Meaningful inclusion of people living with HIV as a model for workplace policies: Key findings from the project PEER study.

BACKGROUND: As a large number of people live with HIV, it is worthwhile to examine the integration of this group in the workplace. OBJECTIVE: To investigate how the operationalization of GIPA/MEPA supports workplace policies and practices for PLHIV. The study aims to explore what is being offered to support PLHIV in community-based agencies and what can be done to enhance the offerings. METHODS: For this community-based research, 2 bilingual online surveys were sent to 150 Canadian organizations that work closely with PLHIV or offer support to them. One of the surveys was for Executive Directors of these organizations while the other was sent to peers; i.e. PLHIV whose job is to offer services to PLHIV. Questions in the surveys varied between open-ended, binary, and Likert. RESULTS: GIPA/MEPA are implemented in most organizations and Executive Directors affirmed that PLHIV and their impacts on the workplace are valued. There is a consensus among Executive Directors that formal support is provided but most respondents argued that this support is not specific for PLHIV. More than half of respondents were either unaware or uncertain about the existence of informal support. Peer-employees claimed that one of the challenges of disclosing HIV to receive peer support is that they may face stigma. CONCLUSION: The application of GIPA/MEPA results in positive outcomes in the workplace. The study emphasizes the need to facilitate access to informal support.

Confusion among doctors regarding sports and exercise medicine as a specialty: an Australian multidisciplinary, cross-sectional survey.

OBJECTIVES: This cross-sectional study aims to characterise the understanding and attitudes medical practitioners have towards sports and exercise medicine (SEM). By identifying knowledge gaps, misunderstandings and barriers to SEM referral, interventions may be suggested to improve the integration of SEM within a multidisciplinary approach to healthcare. DESIGN: A survey was constructed with a multidisciplinary expert panel. Refinement and consensus were achieved through a modified Delphi method. Both quantitative and qualitative data were analysed and intergroup comparisons made using χ2 test of independence and post-hoc paired comparisons. SETTING: The questionnaire was distributed across Australian public and private health sectors, in community and hospital-based settings. PARTICIPANTS: Australian medical doctors practising in specialties likely to intersect with SEM were invited; including general practice, orthopaedics, emergency, rheumatology and anaesthetics/pain. Invitation was uncapped with no reportable response rate. A total of 120 complete responses were collected RESULTS: The minority (42.5%) of respondents understood the role and scope of sports and exercise physicians. SEM was poorly recognised and comprehended, with the most common misconception being that SEM is solely for elite athletes and performance. Few (20%) doctors were familiar with referral pathways to SEM services. Lack of awareness, clear scope and public presence were seen as major barriers. There was near unanimous (92.5%) agreement that 'exercise is medicine'. A strong majority felt SEM would be valuable to collaborate with more in their current practice (63.3%) and as a part of the Australian public health system (82.5%). There were some significant differences among subgroups, including that junior doctors were more likely to express confusion about SEM. CONCLUSIONS: Among non-SEM doctors, there is significant lack of clarity regarding the role of SEM and its optimal integration. Interdisciplinary education and addressing misconceptions may improve the contribution of SEM to community healthcare.

A digital twin ecosystem for additive manufacturing using a real-time development platform.

Additive manufacturing is often used in rapid prototyping and manufacturing, allowing the creation of lighter, more complex designs that are difficult or too expensive to build using traditional manufacturing methods. This work considers the implementation of a novel digital twin ecosystem that can be used for testing, process monitoring, and remote management of an additive manufacturing-fused deposition modeling machine in a simulated virtual environment. The digital twin ecosystem is comprised of two approaches. One approach is data-driven by an open-source 3D printer web controller application that is used to capture its status and key parameters. The other approach is data-driven by externally mounted sensors to approximate the actual behavior of the 3D printer and achieve accurate synchronization between the physical and virtual 3D printers. We evaluate the sensor-data-driven approach against the web controller approach, which is considered to be the ground truth. We achieve near-real-time synchronization between the physical machine and its digital counterpart and have validated the digital twin in terms of position, temperature, and run duration. Our digital twin ecosystem is cost-efficient, reliable, replicable, and hence can be utilized to provide legacy equipment with digital twin capabilities, collect historical data, and generate analytics.

Will the real relationship between lean and safety/ergonomics please stand up?

