Cleaning potential of different air abrasive powders and their impact on implant surface roughness.

BACKGROUND: Implant surface roughness after air abrasive therapy has not been measured precisely in previous research. Debridement with air abrasion facilitates the mechanical removal of bacterial biofilms but may damage implant surfaces on a microscopic level. PURPOSE: This study aimed to investigate the cleaning potential of various air abrasive powders and their effect on titanium implant surfaces. MATERIALS AND METHODS: Twenty implants coated with red ink were inserted into three-dimensional printed circumferential bone defect models. Treatment was completed with three types of air abrasive powders: sodium bicarbonate (SB), glycine, and erythritol for 60 seconds. Water alone was used as control. The percentage of remaining ink was assessed using digital photography and graphic software. Implant surface topography/roughness was quantified using optical profilometry and examined via scanning electron microscopy. The microscopic analysis was performed at two implant areas: collar (Laser-Lok surface) and threads. RESULTS: The cleaned surfaces (%, mean ± SD) after treatment with SB, glycine, and erythritol accounted for 49.3 ± 3.6%, 33.1 ± 1.2%, and 25.1 ± 0.7%, respectively. Statistically significant differences were found between all groups (P < .001). SB was the only powder that significantly increased the implant roughness (Sa ) on both the implant collar (1.53-2.10 µm) and threads (3.53-4.20 µm). Regardless of the abrasive powder used, the collar, emerging implant surfaces from the defect base, and surfaces beneath implants threads exhibited more post-treatment residual ink. CONCLUSION: Large-sized powder showed the greatest cleaning capacity, but caused more alterations to the implant surface. Glycine and erythritol displayed no significant changes in surface roughness, however, demonstrated a limited ink removal capacity.

Recurrence after hospitalization for acute coronary syndrome among HIV-infected and HIV-uninfected individuals.

OBJECTIVES: We evaluated the association of HIV infection and immunodeficiency with acute coronary syndrome (ACS) recurrence, and with all-cause mortality as a secondary outcome, after hospitalization for ACS among HIV-infected and HIV-uninfected individuals. METHODS: We conducted a retrospective cohort study within Kaiser Permanente Northern California of HIV-infected and HIV-uninfected adults discharged after ACS hospitalization [types: ST-elevation myocardial infarction (STEMI), non-STEMI, or unstable angina] during 1996-2010. We compared the outcomes of ACS recurrence and all-cause mortality within 3 years, both overall by HIV status and stratified by recent CD4 count, with HIV-uninfected individuals as the reference group. Hazard ratios (HRs) were obtained from Cox regression models with adjustment for age, sex, race/ethnicity, year, ACS type, smoking, and cardiovascular risk factors. RESULTS: Among 226 HIV-infected and 86 321 HIV-uninfected individuals with ACS, HIV-infected individuals had a similar risk of ACS recurrence compared with HIV-uninfected individuals [HR 1.08; 95% confidence interval (CI) 0.76-1.54]. HIV infection was independently associated with all-cause mortality after ACS hospitalization overall (HR 2.52; 95% CI 1.81-3.52). In CD4-stratified models, post-ACS mortality was higher for HIV-infected individuals with CD4 counts of 201-499 cells/µL (HR 2.64; 95% CI 1.66-4.20) and < 200 cells/µL (HR 5.41; 95% CI 3.14-9.34), but not those with CD4 counts ≥ 500 cells/µL (HR 0.67; 95% CI 0.22-2.08), compared with HIV-uninfected individuals (P trend < 0.001). CONCLUSIONS: HIV infection and immunodeficiency were not associated with recurrence of ACS after hospitalization. All-cause mortality was higher among HIV-infected compared with HIV-uninfected individuals, but there was no excess mortality risk among HIV-infected individuals with high CD4 counts.

Helping our patients take HIV pre-exposure prophylaxis (PrEP): a systematic review of adherence interventions.

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.

