Launching a multidisciplinary European collaboration towards a cure for HIV: The EU2Cure Consortium.

We felt the urgency to launch the EU2Cure Consortium to support research and find a cure for the human immunodeficiency virus (HIV) infection through intensified collaboration within Europe. This consortium is open to stakeholders on cure in Europe from academia and the community to connect. The aim of this consortium is to intensify the research collaboration amongst European HIV cure groups and the community and facilitate interactions with other academic and community cure consortia, private parties, and policy makers. Our main aim is to create a European research agenda, data sharing, and development of best practice for clinical and translational science to achieve breakthroughs with clinically feasible HIV cure strategies. This consortium should also enable setting up collaborative studies accessible to a broader group of people living with HIV. Besides reservoir studies, we have identified three overlapping scientific interests in the consortium that provide a starting point for further research within a European network: developing "shock and kill" cure strategies, defining HIV cure biomarkers, and connecting cure cohorts. This strategy should aid stakeholders to sustain progress in HIV cure research regardless of coincidental global health or political crises.

[The therapeutic alliance in community mental health services]. / De therapeutische relatie tijdens outreachende behandeling.

BACKGROUND: The treatment of severe mental illnesses is increasingly taking place in a domiciliary setting due to the deinstitutionalisation.
AIM: Theoretical reflection on the influence of home treatment on the therapeutic alliance.
METHOD: Qualitative review of possible effects of home treatment based on own experiences, the scientific literature, and recent handbooks on community mental health.
RESULTS: The therapeutic relationship appears to be an important general factor in the outcomes of community mental health approaches. The working alliance has a more egalitarian and reciprocal nature. It improved when the scope of treatment was defined by the needs of the client. Boundaries concerning both the extent of personal involvement of the caregiver and the autonomy of the client presented important challenges in a context that lacks formal professional boundaries such as those seen in a consultation room or a hospital.
CONCLUSION: Characteristic features of the therapeutic alliance during home treatment pose a challenge to the caregiver in terms of balancing interpersonal involvement and distance. The need to intervene in the personal life of the patient often causes ethical dilemmas. A dialectical form of intervision is proposed to explore the emotional involvement of the caregiver and to systematically reflect on possible ethical issues as a tool for daily practice.

Novel approach to combined defaecation and micturition disorders with rectovaginovesicopexy.

BACKGROUND: This study was conducted to investigate the results of rectovaginovesicopexy (RVVP) in patients with combined defaecation and micturition disorders. RVVP was developed from a standard procedure for different forms of defaecation disorders (the rectovaginopexy (RVP)). It is only a limited extension to the RVP and results in elevation of all three pelvic compartments. METHODS: In a consecutive series of 25 patients the effects or RVVP were evaluated prospectively. Information about the clinical history and results was obtained by a standard questionnaire filled out before and 3 and 12 months after operation. Dynamic defaecography was performed before and 3 months after RVVP. Before operation urodynamic studies were conducted. RESULTS: RVVP improved constipation (14 of 18 patients improved, P = 0.001), faecal incontinence (11 of 16 patients improved, P = 0.005) and dysfunctional voiding (ten of 16 patients improved, P = 0.07) without induction of these disorders. Overall urinary incontinence improved in 11 of 22 patients (P = 0.18), with deterioration of urinary incontinence in three and induction of urinary incontinence in two of the patients. Patients with isolated urinary stress incontinence fared better (eight of 13 patients improved) than those with mixed urinary incontinence. CONCLUSION: RVVP provides satisfactory improvement of combined defaecation and micturition disorders. The benefits of a limited extension of the RVP seem to outweigh potential side-effects such as deterioration or de novo defaecation or micturition disorders.

Surgical support and suspension of genital prolapse, including preservation of the uterus, using the Gore-Tex soft tissue patch (a preliminary report).

Abdominal-retroperitoneal sacral genito-colpopexy using the expanded polytetrafluoroethylene (ePTFE) soft tissue patch has been found to be highly effective for repair of genito-vaginal prolapse. We treated 61 patients in this way, including patients who had failed multiple previous attempts at repair. At a mean of 32 months of follow-up, more than 95% of patients were still classified as successfully treated. To preserve the uterus in cases of complete genito-vaginal prolapse, we have developed a new surgical technique, which we describe in this paper.

Airborne concentrations, skin contamination, and urinary metabolite excretion of polycyclic aromatic hydrocarbons among paving workers exposed to coal tar derived road tars.

The exposure of surface dressing workers to polycyclic aromatic hydrocarbons (PAH) was studied. Four different paving sites, at which coal tar-containing binders were applied, were selected as work sites with high exposure levels of PAH. Breathing zone airborne particulates, contamination of the skin with PAH, and 1-hydroxypyrene in urine of the workers involved in chip sealing were determined. Substantial concentrations of cyclohexane-soluble airborne particulate matter were found (GM = 0.2 mg/m3, n = 28). Skin contamination was determined using two different methods: with exposure pads and by hand washing. Pads were mounted on several parts of the body: wrist, elbow, neck, shoulder, and ankle. The pads located on the wrist appeared to be the most contaminated (pyrene: GM = 22 ng/1.77 cm2, n = 40). The end-of-shift hand washing showed that the hands of the workers were contaminated with PAH (pyrene: GM = 70 micrograms, n = 35). Preshift hand washing showed far lower, but detectable, quantities of PAH on workers' hands (pyrene: GM = 5 micrograms, n = 35). Enhanced levels of urinary 1-hydroxypyrene among the workers were found. The highest levels were found in the end-of-shift urine samples. Correlations between the pyrene exposure variables were studied. Significant positive correlations were found between pyrene on the wrist pad versus end-of-shift urinary 1-hydroxypyrene; between pyrene on the hands versus end-of-shift urinary 1-hydroxypyrene; and between the two different skin contamination variables.