This paper provides a review of studies containing safety and ergonomic outcomes in lean manufacturing (LM) environments over the past 40 years. The aim is to identify effects from specific LM methods on specific safety/ergonomic outcomes, to understand the relationship in greater detail. One hundred and one studies containing one hundred and seventy outcomes were identified. Thirty-seven outcomes pertained to just-in-time (JIT) production, which contained twenty-three negative, eleven neutral, and three positive safety/ergonomic outcomes. Conversely, twenty-six outcomes pertained to 5S and consisted of twenty-four positive, two negative, and no neutral outcomes. The most common negative JIT outcome was stress and mental strain, while the most common positive 5S outcome was a tie between safety performance and hazard exposure. Studies containing other methods were fewer in number with more mixed outcomes. These findings suggest that individual LM methods, especially JIT and 5S, uniquely contribute to the safety/ergonomic outcomes attributed to LM.

Promoting Neuronal Outgrowth Using Ridged Scaffolds Coated with Extracellular Matrix Proteins.

Spinal cord injury (SCI) results in cell death, demyelination, and axonal loss. The spinal cord has a limited ability to regenerate, and current clinical therapies for SCI are not effective in helping promote neurologic recovery. We have developed a novel scaffold biomaterial that is fabricated from the biodegradable hydrogel oligo(poly(ethylene glycol)fumarate) (OPF). We have previously shown that positively charged OPF scaffolds (OPF+) in an open spaced, multichannel design can be loaded with Schwann cells to support axonal generation and functional recovery following SCI. We have now developed a hybrid OPF+ biomaterial that increases the surface area available for cell attachment and that contains an aligned microarchitecture and extracellular matrix (ECM) proteins to better support axonal regeneration. OPF+ was fabricated as 0.08 mm thick sheets containing 100 µm high polymer ridges that self-assemble into a spiral shape when hydrated. Laminin, fibronectin, or collagen I coating promoted neuron attachment and axonal outgrowth on the scaffold surface. In addition, the ridges aligned axons in a longitudinal bipolar orientation. Decreasing the space between the ridges increased the number of cells and neurites aligned in the direction of the ridge. Schwann cells seeded on laminin coated OPF+ sheets aligned along the ridges over a 6-day period and could myelinate dorsal root ganglion neurons over 4 weeks. This novel scaffold design, with closer spaced ridges and Schwann cells, is a novel biomaterial construct to promote regeneration after SCI.

Collaborative practice in counselling: a scoping review.

Collaborative care (interdisciplinary/interprofessional teamwork) in mental health is emerging as best practice in primary care, hospitals, and government agencies. Counsellors have much to offer and benefit from working with other professions in service of their clients. While most health professions are well on their way integrating collaborating with one another in practice, it is yet unclear how often, and in what ways, counsellors are included in these teams. This scoping review of the literature on collaborative practice in counselling addresses the question: "What is the role of Professional Counselling and Clinical/Counselling Psychology in a collaborative model of mental health care?" This scoping review looks at 40 studies published between 2012 and 2015. Counsellors are often included on multidisciplinary teams in diverse roles. Specific collaborative activities are discussed along with ethical and educational implications.

Associations of Angiotensin Converting Enzyme-1 and Angiotensin II Blood Levels and Cognitive Function.

BACKGROUND: Emerging evidence suggests a possible role of the renin angiotensin system in the pathophysiologic process of Alzheimer's disease, of which angiotensin converting enzyme-1 (ACE-1) and angiotensin II (ANGII) are important proteins. Few studies evaluated associations between blood ACE-1 and none between ANGII levels, and cognition. OBJECTIVE: Our pilot study was aimed to examine associations between blood ACE-1 and ANG II levels and cognitive function in non-demented participants at baseline and over a 1-year period. METHODS: 56 participants were included from the Brain Health Substudy of the Baltimore Experience Corps Study. Linear regression analysis, adjusting for confounders, was used to determine associations between baseline ACE-1 and ANGII, and baseline and 1-year follow-up measures of psychomotor and processing speed, executive function, verbal learning memory and working memory, and whether these associations were mediated by blood pressure. RESULTS: Participants were predominantly female (75%), African-American (93%), with mean age of 67.8 years and education of 14.3 years. There were no associations between baseline ACE-1 or ANGII levels and cognitive function; however, there were significant association between baseline ACE-1 levels and 1-year follow-up Trail Making Test, Part A (ß= 0.003, p = 0.04) and Digit Span (ß= -0.001, p = 0.02). CONCLUSIONS: In this cognitively intact sample, elevated ACE-1 levels were associated with worse processing speed and working memory after 1 year. Findings from this pilot study suggest that changes in the RAS are associated with alterations in cognitive function warranting further assessment of the role of RAS in neurodegenerative disorders.

