Guidelines and practice of breastfeeding in women living with HIV-Results from the European INSURE survey.

INTRODUCTION: Antiretroviral therapy (ART) is integral to HIV prevention, including averting vertical transmission. The World Health Organization (WHO) recommends ART and breastfeeding for all women living with HIV for at least 12 months post-partum [1, 2]. Much of the data on HIV transmission through breastfeeding comes from low-resource settings, with a paucity of data on breastfeeding-related HIV transmission in women living with HIV in other settings. Women Against Viruses in Europe (WAVE), part of the European AIDS Clinical Society (EACS), aims to improve the standard of care for women living with HIV and sought to gain an understanding of breastfeeding guidelines and practice in women living with HIV across Europe. METHODS: A steering group convened by WAVE developed a survey to collate information on breastfeeding trends, practice, and guideline recommendations for women living with HIV in Europe and to establish interest in becoming involved in a collaborative breastfeeding network. The survey was disseminated to 31 countries in March 2022. RESULTS: In total, 25 eligible responses were received: 23/25 (92%) countries have HIV and pregnancy guidelines; 23/23 (100%) guidelines refer specifically to breastfeeding; 12/23 (52%) recommend against breastfeeding; 11/23 (48%) offer an option if certain criteria are met; 12/25 (48%) reported that the number of women living with HIV who breastfeed is increasing; 24/25 (96%) respondents were interested in joining a network on breastfeeding in women living with HIV. CONCLUSIONS: Recommendations vary, and nearly half of the guidelines recommend against breastfeeding. Many countries report an increase in breastfeeding. WAVE will establish a collaborative network to bridge data gaps, conduct research, and improve support for women living with HIV who choose to breastfeed.

Evaluation of the impact of human immunodeficiency virus pre-exposure prophylaxis on new human immunodeficiency virus diagnoses during the COVID-19 pandemic.

AIMS: The national PrEP programme launched in Ireland in November 2019 with tenofovir/emtricitabine free to those meeting eligibility criteria. We assessed the impact of the first year of the PrEP programme on new HIV diagnoses in the largest sexual health and HIV service in Ireland. METHODS: A free PrEP service was established in November 2019. We reviewed the number of new diagnoses of HIV between November 2018-2019, before the introduction of the national PrEP programme and compared this with the number of new HIV diagnosis between November 2019-2020. RESULTS: There were 95 new HIV diagnoses (63.3% MSM) between November 2018 and 2019 and 73 new HIV diagnoses (65.7% MSM) between November 2019 and 2020. There was a statistically significant decline in new HIV diagnoses between the 2 years (P = 0.0003). 546 patients were prescribed PrEP as of December 2020.106 patients (19.4%) changed their PrEP dosing regimen due to lockdown. 178 individuals (32.6%) had a rectal infection diagnosed. CONCLUSION: There has been a reduction in new HIV diagnoses in our cohort (although this has occurred during a global pandemic). It is too early to say if PrEP reduces late presentations of HIV based on our findings. A significant number of rectal infections were identified in the PrEP clinic suggesting ongoing risk despite pandemic restrictions. Further research into sexual practices during COVID-19 is needed to assess if this had an impact on the lower rates of HIV acquisition.

Gastric ulceration causing thoracic spondylodiscitis: a first case of a rare complication post oesophagectomy.

We report the case of an 84-year-old male, who presented with septicaemia, abdominal and back pain. The patient had a background of oesophageal carcinoma and had undergone previous oesophagectomy and gastric pull-up operation 10 years ago. A computerised topography scan demonstrated a probable gastro-vertebral communication with a destructive process at the T8/T9 vertebral level. Further evaluation with MRI clearly showed the tract between the two structures and confirmed the diagnosis of spondylodiscitis at the adjacent spinal level. The patient was resuscitated, treated with intravenous antibiotics and kept nil by mouth. A subsequent gastroscopy demonstrated an eroding gastric ulcer at the enteric opening of the tract between the tubal stomach and the spinal column. The diagnosis was discussed with the patient, his family and the surgical multidisciplinary team. Given the extent of disease and his multiple medical co-morbidities, the decision was made for conservative management and symptom control. This is the first case of a gastro-vertebral communication causing spondylodiscitis to be described in the literature.

Alfvén solitons in a Fermionic quantum plasma.

The propagation of Alfvén envelope solitons through a Fermionic quantum plasma is considered. Starting from the governing equations for Hall magnetohydrodynamics including quantum corrections, coupled Zakharov-type equations are derived for circularly polarized Alfvén waves. The equations are numerically solved for time-independent and time-dependent cases. The time-independent case shows that variations in density take the form of dressed density solitons in which an approximately Gaussian peak is surrounded by smaller sinusoidal variations in the density envelope. The mathematical basis for this behavior is explained. A limited time-dependent case is obtained which uses the numerical time-independent soliton solutions as the initial conditions. This confirms that the soliton solutions retain the same profile as they propagate. The relevance of this work to dense astrophysical plasmas like the interiors of white dwarf stars is discussed.

