The Hepatitis C virus treatment cascade at an urban postincarceration transitions clinic.

Transitions clinics, which provide medical care to individuals who have been released from incarceration, reach a population at high risk for hepatitis C Virus (HCV) infection. We used the HCV treatment cascade to describe HCV care at an urban postincarceration transitions clinic, identifying gaps in care and determining reasons for lapses in care. In this retrospective cohort study, we reviewed electronic health records for all formerly incarcerated individuals receiving care at the Bronx Transitions Clinic. HCV treatment cascade measures included the following: detection of HCV antibodies, confirmation of chronic infection, specialist referral, specialist evaluation, initiation of treatment, completion of treatment and achievement of SVR. We recorded reasons for lapses in care. Of 451 patients accessing care, 317 (70%) were screened for HCV antibodies, and 106 (33%) tested positive. Of the 106 antibody-positive patients, 93 (88%) were evaluated for HCV viremia and 84 (79%) were confirmed to have chronic HCV infection; 19% of the total sample had chronic HCV infection. Of these 84 with chronic HCV, 48 (57%) received specialist referral, 30 (36%) were evaluated, 8 (10%) initiated treatment, and 5 (6%) completed treatment and achieved SVR. Some treatment lapses occurred because patients were deemed unstable for treatment (12%) or were re-incarcerated (5%). Chronic HCV infection was common among transitions clinic patients. Few were treated and cured. Patients lost contact with providers before consideration for antiviral therapy. Referral to specialty providers was a gap in care. Increasing HCV treatment in this population will likely require intensive delivery models.

Controllable optical phase shift over one radian from a single isolated atom.

Fundamental optics such as lenses and prisms work by applying phase shifts of several radians to incoming light, and rapid control of such phase shifts is crucial to telecommunications. However, large, controllable optical phase shifts have remained elusive for isolated quantum systems. We have used a single trapped atomic ion to induce and measure a large optical phase shift of 1.3±0.1 radians in light scattered by the atom. Spatial interferometry between the scattered light and unscattered illumination light enables us to isolate the phase shift in the scattered component. The phase shift achieves the maximum value allowed by atomic theory over the accessible range of laser frequencies, pointing out new opportunities in microscopy and nanophotonics. Single-atom phase shifts of this magnitude open up new quantum information protocols, in particular long-range quantum phase-shift-keying cryptography.

Wavelength-scale imaging of trapped ions using a phase Fresnel lens.

A microfabricated phase Fresnel lens was used to image ytterbium ions trapped in a radio frequency Paul trap. The ions were laser cooled close to the Doppler limit on the 369.5 nm transition, reducing the ion motion so that each ion formed a near point source. By detecting the ion fluorescence on the same transition, near-diffraction-limited imaging with spot sizes of below 440 nm (FWHM) was achieved. To our knowledge, this is the first demonstration of wavelength-scale imaging of trapped ions and the highest imaging resolution ever achieved with atoms in free space.

Creation and piloting of a new hospital capacity assessment tool in a major urban area.

OBJECTIVES: Crowded hospital emergency departments (EDs) can undermine the ability of a region's safety net to provide safe, timely care. However, data to measure hospital capacity community-wide is generally unavailable. This study aimed to assess hospital crowding, capacity and patient flow in an urban community using the newly developed hospital capacity assessment tool (HCAT). STUDY DESIGN: A survey of the eight acute care hospitals in the District of Columbia (DC) with active EDs. METHODS: Existing emergency care assessment tools were reviewed. Eighteen of the 57 questions on the HCAT were adapted from existing hospital surveys, while the remaining 39 questions were constructed de novo for use in this assessment. Hospitals were provided with paper and electronic versions of the HCAT. RESULTS: All eight DC hospitals completed the HCAT; however, three hospitals were unable to answer many of the questions due to a lack of regular data collection. The HCAT data shows throughput times in DC hospitals that are substantially longer than national averages. CONCLUSIONS: The HCAT is a promising tool for evaluating community-wide emergency care. Findings from the HCAT allowed for the introduction of new ED performance data into the local decision-making process.

Evaluation of contingency management as a strategy to improve HCV linkage to care and treatment in persons attending needle and syringe programs: A pilot study.