Understanding Coding and Payment for Psychiatrists' Services: How We Got Here and Where We're Going.

Psychiatrists often have difficulty understanding how to document, code, and bill for their services in a way that expedites adequate payment and avoids billing problems or future issues. This is very understandable because many psychiatrists in small or solo practices do their own billing without any formal training in the vagaries of coding and reimbursement policies. For many years, the American Psychiatric Association (APA) has devoted substantial resources to guiding psychiatrists through this maze, with direct member assistance and resources publicly available at www.psychiatry.org. APA staff, councils, and committees have also been working for many years to improve coding and reimbursement for psychiatric services. Current and former members and staff of the APA Committee on RBRVS, Codes, and Reimbursement have authored this article to help psychiatrists gain a better understanding of the current coding and reimbursement structure for psychiatric services, including how it evolved and what the future holds.

Household Food Security Discordance Among Latino Adolescents and Parents.

OBJECTIVES: We determined the degree of parent-adolescent concordance in reported household food security, and delineated variation in concordance as a function of selected household and parent-adolescent relationship characteristics. METHODS: Cross-tabulations and Cohen's Kappa determined concordance. Multinomial logistic regressions delineated variation in concordance as a function of selected household and parent-adolescent relationship characteristics for Latino parent and adolescent dyads (N = 70). RESULTS: Nearly half the households had concordant reports of household food security, but 34% were "discordant" such that parents reported food insecurity but adolescents did not, and 17% were "discordant" wherein adolescents reported food insecurity but parents did not. Elevated parent-adolescent conflict was associated with greater odds of discordance wherein adolescent reported food insecurity but parent did not. Households with female adolescents and income ≥ $30,000/year were associated with lower odds of discordance wherein parent reported food insecurity but adolescent did not. CONCLUSIONS: Discordant reports of Latino household food security suggest the burden of unequal access to sufficient foods may be underestimated. Discordant reports may follow from cultural values that may encourage adolescents to keep hunger from their parents.

Alcohol use among university students: Considering a positive deviance approach.

Harmful alcohol consumption among university students continues to be a significant issue. This study examined whether variables identified in the positive deviance literature would predict responsible alcohol consumption among university students. Surveyed students were categorized into three groups: abstainers, responsible drinkers and binge drinkers. Multinomial logistic regression modelling was significant (χ(2) = 274.49, degrees of freedom = 24, p < .001), with several variables predicting group membership. While the model classification accuracy rate (i.e. 71.2%) exceeded the proportional by chance accuracy rate (i.e. 38.4%), providing further support for the model, the model itself best predicted binge drinker membership over the other two groups.

Transhepatic venous approach to permanent pacemaker placement in a patient with limited central venous access.

The end-stage renal disease population poses a challenge for obtaining venous access required for life-saving invasive cardiac procedures. In this case report, we describe an adult patient with end-stage renal disease in whom the hepatic vein was the only available access to implant a single-lead permanent cardiac pacemaker. A 63-year-old male with end-stage renal disease on maintenance hemodialysis and permanent atrial fibrillation/atrial flutter presented with symptomatic bradycardia. Imaging studies revealed all traditional central venous access sites to be occluded/non-accessible. With the assistance of vascular interventional radiology, a trans-hepatic venous catheter was placed. This was then used to place a right ventricular pacing lead with close attention to numerous technical aspects. The procedure was completed successfully with placement of a single-lead permanent cardiac pacemaker.

Compression socks and functional recovery following marathon running: a randomized controlled trial.

