training questionnaire scores showed significant overall gains (Le KwaZulu-Natal, en Afrique du Sud, est l'épicentre d'une épidémie de coïnfection par la tuberculose pharmacorésistante (TB-DR) et le virus de l'immunodéficience humaine caractérisée par des taux faibles d'adhérence aux médicaments et de rétention en soins. Les travailleurs sociaux pourraient avoir un rôle unique dans l'amélioration des résultats de la coïnfection TB-DR et VIH. Nous avons conçu, mis en œuvre et évalué une formation pilote basée sur un modèle de soins centré sur le patient, de connaissance du traitement de la coïnfection TB-DR et VIH, de facilitation des groupes de soutien aux patients et de soins auto-administrés. Dix travailleurs sociaux ont participé à une formation d'un jour. Les scores des questionnaires après la formation ont montré des gains d'ensemble significatifs (KwaZulu-Natal, en Suráfrica, es el epicentro de una epidemia de coinfección por el virus de la inmunodeficiencia humana (VIH) y la tuberculosis farmacorresistente (TB-DR), que se caracteriza por bajas tasas de cumplimiento terapéutico y una deficiente retención en la atención. Los trabajadores sociales pueden cumplir una función muy útil en el mejoramiento de los desenlaces clínicos de estos casos. En el presente artículo se describe el diseño, la ejecución y la evaluación de un curso experimental de capacitación a partir de un modelo, sobre la atención centrada en el paciente, la divulgación terapéutica relacionada con la coinfección por el VIH y la TB-DR, la facilitación en grupos de apoyo de pacientes y la autoasistencia. Diez trabajadores sociales participaron en un curso de capacitación de un día de duración. La puntuación de los cuestionarios posteriores a la capacitación reveló progresos notables en general (

Objectives Adherence is critical for maximizing the effectiveness of pre-exposure prophylaxis (PrEP) in preventing HIV infection. Strategies for promoting adherence to HIV treatment, and their potential application to PrEP adherence, have received considerable attention. However, adherence promotion strategies for prevention medications have not been well characterized and may be more applicable to PrEP. We aimed to identify adherence support interventions that have been effective in other prevention fields and could be applied in the HIV prevention context to support pill taking among PrEP users. Methods To identify adherence support interventions that could be evaluated and applied in the PrEP context, we conducted a systematic review across the following prevention fields: hypertension, latent tuberculosis infection, hyperlipidaemia, oral contraceptives, osteoporosis, malaria prophylaxis, and post-exposure prophylaxis for HIV infection. We included randomized controlled trials that evaluated the efficacy of interventions to improve adherence to daily oral medications prescribed for primary prevention in healthy individuals or for secondary prevention in asymptomatic individuals. Results Our searches identified 585 studies, of which 48 studies met the eligibility criteria and were included in the review; nine evaluated multiple strategies, yielding 64 separately tested interventions. Interventions with the strongest evidence for improving adherence included complex, resource-intensive interventions, which combined multiple adherence support approaches, and low-cost, low-intensity interventions that provided education or telephone calls for adherence support. Conclusions Our review identified adherence interventions with strong evidence of efficacy across prevention fields and provides recommendations for evaluating these interventions in upcoming PrEP studies.

Little is known regarding factors implicated in early engagement and retention in HIV care among individuals not yet eligible for antiretroviral therapy (pre-ART) in sub-Saharan Africa. Identifying such factors is critical for supporting retention in pre-ART clinical care to ensure timely ART initiation and optimize long-term health outcomes. We assessed patients' pre-ART HIV care-related information, motivation, and behavioral skills among newly diagnosed ART-ineligible patients, initiating care in KwaZulu-Natal, South Africa. The survey was interviewer-administered to eligible patients, who were aged 18 years or older, newly entering care (diagnosed within the last six-months), and ineligible for ART (CD4 count200 cells/mm(3)) in one of four primary care clinical sites. Self-reported information, motivation, and behavioral skills specific to retention in pre-ART HIV-care were characterized by categorizing responses into those reflecting potential strengths and those reflective of potential deficits. Information, motivation, and behavioral skills deficits sufficiently prevalent in the overall sample (i.e.,≥30% prevalent) were identified as areas in need of specific attention through intervention efforts adapted to the clinic level. Gender-based differences were also evaluated. A total of 288 patients (75% female) completed structured interviews. Across the sample, eight information, eight motivation, and eight behavioral skills deficit areas were identified as sufficiently prevalent to warrant specific targeted attention. Gender differences did not emerge. The deficits in pre-ART HIV care-related information, motivation, and behavioral skills that were identified suggest that efforts to improve accurate information on immune function and HIV disease are needed, as is accurate information regarding HIV treatment and transmission risk prior to ART initiation. Additional efforts to facilitate the development of social support, including positive interactions with clinic staff and decreasing community-level stigma and to decrease structural and resource-depleting demands of HIV care may be particularly valuable to facilitate retention in pre-ART HIV care.

