PIVOT: A New Approach to HIV Capacity-Building Assistance.

In 2004, a national nonprofit established a capacity-building assistance (CBA) program aimed at bolstering the capabilities of health departments and community-based organizations in implementing and evaluating HIV prevention interventions for racial and minority populations. Recognizing the need for a specialized CBA model to support HIV prevention programs, the program developed the Customized Holistic Analytical Networking Grassroots Evaluatory (CHANGE) approach. This article introduces the Prioritizing Intersectional Values for Organizational Technical Assistance (PIVOT) approach as a progressive evolution of CBA strategies tailored to the contemporary HIV landscape. PIVOT, founded on seven core values and focused on four key areas, is structured across three stages of CBA delivery. Effective capacity building mandates the CBA partners to be well versed in HIV organizational culture and capable of delivering strategies ensuring long-term sustainability. This article offers invaluable insights and lessons that inform the development and implementation of the PIVOT approach, drawing from two decades of service delivery.

Building Racial and Gender Equity into a National PrEP Access Program.

Transgender and gender diverse (TGD), Black, and Latinx communities have long borne a disproportionate share of the U.S. HIV epidemic, yet these same key demographics are continually underrepresented in national PrEP prescriptions. Black, Latinx, and TGD individuals are also more likely to be uninsured, meaning that a proposed federal program to cover PrEP for people without insurance could provide significant benefit to potential PrEP users from these populations. However, coverage of PrEP costs alone will not end disparities in uptake. This commentary provides additional context and recommendations to maximize effectiveness of a national PrEP program for TGD, Black, and Latinx populations in the US.

Computational Study of Thermal Comfort and Reduction of CO2 Levels inside a Classroom.

Due to the current COVID-19 pandemic, guaranteeing thermal comfort and low CO2 levels in classrooms through efficient ventilation has become vitally important. This study presents three-dimensional simulations based on computational fluid dynamics of airflow inside an air-conditioned classroom located in Veracruz, Mexico. The analysis included various positions of an air extractor, Reynolds numbers up to 3.5 × 104, four different concentrations of pollutant sources, and three different times of the day. The simulations produced velocity, air temperature, and CO2 concentrations fields, and we calculated average air temperatures, average CO2 concentrations, and overall ventilation effectiveness. Our results revealed an optimal extractor position and Reynolds number conducive to thermal comfort and low CO2 levels due to an adequate ventilation configuration. At high pollutant concentrations, it is necessary to reduce the number of students in the classroom to achieve safe CO2 levels.

Numerical Study of Nanofluid Irreversibilities in a Heat Exchanger Used with an Aqueous Medium.

Heat exchangers play an important role in different industrial processes; therefore, it is important to characterize these devices to improve their efficiency by guaranteeing the efficient use of energy. In this study, we carry out a numerical analysis of flow dynamics, heat transfer, and entropy generation inside a heat exchanger; an aqueous medium used for oil extraction flows through the exchanger. Hot water flows on the shell side; nanoparticles have been added to the water in order to improve heat transfer toward the cold aqueous medium flowing on the tube side. The aqueous medium must reach a certain temperature in order to obtain its oil extraction properties. The analysis is performed for different Richardson numbers (Ri = 0.1-10), nanofluid volume fractions (φ = 0.00-0.06), and heat exchanger heights (H = 0.6-1.0). Results are presented in terms of Nusselt number, total entropy generation, Bejan number, and performance evaluation criterion. Results showed that heat exchanger performance increases with the increase in Ri when Ri > 1 and when reducing H.

The Invisible US Hispanic/Latino HIV Crisis: Addressing Gaps in the National Response.

The federal government has proposed an end to HIV transmission in the United States by 2030. Although the United States has made substantial overall progress in the fight against HIV/AIDS, data released by the Centers for Disease Control and Prevention have raised concerns about widening, yet largely unrecognized, HIV infection disparities among Hispanic and Latino populations.This commentary identifies underlying drivers of increasing new HIV infections among Hispanics/Latinos, discusses existing national efforts to fight HIV in Hispanic/Latino communities, and points to gaps in the federal response. Consideration of the underlying drivers of increased HIV incidence among Hispanics/Latinos is warranted to achieve the administration's 2030 HIV/AIDS goals.Specifically, the proposed reinforcement of national efforts to end the US HIV epidemic must include focused investment in four priority areas: (1) HIV stigma reduction in Hispanic/Latino communities, (2) the availability and accessibility of HIV treatment of HIV-positive Hispanics/Latinos, (3) the development of behavioral interventions tailored to Hispanic/Latino populations, and (4) the engagement of Hispanic/Latino community leaders.

One on One with Guillermo Chacón.