What aspect of handedness is general motor programming related to?

As general motor programming had previously been found to be related to consistency of hand preference (Keane, 1999), the present study attempted to elucidate what general motor programming involves by reinvestigating responses to the Edinburgh Handedness Inventory in order to see if there was some consensus with regards to the items that tended to differentiate the consistent handers from the inconsistent handers. It was found that the opening a box item did differentiate the consistent handers from the inconsistent handers. Control of this type of bimanual task seems to be specifically related to the general motor programmer, and not hand preference as such.

Design search and optimization in aerospace engineering.

In this paper, we take a design-led perspective on the use of computational tools in the aerospace sector. We briefly review the current state-of-the-art in design search and optimization (DSO) as applied to problems from aerospace engineering, focusing on those problems that make heavy use of computational fluid dynamics (CFD). This ranges over issues of representation, optimization problem formulation and computational modelling. We then follow this with a multi-objective, multi-disciplinary example of DSO applied to civil aircraft wing design, an area where this kind of approach is becoming essential for companies to maintain their competitive edge. Our example considers the structure and weight of a transonic civil transport wing, its aerodynamic performance at cruise speed and its manufacturing costs. The goals are low drag and cost while holding weight and structural performance at acceptable levels. The constraints and performance metrics are modelled by a linked series of analysis codes, the most expensive of which is a CFD analysis of the aerodynamics using an Euler code with coupled boundary layer model. Structural strength and weight are assessed using semi-empirical schemes based on typical airframe company practice. Costing is carried out using a newly developed generative approach based on a hierarchical decomposition of the key structural elements of a typical machined and bolted wing-box assembly. To carry out the DSO process in the face of multiple competing goals, a recently developed multi-objective probability of improvement formulation is invoked along with stochastic process response surface models (Krigs). This approach both mitigates the significant run times involved in CFD computation and also provides an elegant way of balancing competing goals while still allowing the deployment of the whole range of single objective optimizers commonly available to design teams.

Job stressors and coping strategies as predictors of mental health and job satisfaction among Irish general practitioners.

Previous research has shown that many general practitioners were experiencing stress levels detrimental to their well-being. To examine coping strategies of Irish general practitioners and the possible impact of their stress on mental health and job satisfaction. Anonymous questionnaires were posted to 226 general practitioners in the Western Health Board. Just over one third of stressors caused moderate to considerable stress. Coping was important in the stress process. Sometimes, coping strategies predicted stress-related outcomes better than stressors. General practitioners' mental health was slightly better than that of a normative group. They tended to be satisfied with all aspects of the job, except hours of work. The provision of counselling services for general practitioners suffering from stress should be encouraged. Stress-management strategies should include training in coping skills and time management. The increased use of co-operatives could help alleviate the stress of out-of-hours work.

Characterization of a new solvent-responsive gene locus in Pseudomonas putida F1 and its functionalization as a versatile biosensor.

A new gene cluster, designated sepABC and a divergently transcribed sepR, was found downstream of the two-component todST phosphorelay system that regulates toluene degradation (the tod pathway) in Pseudomonas putida F1 (PpF1). The deduced amino acid sequences encoded by sepABC show a high homology to bacterial proteins known to be involved in solvent efflux or multidrug pumps. SepA, SepB and SepC are referred to be periplasmic, inner membrane and outer membrane efflux proteins respectively. Effects on growth of various PpF1 mutants compared to that of the wild type in the presence of toluene indicated a possible protective role of the solvent efflux system in a solvent-stressed environment. Growth tests with the complemented mutants confirmed the involvement of the Sep proteins in conferring solvent tolerance. The sepR gene encodes a 260-residue polypeptide that is a member of the E. coli IclR repressor protein family. The repressor role of SepR was established by conducting tests with a sep-lacZ transcriptional fusion in Escherichia coli and PpF1, expression of SepR as a maltose-binding fusion protein in a DNA binding assay, and mRNA analysis. Southern hybridization experiments and analysis of the P. putida KT2440 genome sequence indicated that sepR is a relatively rare commodity compared to homologues of the sepABC genes. We developed a whole-cell bioluminescent biosensor, PpF1G4, which contains a chromosomally based sep-lux transcriptional fusion. The biosensor showed significant induction of the sepABC genes by a wide variety of aromatic molecules, including benzene, toluene, ethylbenzene, and all three isomers of xylene (BTEX), naphthalene, and complex mixtures of aliphatic and aromatic hydrocarbons. PpF1G4 represents a second-generation biosensor that is not based on a catabolic promoter but is nonetheless inducible by aromatic pollutants and moreover functional under nutrient-rich conditions.