Compression socks have become a popular recovery aid for distance running athletes. Although some physiological markers have been shown to be influenced by wearing these garments, scant evidence exists on their effects on functional recovery. This research aims to shed light onto whether the wearing of compression socks for 48 hours after marathon running can improve functional recovery, as measured by a timed treadmill test to exhaustion 14 days following marathon running. Athletes (n = 33, age, 38.5 ± 7.2 years) participating in the 2012 Melbourne, 2013 Canberra, or 2013 Gold Coast marathons were recruited and randomized into the compression sock or placebo group. A graded treadmill test to exhaustion was performed 2 weeks before and 2 weeks after each marathon. Time to exhaustion, average and maximum heart rates were recorded. Participants were asked to wear their socks for 48 hours immediately after completion of the marathon. The change in treadmill times (seconds) was recorded for each participant. Thirty-three participants completed the treadmill protocols. In the compression group, average treadmill run to exhaustion time 2 weeks after the marathon increased by 2.6% (52 ± 103 seconds). In the placebo group, run to exhaustion time decreased by 3.4% (-62 ± 130 seconds), P = 0.009. This shows a significant beneficial effect of compression socks on recovery compared with placebo. The wearing of below-knee compression socks for 48 hours after marathon running has been shown to improve functional recovery as measured by a graduated treadmill test to exhaustion 2 weeks after the event.

Low-intensity daily walking activity is associated with hippocampal volume in older adults.

Hippocampal atrophy is associated with memory impairment and dementia and serves as a key biomarker in the preclinical stages of Alzheimer's disease. Physical activity, one of the most promising behavioral interventions to prevent or delay cognitive decline, has been shown to be associated with hippocampal volume; specifically increased aerobic activity and fitness may have a positive effect on the size of the hippocampus. The majority of older adults, however, are sedentary and have difficulty initiating and maintaining exercise programs. A modestly more active lifestyle may nonetheless be beneficial. This study explored whether greater objectively measured daily walking activity was associated with larger hippocampal volume. We additionally explored whether greater low-intensity walking activity, which may be related to leisure-time physical, functional, and social activities, was associated with larger hippocampal volume independent of exercise and higher-intensity walking activity. Segmentation of hippocampal volumes was performed using Functional Magnetic Resonance Imaging of the Brain's Software Library (FSL), and daily walking activity was assessed using a step activity monitor on 92, nondemented, older adult participants. After controlling for age, education, body mass index, cardiovascular disease risk factors, and the Mini Mental State Exam, we found that a greater amount, duration, and frequency of total daily walking activity were each associated with larger hippocampal volume among older women, but not among men. These relationships were specific to hippocampal volume, compared with the thalamus, used as a control brain region, and remained significant for low-intensity walking activity, independent of moderate- to vigorous-intensity activity and self-reported exercise. This is the first study, to our knowledge, to explore the relationship between objectively measured daily walking activity and hippocampal volume in an older adult population. Findings suggest the importance of examining whether increasing nonexercise, lifestyle physical activities may produce measurable cognitive benefits and affect hippocampal volume through molecular pathways unique to those related to moderate-intensity exercise.

Feasibility study to quantify the auditory and social environment of older adults using a digital language processor.

OBJECTIVE: To investigate the feasibility of using a digital language processor (DLP) to objectively quantify the auditory and social environment of older adults. DESIGN: Thirty-seven participants aged 64 to 91 years residing in a retirement community were asked to wear a DLP to record their auditory and language environment during 1 waking day. Recordings were analyzed with specialized software to derive quantitative estimates such as the number of spoken words heard and percentage of time spent around meaningful speech versus television/radio. RESULTS: Adequate DLP recordings that began before 10 AM and lasted for 10 hours or greater were collected from 24 participants. The mean duration of recording was 13 hours and 13 minutes, and individuals spent a mean of 26.7% (range, 4%-58%) of their waking day near a television or other electronic sounds. The projected mean word count over a maximum of 16 hours was 33,141 with nearly a 14-fold range between the lowest and highest observed values (range, 5120-77,882). CONCLUSIONS: High-quality objective data on the auditory environment of older adults can be feasibly measured with the DLP. Findings from this study may guide future studies investigating auditory and language outcomes in older adults.

Patterns and correlates of cannabis use among individuals with HIV/AIDS in Maritime Canada.

