Pulmonary Mucosa-Associated Lymphoid Tissue Lymphoma Treated with Radiation Therapy: A Case Report and Review of the Literature.

Introduction: Mucosa-associated lymphoid tissue lymphoma (MALT lymphoma or MALToma) is a prevalent type of primary pulmonary lymphoma. Typically, the primary therapeutic approaches involve surgery or chemotherapy, although there have been instances of radiation therapy being employed. Case Report: We present a case of pulmonary MALToma that exhibited progression despite rituximab therapy. Subsequently, the patient demonstrated a positive response to radiation therapy. Conclusion: This case highlights the potential efficacy of radiation therapy as a treatment option for pulmonary MALToma, especially in cases where other conventional treatments like rituximab have proven ineffective. Further research and studies are warranted to better understand the role of radiation therapy in managing pulmonary MALToma and to determine optimal treatment strategies for patients with this condition.

Speaking Out on Sexualized Violence Through Artistic Storytelling in Post-conflict Northern Ireland.

Directly related to The Troubles, sexualized violence has been largely ignored, yet continues to affect significant numbers of individuals in Northern Ireland today. This article analyzes various women's stories concerning sexualized violence shared in testimonial theater projects in Northern Ireland. We argue that (a) artistic storytelling about sexualized violence in theater projects can be a tool to release individuals and the collective from the (normalized) silence surrounding these violent acts and (b) it is an epistemological transformative method of inquiry to address these acts with the aim of eliminating them.

Examining the Range and Scope of Artists' Professional Practices With Individuals With Palliative Care Needs: An International, Cross-Sectional Online Survey.

Background: Internationally, it is recognized that artists facilitate arts engagement with individuals with palliative care needs. There is a gap in the literature describing the range and scope of artists' professional practices in palliative care. The aim of this study was to examine an international range of professional practices among artists who work in palliative care including key professionals' perceptions of these practices. Methods: An international, cross-sectional, online survey was conducted with health professionals, artists, and program coordinators with experience with artists working in palliative care. This survey was part of a larger mixed methods study. An instrument was systematically developed to examine artists' professional practices. Descriptive statistics were reported for the total sample including frequencies, means and standard deviations and open-ended items were analyzed thematically. Results: 101 valid surveys were analyzed. Findings outlined: (1) who delivers the arts; (2) where and with whom; (3) practice descriptors; and (4) perceptions of practice. Themes identified from open-ended items on benefits and risks of practice revealed impacts on patients and artists alike, including: (1) enhanced well-being; (2) vulnerabilities; and (3) facilitators and barriers. Conclusion: Findings demonstrated a wide range of artists' practices in palliative and end-of-life care, featuring notable consistencies in international practice worth further exploration. Ongoing and international efforts examining artists' practices in palliative care contribute to the development of future research, policy and practice.

Arts engagement facilitated by artists with individuals with life-limiting illness: A systematic integrative review of the literature.

BACKGROUND: Living with life-limiting illness significantly impacts quality of life. A growing body of evidence suggests that arts engagement facilitated by artists promotes well-being. However, no synthesis of the literature exists to describe arts engagement delivered by artists with individuals receiving palliative care. AIM: To systematically review and synthesize evidence to identify outcomes and key knowledge gaps to inform future research and practice. DESIGN: A systematic integrative literature review was conducted using a pre-defined search strategy and reported using PRISMA guidelines. Analysis was conducted iteratively and synthesis achieved using constant comparison to generate themes. DATA SOURCES: PubMed/MEDLINE, CINAHL, PsycINFO, Scopus, Web of Science, and Embase were searched for studies published between database inception and August 2020. Search terms included variations on arts/artists; patients/service users; and palliative or end-of-life care. Eligibility criteria was applied and study quality assessed. RESULTS: Seven reviewed studies explored literary, performing, and visual arts engagement in hospitals, hospice and community settings in England, the United States, France, and Canada. Study designs, interventions and findings were discussed. Themes identified across studies associated arts engagement with (1) a sense of well-being, (2) a newly discovered, or re-framed, sense of self, (3) connection with others, and (4) challenges associated with practice. CONCLUSION: Recommendations for future research were offered in order to maximize benefits, minimize risks and address complexity of artists' engagement in palliative care including: (1) consistency in methods and reporting; (2) inclusion of wider perspectives; and (3) key considerations for adapting the arts by health condition and art form.