This paper examines the pitfalls and planning opportunities for taxpayers attempting to change domicile from our case study state, Tennessee, to avoid Tennessee inheritance tax to a state that doesnt have such taxes. Various court cases and state tax authority will be examined in order to synthesize the issues and formulate some general guidelines to assist taxpayers and their advisors in successfully using a change of domicile as a tool in state estate tax planning. A leading New Jersey case will be examined as an example of the consequences of unsuccessful state domicile planning causing the taxpayer to be subject to state inheritance tax in multiple states.

Che cos’è la politica? Come si può cercare di capirla e farla capire? Gli autori del libro rispondono a questa domanda utilizzando i concetti, gli strumenti e i metodi della scienza politica, nella sua essenza/qualità di scienza sociale empirica che quindi osserva la politica, nella storia e nella vita di tutti noi, così come essa è, non come si vorrebbe che fosse. Il libro individua nelle radici della politica la chiave di lettura che aiuta a comprendere il comportamento politico, individuale e collettivo. Le radici, ovvero le cause, le ragioni, le spinte, gli stimoli dell’agire politico, sono il filo rosso che tiene insieme i diversi contributi del libro, che si articola in quattro sezioni. Partendo dalla cultura politica, come insieme di atteggiamenti culturali, una sorta di causa prima che dà nutrimento alle radici e interagisce con le istituzioni della politica, si passa per i partiti, i soggetti collettivi che fanno emergere le radici, proponendosi come i loro referenti politici, organizzandole nella società e strutturandole in offerta elettorale. Si analizzano, poi, il contesto e le regole attraverso cui le radici competono per il potere, vale a dire le elezioni e il comportamento di voto, e le nuove identità politiche legate alla costruzione dell’Unione Europea. Si chiude così il cerchio di analisi del libro, interrogandosi su quali siano le nuove radici per la politica. Il volume raccoglie i contributi di alcuni tra i maggiori specialisti italiani ed europei ed offre al lettore un quadro di lettura comparata, in ciascuna delle quattro sezioni, di rara ampiezza e profondità. Una rigorosa e costante prospettiva comparata ha rappresentato anche l’essenza del lavoro, di ricerca e di insegnamento, di Mario Caciagli, in onore del quale è stato scritto questo libro.

BackgroundDespite renewed focus on molecular tuberculosis (TB) diagnostics and new antimycobacterial agents, treatment outcomes for patients co-infected with drug-resistant TB and human immunodeficiency virus (HIV) remain dismal, in part due to lack of focus on medication adherence as part of a patient-centered continuum of care.ObjectiveTo review current barriers to drug-resistant TB-HIV treatment and propose an alternative model to conventional approaches to treatment support.DiscussionCurrent national TB control programs rely heavily on directly observed therapy (DOT) as the centerpiece of treatment delivery and adherence support. Medication adherence and care for drug-resistant TB-HIV could be improved by fully implementing team-based patient-centered care, empowering patients through counseling and support, maintaining a rights-based approach while acknowledging the responsibility of health care systems in providing comprehensive care, and prioritizing critical research gaps.ConclusionIt is time to re-invent our understanding of adherence in drug-resistant TB and HIV by focusing attention on the complex clinical, behavioral, social, and structural needs of affected patients and communities.