Since its founding in 1990, the Latino Commission on AIDS has become the largest organization in the U.S. advocating for the health needs of the Latino community in response to the HIV/AIDS epidemic. Also known as Latino AIDS, the commission works with community organizations in developing HIV education, prevention programs, and capacity building. The commission, which began in New York City, now serves Latino communities in more than 40 states and Puerto Rico. Guillermo Chacón has been president of Latino AIDS since 2009.

Evaluation of patient experience and satisfaction with immediately loaded metal-acrylic resin implant-supported fixed complete prosthesis.

PURPOSE: Today patients are living longer and demanding more stable prostheses to replace lost teeth. The restoration of the mandibular dentition with metal-acrylic resin implant-supported fixed complete prostheses via an immediate loading protocol allows patients to have an immediate definitive restorative solution. However, little is known about the patient experience and satisfaction with this protocol. The aim of this study was to determine patient experiences and satisfaction with metal-acrylic resin implant-fixed complete prosthesis fabricated according to the Ohio State University protocol. MATERIALS AND METHODS: The records of patients who had received full-arch implant-supported restorations in a 7-year period were examined; patients who met the inclusion criteria were sent a questionnaire. Patients were given an opportunity to rate their postoperative experience using a visual analog scale and to agree or disagree with regard to their overall satisfaction with the surgical and prosthetic treatment. RESULTS: The records of 82 patients were initially examined; 61 patients were retained after the inclusion criteria were applied. The questionnaire was sent to the 61 patients, and 24 returned their surveys. Data from the written questionnaires revealed that patient postoperative experiences were not considered severe and that the patients were generally very pleased with treatment and the outcome. CONCLUSIONS: The results of this questionnaire-driven study suggest that delivering the definitive fixed metal-acrylic resin prosthesis immediately after implant placement is a successful and patient-approved treatment approach for mandibular edentulism.

Early loading of surface modified implants in the posterior mandible - 5 year results of an open prospective non-controlled study.

AIM: The aim of the present study was to evaluate an early loading protocol for surface modified implants placed in the posterior mandible. MATERIAL AND METHODS: A total of 134 implants with a TiO(2) blasted, fluoride modified surface were inserted into the posterior mandibles of 44 patients. The implants were functionally loaded after 7 weeks of healing. Implant stability quotient (ISQ) values (during the first year), bleeding on probing (BOP), plaque accumulation and marginal bone level (MBL) were assessed until the end of the observation period of 5 years. A total of 41 patients with 123 implants completed the study. RESULTS: No implants were lost. ISQ values decreased significantly from the time of insertion to 2 weeks and increased significantly until the 1-year follow up. BOP varied until the end of the observation period between 7.9% and 13.0%. Plaque accumulation decreased from the time of early loading to the end of the study. MBL changed from 0.59 mm at the time of implant placement to 0.80 mm at the time of early loading. Thereafter, only slight variations in MBL occurred until the end of the observation period. CONCLUSIONS: The results confirm that early loading is a promising option also in posterior edentulism of the mandible.

Distribution of anthocyanins delivered from a bioadhesive black raspberry gel following topical intraoral application in normal healthy volunteers.

PURPOSE: Results from our oral cavity chemoprevention trial demonstrated appreciable interpatient variations regarding chemopreventive efficacy of a freeze dried black raspberry (FBR) gel. We speculated these data reflected individual patient-related differences in absorption, target tissue uptake and local compound metabolism of key FBR compounds (anthocyanins). Accordingly, this study assessed the distribution of anthocyanins from the 10% (w/w) FBR gel in saliva, oral tissues and plasma. METHODS: Human subject participation entailed collection of: (1) saliva, tissue and plasma (5 min following gel application, keratinized tissues), (2) saliva and plasma (5 min after sublingual gel application), (3) saliva and plasma at 1, 2, and 4 h post gel application (keratinized tissues), and (4) saliva (cyanidin 3-rutinoside incubations). Levels of FBR anthocyanins in the respective samples were analyzed by LC/MS/MS. RESULTS: Our data show: significantly higher anthocyanin levels in saliva and oral tissues relative to matched plasma samples, marked donor-specific variations in anthocyanin uptake, sustainability of anthocyanins at the target site, pH affects anthocyanin penetration and intraoral anthocyanin decomposition and/or metabolism. CONCLUSIONS: No previous oral cavity chemoprevention trials evaluated compound distribution at the treatment site. Our data, which demonstrate a local delivery-derived pharmacologic advantage, provide insights which could advance oral cavity chemoprevention strategies.

Palatal mini-implants to increase retention and stability of implant-retained maxillary overdentures: a case report.

Maxillary edentulous patients have been successfully treated with implant-supported fixed and removable dental prostheses. The fixed implant-supported dental prosthesis has been used for >20 years. It has lost popularity because the design of this restoration requires special access for oral hygiene around the abutment cylinders creating an esthetic quandary in the maxilla. The use of the mid-sagital palatal suture to osseointegrate anchorage devices for orthodontic purposes has shown satisfactory results. This clinical case documents the successful use of mid-palatal implants as an extension of orthodontic anchorage to gain accessory support and retention for a maxillary complete removable dental prosthesis.