Evaluation of a benzalkonium chloride hand sanitizer in reducing transient Staphylococcus aureus bacterial skin contamination in health care workers.

BACKGROUND: This study was performed to evaluate the effectiveness of a new commercially available hand sanitizer using 0.12% benzalkonium chloride (BZK) as the active ingredient in reducing transient skin contamination with Staphylococcus aureus in health care workers (HCWs), as compared with the effectiveness of a 70% ethanol-based hand sanitizer. METHODS: Fingertip touch culture plates were obtained from 40 HCWs in which all HCWs used antimicrobial soap containing 0.6% chloroxylenol for handwashing according to the Centers for Disease Control and Prevention guidelines for the entire study, while continuing to use the 70% ethanol-based hand sanitizer according to the Centers for Disease Control and Prevention guidelines for the first week. After the first week, the test subjects used the BZK hand sanitizer in place of the ethanol sanitizer. A paired sample t test was conducted to compare the mean bacterial colonies grown from HCWs fingertips during the use of the BZK and ethanol hand sanitizer. RESULTS: The results showed a significant reduction in total bacterial colony counts of S aureus during the week of BZK use as compared with the week of 70% ethanol sanitizer use. CONCLUSIONS: There was a significant decrease in transient S aureus on the fingertips of HCWs in the BZK hand sanitizer use week as compared with the 70% ethanol hand sanitizer use week.

Expanding Hospital Human Immunodeficiency Virus Testing in the Bronx, New York and Washington, District of Columbia: Results From the HPTN 065 Study.

Background: Human immunodeficiency virus (HIV) testing is critical for both HIV treatment and prevention. Expanding testing in hospital settings can identify undiagnosed HIV infections. Methods: To evaluate the feasibility of universally offering HIV testing during emergency department (ED) visits and inpatient admissions, 9 hospitals in the Bronx, New York and 7 in Washington, District of Columbia (DC) undertook efforts to offer HIV testing routinely. Outcomes included the percentage of encounters with an HIV test, the change from year 1 to year 3, and the percentages of tests that were HIV-positive and new diagnoses. Results: From 1 February 2011 to 31 January 2014, HIV tests were conducted during 6.5% of 1621016 ED visits and 13.0% of 361745 inpatient admissions in Bronx hospitals and 13.8% of 729172 ED visits and 22.0% of 150655 inpatient admissions in DC. From year 1 to year 3, testing was stable in the Bronx (ED visits: 6.6% to 6.9%; inpatient admissions: 13.0% to 13.6%), but increased in DC (ED visits: 11.9% to 15.8%; inpatient admissions: 19.0% to 23.9%). In the Bronx, 0.4% (408) of ED HIV tests were positive and 0.3% (277) were new diagnoses; 1.8% (828) of inpatient tests were positive and 0.5% (244) were new diagnoses. In DC, 0.6% (618) of ED tests were positive and 0.4% (404) were new diagnoses; 4.9% (1349) of inpatient tests were positive and 0.7% (189) were new diagnoses. Conclusions: Hospitals consistently identified previously undiagnosed HIV infections, but universal offer of HIV testing proved elusive.

Costs of Expanded Rapid HIV Testing in Four Emergency Departments.

OBJECTIVE: The HIV Prevention Trials Network (HPTN) 065 trial sought to expand HIV screening of emergency department (ED) patients in Bronx, New York, and Washington, D.C. This study assessed the testing costs associated with different expansion processes and compared them with costs of a hypothetical optimized process. METHODS: Micro-costing studies were conducted in two participating EDs in each city that switched from point-of-care (POC) to rapid-result laboratory testing. In three EDs, laboratory HIV testing was only conducted for patients having blood drawn for clinical reasons; in the other ED, all HIV testing was conducted with laboratory testing. Costs were estimated through direct observation and interviews to document process flows, time estimates, and labor and materials costs. A hypothetical optimized process flow used minimum time estimates for each process step. National wage and fringe rates and local reagent costs were used to determine the average cost (excluding overhead) per completed nonreactive and reactive test in 2013 U.S. dollars. RESULTS: Laboratory HIV testing costs in the EDs ranged from $17.00 to $23.83 per completed nonreactive test, and POC testing costs ranged from $17.64 to $37.60; cost per completed reactive test ranged from $89.29 to $123.17. Costs of hypothetical optimized HIV testing with automated process steps were approximately 45% lower for nonreactive tests and 20% lower for reactive tests. The cost per ED visit to conduct expanded HIV testing in each hospital ranged from $1.21 to $3.96. CONCLUSION: An optimized process could achieve additional cost savings but would require an investment in electronic system interfaces to further automate testing processes.

