Changes in the influence of lymphoma- and HIV-specific factors on outcomes in AIDS-related non-Hodgkin lymphoma.

BACKGROUND: We undertook the present analysis to examine the shifting influence of prognostic factors in HIV-positive patients diagnosed with aggressive non-Hodgkin lymphoma (NHL) over the last two decades. PATIENTS AND METHODS: We carried out a pooled analysis from an existing database of patients with AIDS-related lymphoma. Individual patient data had been obtained prior from prospective phase II or III clinical trials carried out between 1990 until 2010 in North America and Europe that studied chemo(immuno)therapy in HIV-positive patients diagnosed with AIDS-related lymphomas. Studies had been identified by a systematic review. We analyzed patient-level data for 1546 patients with AIDS-related lymphomas using logistic regression and Cox proportional hazard models to identify the association of patient-, lymphoma-, and HIV-specific variables with the outcomes complete response (CR), progression-free survival, and overall survival (OS) in different eras: pre-cART (1989-1995), early cART (1996-2000), recent cART (2001-2004), and contemporary cART era (2005-2010). RESULTS: Outcomes for patients with AIDS-related diffuse large B-cell lymphoma and Burkitt lymphoma improved significantly over time, irrespective of baseline CD4 count or age-adjusted International Prognostic Index (IPI) risk category. Two-year OS was best in the contemporary era: 67% and 75% compared with 24% and 37% in the pre-cART era (P < 0.001). While the age-adjusted IPI was a significant predictor of outcome in all time periods, the influence of other factors waxed and waned. Individual HIV-related factors such as low CD4 counts (<50/mm(3)) and prior history of AIDS were no longer associated with poor outcomes in the contemporary era. CONCLUSIONS: Our results demonstrate a significant improvement of CR rate and survival for all patients with AIDS-related lymphomas. Effective HIV-directed therapies reduce the impact of HIV-related prognostic factors on outcomes and allow curative antilymphoma therapy for the majority of patients with aggressive NHL.

Police officer anxiety after occupational blood and body fluid exposure.

BACKGROUND: In the course of their work, police staff are at risk of exposure to blood and body fluids (BBF) and potentially at risk of acquiring a blood-borne viral infection. AIMS: To examine levels of anxiety among Scottish police staff following an occupational exposure to BBF. METHODS: Police staff who reported an incident of exposure to their occupational health (OH) provider were invited to complete a postal questionnaire about their levels of self-reported anxiety after the incident and after contact with medical services (namely, OH and accident and emergency (A&E)). RESULTS: Seventy exposed individuals (66% of those invited to take part) completed a questionnaire. Participants' self-reported anxiety after the incident varied widely. Levels of anxiety reduced over time and following contact with medical services. A&E staff were more likely to be the first point of medical contact for the most anxious individuals. Pre-incident training was not associated with post-incident anxiety. CONCLUSIONS: The findings suggest that contact with medical services helps to alleviate post-exposure anxieties among police staff.

Management of blood and body fluid exposures in police service staff.

BACKGROUND: Police service staff are at risk of occupational exposure to blood and body fluids with the consequent risk of blood-borne virus (BBV) infection. AIMS: To examine the types of occupational exposure incidents experienced by Scottish police service staff and to evaluate the post-incident management provided by their occupational health (OH) services. METHODS: Data were collected on the circumstances and the post-incident management of each incident reported to OH over 12 months. An expert panel reviewed the post-incident management provided by OH. RESULTS: The panel considered that the majority of cases of occupational exposure incurred little or no risk of BBV transmission. In general, the expert panel assessed the post-incident management provided by OH units serving the police as adequate and appropriate. However, some concerns were raised in relation to a small number of incorrect risk assessments and an inconsistent approach to hepatitis C virus (HCV) follow-up blood testing. CONCLUSIONS: The study findings suggest that most Scottish police OH departments were providing adequate post-incident management. There is, however, a need for more clarity around BBV risk assessment terminology and development of a standardized HCV testing protocol.

Comparative effectiveness of Pilates and yoga group exercise interventions for chronic mechanical neck pain: quasi-randomised parallel controlled study.