La psicopatología como máscara de la existencia / Psychopathology as a mask of existence

En este artículo se presenta una reflexión teórica acerca de lo que significa la psicopatología en el contexto del proyecto de vida de los seres humanos. Dicha reflexión se basa parcialmente en los resultados de cuatro estudios cualitativos de caso realizados desde una perspectiva fenomenológica hermenéutica sobre la comprensión de la experiencia de ansiedad. En este sentido, se clarifican los fundamentos existenciales implícitos en la psicopatología y se hace un análisis epistemológico acerca de la forma en que podemos aproximarnos existencialmente a la psicopatología para poder comprender apropiadamente los síntomas, teniendo presente conceptos como intencionalidad y sentido de la experiencia de la persona que está vivenciando los síntomas psicopatológicos.

In this article, we present a theoretical reflection about the meaning ofpsychopathology in the context of human projects of life. This reflectionis partially based upon the findings of four qualitative case studies about the understanding of the experience of anxiety. In this way, we clarify theexistential foundations implicit in psychopathology, and we also performan epistemological analysis on the way human beings could existentiallyapproach psychopathology, in order to comprehend symptoms properly,bearing in mind some important concepts, such as intentionality and themeaning of the experience for the person who is living the psychopathological symptoms.

Case report: autotransplantation for a missing permanent maxillary incisor.

Patients with nonrestorable or missing anterior teeth are typically seen by their general or pediatric dentist who directs the course of consultation, referral, and treatment. In the mixed dentition stage, loss of permanent maxillary incisors is usually treated by various forms of removable/fixed prosthetic appliances. Because premolars are developing during this time period, transplantation of an available premolar to an incisor position is a viable alternative, that may provide a better biological substitute for a missing incisor than other choices. The purpose of this case report was to describe the treatment of the loss of a permanent maxillary central incisor by transplantation of a maxillary first premolar to the incisor position. Autotransplantation allowed normal alveolar bone development and a future option of permanent restoration without implants or partial dentures. Autotransplantation should be given consideration as a reasonable option for the treatment of missing incisors in mixed dentition.

Genetic disorders and bone affecting the craniofacial skeleton.

Genetic disorders of bone constitute a large number of alterations approaching almost 300 types. This article focuses on the most common disorders in this group, which at the same time are the most clinically significant because of their incidence and degree of involvement of the craniofacial skeleton.

Development of cephalometric norms using a unified facial and dental approach.

OBJECTIVE: To develop a cephalometric determination of anteroposterior skeletal occlusion on the basis of a clinically rational "gold standard" and objectively determined cut points. MATERIALS AND METHODS: Pretreatment cephalograms from 10- to 18-year-old Caucasian patients with a normal vertical face dimension were digitized. Facial profile line drawings were judged by orthodontist raters as Class I, II, or III. Subjects who met all inclusion criteria were divided into Class I, Class II, and Class III on the basis of the matched skeletal (facial) and dental occlusion and comprised our gold standard for anteroposterior skeletal occlusions. Cephalometric variables included ANB angle, McNamara analysis, Harvold unit differential, anteroposterior dysplasia index (APDI), and Wits analysis. Half the sample was used to derive skeletal classification norms using receiver operator characteristic (ROC) curves, and half the sample was used to test for diagnostic ability and to compare the diagnoses based on traditional cephalometric norms with the new norms. RESULTS: Results of the study showed that ANB and McNamara analysis performed well with traditional and ROC-derived norms, whereas Wits, Harvold unit differential, and APDI showed fewer errors in diagnosis with ROC norms compared with traditional norms. CONCLUSIONS: The use of a single set of diagnostic norms for each analysis to distinguish between the skeletal classifications for the 10- to 18-year-age group proved to be highly successful for each of the analyses and performed as well or better than when using traditional norms based on age and sex.

Effect of alendronate on endosseous implant integration: an in vivo study in rabbits.

