Longitudinal Modeling of Bacterial Sexually Transmitted Infections Among Sexual Minority Men Living with HIV.

Bacterial sexually transmitted infections (BSTIs) are largely preventable, yet their rates remain high across the U.S., particularly among sexual minority men (SMM) living with HIV (LWH). We explored longitudinal factors associated with BSTI acquisition in a national online sample of SMM LWH with recent suboptimal adherence to antiretroviral therapy (ART) or virologic non-suppression, such as spread within sexual networks, drug use in a sexual context (chemsex), and mental health issues. Participants completed online surveys over 12 months as part of an eHealth intervention. Over 12 months, 30% of participants self-reported at least one BSTI, with 28-45% reporting recurrent infections in consecutive surveys. Using generalized estimating equations with a binomial distribution and an exchangeable correlation structure, we found that BSTI accumulation was associated with chemsex, a higher number of anal sex partners, participation in exchange sex, and depressive symptoms. To reduce the burden of BSTIs among SMM LWH, public health initiatives and clinical settings should adopt a comprehensive sexual health approach, addressing chemsex, exchange sex, and associated mental health conditions. Addressing these factors can mitigate BSTI recurrence and improve overall sexual health among SMM LWH.

Sustainable oral healthcare: what is it and how do we achieve it?

In recent years, there has been an increase in interest in what environmental sustainability means for healthcare, including oral health and dentistry. To help facilitate discussions among key stakeholders in this area, the Scottish Dental Clinical Effectiveness Programme held a workshop in November 2022. The purpose of this workshop was to explore current thinking on the subject of sustainability as it relates to oral health and to help stakeholders identify how to engage with the sustainability agenda. This paper presents an overview of the presentations and discussions from the workshop and highlights potential avenues for future work and collaboration.

Using live stream technology to conduct workplace observation assessment of trainee dental nurses: an evaluation of effectiveness and user experience.

AIM/OBJECTIVE: This study evaluates the effectiveness and users' experience of using live stream technology to conduct workplace observation assessments of trainee dental nurses. Information on the usability, accessibility, and general satisfaction of this technological technique were collected. MATERIALS AND METHODS: This nationwide cross-sectional survey was conducted in Scotland and included one focus group and three online questionnaires with qualitative and quantitative questions. The quantitative responses were described using standard descriptive analysis, while the quantitative data were investigated using thematic analysis. RESULTS: Eighty-one trainee dental nurses, 35 clinicians and 19 assessors participated in this study. Live stream observation was generally well received by the trainee dental nurses and clinicians, who thought that it had helped increase their confidence to perform practical skills. The assessors also stated that overall satisfaction was high, and that live stream observation met their expectations for efficacy. However, several technical challenges, such as network issues were brought up by responders. CONCLUSION: This study provides evidence that workplace observation assessments can be performed in the future by using live stream technology. However, additional investigation and comparison will aid in determining the most effective way of using this approach and providing feedback to promote learning among dental trainees.

Accelerating GPCR Drug Discovery With Conformation-Stabilizing VHHs.

The human genome encodes 850 G protein-coupled receptors (GPCRs), half of which are considered potential drug targets. GPCRs transduce extracellular stimuli into a plethora of vital physiological processes. Consequently, GPCRs are an attractive drug target class. This is underlined by the fact that approximately 40% of marketed drugs modulate GPCRs. Intriguingly 60% of non-olfactory GPCRs have no drugs or candidates in clinical development, highlighting the continued potential of GPCRs as drug targets. The discovery of small molecules targeting these GPCRs by conventional high throughput screening (HTS) campaigns is challenging. Although the definition of success varies per company, the success rate of HTS for GPCRs is low compared to other target families (Fujioka and Omori, 2012; Dragovich et al., 2022). Beyond this, GPCR structure determination can be difficult, which often precludes the application of structure-based drug design approaches to arising HTS hits. GPCR structural studies entail the resource-demanding purification of native receptors, which can be challenging as they are inherently unstable when extracted from the lipid matrix. Moreover, GPCRs are flexible molecules that adopt distinct conformations, some of which need to be stabilized if they are to be structurally resolved. The complexity of targeting distinct therapeutically relevant GPCR conformations during the early discovery stages contributes to the high attrition rates for GPCR drug discovery programs. Multiple strategies have been explored in an attempt to stabilize GPCRs in distinct conformations to better understand their pharmacology. This review will focus on the use of camelid-derived immunoglobulin single variable domains (VHHs) that stabilize disease-relevant pharmacological states (termed ConfoBodies by the authors) of GPCRs, as well as GPCR:signal transducer complexes, to accelerate drug discovery. These VHHs are powerful tools for supporting in vitro screening, deconvolution of complex GPCR pharmacology, and structural biology purposes. In order to demonstrate the potential impact of ConfoBodies on translational research, examples are presented of their role in active state screening campaigns and structure-informed rational design to identify de novo chemical space and, subsequently, how such matter can be elaborated into more potent and selective drug candidates with intended pharmacology.