BACKGROUND: A greater proportion of HCV-infected people who inject drugs (PWID) need to be linked to care for HCV antiviral treatment. This study sets out to evaluate the efficacy of contingency management (CM) for improving HCV linkage to care, treatment initiation, adherence, and cure for PWID recruited from a needle and syringe program. METHODS: Between March 2015 and April 2016, 20 participants were enrolled into the CM arm, and then subsequently enrolled 20 participants in the enhanced standard of care (eSOC) arm. Participants in the eSOC arm received an expedited appointment and a round-trip transit card. Participants enrolled in the CM arm received eSOC plus $25 for up to ten HCV clinical visits and $10 for each returned weekly medication blister pack. Adherence was measured via electronic blister packs. RESULTS: Overall the median age was 47 years; most were men (67%) and Hispanic (69%). There were no significant differences in demographic characteristics between participants in the study arms. In the CM arm 74% were linked to HCV care, compared to 30% in the eSOC arm (p = 0.01). In the CM arm, 75% (9/12) of treatment eligible participants initiated treatment, compared to 100%(4/4) in the eSOC arm (p = 0.53). All patients (9/9) achieved cure in the CM arm, as compared to 75% (3/4) of patients in the eSOC arm. There were no differences in adherence between study arms. CONCLUSIONS: In this pilot study, contingency management led to higher rates of HCV linkage to care for PWID, as compared to standard of care. CM should be considered as a possible intervention to improve the HCV treatment cascade for PWID.

TGF-beta 1 and 25-hydroxycholesterol stimulate osteoblast-like vascular cells to calcify.

Previous studies in our laboratory demonstrated messenger RNA for bone morphogenetic protein-2a in human calcified plaque, suggesting that arterial calcification is a regulated process, similar to osteogenesis. To further test this hypothesis, we have isolated and cloned a subpopulation of cells from bovine aortic media that show osteoblastic potential. These novel cells are primarily distinguished from smooth muscle cells by expression of a surface marker preliminarily identified as a modified form of the ganglioside sialyl-lactosylceramide (GM3). Osteoblastic potential was indicated by high levels of alkaline phosphatase and collagen I, expression of osteopontin and osteonectin (SPARC), and production of bone-specific osteocalcin and hydroxyapatite. Cultures of these cells were stimulated to form increased numbers of calcium-mineral-producing nodules by the oxysterol 25-hydroxycholesterol as well as by transforming growth factor-beta 1, both known to be present in atherosclerotic lesions. The stimulation of calcifying vascular cells in the artery wall by these two factors suggests a possible mechanism for the colocalization of calcification with atherosclerosis in vivo.

Effect of biotin supplementation on meat quality of F1 Wagyu/Black Angus feedlot steers of known genotype.

Biotin (D-biotin) was supplemented to F1 Wagyu/Black Angus steers fed a wheat-based ration to evaluate the effect on meat quality. One hundred and eight steers of known Wagyu sire lines were assigned to three biotin treatments (0, 10 and 20mg/head/day) with each treatment replicated four times using an unfasted liveweight of 410.5kg (±24.42 SD). Biotin supplementation had no effect (P>0.05) on beef marbling standard at either the 5/6th or 10/11th rib quartering site, 10/11th rib intra-muscular fat percentage, intra-muscular fat fatty acid composition or adipose melting points. Wagyu genotype had an effect (P<0.05) on beef marbling standard and intra-muscular fat percentage at the 10/11th rib, inter-muscular and intra-muscular melting point and fatty acid composition of intra-muscular fat. A significant (P<0.001) but poor correlation existed between beef marbling standard and intra-muscular fat percentage (R(2)=0.198). Total conjugated linoleic acid had a highly significantly (P<0.0001) positive correlation to intra-muscular fat percentage (R(2)=0.446).

Retention in buprenorphine treatment is associated with improved HCV care outcomes.