Direction of hand preference: the connection with speech and the influence of familial handedness.

Taking familial handedness into account, right- and left-handers with differing degrees of hand preference were monaurally presented with verbal stimuli (CVs) to which they responded using their right and left hands at separate times. This reaction time design was used to ascertain the relative cognitive functioning capacity of each hemisphere for verbal processing. However, the results disclosed more about the determination of direction of hand preference than about cognitive processing, per se. It was found that in both strong right-handers and strong left-handers with an incongruent hand preference (i.e., own handedness incongruent with family history of handedness) direction of hand preference is the result of suppression of the nonpreferred hand in the left hemisphere. Strong right- and strong left-handers with a congruent hand preference (i.e., hand preference congruent with family history of handedness) appear to have a more direct hand preference-left hemisphere mechanism. The findings of the present study are used to form part of a new theory of hand preference determination.

Motor control of the hands: the effect of familial sinistrality.

Left- and right-handed subjects, selected on the basis of degree of hand preference and for the presence or absence of familial sinistrality, responded to monaurally presented tonal stimuli (440 Hz note played on four different instruments) using their right and left hands on separate occasions. It was found that in both the strong left-handers and the inconsistent strong right-handers, motor control of the hands was related to familial sinistrality (FS). Specifically, strong left-handers and inconsistent strong right-handers with FS have a difference in the motor control of the hands in the left hemisphere, with a left hemisphere-left hand advantage. Strong left-handers and inconsistent strong right-handers with no FS have a difference in the motor control of the hands in the right hemisphere, with a right hemisphere-left hand advantage.

Rural general practitioners' experience of the provision of out-of-hours care: a qualitative study.

BACKGROUND: Published research into the provision and utilisation of out-of-hours services shows long-term trends towards decreasing personal commitment among general practitioners (GPs). However, the on-call commitments of rural GPs remain especially onerous. There has been little research relating to either rural out-of-hours services or the implications of such services for the families of the providers. AIM: To explore and describe how rural GPs in Ireland perceive and experience out-of-hours care provision. DESIGN OF STUDY: A qualitative study was conducted with 10 rural GPs and their spouses in their homes or practices using one-to-one in-depth interviews. SETTING: Ten general practices in rural Ireland. METHOD: The interviews were guided by an interview schedule that was based on pertinent themes that had emerged from previous relevant literature. The interviews were audiotaped, transcribed, and analysed for themes and issues. RESULTS: Results indicated that rural GPs experience a wide variety of satisfactions from work related to the provision of out-of-hours care. However, the large proportion of time committed to out-of-hours care greatly infringes on their social and family life. The key stressors identified related to organisational system difficulties, especially with regard to locum cover, and unrealistic patient expectations. The stressors were mainly expressed as lack of time off, restrictions on family life, and interruptions. CONCLUSION: System difficulties, such as difficulty with obtaining locums and rota extension, need to be addressed at an organisational level. Patient expectations of the role of the rural GP have significant implications for practitioners and their families.

Quality Enhancement Research Initiative in ischemic heart disease: a quality initiative from the Department of Veterans Affairs. QUERI IHD Executive Committee.

Despite the dramatic fall in ischemic heart disease (IHD) mortality rates over the last 3 decades, it remains the number one cause of death in the United States, and one of the most frequent indications for care by the US Department of Veterans Affairs. National practice guidelines have been developed and disseminated both by societies that specialize in cardiology and within the Veterans Health Administration. Despite these efforts, a substantial minority remains of patients with IHD who are not treated with guideline-recommended therapies. The Quality Enhancement Research Initiative in IHD is a Veterans Health Administration-sponsored initiative to address the gap between guideline-recommended therapies and actual Department of Veterans Affairs practice. Because guideline development for patients with IHD is relatively mature, the Quality Enhancement Research Initiative in IHD will concentrate on measuring existing practices, implementing interventions, and evaluating outcomes in veterans with IHD. Measurement of existing practices will be evaluated through analyses of existing Veterans Affairs databases developed for the Continuous Improvement in Cardiac Surgery Program, as well as data collected at the Center for the Study of Practice Patterns in veterans with acute myocardial infarction. To measure existing practices in outpatients with IHD, we plan to develop a new database that extracts electronic data from patient laboratory and pharmacy records into a relational database. Interventions to address gaps between guideline recommendations and actual practice will be solicited and implemented at individual medical centers. We plan to emphasize point-of-care electronic reminders as well as online decision support as methods for improving guideline compliance.

A typology of residential fire survivors' multidimensional needs.