[CME-EKG 69/Answers: Sinus Pauses in Long-Term Monitoring]. / CME-EKG 69/Antworten: Sinuspausen im Monitoring.

CME-EKG 69/Answers: Sinus Pauses in Long-Term Monitoring Abstract. While the indication for a pacemaker therapy in patients with high-degree AV block or symptomatic bradycardias is straightforward in most cases, intermittent oligo- and asymptomatic sinus bradycardias and pauses turn out to be more challenging. In this case report potential causes, diagnostic steps and possible therapies will be discussed.

[CME-EKG 69: Sinus Pauses in Long-Term Monitoring]. / CME-EKG 69: Sinuspausen im Monitoring CME-Fragen.

CME-EKG 69: Sinus Pauses in Long-Term Monitoring Abstract. While the indication for a pacemaker therapy in patients with high-degree AV block or symptomatic bradycardias is straightforward in most cases, intermittent oligo- and asymptomatic sinus bradycardias and pauses turn out to be more challenging. In this case report potential causes, diagnostic steps and possible therapies will be discussed.

Flexible Microtube Plasma (FµTP) as an Embedded Ionization Source for a Microchip Mass Spectrometer Interface.

Dielectric barrier discharges are used as soft ionization sources for mass spectrometers or ion mobility spectrometers, enabling excellent possibilities for analytical applications. A new robust and small-footprint discharge design, flexible microtube plasma (FµTP), developed as a result of ongoing miniaturization and electrode design processes, is presented in this work. This design provides major safety benefits by fitting the electrode into an inert flexible fused silica capillary (tube). Notably, in this context, the small discharge dimensions enable very low gas flows in the range of <100 mL min-1; portability; the use of hydrogen, nitrogen, and air in addition to noble gases such as helium and argon, including its mixtures with propane; and application in microchip environments. By coupling FµTP with gas chromatography/mass spectrometry, we show that the polarity principle of the new discharge design allows it to outperform established ionization sources such as dielectric barrier discharge for soft ionization (DBDI) and low-temperature plasma (LTP) at low concentrations of perfluoroalkanes in terms of sensitivity, ionization efficiency, chemical background, linear dynamic range, and limit of detection by a large margin. In negative ion mode, the limit of detection is improved by more than 3-fold compared with that of DBDI and by 8-fold compared with that of LTP. The protonation capability was evaluated by headspace measurements of diisopropyl methylphosphonate in positive ion mode, showing low fragmentation and high stability in comparison to DBDI and LTP.

Spatially and Temporally Resolved Detection of Arsenic in a Capillary Dielectric Barrier Discharge by Hydride Generation High-Resolved Optical Emission Spectrometry.

A new method for arsenic detection by optical emission spectrometry (OES) is presented. Arsine (AsH3) is generated from liquid solutions by means of hydride generation (HG) and introduced into a capillary dielectric barrier discharge (DBD) where it is atomized and excited. A great challenge in OES is the reduction of the recorded background signal, because it negatively affects the limit of detection (LOD). In conventional DBD/OES methods, the signal intensity of the line of interest, in this case arsenic, is integrated over a long time scale. However, due to the pulsed character of the plasma, the plasma on-time is only a small fraction of the integration time. Therefore, a high amount of noise is added to the actual signal in each discharge cycle. To circumvent this, in the present study the emitted light from the DBD is collected by a fast gated iCCD camera, which is mounted on a modified monochromator. The experimental arrangement enables the recording of the emission signal of arsenic in the form of a monochromatic 2D-resolved picture. The temporal resolution of the iCCD camera in the nanosecond range provides the information at which point in time and how long arsenic is excited in the discharge. With use of this knowledge, it is possible to integrate only the arsenic emission by temporally isolating the signal from the background. With the presented method, the LOD for arsenic could be determined to 93 pg mL-1 with a calibration curve linear over 4 orders of magnitude. As a consequence, the developed experimental approach has a potential for both mechanistic studies of arsine atomization and excitation in DBD plasmas as well as routine applications, in which arsenic determination at ultratrace levels is required.

