Understanding calcinosis cutis.

Calcinosis cutis is the aberrant deposition of insoluble calcified salts in cutaneous tissue that occurs in association with a variety of diseases. A relatively uncommon disorder, it can range in severity from mild to debilitating. This article describes a patient with a long history of dermatomyositis who developed multiple calcific lesions in the extremities that did not respond to conservative therapies and eventually required multiple surgical interventions.

Establishing National Multisectoral Coordination and collaboration mechanisms to prevent, detect, and respond to public health threats in Guinea, Liberia, and Sierra Leone 2016-2018.

BACKGROUND: The governments of Guinea, Liberia, and Sierra Leone have acknowledged that weak health systems and poor coordination of efforts hampered effectiveness of the 2014-2016 Ebola outbreak response. The bitter experience of the Ebola outbreak response served as an important catalyst for increased efforts to comply with World Health Organization (WHO) International Health Regulations (IHR 2005), Performance of Veterinary Services (PVS) Pathway capacities, and Global Health Security Agenda (GHSA) goals. In November 2016, an interministerial meeting held in Dakar, Senegal, resulted in formalized commitments from the three nations to strengthen resilience to health threats by establishing a Regional Strategic Roadmap to institutionalize the One Health approach. Since then, each country has made significant progress towards establishing National One Health Platforms to coordinate health security interventions, in collaboration with international partners. This paper outlines the methodology and results of these efforts for the period June 2016-January 2019, with a specific focus on activities supported by the US Agency for International Development (USAID)-funded Preparedness & Response (P&R) project. OBJECTIVES: In support of the West African Health Organization's November 2016 Regional Strategic Roadmap for institutionalization of the One Health approach, the Preparedness & Response (P&R) project worked in coordination with national partners in Guinea, Liberia, and Sierra Leone to establish multisectoral, One Health coordinating mechanisms. METHODOLOGY: The global USAID-funded P&R project was launched in 2014 to support the achievement of this objective, and began coordinating with partners in Guinea, Liberia, and Sierra Leone in 2016 to tailor its multi-step conceptual framework to fit the priorities and operating constraints of national stakeholders. Organized in phases of Collaboration (building key relationships), Formalization (defining and establishing a coordination structure), and Implementation (using newfound coordination to produce better health security outcomes), the framework features steps such as One Health sensitizations for multisectoral national stakeholders, development of One Health platform terms of reference and other operating guidelines, and application of these tools to coordination of technical assistance during outbreaks. RESULTS: In Guinea, Liberia, and Sierra Leone, in less than 3 yrs there has been a marked improvement in cross-sectoral coordination on health security actions. All three countries have passed legislation establishing permanent multisectoral coordination mechanisms referred to in this document as National One Health Platforms, or simply Platforms; instituted an annual mechanism for assessing capacity and performance of these platforms to lead health security actions; and have undertaken key steps towards developing and updating National Preparedness & Response Plans which truly reflect the multisectoral nature of emerging disease threats. However, multisectoral coordination is a work in progress: government stakeholders and their international partners continue to work together to further strengthen national ownership and investment in the newly established Platforms. CONCLUSION AND NEXT STEPS: Newly established Platforms in Guinea, Liberia, and Sierra Leone offer a long-term structure for coordinating health security actions. However, given the short period of time since their formalization, they depend on continued national, regional, and international resources to build from recent progress and further improve capacity and performance. Regional programs such as the World Bank Regional Disease Surveillance Systems Enhancement (REDISSE) project are of critical importance in keeping the momentum going. The highlighted progress and outputs to date provide reasons and motivation for continued, longer-term investment in the Platforms.

The need for a concept of shape homeostasis.