A Novel Approach to Realizing Routine HIV Screening and Enhancing Linkage to Care in the United States: Protocol of the FOCUS Program and Early Results.

BACKGROUND: The United States health care system remains far from implementing the Centers for Disease Control and Prevention's recommendation of routine human immunodeficiency virus (HIV) screening as part of health care for adults. Although consensus for the importance of screening has grown, innovations in implementing routine screening are still lacking. HIV on the Frontlines of Communities in the United States (FOCUS) was launched in 2010 to provide an environment for testing innovative approaches to routine HIV screening and linkage to care. OBJECTIVE: The strategy of the FOCUS program was to develop models that maximize the use of information systems, fully integrate HIV screening into clinical practice, transform basic perceptions about routine HIV screening, and capitalize on emerging technologies in health care settings and laboratories. METHODS: In 10 of the most highly impacted cities, the FOCUS program supports 153 partnerships to increase routine HIV screening in clinical and community settings. RESULTS: From program launch in 2010 through October 2013, the partnerships have resulted in a total of 799,573 HIV tests and 0.68% (5425/799,573) tested positive. CONCLUSIONS: The FOCUS program is a unique model that will identify best practices for HIV screening and linkage to care.

Strengthening the network of mentored, underrepresented minority scientists and leaders to reduce HIV-related health disparities.

OBJECTIVES: We reviewed data for the Minority HIV/AIDS Research Initiative (MARI), which was established in 2003 to support underrepresented minority scientists performing HIV prevention research in highly affected communities. METHODS: MARI was established at the Centers for Disease Prevention and Control as a program of competitively awarded, mentored grants for early career researchers conducting HIV prevention research in highly affected racial/ethnic and sexual minority communities. We have described progress from 2003 to 2013. RESULTS: To date, MARI has mentored 27 scientist leaders using low-cost strategies to enhance the development of effective HIV prevention interventions. These scientists have (1) developed research programs in disproportionately affected communities of color, (2) produced first-authored peer-reviewed scientific and programmatic products (including articles and community-level interventions), and (3) obtained larger, subsequent funding awards for research and programmatic work related to HIV prevention and health disparities work. CONCLUSIONS: The MARI program demonstrates how to effectively engage minority scientists to conduct HIV prevention research and reduce racial/ethnic investigator disparities and serves as a model for programs to reduce disparities in other public health areas in which communities of color are disproportionately affected.

HIV transmission in a state prison system, 1988-2005.

INTRODUCTION: HIV prevalence among state prison inmates in the United States is more than five times higher than among nonincarcerated persons, but HIV transmission within U.S. prisons is sparsely documented. We investigated 88 HIV seroconversions reported from 1988-2005 among male Georgia prison inmates. METHODS: We analyzed medical and administrative data to describe seroconverters' HIV testing histories and performed a case-crossover analysis of their risks before and after HIV diagnosis. We sequenced the gag, env, and pol genes of seroconverters' HIV strains to identify genetically-related HIV transmission clusters and antiretroviral resistance. We combined risk, genetic, and administrative data to describe prison HIV transmission networks. RESULTS: Forty-one (47%) seroconverters were diagnosed with HIV from July 2003-June 2005 when voluntary annual testing was offered. Seroconverters were less likely to report sex (OR [odds ratio] = 0.02, 95% CI [confidence interval]: 0-0.10) and tattooing (OR = 0.03, 95% CI: <0.01-0.20) in prison after their HIV diagnosis than before. Of 67 seroconverters' specimens tested, 33 (49%) fell into one of 10 genetically-related clusters; of these, 25 (76%) reported sex in prison before their HIV diagnosis. The HIV strains of 8 (61%) of 13 antiretroviral-naïve and 21 (40%) of 52 antiretroviral-treated seroconverters were antiretroviral-resistant. DISCUSSION: Half of all HIV seroconversions were identified when routine voluntary testing was offered, and seroconverters reduced their risks following their diagnosis. Most genetically-related seroconverters reported sex in prison, suggesting HIV transmission through sexual networks. Resistance testing before initiating antiretroviral therapy is important for newly-diagnosed inmates.