Soft Argon-Propane Dielectric Barrier Discharge Ionization.

Dielectric barrier discharges (DBDs) have been used as soft ionization sources (DBDI) for organic mass spectrometry (DBDI-MS) for approximately ten years. Helium-based DBDI is often used because of its good ionization efficiency, low ignition voltage, and homogeneous plasma conditions. Argon needs much higher ignition voltages than helium when the same discharge geometry is used. A filamentary plasma, which is not suitable for soft ionization, may be produced instead of a homogeneous plasma. This difference results in N2, present in helium and argon as an impurity, being Penning-ionized by helium but not by metastable argon atoms. In this study, a mixture of argon and propane (C3H8) was used as an ignition aid to decrease the ignition and working voltages, because propane can be Penning-ionized by argon metastables. This approach leads to homogeneous argon-based DBDI. Furthermore, operating DBDI in an open environment assumes that many uncharged analyte molecules do not interact with the reactant ions. To overcome this disadvantage, we present a novel approach, where the analyte is introduced in an enclosed system through the discharge capillary itself. This nonambient DBDI-MS arrangement is presented and characterized and could advance the novel connection of DBDI with analytical separation techniques such as gas chromatography (GC) and high-pressure liquid chromatography (HPLC) in the near future.

Genetic Background and Expression of the New qepA4 Gene Variant Recovered in Clinical TEM-1- and CMY-2-Producing Escherichia coli.

A new QepA4 variant was detected in an O86:H28 ST156-fimH38 Escherichia coli, showing a multidrug-resistance phenotype. PAßN inhibition of qepA4-harboring transconjugant resulted in increase of nalidixic acid accumulation. The qepA4 and catA1 genes were clustered in a 26.0-kp contig matching an IncF-type plasmid, and containing a Tn21-type transposon with multiple mobile genetic elements. This QepA variant is worrisome because these determinants might facilitate the selection of higher-level resistance mutants, playing a role in the development of resistance, and/or confer higher-level resistance to fluoroquinolones in association with chromosomal mutations.

Photorelease of microcystin-LR from resuspended sediments.

A series of ten photolysis experiments was conducted with sediments exposed to Microcystis sp. blooms to determine if sunlight is capable of mobilizing the biotoxin microcystin-LR (MC-LR) into the water column. There was a net photorelease of MC-LR in irradiated suspensions in all cases relative to dark controls, ranging from 0.4 to 192µgL-1g-1 into the dissolved phase. This should be viewed as a minimum estimate of photorelease due to concurrent photodegradation of dissolved toxin. Dissolved MC-LR concentrations in a sediment suspension increased linearly in the aqueous phase during a six-hour irradiation with simulated sunlight suggesting that longer exposure times produce greater quantities of MC-LR. There was a significant positive correlation between photorelease of toxin and percent organic carbon of the resuspended material, implying that organic-rich sediments yield the greatest photorelease of MC-LR upon exposure to full spectrum sunlight. Samples exposed to photosynthetically active radiation (400nm-700nm) were responsible for less than 2% of the photorelease compared to full spectrum exposures. Model calculations indicate that photochemical processing of bloom impacted sediments could be responsible for as much as 100% of the average standing stock of MC-LR in a freshwater pond located in southeastern North Carolina, where surface water concentrations were also measured. Mass spectrometric analysis revealed a new peak in light exposed flasks that appears to be a photo-induced isomerized product of MC-LR. Photoproduction from resuspended sediments therefore represents a significant but previously unrecognized source of highly toxic MC-LR and photoproducts of unknown toxicity and fate to aquatic ecosystems.

Large Diversity of Functional Nanobodies from a Camelid Immune Library Revealed by an Alternative Analysis of Next-Generation Sequencing Data.

Next-generation sequencing (NGS) has been applied successfully to the field of therapeutic antibody discovery, often outperforming conventional screening campaigns which tend to identify only the more abundant selective antibody sequences. We used NGS to mine the functional nanobody repertoire from a phage-displayed camelid immune library directed to the recepteur d'origine nantais (RON) receptor kinase. Challenges to this application of NGS include accurate removal of read errors, correct identification of related sequences, and establishing meaningful inclusion criteria for sequences-of-interest. To this end, a sequence identity threshold was defined to separate unrelated full-length sequence clusters by exploring a large diverse set of publicly available nanobody sequences. When combined with majority-rule consensus building, applying this elegant clustering approach to the NGS data set revealed a wealth of >5,000-enriched candidate RON binders. The huge binding potential predicted by the NGS approach was explored through a set of randomly selected candidates: 90% were confirmed as RON binders, 50% of which functionally blocked RON in an ERK phosphorylation assay. Additional validation came from the correct prediction of all 35 RON binding nanobodies which were identified by a conventional screening campaign of the same immune library. More detailed characterization of a subset of RON binders revealed excellent functional potencies and a promising epitope diversity. In summary, our approach exposes the functional diversity and quality of the outbred camelid heavy chain-only immune response and confirms the power of NGS to identify large numbers of promising nanobodies.