A major step forward for developmental biology will be accomplished when someone figures out how to extend the concept of homeostasis to apply to shapes, in the sense of geometric properties of cells, tissues and organs. I propose that the biggest obstacle to this forward step is that biological researchers are not yet familiar with the properties of tensor variables, as compared with scalars. This key difference is that tensor properties can and usually do have different amounts in different directions, whereas scalar properties cannot vary with direction. Examples of tensor variables include stress, strain, curvature, permeability, and stiffness. Examples of scalar properties include chemical concentrations, osmotic pressure, hydrostatic pressure, adhesiveness and electrical voltage. Even D'Arcy Thompson treated mechanical tension (which is the classic example of a tensor variable) as if it were a scalar constant. This greatly reduced the number of geometric shapes that he could explain as being directly produced by forces. For example, in order to generate cylinders, surface contractions need to be twice as strong in one direction as compared with the perpendicular direction. Unless surface contractions vary with direction, only spheres can be generated. Another example of not distinguishing tensors from scalars is the use of suction pipettes to measure stresses of cell surfaces (for example, during cytokinesis). This method of measurement inescapably lumps together directional components of two different tensors (tension and stiffness) as if they were one scalar. Yet another obstacle was that certain scientists argued persuasively, but mistakenly, that attractor basins were evidence of minimization of thermodynamic free energy. Chemical concentrations have no special ability to generate gradients. Neither do any other scalar variables. As will be discussed below, repeated local equilibration of any quantitative variable will generate at least as good a gradient as diffusion can. It is misguided to think of scalars as being in any sense more quantitative than tensors. In fact, tensor variables can convey more information than chemical gradients, often faster and with less vulnerability to disturbance.

Preliminary Impacts of an HIV-Prevention Program Targeting Out-of-School Youth in Postconflict Liberia.

Adolescents in Sub-Saharan Africa account for greater HIV/STI (human immuno defiency virus/sexually transmitted infection) burdens and difficult-to-reach populations. This study implemented a community-based HIV/STI program to reach at-risk youth aged 15 to 17 years in postconflict Liberia. Using a randomized controlled trial, community youths were assigned to an adapted version of an effective HIV/STI program, Making Proud Choices, or attention-matched comparison curriculum, General Health Program. Both programs were of similar doses, reach and coverage, and administered in classroom settings by trained health educators. The findings suggest that the adapted HIV/STI program had positive effects on knowledge, sexual refusal and condom use self-efficacy, condom negotiation self-efficacy, positive condom attitudes, parental communication about sex, and negative condom attitudes over time. Culturally adapted community-based, behavioral-driven programs can positively affect mediators of sexual behaviors in at-risk adolescents in postconflict settings. This is the first published report of an evidence-based HIV/STI program on sexual risk-taking behaviors of community youths in Liberia.

HIV/STD risk behaviors among in-school adolescents in post-conflict Liberia.

We conducted a randomized trial to address the health needs of in-school adolescents in Liberia, where we analyzed data from a behavioral survey administered to 820 students from eight urban schools. Our findings suggest that adolescents are at significant risk for HIV and other sexually transmitted diseases (STDs): 36% of respondents were sexually experienced, 34% of those had first sex at ages 14 or younger, 66% of first sexual encounters were unprotected, and 16% were described as "forced." Also, females were more likely to have older boyfriends (Pearson's chi square = 19.2, p = .0001) and sex resulting in pregnancies (Pearson's chi square = 11.5, p = .01), while males were more likely to have a greater number of sexual partners (Pearson's chi square = 5.6, p = .05) in the previous 3 months. We recommend further research to explore challenges associated with implementing behavioral-driven studies in post-conflict environments.

Metacarpal neck fractures: results of treatment with traction reduction and cast immobilization.

Although fractures of the fifth metacarpal neck (boxer's fractures) are common, their treatment can be problematic. A description of a technique utilizing traction reduction is presented in this paper. The records and radiographs of 59 patients who underwent reduction using longitudinal traction and subsequent immobilization in a specially molded cast were retrospectively reviewed. On average, 80% of initial fracture angulation in the sagittal plane was corrected, and only 1 degrees of this correction was lost at the discontinuation of casting (3-4 weeks). We have found this technique to be highly effective in the treatment of boxer's fractures. Advantages of this treatment include its efficacy, ease, and improved patient tolerance over other casting techniques.

An unusual presentation of acute calcific tendinitis in the hand.

Acute calcific tendinitis (ACT) is a relatively uncommon disorder of the hand and wrist. ACT is a well-known condition of the shoulder, but it often goes unrecognized when occurring in the hand or wrist. The overall lack of familiarity along with the non-specific symptoms associated with ACT frequently leads to misdiagnosis or delay in diagnosis. We report a case of acute calcific tendinitis occurring in the carpal tunnel which is a rare presentation.

Direct physical formation of anatomical structures by cell traction forces. An interview with Albert Harris by Lev Beloussov.