Persons who inject drugs, most of whom are opioid dependent, comprise the majority of the HCV infected in the United States. As the national opioid epidemic unfolds, increasing numbers of people are entering the medical system to access treatment for opioid use disorder, specifically with buprenorphine. Yet little is known about HCV care in patients accessing buprenorphine-based opioid treatment. We sought to determine the HCV prevalence, cascade of care, and the association between patient characteristics and completion of HCV cascade of care milestones for patients initiating buprenorphine treatment. We reviewed electronic health records of all patients who initiated buprenorphine treatment at a primary-care clinic in the Bronx, NY between January 2009 and January 2014. Of the 390 patients who initiated buprenorphine treatment, 123 were confirmed to have chronic HCV infection. The only patient characteristic associated with achieving HCV care milestones was retention in opioid treatment. Patients retained (vs. not retained) in buprenorphine treatment were more likely to be referred for HCV specialty care (63.1% vs. 34.0%, p<0.01), achieve an HCV-specific evaluation (40.8% vs. 21.3%, p<0.05), be offered HCV treatment (22.4% vs. 8.5%, p<0.05), and initiate HCV treatment (9.2% vs. 6.4%, p=0.6). Given the current opioid epidemic in the US and the growing number of people receiving buprenorphine treatment, there is an unprecedented opportunity to access and treat persons with HCV, reducing HCV transmission, morbidity and mortality. Retention in opioid treatment may improve linkage and retention in HCV care; innovative models of care that integrate opioid drug treatment with HCV treatment are essential.

The efficacy of a vitamin D(3) metabolite for improving the myofibrillar tenderness of meat from Bos indicus cattle.

The influence of a once only administration of a metabolite of vitamin D(3) (HY·D(®)-25-hydroxy vitamin D(3)) on myofibrillar meat tenderness in Australian Brahman cattle was studied. Ninety-six Brahman steers of three phenotypes (Indo-Brazil, US and US/European) and with two previous hormonal growth promotant (HGP) histories (implanted or not implanted with Compudose(®)) were fed a standard feedlot ration for 70d. Treatment groups of 24 steers were offered daily 10g/head HY·D(®) (125mg 25-hydroxyvitamin D(3)) for 6, 4, or 2d before slaughter. One other group of 24 steers was given the basal diet without HY·D(®). Feed lot performance, blood and muscle samples and carcass quality data were collected at slaughter. Calcium, magnesium, potassium, sodium, iron and Vitamin D(3) metabolites were measured in plasma and longissimus dorsi muscle. Warner-Bratzler (WB) shear force (peak force, initial yield) and other objective meat quality measurements were made on the longissimus dorsi muscle of each steer after ageing for 1, 7 and 14d post-mortem at 0-2°C. There were no significant effects of HY·D(®) supplements on average daily gain (ADG, 1.28-1.45kg/d) over the experimental period. HY·D(®) supplements given 6d prior to slaughter resulted in significantly higher (P<0.05) initial yield values compared to supplements given 2d prior to slaughter. Supplementation had no significant effect on meat colour, ultimate pH, sarcomere length, cooking loss, instron compression or peak force. There was a significant treatment (HY·D(®)) by phenotype/HGP interaction for peak force (P=0.028), in which Indo-Brazil steers without previous HGP treatment responded positively (increased tenderness) to HY·D(®) supplements at 2d when compared with Indo-Brazil steers previously given HGP. There were no significant effects of treatment on other phenotypes. HY·D(®) supplements did not affect muscle or plasma concentrations of calcium, potassium or sodium, but did significantly decrease plasma magnesium and iron concentrations when given 2d before slaughter. There were no detectable amounts of 25-hydroxyvitamin D(3) in the blood or muscle of any cattle at slaughter.

Catechol estrogen formation in the central nervous system of the rat.

Conversion of estradiol and estrone to catechol estrogens by rat hypothalamic tissue but not by the cerebral cortex was demonstrated from the incubation of these tissues with estradiol-2-3H and estrone-2-3H and monitoring the incorporation of tritium into water. Direct evidence for this transformation was obtained by isolating the labelled phenazine derivative of 2-hydroxyestrone after hypothalamic incubation with estrone-4-14C.

19-Hydroxylation of androgens by rat granulosa cells.