Immunogenic potential of Rhipicephalus (Boophilus) microplus aquaporin 1 against Rhipicephalus sanguineus in domestic dogs / Potencial imunogênico da aquaporina 1 de Rhipicephalus (Boophilus) microplus contra o carrapato Rhipicephalus sanguineus em cães domésticos

Abstract This study evaluated a recombinant aquaporin 1 protein of Rhipicephalus (Boophilus) microplus (RmAQP1) as antigen in a vaccine against R. sanguineus. Five dogs were immunized with RmAQP1 (10 µg) + adjuvant (Montanide) (G1), and five were inoculated with adjuvant only (G2), three times. Twenty-one days after the last immunization, animals of both groups were challenged with R. sanguineus larvae, nymphs and adults, and their biotic potential was compared. Blood samples were collected before each immunization and every 28 days after the last immunization for 10 weeks. Serum antibody titers (IgG) were assessed by ELISA. We observed that: engorgement period of adult females from G1 was 12% shorter than G2; larvae from G1 had 8.7% longer engorgement period than G2 and weighed 7.2% less; nymphs from G1 had 4.5% shorter engorgement period than G2 and weighed 3.6% less; although the antibody titers increased following the second immunization, they rapidly decreased after the third immunization. Results indicated low immunoprotection of RmAQP1 against adult R. sanguineus ticks, and possible efficacy on larvae and nymphs fed on immunized dogs. Further studies should be performed for a full evaluation of the immunoprotection of RmAQP1 against R. sanguineus infestations in dogs.

Resumo Este estudo avaliou a proteína recombinante (aquaporina) do carrapato Rhipicephalus (Boophilus) microplus como antígeno em vacina contra Rhipicephalus sanguineus. Cinco cães foram imunizados com RmAQP1 (10 µg) + adjuvante (G1) e cinco foram inoculados apenas com adjuvante (G2), três vezes. 21 dias após a última imunização todos os animais foram desafiados com larvas, ninfas e adultos de R. sanguineus, e potencial biótico dos carrapatos foi comparado. Amostras de sangue foram coletadas antes de cada imunização e a cada 28 dias após a última imunização, durante 10 semanas. Títulos de anticorpos dos soros dos cães foram avaliados por ELISA. Resultados: o período de ingurgitamento das fêmeas do G1 foi 12% mais curto que o período de ingurgitamento de G2; o período de ingurgitamento das larvas do G1 8,7% foi mais longo e o peso 7,2% menor que no caso de G2; o período de ingurgitamento das ninfas do G1 4,5% foi mais curto e peso 3,6% menor que no caso do G2; aumento dos títulos de anticorpos do G1 após a segunda imunização e declínio após a terceira imunização. Os resultados indicaram baixo potencial de imunoproteção de RmAQP1 contra R. sanguineus adultos, e possível eficácia contra larvas e ninfas, na dose testada. Sugere-se desenvolver novos estudos para melhor avaliação da eficácia de RmAQP1 contra R. sanguineus em cães.

Immunogenic potential of Rhipicephalus (Boophilus) microplus aquaporin 1 against Rhipicephalus sanguineus in domestic dogs.

This study evaluated a recombinant aquaporin 1 protein of Rhipicephalus (Boophilus) microplus (RmAQP1) as antigen in a vaccine against R. sanguineus. Five dogs were immunized with RmAQP1 (10 µg) + adjuvant (Montanide) (G1), and five were inoculated with adjuvant only (G2), three times. Twenty-one days after the last immunization, animals of both groups were challenged with R. sanguineus larvae, nymphs and adults, and their biotic potential was compared. Blood samples were collected before each immunization and every 28 days after the last immunization for 10 weeks. Serum antibody titers (IgG) were assessed by ELISA. We observed that: engorgement period of adult females from G1 was 12% shorter than G2; larvae from G1 had 8.7% longer engorgement period than G2 and weighed 7.2% less; nymphs from G1 had 4.5% shorter engorgement period than G2 and weighed 3.6% less; although the antibody titers increased following the second immunization, they rapidly decreased after the third immunization. Results indicated low immunoprotection of RmAQP1 against adult R. sanguineus ticks, and possible efficacy on larvae and nymphs fed on immunized dogs. Further studies should be performed for a full evaluation of the immunoprotection of RmAQP1 against R. sanguineus infestations in dogs.