Albert Harris was educated at The Norfolk Academy, Norfolk, Virginia, USA (1961). He then earned a Batchelor of Arts Degree in Biology from Swarthmore College, in Pennsylvania, USA (1965), followed by a Ph.D. in Biology (1971) from Yale University, where his Dissertation Advisor was the great John Phillip Trinkaus. He held a Damon-Runyon Postdoctoral Fellowship in Cancer Research in 1970-72, under Michael Abercrombie, FRS, at the Strangeways Research Laboratory of Cambridge University, England. Then he accepted a position as Assistant Professor in the Zoology Department of the University of North Carolina at Chapel Hill, N.C. USA. In 1977, he was promoted to Associate Professor of Zoology, and in 1983 was promoted to Full Professor of Biology. In Oct.-Nov. 1991 he was honored to be Distinguished Visiting Professor of Zoology at the University of California at Davis.

Strengthening the HIV/AIDS service delivery system in Liberia: an international research capacity-building strategy.

Liberia's prolonged post-conflict transition has negatively impacted its health infrastructure, including the functioning of its health care delivery system. Considering the current national health crises, a study was conducted to identify research gaps and the need to propose changes for improving the health care delivery system in the country. The study results clearly demonstrated a lack of HIV/AIDS research infrastructure including organizational structure, linkages, leadership, champions, expertise, resources, and policies and procedures. Alignment of research needs and practice, and research use to support HIV/AIDS service delivery programmes in the country was also limited. An international research capacity-building partnership is proposed as an effective planned change strategy to strengthen HIV/AIDS-related research infrastructure and to inform management and practice within the Liberian HIV/AIDS service delivery system. A proposed capacity-building planning model can also strengthen research infrastructure and the production and use of research to positively impact the HIV/AIDS epidemic in Liberia and other developing countries.

Evaluation of HIV/AIDS prevention resources in Liberia: strategy and implications.

The purpose of this preliminary study was to assess the HIV/AIDS prevention needs, services, and resources in Liberia, including the readiness of local providers to conduct HIV/AIDS-related prevention programs based on a set of six key dimensions (prevention needs, knowledge, leadership, environment, risky behaviors, and resources). A valid self-administered qualitative-based health survey, based on a community readiness model, was utilized as the primary data collection source. A cross-sectional design that utilized a convenient sample of key informants such as health coordinators, program directors, and health administrator from both public and private HIV/AIDS-based organizations was used. Furthermore, an extensive review of the National Library of Medicine database of published articles from mid-1980 to 2002 was simultaneously conducted to gauge the extent of scientific publications on HIV/AIDS-related prevention services in Liberia. The findings from this study strongly suggest that Liberia is in a stage of vague awareness, as defined by the Tri-Ethnic Center community readiness framework, regarding HIV/AIDS-related activities, including a significant lack of HIV/AIDS-related resources and scientific publications. Accordingly, there is a critical need to acquire adequate resources and build capacity to implement effective HIV/AIDS-related prevention programming services in order to avert the negative public health consequences associated with HIV/AIDS, including the implementation of relevant evaluation and dissemination strategies. Most importantly, this model has the potential to be utilized in other resource-constraint settings, especially in the developing world, to assess prevention-related resources and programmatic readiness. This is the first published study to evaluate Liberia's HIV/AIDS prevention resources and to systematically document the extent and magnitude of the HIV/AIDS crises in the country.

The accuracy of needle placement in lower-limb muscles: a blinded study.

OBJECTIVE: To assess the accuracy of common anatomic guides for electromyographic needle placement in muscles. DESIGN: Blinded study. The dissector identified different needle placements by a random number attached to a wire in the insertion site. SETTING: A university anatomy laboratory. CADAVERS: Ten cadaver lower limbs. INTERVENTIONS: By using techniques published in texts by Gieringer and Delagi and Perotto, clinical electromyographers palpated and measured appropriate locations for needle placement. A thin wire was inserted through the needle into 36 different muscles in 10 cadavers, resulting in 263 targeted muscles. An anatomist blinded to intended location dissected and recorded muscles and other tissues that the wire pierced or passed near. MAIN OUTCOME MEASURES: Targeted muscle penetration, final resting place of the wire tip, and proximity to vital structures. RESULTS: Fifty-seven percent of insertions penetrated the intended muscle. The wire tip was in the intended muscle 45% of the time. Seventeen percent of insertions penetrated or passed within 5mm of an important structure, including nerve (9.1%), tendon (3.0%), named artery (2.7%), vein (2.7%), or joint (0.8%). Specific muscle accuracy was highly variable, from 0% for 12 tries in various deep hip muscles to 100% of 10 tries in the vastus medialis. CONCLUSION: The accuracy of blind needle placement varied according to muscle. With the blind insertion technique, more accurate and safe needle placement strategies can be developed.