Barriers, opportunities, and potential costs of expanding HIV support services.

Experiencing housing instability, food insecurity, and financial stress can negatively impact retention in care and treatment adherence for people living with HIV. Expanding services that support socioeconomic needs could help improve HIV outcomes. Our objective was to investigate barriers, opportunities, and costs of expanding socioeconomic support programs. Semi-structured interviews were conducted with organizations serving U.S. Ryan White HIV/AIDS Program clients. Costs were estimated from interviews, organization documents, and city-specific wages. Organizations reported complex patient, organization, program, and system challenges as well as several opportunities for expansion. The average one-year per-person cost for engaging new clients was $196 for transportation, $612 for financial aid, $650 for food aid, and $2498 for short-term housing (2020 USD). Understanding potential expansion costs is important for funders and local stakeholders. This study provides a sense of magnitude for costs to scale-up programs to better meet socioeconomic needs of low-income patients living with HIV.

Variation in local Ryan White HIV/AIDS program service use and impacts on viral suppression: informing quality improvement efforts.

The U.S. Ryan White HIV/AIDS Program (RWHAP) funds comprehensive services for people living with HIV to support viral suppression (VS). We analyzed five years of RWHAP data from the Minneapolis-St. Paul region to (1) assess variation and (2) evaluate the causal effect of each RWHAP service on sustained VS by race/ethnicity. Sixteen medical and support services were included. Descriptive analyses assessed service use and trends over time. Causal analyses used generalized estimating equations and propensity scores to adjust for the probability of service use. Receipt of AIDS Drug Assistance Program and financial aid consistently showed higher probabilities of sustained VS, while food aid and transportation aid had positive impacts on VS at higher levels of service encounters; however, the impact of services could vary by race/ethnicity. For example, financial aid increased the probability of sustained VS by at least 3 percentage points for white, Hispanic and Black/African American clients, but only 1.6 points for Black/African-born clients. This study found that services addressing socioeconomic needs typically had positive impacts on viral suppression, yet service use and impact of services often varied by race/ethnicity. This highlights a need to ensure these services are designed and delivered in ways that equitably serve all clients.

Case Series: Tattoo-associated Uveitis.

SIGNIFICANCE: Tattoo-associated uveitis describes simultaneous tattoo inflammation and uveitis. Multiple cases exist in the literature related to systemic sarcoidosis or a delayed hypersensitivity reaction; however, there is no consensus on etiology. Clinicians should consider new tattoos as an associated factor for patients presenting with a new uveitis. PURPOSE: In this retrospective review case series, two African American men with simultaneous tattoo inflammation and bilateral anterior uveitis were examined. Systemic sarcoidosis was suspected as the leading differential in both cases; however, laboratory evidence and imaging did not confirm a sarcoidosis diagnosis. Both patients were therefore suspected to have tattoo-associated uveitis. CASE REPORTS: Acute anterior uveitis was diagnosed in 24- and 42-year-old African American men who presented with bilateral uveitis and inflammation of tattoos received greater than 1 year before the onset of symptoms. One patient presented with granulomatous ocular signs, whereas the other did not. Both patients received skin biopsies of their tattoos confirming noncaseating granulomas. Both patients had unremarkable radiological chest scans and were treated with topical and oral corticosteroids but only had complete inflammatory resolution after removal of their tattoos. After tattoo removal, neither patient experienced recurrent inflammation. CONCLUSIONS: Simultaneous tattoo granuloma and uveitis is well supported by literature evidence. It is suspected that both patients either had a localized sarcoidosis reaction or had tattoo-associated uveitis due to a delayed-type hypersensitivity reaction caused by an unknown antigen in the tattoo ink.

Negative Symptom Interventions in Youth at Risk of Psychosis: A Systematic Review and Network Meta-analysis.

Objective: Youth at clinical high risk (CHR) for psychosis often demonstrate significant negative symptoms, which have been reported to be predictive of conversion to psychosis and a reduced quality of life but treatment options for negative symptoms remain inadequate. Therefore, we conducted a systematic review and network meta-analysis of all intervention studies examining negative symptom outcomes in youth at CHR for psychosis. Method: The authors searched PsycINFO, Medline, Embase, CINAHL, and EBM from inception to December 2016. Studies were selected if they included any intervention that reported follow-up negative symptoms in youth at CHR for psychosis. Treatment comparisons were evaluated using both pairwise and network meta-analyses. Due to the differences in negative symptom scales the effect sizes were reported as the standardized mean difference (SMD). Results: Of 3027 citations, 32 studies met our inclusion criteria, including a total of 2463 CHR participants. The null hypothesis was not rejected for any of the 11 treatments. N-methyl-D-aspartate-receptor (NMDAR) modulators trended toward a significant reduction in negative symptoms compared to placebo (SMD = -0.54; 95% CI = -1.09 to 0.02; I2 = 0%, P = .06). In respective order of descending effectiveness as per the treatment hierarchy, NMDAR modulators were more effective than family therapy, need-based interventions, risperidone, amisulpride, cognitive behavioral therapy, omega-3, olanzapine, supportive therapy, and integrated psychological interventions. Conclusions: Efficacy and effectiveness were not confirmed for any negative symptom treatment. Many studies had small samples and the majority were not designed to target negative symptoms.