Epidemiological studies have correlated arsenic exposure in drinking water with adverse developmental outcomes such as stillbirths, spontaneous abortions, neonatal mortality, low birth weight, delays in the use of musculature, and altered locomotor activity. Killifish (Fundulus heteroclitus) were used as a model to help to determine the mechanisms by which arsenic could impact development. Killifish embryos were exposed to three different sodium arsenite concentrations and were collected at 32 h post-fertilization (hpf), 42 hpf, 168 hpf, or < 24 h post-hatch. A killifish oligo microarray was developed and used to examine gene expression changes between control and 25-ppm arsenic-exposed hatchlings. With artificial neural network analysis of the transcriptomic data, accurate prediction of each group (control vs. arsenic-exposed embryos) was obtained using a small subset of only 332 genes. The genes differentially expressed include those involved in cell cycle, development, ubiquitination, and the musculature. Several of the genes involved in cell cycle regulation and muscle formation, such as fetuin B, cyclin D–binding protein 1, and CapZ, were differentially expressed in the embryos in a time- and dose-dependent manner. Examining muscle structure in the hatchlings showed that arsenic exposure during embryogenesis significantly reduces the average muscle fiber size, which is coupled with a significant 2.1- and 1.6-fold upregulation of skeletal myosin light and heavy chains, respectively. These findings collectively indicate that arsenic exposure during embryogenesis can initiate molecular changes that appear to lead to aberrant muscle formation.

The 16th Annual Scientific Meeting of the Society for Neuro-Oncology in Conjunction with the AANS/CNS Section on Tumors, Orange County, California, USA, 17-20 November 2011. In Neuro-Oncology, 2011, v. 13 n. Suppl. 3, p. iii111, abstract no. ET-18

To retrospectively assess the diagnostic performance of magnetic resonance cholangiopancreatography (MRCP) performed by using a high-spatial-resolution isotropic three-dimensional (3D) fast-recovery fast spin-echo (FSE) sequence with parallel imaging for the evaluation of possible biliary disease.This HIPAA-compliant study was approved by the institutional review board; informed consent was waived. Ninety-five patients (58 female, 37 male; mean age, 51 years; range, 15-91 years) underwent MRCP by using the respiratory-triggered isotropic 3D fast-recovery FSE sequence and endoscopic or percutaneous direct visualization between March 2003 and June 2007. Two independent readers evaluated the MRCP images for strictures, dilatation, and intraductal filling defects. Sensitivity, specificity, and interobserver agreement (kappa statistics) were determined.The respective sensitivity and specificity for strictures, dilatation, and intraductal filling defects (all choledocholithiasis) were 86% (40 of 47) and 94% (45 of 48), 98% (57 of 58) and 100% (37 of 37), and 68% (19 of 28) and 97% (65 of 67) for reader 1 and 88% (41 of 47) and 94% (45 of 48), 96% (56 of 58) and 100% (37 of 37), and 75% (21 of 28) and 99% (66 of 67) for reader 2. The sensitivity for stones larger than 3 mm was 94% (15 of 16) for reader 1 and 100% (16 of 16) for reader 2, whereas the sensitivity for stones 3 mm or smaller was 33% (four of 12) for reader 1 and 42% (five of 12) for reader 2. Agreement between readers was good to excellent, with kappa values of 0.76, 0.85, and 0.98 for strictures, dilatation, and choledocholithiasis, respectively.MRCP by using the respiratory-triggered isotropic 3D fast-recovery FSE sequence with parallel imaging demonstrates excellent diagnostic capabilities for possible biliary disease, although it is limited for stones 3 mm or smaller in size.

OBJECTIVE. The objective of this article is to review the types, pathogenesis, MRI appearance, treatment, and prognosis of interrupted aortic arch (IAA).CONCLUSION. IAA is a rare congenital vascular anomaly. Although this entity has been evaluated traditionally with echocardiography and angiography, MRI can accurately diagnose and characterize the various forms of IAA and associated congenital heart defects. MRI can also be used to evaluate for postoperative complications after repair.

Nearly perfect adherence to demanding antiretroviral therapy (ART) is now recognized as essential for HIV-positive patients to realize its life sustaining benefits. Despite the dire consequences of non-adherence, a large number of patients do not follow their ART regimen. While many factors influence adherence, the literature is dominated by studies on only one or a small set of them. Multivariate, theory-based models of adherence behavior are of great interest. The current study tested one such model, the Information, Motivation and Behavioral Skills (IMB) model of ART adherence (Fisher et al., under review). A sample of HIV-positive patients on ART in clinical care in Puerto Rico (N=200) provided data on adherence-related information, motivation and behavioral skills as well as adherence behavior per se. Structural equation model tests used to assess the propositions of the IMB model of ART adherence provided support for the interrelations between the elements proposed by the model and extended previous work. Implications for future research and intervention development are discussed.

Objectives To examine the extent of immune reconstitution in treatment-naive patients with CD4 T-cell counts