BACKGROUND: The prevalence of cannabis use in HIV-infected individuals is high and its long-term effects are unclear. METHODS: The prevalence, perceived benefits and consequences, and predictors of cannabis use were studied using a cross-sectional survey in two immunodeficiency clinics in Maritime Canada. RESULTS: Current cannabis use was identified in 38.5% (87 of 226) of participants. Almost all cannabis users (85 of 87 [97.7%]) acknowledged its use for recreational purposes, with 21.8% (19 of 87) reporting medicinal cannabis use. The majority of patients enrolled in the present study reported mild or no symptoms related to HIV (n=179). Overall, 80.5% (70 of 87) of the cannabis-using participants reported a symptom-relieving benefit, mostly for relief of stress, anorexia or pain. Participants consumed a mean (± SD) of 18.3±21.1 g of cannabis per month and spent an average of $105.15±109.87 on cannabis per month. Cannabis use was associated with rural residence, lower income level, driving under the influence of a substance, and consumption of ecstasy and tobacco. Income level, ecstasy use and tobacco use were retained as significant predictors in regression modelling. Cannabis use was not associated with adverse psychological outcomes. DISCUSSION: Prolonged previous cannabis consumption and the substantial overlap between recreational and medicinal cannabis use highlight the challenges in obtaining a tenable definition of medicinal cannabis therapy.

HISTORIQUE: La prévalence de consommation de cannabis est élevée chez les personnes infectées par le VIH, mais on n'en connaît pas les effets à long terme. MÉTHODOLOGIE: Les chercheurs ont étudié la prévalence, les avantages perçus et les conséquences et prédicteurs de consommation de cannabis au moyen d'un sondage transversal mené dans deux cliniques d'immunodéficience des Maritimes, au Canada. RÉSULTATS: Les chercheurs ont constaté une consommation courante de cannabis chez 38,5 % des participants (87 sur 226). Presque tous les consommateurs de cannabis (85 sur 87 [97,7 %]) admettaient en prendre pour des fins récréatives, et 21,8 % (19 sur 87) indiquaient en prendre pour des fins médicinales. La majorité des patients qui participaient à la présente étude a déclaré des symptômes du VIH légers, sinon inexistants (n=179). Dans l'ensemble, 80,5 % des participants consommateurs de cannabis (70 sur 87) ont affirmé remarquer un soulagement des symptômes, particulièrement le stress, l'anorexie ou la douleur. Les participants consommaient en moyenne 18,3±21,1 g de cannabis par mois et dépensaient en moyenne 105,15±109,87 $ par mois pour se le procurer. La consommation de cannabis était liée à un logement en milieu rural, à un niveau de revenu plus bas, à la conduite sous l'influence d'une substance et à la consommation d'ecstasy et de tabac. Le niveau de revenu, la consommation d'ecstasy et la consommation de tabac étaient considérés comme des prédicteurs importants selon le modèle de régression. La consommation de cannabis ne s'associait pas à des résultats psychologiques indésirables. EXPOSÉ: Une consommation antérieure prolongée de cannabis et le chevauchement important entre la consommation de cannabis à des fins récréatives et médicinales font ressortir la difficulté d'obtenir une définition viable du traitement médicinal par le cannabis.

Cardiovascular risks and brain function: a functional magnetic resonance imaging study of executive function in older adults.

Cardiovascular (CV) risk factors, such as hypertension, diabetes, and hyperlipidemia are associated with cognitive impairment and risk of dementia in older adults. However, the mechanisms linking them are not clear. This study aims to investigate the association between aggregate CV risk, assessed by the Framingham general cardiovascular risk profile, and functional brain activation in a group of community-dwelling older adults. Sixty participants (mean age: 64.6 years) from the Brain Health Study, a nested study of the Baltimore Experience Corps Trial, underwent functional magnetic resonance imaging using the Flanker task. We found that participants with higher CV risk had greater task-related activation in the left inferior parietal region, and this increased activation was associated with poorer task performance. Our results provide insights into the neural systems underlying the relationship between CV risk and executive function. Increased activation of the inferior parietal region may offer a pathway through which CV risk increases risk for cognitive impairment.

Correlates of protection following vaccination of mice with gene deletion mutants of Francisella tularensis subspecies tularensis strain, SCHU S4 that elicit varying degrees of immunity to systemic and respiratory challenge with wild-type bacteria.