The transformation of androgens by rat granulosa cells was examined employing [19-C3H3]-, [1 beta-3H]-, and [1,2,6,7-3H]androgens as substrates. Rat granulosa cell homogenates incubated with [19-C3H3]androstenedione generated [3H] water and [3H]formic acid in a ratio of 8-9, indicating considerable 19-hydroxylation which was not followed by aromatization. This ratio remained relatively constant regardless of the time in the estrous cycle when the ovaries were removed, although there were large differences in the extent of the reactions. Parallel incubations with [1 beta-3H]]androstenedione showed that the aromatization of [19-C3H3]androstenedione in this tissue proceeds with a negative isotope effect of approximately 3, similar to that in human placenta. Incubation of the same substrates with granulosa cell cultures produced [3H]water and [3H]formic acid in ratios of 4-5 and showed a smaller negative isotope effect in the aromatization of [19-C3H3]androstenedione. FSH stimulation of the cell cultures had no influence on the ratio of 19-hydroxylation to aromatization with respect of either the duration of stimulation or the concentration of the pituitary hormone. Incubation of the cell cultures with [1,2,6,7-3H]androstenedione yielded tritium-labeled 19-hydroxy- and 19-oxoandrostendiones and estrogens in relative quantities corresponding to those expected from the [3H]water and [3H]formic acid formation. Virtually all of the products were found in the medium, with only trace quantities located intracellularly. Similarly, incubation of granulosa cell homogenates with [14C]androstenedione yielded [14C]19-oxygenated androgens in excess of [14C] estrogens. These results indicate that rat granulosa cells effect C-19-hydroxylation of androgens greater than that linked to aromatization and that the rat ovaries produce 19-oxygenated androgens in quantities exceeding those of estrogens. The excess 19-hydroxylation is synchronous with aromatization, but it is not known whether it is catalyzed by the same or a different enzyme. The formation of 19-oxygenated androgens in cell cultures indicates that they are distinct metabolites of androgens in the rat ovary and are not merely trapped transient aromatization intermediates.

Catechol estrogen formation and metabolism in brain tissue: comparison of tritium release from different positions in ring A of the steroid.

Catechol estrogens labeled with 3H at different positions in rings A and B of the steroid were synthesized by chemical or enzymatic methods, and their oxidative transformation by male rat brain microsomes was followed by the transfer of 3H into 3H2O. This reaction was shown to occur more readily with the catechol estrogens than with the parent steroid and was also influenced by the position of the radiolabel. Tritium was displaced less readily from C-1 than from C-2 or C-4 of the aromatic ring. Spermine, which is known to increase cytochrome P-450-mediated hydroxylation reactions, had no effect on the release of 3H from ring A of either estradiol or 2-hydroxyestradiol with rat brain microsomes in contrast to liver. Glutathione and other thiols were able to cause a rapid loss of 3H from labeled catechol estrogens, even in the absence of tissue, but in double label experiments with [4-3H]- and [4-14C]2-hydroxyestradiol, the isotope ratio in the recovered catechol estrogen was unchanged. The results illustrate some of the problems in determining accurately the metabolism of estrogens by measuring 3H2O formation when aromatic hydroxylation is involved and also highlight the possible interaction of the catechol estrogens with cellular nucleophiles such as glutathione.

Pharmacological studies of K+ loss from ischaemic myocardium in vitro: roles of ATP-dependent K+ channels and lactate-coupled efflux.

Perfused guinea-pig hearts were rendered ischaemic by 95% reductions in coronary flow. K+ and lactate release over the first 6 min of ischaemia were reduced by glibenclamide (described as a K+ATP channel blocker), 2-deoxyglucose (inhibitor of lactate synthesis) and alpha-cyano-4-hydroxycinnamic acid (inhibitor of lactate transport). Glibenclamide did not selectively reduce K+ loss without affecting lactate release, as would be expected for a selective K+ATP channel blocker. During a single 30 min period of ischaemia, a secondary release of K+ was observed corresponding to the onset of ventricular fibrillation, with no associated increase in lactate efflux, which appeared sensitive to glibenclamide. In conclusion, glibenclamide failed to reduce K+ loss in early ischaemia without reducing lactate release as would be expected for a selective K+ATP channel blocker. Caution should be exercised when using glibenclamide as a specific blocker of K+ATP channels in the absence of measurements of metabolic parameters.

Formation of 3H2O from [2-3H]- and [4-3H] estradiol by rat uteri in vitro: possible role of peroxidase.

The mitochondrial fraction of diethylstilbestrol-treated rat uteri, known to contain an estrogen-induced peroxidase, was able to catalyze the release of 3H2O from either [2-3H]- or [4-3H]estradiol. Hydrogen peroxide added to this system increased the yield of 3H2O but had no effect on mitochondrial preparations from ovariectomized rat uteri having only very low peroxidase activity. The reaction was inhibited by catalase and also occurred with lactoperoxidase in the presence of H2O2 but 2-hydroxyestradiol was not detected in any of these experiments. Under similar conditions, tyrosinase catalyzed the formation of the catechol estrogen with loss of 3H from [2-3H]- or [2,4,6,7-3H]- but not [4-3H]- or [6,7-3H]estradiol. It is proposed that the formation of 3H2O from 3H-labeled estradiol in the estrogen-treated rat uterus may occur by a peroxidative mechanism which does not necessarily result in hydroxylation of the steroid.