PURPOSE: Alendronate sodium (Fosamax; Merck, Whitehouse Station, NJ) is a second-generation bisphosphonate used widely in osteopenic individuals for decreasing bone resorption and increasing bone density. The ability of alendronate to affect systemic bone remodeling raises natural questions about the drug's influence on dental implant osseointegration. Current knowledge regarding the effect of systemic bisphosphonates, specifically alendronate, on all 3 phrases of osseointegration is incomplete and only a few studies have started to investigate peri-implant bone responses to alendronate-coated implants. The purpose of this study was to determine the effect of systemic alendronate therapy on osseointegration of dental implants based on torque-removal values in rabbits. MATERIALS AND METHODS: Identical titanium dental implants were placed using a standardized surgical protocol in the bilateral distal femur and proximal tibia of 20 New Zealand white rabbits (79 implants total). One week before implant placement, 10 rabbits were given doses of alendronate and continued on weekly dosing for 5 weeks until euthanized. The other 10 rabbits were untreated controls. Torque-removal values were determined using a Tohinichi 15-BTG torque wrench (Tohinichi Mfg Co, Ltd, Tokyo, Japan) for all implants. RESULTS: Analysis of torque data showed no statistical differences between the alendronate and control groups in both femur and tibia sites. A statistically significant difference, however, was noted in torque removal values between femur and tibia sites regardless of drug or non-drug groups. CONCLUSIONS: In summary, orally dosed alendronate administration in rabbits had no significant effect on dental implant torque-removal values 6 weeks after endosseous placement in femur and tibia.

Heat production by 3 implant drill systems after repeated drilling and sterilization.

PURPOSE: The goal was to measure heat generated in bone by 3 implant drill systems after repeated drilling and sterilization. MATERIALS AND METHODS: Temperature was measured with thermocouple technology in vitro using the bovine femoral cortical bone model. Intermittent drilling was accomplished at a constant 2.4-kg load and drill speed of 2,500 rpm. External irrigation at 40 mL/min with normal saline was used. Three implant drill systems-system A (triple twist drills with a relief angle), system B (triple twist drills without a relief angle), and system C (double twist drills with a relief angle)-were evaluated and heat was measured at the final drill in the drilling sequence (4.0 mm or 4.2 mm) at a depth of 15 mm. Thermocouples were placed 0.5 mm from the osteotomy at a depth of 15 mm. Heat measurements were recorded out to 25 uses. RESULTS: Results showed temperature increased with multiple uses. System A and C drills had temperature measurements that were below 47 degrees C, even after 25 uses. System B drills had temperatures that exceeded 47 degrees C from the initial use. Light microscopy showed little drill wear even after 25 uses. CONCLUSIONS: Drill geometry plays a major role in heat production and may explain the increased temperature readings seen in system B. These drills lack relief angles and have the smallest clearance angles of the 3 systems. It also has fewer drills in its drilling sequence compared with systems A and C. This study shows that temperatures increase when drills are used multiple times. Systems A and C had acceptable temperature measurements out to 25 uses. System B drills showed significantly higher heat production with little visual signs of wear.

Perioperative management of the patient with hematologic disorders.

Bleeding at the time of surgery has the potential to become a serious complication. Careful patient assessment and review of history are of the utmost importance if this situation is to be avoided on the operating table. Unfortunately, many patients, particularly younger individuals with little to no previous exposure to surgery, are unaware of underlying bleeding disorders that they may have. Understanding the basic pathophysiology and management of these conditions becomes critical for the treating surgeon. For patients who have known conditions, close interconsultation with the treating hematologists and careful observation of preoperative, intraoperative, and postoperative established protocols reduces the risk of complications for patients and makes the possibility of success a reality for these individuals.

Comparison of strains produced by titanium and poly D, L-lactide Acid plating systems to in vitro forces.

PURPOSE: To determine if a specific resorbable plating system provides similar fixation, in terms of strain distribution under load, to a titanium system when the Champy technique is applied for the treatment of a mandibular angle fracture. MATERIALS AND METHODS: A formalin-fixed cadaver mandible was harvested just before the study. A bicortical osteotomy was then made using a diamond disc extending in an oblique direction in the area of the angle. It was then passively fixated with a 4-hole 2.0-mm miniplate. Two stacked rosette strain gauges were bonded to the mandible on either side of the fracture. Each rosette had 3 strain gauges arranged in specific degrees relative to each other. The mandible was then placed on a dynanometer and 30 lb loads were delivered on the ipsilateral molar. Static resistance was placed in the condylar neck region to simulate the glenoid fossa. Loading was repeated 10 times with a period of 3 minutes between loads. Measurements were recorded for each strain gauge after loads were in place for 30 seconds. The same process was repeated using a 4-hole 2.1-mm resorbable miniplate. The strains were then used to calculate the maximum and minimum strains for each rosette. Hooke's law was used to calculate the principal stresses. RESULTS: Differences were observed between the strain gauges for each individual plating system. There was variability within the resorbable plate measurements as shown by the standard deviation. Using the REML ANOVA test, a significant difference was found between the 2 materials. CONCLUSION: In this in vitro study, there were significant biomechanical differences observed between a 2.0-mm titanium miniplate and a 2.1-mm resorbable miniplate when used to treat a mandibular angle fracture following Champy's principles. Based on our finding, both systems cannot be used interchangeably for the treatment of mandibular angle fractures under the same clinical conditions.