Type A behavior pattern, inhibited power motivation, and activity inhibition.

The constructs of the Type A behavior pattern and the Inhibited Power Motive Syndrome (IPMS) have many features in common. The empirical relation between the two constructs was investigated in this study with 45 employed, male medical and surgical patients. Four different measures of the Type A pattern were examined. Results showed that, of the four measures, the Structured Interview and the Hostility Scale were related significantly to the IPMS. Systolic blood pressure reactivity was also related significantly to the IPMS. These relations could be ascribed largely to activity inhibition alone. The contribution of activity inhibition to an understanding of the biological and psychological substrates of the Type A behavior pattern is discussed.

Social insecurity, the type A behavior pattern, and sympathetic arousal.

Social insecurity is a psychological orientation that has been found to be associated significantly with both coronary atherosclerosis and psychological distress. Although sympathetic arousal has been assumed to be a cause of coronary atherosclerosis and an effect of psychological distress, neither of the prior studies included a measure of sympathetic arousal in its design. The present study fills this gap by examining social insecurity in relation to blood pressure, as an index of sympathetic arousal. The results, derived from 50 male, medical/surgical patients, are consistent with the pattern of findings in previous studies in that social insecurity was independent of the Type A pattern and additive to it in its association with blood pressure. Differences between social insecurity and the Type A pattern are discussed in terms of their differential associations with systolic versus diastolic pressure and their differential trait-like and state-like patterns of association with blood pressure.

Psychological impairment and psychological health in the psychological well-being of the physically ill.

There has been a growing acceptance of the view that psychological health is not merely the absence of psychological impairment, but rather is a separate state making its own contribution to a person's overall psychological well-being. Research on the separation of positive and negative affect represents a major empirical development of this view. The present study supports the model as it has been developed from people's self-reports. However, the postulation of complete separation of positive and negative affect is too extreme for others' reports about people. For others' reports, the model should be modified to state that positive and negative affect are partially separate and have differentially strong associations with harmonious and disruptive/distressing behaviors. These findings have implications for the measurement of psychological well-being in investigations of the physically ill. Both psychological impairment and psychological health should be represented, particularly when they are assessed from people's self-reports. Finally, there are promising indications that this view of psychological well-being is applicable to mentally ill persons as well.

The screening of non-H-2 congenic lines forSk loci.

Thirty-seven histocompatibility congenic lines of mice, including at least 27non- H-2 lines, developed by Bailey on the C57BL/6 background, were screened for loci determining Sk (skin-specific) histocompatibility antigens. Background strain hosts were inoculated with lymphoid cells from the congenic lines and subsequently challenged with skin test grafts from the same donors. Comparison of the survival times of these test grafts with those of first- and second-set skin grafts in the same donor-host combinations suggests that the lymphoid cells from 35 of the congenic lines apparently immunized or tolerized at least some of the hosts. Thus, the histocompatibility antigens involved were shared by lymphoid cells and skin, and by definition could not be Sk antigens. The tests were indecisive with two of the non-H-2 lines, but if Sk antigens were involved, their contribution to the immunogenicity of conventional skin allografts probably was negligible. Hence ifSk congenic lines are desired, they probably will have to be developed on their own by procedures specifically designed to select for Sk antigens of significant immunogenicity.

Coping with interpersonal conflicts through life events and hospitalization.

Previous studies have helped to explicate the coping process prior to hospitalization by investigating the frequency and pattern of life events during this period. The present study extends the empirical applicability of the model to the period following hospitalization. Predictive validity for the model is provided by an investigation of posthospital community adjustment and rehospitalization. It was found that the resolutions of interpersonal conflicts during the period of hospitalization enhanced the ability to predict these outcome measures substantially when the conflict resolutions were added as predictors to patients' demographic and background characteristics, their hospital behavior, and their therapists' evaluations. Two case histories are presented to illustrate the applicability of the model for furthering the understanding of individual patient's lives.