Intra-hepatic false aneurysm: a rare complication of ERCP.

We report a rare case in which an intra-hepatic false aneurysm formed following endoscopic retrograde cholangiopancreatography and presented with life-threatening gastrointestinal bleeding. The aetiology, investigation and management of intra-hepatic false aneurysm is discussed.

Age-related changes in auditory evoked potentials of gerbils. I. Response amplitudes.

Auditory brainstem responses (ABRs) were recorded in young (6-10 month) and aged (36 month) Mongolian gerbils. For each subject, ABR thresholds and response amplitudes were measured at octave intervals from 1 through 16 kHz. Data from the young animals served as the baselines for comparison to aged animals which were categorized on the basis of auditory brainstem response (ABR) thresholds. The aged groups included subjects with thresholds (a) at the mean of a pool of 50 aged gerbils, (b) one standard deviation (SD) lower than the mean, (c) one sd higher than the mean, and (d) near normal for young gerbils. The amplitudes of ABR waveforms for the aged gerbils were reduced compared to the young subjects, particularly at high sound pressure levels. This was true even for aged subjects with thresholds similar to those for younger subjects. The slopes of the amplitude-intensity (I/O) functions were shallower in all aged subjects compared to young subjects. The results suggest that ABR amplitudes and I/O slopes decrease as a function of age and that the decreases are not a direct result of loss of auditory sensitivity. The reductions in ABR amplitudes from aged gerbils presumably reflect age-related pathology in the auditory periphery, as previous studies have shown reductions in amplitudes of the compound action potential of aged gerbils.

Age-related changes in auditory evoked potentials of gerbils. II. Response latencies.

Auditory brainstem responses (ABR) were recorded in young (6-10 month) and aged (36 month) Mongolian gerbils. Data from the young animals served as the baselines for comparison to aged animals which were categorized on the basis of ABR thresholds. Aged gerbils with normal thresholds (re young controls) had wave i and ii latencies of the ABR which were relatively normal at 1-4 kHz and slightly reduced at 8 and 16 kHz. Wave iv latencies in the aged gerbils with normal thresholds were reduced at all frequencies. Aged gerbils with 10-30 dB of hearing loss had wave i, ii, and iv latencies which were prolonged at low sound pressure levels and normal at high stimulus levels. Aged gerbils with 30 dB or greater losses had prolonged wave i, ii, and iv latencies at most levels. Slopes of latency-intensity (L/I) functions were steeper at 1-4 kHz than controls in aged subjects with hearing losses of 10 dB or greater. Slopes of L/I functions for wave iv were normal in aged subjects. The wave i-iv interval was shorter than normal in aged subjects with no hearing loss, normal in aged subjects with 10-30 dB of loss, and prolonged in subjects with greater than 30 dB of loss.

Guide for the interpretation of one-way analysis of variance.

In summary, one-way ANOVA for independent groups is used to test whether the group means for a specific dependent variable differ significantly after exposing each group to a unique level of a single factor or independent variable. You may recognize the preceding sentence. We hope it makes more sense to you now than when you first read it at the beginning of this article.

Reliability of kinematic measurements of rear-foot motion.

The purpose of this study was to examine the ability of a video-based, computer-interfaced motion analysis system to provide reliable data. Ten subjects with no significant orthopedic or neurological dysfunction and ranging in age from 22 to 45 years (mean = 29.6, SD = 7.8) were tested. Retroreflective markers were placed on the posterior shank and foot of each subject. Footswitches were attached to the plantar forefoot and rear foot. A video camera was placed behind the subject, and video data were collected while the subject walked on a treadmill. One representative gait cycle for each subject was selected and processed 10 times with a video processor and analysis software. Three intraclass correlation coefficients (ICCs) were calculated for variables generated by the analysis software, one for two individual measures and one each for the mean of three and five repeated measures. Except for temporal variables, processing data introduced additional variability into the measurement process, particularly for angular velocity data. Measurement of all variables was highly reliable (ICC values greater than or equal to .95) when based on the mean of at least three repeated measures. Although a single measure of temporal and angular position variables may be considered reliable, we recommend using a mean of three trials for angular velocity variables. Additional research is needed to determine tester and subject variability and validity of the measures.