This article presents an analysis of the tangible, psychological, and general needs of adults and their children reported by residential fire survivors approximately 14 weeks postfire. Three hundred and seven survivors, who identified that they needed help for themselves or their children, differed from 133 survivors who did not request help. Those needing help were more likely to be women with children younger than age 18 living in their household, have low-income status, less education, and to have already received services from church groups. The classification of self-identified needs of fire survivors included the need for specific tangible and social service assistance, psychological and spiritual support, and nonspecific assistance. This classification contributes to our understanding of the relationship between needs and loss, grief, and changes in family and life situations postfire.

A computational model for the prediction of total knee replacement kinematics in the sagittal plane.

A computational model has been developed using a current generation computer-aided engineering (CAE) package to predict total knee replacement (TKR) kinematic in the sagittal plane. The model includes friction and soft tissue restraint varying according to the flexion angle. The model was validated by comparing the outcomes of anterior-posterior (A-P) laxity tests of two contemporary knee replacements against data obtained from a knee simulating machine. It was also validated against predictions from a computer model reported in the literature. Results show good agreement in terms of A-P displacements. Further tests were performed to determined the influence of the soft tissue restraints varying with flexion angle. This work represents the first attempt to use a sophisticated commercial CAE package to predict TKR motions and the advantages of the modelling procedure chosen are discussed.

The Food and Drug Administration and atrial defibrillation devices.

CONTEXT: Atrial fibrillation is a common arrhythmia. It leads to significant morbidity and mortality, primarily from the increased incidence of stroke. The implantable atrial defibrillator, a new therapeutic option for the management of atrial fibrillation, is currently undergoing Food and Drug Administration (FDA) scrutiny for approval to market in the United States. DATA SOURCES: A review of the basic epidemiology of atrial fibrillation, as well as the current status of accepted treatment options in light of the development of the implantable atrial defibrillator, was conducted. A literature search using the terms atrial fibrillation, implantable defibrillator, Food and Drug Administration, medical devices, and medical device regulatory law was conducted using the MEDLINE and Current Contents databases. RESULTS: Currently, there is no consensus on the optimal treatment of atrial fibrillation. Despite the lack of definitive studies showing overall benefit associated with maintaining sinus rhythm in patients in atrial fibrillation, the implantable atrial defibrillator may soon reach the general market. We examine the FDA process for the evaluation of this new medical device and discuss implications for the patient, physician, industry, and health insurers. CONCLUSIONS: Current FDA approval processes for new devices are a compromise between (a) the needs for expediency and encouraging innovation by the medical device industry and (b) the need to ensure that new devices will contribute to improved patient outcomes. We suggest alternative FDA-approval processes that address these issues.

Language plus for international graduate students in nursing.

PURPOSE: To provide information about an English-language support program that focuses on the needs of international graduate nursing students. The growing presence of these students coincides with the increasing numbers of universities committed to world health. Crucial social and language competence affect the success and progress of international students in graduate nursing programs. DESIGN: Reviewed literature was 1980 to 1998, in nursing and applied linguistic research including second-language acquisition, phonology, discourse analysis, and language pragmatics to identify social and language phenomena. FINDINGS: Investigators suggest essential elements such as conventions of academic writing, reading comprehension, vocabulary, and pronunciation skills be included in the supportive Language Plus program. CONCLUSIONS: Ongoing development of the Language Plus program can promote collaboration between nurses and linguists and increase the success of international graduate nursing students.

Cerebral organization of motor programming and verbal processing as a function of degree of hand preference and familial sinistrality.

Seventy-six right- and left-handed subjects responded to monaurally presented verbal stimuli (CVs) using their right and left hands on separate occasions. Both degree of hand preference and familial sinistrality (FS) were taken into account. It was found that, contrary to expectation, the manual response interfered with the verbal perception task, but only in the consistent strong handers. The pattern of interference suggests that those with a consistent hand preference (right or left) have general motor programming in the left hemisphere. Those with an inconsistent strong hand preference probably have some degree of general motor programming in both hemispheres. No effect for FS was found for the lateralization of verbal processing or general motor programming.

Child safety seat misuse: home visiting assessment and intervention.

This project piloted the use of nurse-initiated home visits for child safety seat (CSS) assessment and intervention. Nurses made home visits to 149 rural and suburban Wisconsin women with children under 2 years of age, and assessed CSS misuse through observation and physical manipulation. Over three-quarters of CSSs were misused, although mothers were aware of only one-quarter of the instances of incorrect use. Nurses taught proper CSS use through verbal instruction, demonstration with parent's own vehicle and CSS, and supervised parental manipulation of CSS. While mothers were receptive to home visiting for CSS assessment and education, this project involved substantial nurse training. Because thorough CSS assessment and intervention during home visits is resource-intensive, other options for improving correct CSS use and parental awareness are discussed.