OBJECTIVES: To determine the effectiveness of Pilates and yoga group exercise interventions for individuals with chronic neck pain (CNP). DESIGN: Quasi-randomised parallel controlled study. SETTING: Community, university and private practice settings in four locations. PARTICIPANTS: Fifty-six individuals with CNP scoring ≥3/10 on the numeric pain rating scale for >3 months (controls n=17, Pilates n=20, yoga n=19). INTERVENTIONS: Exercise participants completed 12 small-group sessions with modifications and progressions supervised by a physiotherapist. MAIN OUTCOME MEASURES: The primary outcome measure was the Neck Disability Index (NDI). Secondary outcomes were pain ratings, range of movement and postural measurements collected at baseline, 6 weeks and 12 weeks. Follow-up was performed 6 weeks after completion of the exercise classes (Week 18). RESULTS: NDI decreased significantly in the Pilates {baseline: 11.1 [standard deviation (SD) 4.3] vs Week 12: 6.8 (SD 4.3); mean difference -4.3 (95% confidence interval -1.64 to -6.7); P<0.001} and yoga groups [baseline: 12.8 (SD 7.4) vs Week 12: 8.1 (SD 5.6); mean difference -4.7 (95% confidence interval -2.1 to -7.4); P<0.00], with no change in the control group. Pain ratings also improved significantly. Moderate-to-large effect sizes (0.7 to 1.8) and low numbers needed to treat were found. There were no differences in outcomes between the exercise groups or associated adverse effects. No improvements in range of movement or posture were found. CONCLUSIONS: Pilates and yoga group exercise interventions with appropriate modifications and supervision were safe and equally effective for decreasing disability and pain compared with the control group for individuals with mild-to-moderate CNP. Physiotherapists may consider including these approaches in a plan of care. CLINICAL TRIAL REGISTRATION NUMBER: ClinicalTrials.gov NCT01999283.

Treatment of diabetes by xenogeneic islets without immunosuppression. Use of a vascularized bioartificial pancreas.

Tight glycemic control by intensive insulin therapy effectively delays the onset and slows the progression of diabetic complications but is associated with frequent dose adjustments and a high incidence of hypoglycemia. Successful pancreas transplantation corrects abnormal glucose metabolism but subjects patients to morbidity and mortality associated with chronic immunosuppression. A vascularized artificial pancreas device containing pancreatic islets is designed to provide glycemic control without immunosuppression. We report here that devices seeded with porcine islets implanted into pancreatectomized severely diabetic dogs maintained a marked improvement in glycemic control with reduced exogenous insulin requirements for up to 9 months with improved glucose tolerance and a reduction in glycosylated hemoglobin levels. No immunosuppression was used. Thus, use of a vascularized artificial pancreas containing xenogeneic porcine islets could be an alternative to intensive insulin therapy and pancreatic transplantation in treating diabetic patients before the development of severe diabetic complications.

Evaluation of anti-AIDS drugs in conventional mice implanted with a permeable membrane device containing human T cells infected with HIV.

We now report the confirmation of the work of Hollingshead et al. (1995) on development of a cell based hollow fiber (HF) system for evaluating potential anti-AIDS drugs in vivo using conventional mice rather than SCID mice. CD4 +, CEM-SS cells infected with HIV/1, strain RF, at a multiplicity of infection of 0.1 were placed into HFs. The fibers were implanted into the peritoneal cavity of outbred Swiss mice. Using this model, the antiviral activity of azidothymidine (AZT) at doses of approximately 150, 75 and 37.5 mg/kg/day was evaluated by administering AZT to the mice in drinking water. Upon fiber removal on day 6, AZT treatment was shown to significantly increase CEM cell viability over the untreated, virus control group and significantly reduced the levels of HIV p24 and HIV RT activity.

Job choice and personality: a profile of Michigan occupational and physical therapists.

The aim of this descriptive study was to compare the personality profiles of occupational therapists (OTs) and physical therapists (PTs) and examine the relationship between personality and job choice. The Kiersey-Bates Personality Inventory (70-item questionnaire) and a brief demographic survey were mailed to a random sample of 400 Ts and 400 PTs in Michigan. A total of 294 completed surveys were returned for analysis, for a combined response rate of 37%. Results showed that while the demographic profiles of OTs and PTs were similar, there were very significant differences between OTs and PTs with respect to personality. The implications of these findings for professional health education are discussed.