Does patient-provider racial/ethnic concordance influence ratings of trust in people with HIV infection?

Despite widely available and effective treatments, there are racial/ethnic disparities in HIV-related mortality rates. The reason for inadequate HIV/AIDS management among minority populations is not fully understood, however recent research indicates that patients rate the quality of their health care higher if they are racially/ethnically concordant with their providers. As trust plays prominently on health care ratings, we examined whether racial/ethnicity concordance was associated with two dimensions of trust, trust in the provider and mistrust in the health care system, in 380 HIV infected people New York City. In this sample, concordance was associated with lower mistrust in the health care system, but not with trust in provider. We conclude that in this patient population and within the health care system available to them, racial/ethnic concordance might be more important for helping patients to understand and navigate the health care system rather than in interpersonal relationships with a single provider.

A case-control study of factors associated with HIV infection among black women.

OBJECTIVE: To identify social, behavioral and epidemiologic factors associated with HIV infection among HIV-infected and HIV-uninfected black women residing in North Carolina. DESIGN: A case-control study conducted in August 2004 in North Carolina. METHODS: Cases were 18-40-year-old women with HIV infections diagnosed from 2003-2004. Controls were 18-40-yearold, HIV-negative heterosexually active women recruited from HIV testing sites. Five focus group discussions were also conducted with women not participating in the case-control study. RESULTS: Multivariate analyses of 31 cases and 101 controls showed that HIV-positive women were more likely to receive public assistance [adjusted odds ratio (aOR) 7.3; 95% confidence interval (CI) 2.1, 26.0], to report a history of genital herpes infection (aOR 10.6; 95% CI 2.4, 47.2), and were less likely to have discussed a variety of sexual and behavioral issues relevant to risk of HIV infection with their male partners (aOR 0.6; 95% CI 0.4, 0.8). Focus group participants indicated that financial and social demands created competing challenges for making HIV prevention a priority. CONCLUSIONS: Inadequate communication between black women and their sexual partners may create barriers to sexual and behavioral risk reduction. A multidimensional approach that addresses both biological factors such as herpes infection and socioeconomic factors may be needed to reduce HIV transmission in this population.

Toward eliminating health disparities in HIV/AIDS: the importance of the minority investigator in addressing scientific gaps in Black and Latino communities.

Dialogue in the medical and public health communities has increasingly focused attention in the area of health disparities. We believe that the elimination of health disparities in the United States will require a multipronged approach that includes, at the very least, new approaches in both biomedical and prevention interventions. We also believe that since health disparities primarily affect communities of color, a model which fosters the development of junior scientists, clinicians and researchers of color who serve these communities will yield important progress in this field. The Minority HIV/AIDS Research Initiative at the Centers for Disease Control and Prevention (CDC) is a program that, through targeted research, aims to address health disparities in HIV/AIDS. Although the program is disease specific, there are a variety of lessons learned from its inception and implementation that can be useful throughout the scientific, medical and public health communities.

Extraction solvent selection in environmental analysis.

A method for the prediction of a suitable solvent for the extraction of pesticides is outlined. The procedure is based on the Hildebrand solubility parameter, delta(t). The solubility parameter is broken down into three individual components, which are calculated by the addition of group contributions. To demonstrate the applicability of the approach pressurized fluid extraction was used to extract 4,4'-DDT [1,1,1-trichloro-2,2-bis(p-chlorophenyl)ethane] and its metabolites, 4,4'-DDD [1,1-dichloro-2,2-bis(p-chlorophenyl)ethane] and 4,4'-DDE [1,1-dichloro-2,2-bis(p-chlorophenyl)ethylene], from an historically contaminated soil from the United States and pentachlorophenol from a certified reference material (CRM524) using various solvents. Visual representation of the individual parameters predicted the ideal extraction solvent to be DCM for 4,4'-DDT and its metabolites and a mixture of acetonitrile and dichloromethane (1:1, v/v) for PCP. These findings were confirmed by the experimental results.