The Protective Role of Autophagy in Human Vocal Fold Fibroblasts under Cigarette Smoke Extract Exposure: A New Insight into the Study of Reinke's Edema.

BACKGROUND/AIMS: Reinke's edema (RE), one of the most common benign lesions of the human vocal folds, has been associated with cigarette smoking. We have observed an abundant number of autophagosomes in the cytoplasm of fibroblasts in the lamina propria of human vocal folds under transmission electron microscopy in RE tissue. Thus, we conducted a study about autophagy induced by cigarette smoke extract (CSE) exposure in cultured human vocal fold fibroblasts (hVFFs). METHODS: Sampled tissues were cultured and exposed to varying levels of CSE. Immunochemistry staining and Western blot analyses were then performed on the cultures. RESULTS: We demonstrated that CSE significantly promoted intracellular reactive oxygen species accumulation and reduced the viability of hVFFs in a concentration-dependent manner. Both immunocytochemistry and Western blot analysis showed increased expression of the autophagy marker type II-membrane-associated light chain 3 in fibroblasts following 24 h of CSE exposure, indicating the upregulation of autophagy activity. Furthermore, the results demonstrate that the induction of autophagy played a protective role in hVFFs exposed to CSE. CONCLUSION: Autophagy can be induced by CSE in hVFFs, and it is a protective response of hVFFs to the exposure of CSE. This study provides a new insight into the process involved in the development of RE.

A unique architecture based on 1 D semiconductor, reduced graphene oxide, and chalcogenide with multifunctional properties.

A unique heterostructured optoelectronic material (HOM), consisting of a reduced graphene oxide (RGO) layer with spatially distributed CdS, suspended by zinc oxide (ZnO) nanorods, is presented. The key features of this HOM are the assembly of the components in a manner so as to realize an effective integration between the constituents and the ability to modify the electronic properties of the RGO. For the first time, the location of RGO (as a suspended layer) along with the tuning of its charge-transport properties (n-/p-type) and its influence on the photo(electro)chemical processes has been examined systematically by using this ZnO/RGO/CdS HOM as a case study. The n-type RGO interlayer facilitates >100 % increase in the photocurrent density and 25 % increase in the photodegradation of a dye, compared to ZnO/CdS, thus demonstrating its multifunctionality. At 3.2 mA cm(-2) , this HOM architecture helps to achieve the highest photocurrent density utilizing ZnO, RGO, and CdS as building blocks in any form. The work is significant for the following reasons: i) other one dimensional (1D) oxides/chalcogenides or 1D oxides/dyes may be designed with similar architectures; ii) HOMs with tunable optical absorbance and charge-transport properties could be realized; iii) related application areas (e.g., sensing or solar fuel generation) should be greatly benefited.

1D CdS/PbS heterostructured nanowire synthesis using cation exchange.

Heterostructured CdS nanowires with PbS deposits forming p-n junctions have been synthesized by successive cation exchange. The method developed herein opens up the possibility of preparing a spatially distributed heterojunction-based multifunctional electrode. The (photo)electrochemical activity of the material may be chemically tuned by changing the size and density of the p type PbS nanoparticles.

A status report on drug-associated acne and acneiform eruptions.

Several drugs have been associated with the development of eruptions that may simulate acne vulgaris. These drugs include corticosteroids, epidermal growth factor receptor inhibitors, cyclosporine, anticonvulsants, antipsychotics, antidepressants, tumor necrosis factor-alpha (TNF-alpha) inhibitors, anabolic steroids, danazol, antituberculosis drugs, quinidine, azathioprine and testosterone. In some cases, the eruption is clinically and histologically similar to acne vulgaris while, in other cases, the eruption is clinically suggestive of acne vulgaris without any histologic information. Additionally, in other cases of drug-associated acneiform eruptions, despite clinical similarity, histologic features are not consistent with acne vulgaris.

Acute generalized exanthematous pustulosis as a delayed dermatotoxic reaction to IV-administered nonionic contrast media.

OBJECTIVE: Our objective was to report three delayed, generalized, and protracted cutaneous reactions in two patients that are compatible with acute generalized exanthematous pustulosis (AGEP) after contrast medium administration. CONCLUSION: Radiologists and referring clinicians need to be aware of late adverse reactions to the administration of contrast media and to distinguish these from other possible causes.