Francisella tularensis subspecies tularensis is an extremely virulent facultative intracellular bacterial pathogen capable of causing significant mortality in humans when inhaled. Consequently, subspecies tularensis was developed as a biological weapon more than 50 years ago. To counter this threat the US Army empirically developed a live vaccine strain, F. tularensis LVS, from the less virulent holarctica subspecies. In human experiments LVS afforded substantial protection against transdermal challenge with clinical subspecies tularensis strain, SCHU S4, but lesser protection against infection initiated by inhalation of the pathogen. Several regulatory and clinical issues remain unresolved for this vaccine, including the absence of a robust correlate of protection. To try to address this, we have developed several defined gene deletion mutants of SCHU S4 that elicit varying degrees of protection in a mouse dermal or respiratory challenge model. In the present study, we have examined whether host immune responses to immunization with such live vaccine candidates can serve as correlates of protection. Antibody responses were unable to distinguish between effective and ineffective vaccine strains. However, several cytokine responses to vaccination showed some promise. Especially, serum levels of TNFα, IFNγ, and MCP-1 between days 4 and 7 after vaccination appear to correlate with protection against respiratory challenge.

Hyponatremia is associated with higher NT-proBNP than normonatremia after prolonged exercise.

OBJECTIVE: To determine the incidence of and risk factors for exercise-associated hyponatremia (EAH) in cyclists completing a long-distance bike ride and to assess whether postexercise serum NT-proBNP concentration (brain natriuretic protein precursor) differed between riders with and without EAH. DESIGN: Observational study. SETTING: "Around the Bay in a Day" cycle event, October 2010. PARTICIPANTS: One hundred thirty-nine cyclists prospectively enrolled, with 90 completing 210 or 250 km. MAIN OUTCOME MEASURES: Body weight change and fluid intake during the event, and postevent serum sodium concentration ([Na+]) and NT-proBNP concentration ([NT-proBNP]). RESULTS: Four riders (4.5%) were hyponatremic ([Na+] < 135 mmol/L). The lowest postride [Na+] was 126 mmol/L. Hyponatremia was associated with a mean weight gain of 3.4 kg (3.9% of total body weight). Significant negative correlations were found between postride [Na+] and change in weight (r = -0.34; P < 0.01) and fluid intake when expressed as total volume (r = -0.35; P < 0.01), mL/kg body weight (r = 0.33; P < 0.01), mL·kg·h (r = -0.27; P < 0.01), or mL/h (r = -0.29; P < 0.01). NT-proBNP concentrations levels in 3 of the 4 hyponatremic subjects were markedly elevated compared with eunatremic subjects matched for age, sex, distance ridden, training, and medical history. CONCLUSIONS: Exercise-associated hyponatremia was found to occur in 4.5% of the study group and was associated with weight gain during a prolonged bike ride. Postride [Na+] varied inversely with weight change and with fluid intake. Three of 4 hyponatremic riders had significant elevations of [NT-proBNP]. These results support the hypothesis that overconsumption of hypotonic fluids in this setting is the most important cause of EAH.

BALB/c mice, but not C57BL/6 mice immunized with a ΔclpB mutant of Francisella tularensis subspecies tularensis are protected against respiratory challenge with wild-type bacteria: association of protection with post-vaccination and post-challenge immune responses.

Francisella tularensis subspecies tularensis is highly virulent for humans especially when it is inhaled. Therefore, it has the potential to be used as a biothreat agent. Vaccines against F. tularensis will need to be approved in accordance with the FDA Animal Rule. This will require identification of robust correlates of protection in experimental animals and the demonstration that similar immune responses are generated in vaccinated humans. Towards this goal, we have developed an experimental live vaccine strain by deleting the gene, clpB, encoding a heat shock protein from virulent subsp. tularensis strain, SCHU S4. SCHU S4ΔclpB administered intradermally protects BALB/c, but not C57BL/6 mice from subsequent respiratory challenge with wildtype SCHU S4. A comparison of post-vaccination and post-challenge immune responses in these two mouse strains shows an association between several antibody and cytokine responses and protection. In particular, elevated IFNγ levels in the skin 2 days after vaccination, sero-conversion to hypothetical membrane protein FTT_1778c, and to 30S ribosomal protein S1 (FTT_0183c) of F. tularensis after 30 days of vaccination, and elevated levels of pulmonary IL-17 on day 7 after respiratory challenge with SCHU S4 were all associated with protection.