Pharmacotherapy considerations in transgender individuals living with human immunodeficiency virus.

Pharmacotherapy considerations are often a concern for transgender individuals who are living with human immunodeficiency virus (HIV) due to concerns for drug-drug interactions between their hormone and antiretroviral therapies. Many of the first-line therapies offered to patients for the management of HIV have reduced concerns for safety, resistance, and drug-drug interactions. In this review, we highlight common medications and important considerations for caring for transgender people living with HIV.

A Sheaf Theoretical Approach to Uncertainty Quantification of Heterogeneous Geolocation Information.

Integration of multiple, heterogeneous sensors is a challenging problem across a range of applications. Prominent among these are multi-target tracking, where one must combine observations from different sensor types in a meaningful and efficient way to track multiple targets. Because different sensors have differing error models, we seek a theoretically justified quantification of the agreement among ensembles of sensors, both overall for a sensor collection, and also at a fine-grained level specifying pairwise and multi-way interactions among sensors. We demonstrate that the theory of mathematical sheaves provides a unified answer to this need, supporting both quantitative and qualitative data. Furthermore, the theory provides algorithms to globalize data across the network of deployed sensors, and to diagnose issues when the data do not globalize cleanly. We demonstrate and illustrate the utility of sheaf-based tracking models based on experimental data of a wild population of black bears in Asheville, North Carolina. A measurement model involving four sensors deployed among the bears and the team of scientists charged with tracking their location is deployed. This provides a sheaf-based integration model which is small enough to fully interpret, but of sufficient complexity to demonstrate the sheaf's ability to recover a holistic picture of the locations and behaviors of both individual bears and the bear-human tracking system. A statistical approach was developed in parallel for comparison, a dynamic linear model which was estimated using a Kalman filter. This approach also recovered bear and human locations and sensor accuracies. When the observations are normalized into a common coordinate system, the structure of the dynamic linear observation model recapitulates the structure of the sheaf model, demonstrating the canonicity of the sheaf-based approach. However, when the observations are not so normalized, the sheaf model still remains valid.

Addressing the siphoning effect in new shunt designs by decoupling the activation pressure and the pressure gradient across the valve.

OBJECT: Although several improvements have been observed in the past few years in shunt technology, currently available systems still present several associated problems. Among these, overdrainage along with its complications remains one of the great challenges for new shunt designs. To address the so-called siphoning effect, the authors provide a practical example of how it is possible to decouple the activation pressure and the pressure gradient across the valve through a 3-key component system. In this new shunt design, the flow is expected to depend only on the intracranial pressure and not on the pressure gradient across the valve, thus avoiding the so-called siphoning effect. METHODS: The authors used computer models to theoretically evaluate the mechanical variables involved in the operation of the newly designed valve, such as the fluid's Reynolds number, proximal pressure, distal pressure, pressure gradient, actual flow rate, and expected flow rate. After fabrication of the first superscaled model, the authors performed benchmark tests to analyze the performance of the new shunt prototype, and the obtained data were compared with the results predicted by the previous mathematical models. RESULTS: The final design of the new paddle wheel valve with the 3-key component antisiphoning system was tested in the hydrodynamics laboratory to prove that the siphoning effect did not occur. According to the calculations obtained using the LabVIEW program during the experiments, each time the distal pressure decreased without an increase in the proximal pressure (despite the range of the pressure gradient), the pin blocked the spinning of the paddle wheels, and the calculated fluid velocity through the system tended to zero. Such a situation was significantly different from the expected flow rate for such a pressure gradient in a siphoning situation without the new antisiphon system. CONCLUSIONS: The design of this new prototype with a 3-key component antisiphoning system demonstrated that it is possible to decouple the activation pressure and the pressure gradient across the valve, avoiding the siphoning effect. Although further developments are necessary to provide a model compatible to clinical use, the authors believe that this new prototype illustrates the possibility of successfully addressing the siphoning effect by using a simple 3-key component system that is able to decouple the activation pressure and the pressure gradient across the valve by using a separate pressure chamber. It is expected that such proof of concept may significantly contribute to future shunt designs attempting to address the problem of overdrainage due to the siphoning effect.

Speed modulation of the continuous-flow total artificial heart to simulate a physiologic arterial pressure waveform.

This study demonstrated the concept of using speed modulation in a continuous-flow total artificial heart (CFTAH) to shape arterial pressure waveforms and to adjust pressure pulsatility. A programmable function generator was used to determine the optimum pulsatile speed profile. Three speed profiles [sinusoidal, rectangular, and optimized (a profile optimized for generation of a physiologic arterial pressure waveform)] were evaluated using the CFTAH mock circulatory loop. Hemodynamic parameters were recorded at average pump speeds of 2,700 rpm and a modulation cycle of 60 beats per minute. The effects of varying physiologically relevant vascular resistance and lumped compliance on the hemodynamics were assessed. The feasibility of using speed modulation to manipulate systemic arterial pressure waveforms, including a physiologic pressure waveform, was demonstrated in vitro. The additional pump power consumption needed to generate a physiologic pulsatile pressure was 16.2% of the power consumption in nonpulsatile continuous-flow mode. The induced pressure waveforms and pulse pressure were shown to be very responsive to changes in both systemic vascular resistance and arterial compliance. This system also allowed pulsatile pulmonary arterial waveform. Speed modulation in the CFTAH could enable physicians to obtain desired pressure waveforms by simple manual adjustment of speed control input waveforms.