Dielectric barrier discharges applied for soft ionization and their mechanism.

Dielectric barrier discharges are used for analytical applications as dissociative source for optical emission spectrometry and for ambient-ionization techniques. In the range of ambient-ionization techniques it has attracted much attention in fields like food safety, biological analysis, mass spectrometry for reaction monitoring and imaging forensic identification. In this review some examples are given for the application as desorption/ionization source as well as for the sole application as ionization source with different sample introductions. It will be shown that the detection might depend on the certain distance of the plasma in reference to the sample or the kind of discharge which might be produced by different shapes of the applied high voltage. Some attempts of characterization are presented. A more detailed characterization of the dielectric barrier discharge realized with two ring electrodes, each separately covered with a dielectric layer, is described.

Tuning Soft Ionization Strength for Organic Mass Spectrometry.

Besides the progress of new mass spectrometer technologies, the investigation and development of soft ionization sources play an important key role for analytical sciences. Since the dielectric barrier discharge ionization (DBDI) is identified as two temporally separated events, a selective prevention of the coincident plasma can lead to improved ionization strength. Although a DBDI is known as a soft ionization source, a modulation of the high-voltage amplitude and duty cycle can lead to optimized ionization strength. This is an advantage to cover different types of analytes.

Capillary Dielectric Barrier Discharge: Transition from Soft Ionization to Dissociative Plasma.

A capillary He dielectric barrier discharge was investigated with respect to its performance as a soft or dissociative ionization source. Spatiotemporal measurements of the plasma emission showed that in one voltage duty cycle the plasma evolved from a soft to dissociative ionization source. At the earliest time, the soft plasma was generated between the electrodes as well as outside the capillary forming the plasma jet. It was characterized by significant radiation arising only from He and N2(+), which are known to be important in the process of the soft ionization of the analyte. Later in time, the plasma capable of dissociating molecules develops. It is characterized by appreciable radiation from analyte dissociation products and is restricted to the interelectrode region in the capillary. Thus, for the soft ionization purposes, it is feasible to introduce the analyte exclusively in the plasma jet. For elemental analysis, the interelectrode plasma is appropriate.

Invasive Aspergillosis Associated with a Foreign Body.

Invasive aspergillosis is a serious complication in immunocompromised individuals. It is associated with a high mortality rate, which demands a combined approach involving radical surgery and antifungal therapy. Here, we describe a patient who presented with nonspecific fever, refractory to antimicrobial agents. Though it primarily involved the nasal cavity and sinuses, it perforated into the oral cavity causing palatal changes. Surprisingly, a foreign body was found in the involved tissues that might have acted as a nidus of infection. A sufficient dose (3 mg/kg/day) of liposomal amphotericin B was initiated soon after a thorough debridement procedure and the patient survived.

The Francis Report--Implications for the Education and Training of Dental Professionals.

This paper explores the implications of the Francis Report for education of the dental team. It considers selection of candidates for training, issues relating to the curriculum itself, including assessment and the importance of listening to trainees. The overriding importance of the 'informal' or 'hidden' curriculum, through which students and trainees observe their teachers and develop a sense of the professional and ethical culture within an educational institution, is stressed. Clinical relevance: Sound education, rooted in the recognized ethical principles highlighted in the Francis Report, is essential to the delivery of a dental work force that will deliver care according to the fundamental standards laid down by the GDC.

World Workshop on Oral Medicine VI: an international validation study of clinical competencies for advanced training in oral medicine.

OBJECTIVE: To explore international consensus for the validation of clinical competencies for advanced training in Oral Medicine. STUDY DESIGN: An electronic survey of clinical competencies was designed. The survey was sent to and completed by identified international stakeholders during a 10-week period. To be validated, an individual competency had to achieve 90% or greater consensus to keep it in its current format. RESULTS: Stakeholders from 31 countries responded. High consensus agreement was achieved with 93 of 101 (92%) competencies exceeding the benchmark for agreement. Only 8 warranted further attention and were reviewed by a focus group. No additional competencies were suggested. CONCLUSION: This is the first international validated study of clinical competencies for advanced training in Oral Medicine. These validated clinical competencies could provide a model for countries developing an advanced training curriculum for Oral Medicine and also inform review of existing curricula.