Caregiver self-efficacy to talk about sex predicts conversations about HIV transmission risk with perinatally infected young people in Zimbabwe.

Given advances in care and treatment for HIV, perinatally infected young people are surviving into adolescence. These young people are making decisions about engaging in sexual relationships and it is critical to ensure they have the information they need to engage responsibly in sexual activity, particularly in an era where adherence to treatment could make their virus undetectable. The main objective of this analysis was to examine whether an HIV-positive young person's knowledge about forward transmission is associated with caregiver self-efficacy to talk about sex and general caregiver communication. Using data from a 12-month prospective cohort of caregivers of HIV-positive children aged 9-15 on ART and pre-ART in rural Zimbabwe, we found that caregiver self-efficacy to talk about sex predicted whether conversations about HIV transmission would occur between caregiver and the young person. However, by the end of 12-months, nearly two-thirds of caregivers of HIV-positive teenagers in our sample had still not explained how their adolescents could spread the virus to others despite these caregivers saying their adolescent should know this information at baseline. We discuss the implications for designing sexual and reproductive health (SRH) programs among populations of young people perinatally infected with HIV to ensure that this breakthrough generation receives the SRH support they need.

Correction to: Suspension syndrome: a potentially fatal vagally mediated circulatory collapse-an experimental randomized crossover trial.

The original version of this article unfortunately contained a mistake. Information was missing in the acknowledgements section. The correct information is given below.

Suspension syndrome: a potentially fatal vagally mediated circulatory collapse-an experimental randomized crossover trial.

PURPOSE: Suspension syndrome describes a potentially life-threatening event during passive suspension on a rope. The pathophysiological mechanism is not fully understood and optimal treatment unknown. We aimed to elucidate the pathophysiology and to give treatment recommendations. METHODS: In this experimental, randomized crossover trial, 20 healthy volunteers were suspended in a sit harness for a maximum of 60 min, with and without prior climbing. Venous pooling was assessed by measuring the diameter of the superficial femoral vein (SFV), lower leg tissue oxygenation (StO2) and by determining localized bioelectrical impedance. Hemodynamic response was assessed by measuring heart rate, blood pressure, stroke volume, and left ventricular diameters. Signs and symptoms of pre-syncope were recorded. RESULTS: Twelve (30%) out of 40 tests were prematurely terminated due to pre-syncopal symptoms (mean 44.7 min, minimum 13.4, maximum 59.7). SFV diameter increased, StO2 and the capacitive resistance of the cells decreased indicating venous pooling. Heart rate and blood pressure did not change in participants without pre-syncope. In contrast, in participants experiencing pre-syncope, heart rate and blood pressure dropped immediately before the event. All symptoms dissolved and values returned to normal within 5 min with participants in a supine position. CONCLUSIONS: Sudden pre-syncope during passive suspension in a harness was observed in 30% of the tests. Blood pools in the veins of the lower legs; however, a vagal mechanism finally leads to loss of consciousness. Time to pre-syncope is unpredictable and persons suspended on a rope should be rescued and put into a supine position as soon as possible.

Pre-concentration of Zn(II) ions from aqueous solutions using meso-porous pyridine-enrobed magnetite nanostructures.

A simple, cheap and efficient method for pre-concentrating and separating Zn(II) ions from aqueous solutions and real samples has been designed. The method was implemented in a prototype featuring interchangeable chromatography-column-like cartridges, filled with meso-porous silica nanostructures, allowing easy exchange of the type and quantity of the sorbent. The adsorbents inside the column are held in place by means of porous polymer nano-fibre membranes. The effects of various parameters on the adsorption of Zn(II) ions from aqueous solutions were investigated. Maximal adsorption (∼99%) was found for Zn(II) ions amongst a mixture of Cu(II), Co(II), Ni(II), Ag(I), Au(III), Pd(II) and Pb(II) in aqueous solution. The procedure was tested for pre-concentrating and determining traces of zinc in real samples of meat, fish and hen marketed in Tehran. A desorption process using 0.5 mol L-1 HCl as eluent, showed ∼97% recovery of the Zn(II) ions adsorbed on the MSMPP sorbent.

Patient-reported outcome measurement compared with professional judgment of cosmetic results after breast-conserving therapy.

Background: In the present study, we set out to compare patient-reported outcomes with professional judgment about cosmesis after breast-conserving therapy (bct) and to evaluate which items (position of the nipple, color, scar, size, shape, and firmness) correlate best with subjective outcome. Methods: Dutch patients treated with bct between 2008 and 2009 were analyzed. Exclusion criteria were prior amputation or bct of the contralateral breast, metastatic disease, local recurrence, or any prior cosmetic breast surgery. Structured questionnaires and standardized six-view photographs were obtained with a minimum of 3 years' follow-up. Cosmetic outcome was judged by the patients and, based on photographs, by 5 different medical professionals using 3 different scoring systems: the Harvard scale, the Sneeuw questionnaire, and a numeric rating scale. Agreement was scored using the intraclass correlation coefficient (icc). The association between items of the Sneeuw questionnaire and a fair-poor Harvard score was estimated using logistic regression analysis. Results: The study included 108 female patients (age: 40-91 years). Based on the Harvard scale, agreement on cosmetic outcome between the professionals was good (icc: 0.78). In contrast, agreement between professionals as a group compared with the patients was found to be fair to moderate (icc range: 0.38-0.50). The items "size" and "shape" were identified as the strongest determinants of cosmetic outcome. Conclusions: Cosmetic outcome was scored differently by patients and professionals. Agreement was greater between the professionals than between the patients and the professionals as a group. In general, size and shape were the most prominent items on which cosmetic outcome was judged by patients and professionals alike.

Exercise physiology and nutritional perspectives of elite soccer refereeing.

Referees are an integral part of soccer, and their performance is fundamental for regular match flow, irrespective of the competition level or age classes. So far, scientific interest was mainly limited to aspects of exercise physiology and match performance of soccer referees, whereas recommendations for nutrition were adopted from active professional soccer. In contrast to elite soccer players, most referees are non-professional and engaged in different occupations. Furthermore, elite referees and soccer players differ in regard to age, body composition, aerobic capacity, and training load. Thus, referees' caloric needs and recommended daily carbohydrate intake may generally be lower compared to active soccer players, with higher intakes limited to periods of increased training load and match days or for referees engaged in physical demanding occupations. With respect to fluid intake, pre-match and in-match hydration strategies generally valid in sports are recommended also for referees to avoid cognitive and physical performance loss, especially when officiating in extreme climates and altitude. In contrast to elite soccer, professional assistance concerning nutrition and training is rarely available for national elite referees of most countries. Therefore, special attention on education about adequate nutrition and fluid intake, about the dietary prevention of deficiencies (iron in female referees, vitamin D irrespective of sex and age), and basic precautions for travels abroad is warranted. In conclusion, the simple adoption of nutritional considerations from active soccer for referees may not be appropriate. Recommendations should respect gender differences, population-specific physical characteristics, and demands just as well as individual characteristics and special needs.

Efficacy of localization of non-palpable, invasive breast cancer: Wire localization vs. Iodine-125 seed: A historical comparison.

BACKGROUND: To achieve radical tumour excision in non-palpable breast cancer accurate tumour localization is essential. Historically, this has been achieved by wire localization (WL). Recently, new techniques like Iodine-125 seeds (IL) have become available. The aim of this study was to determine whether the results in case of IL are better than when WL is used. METHOD: A consecutive series of patients operated on because of non-palpable breast cancer was analysed. Between January 2007 and April 2011 WL was method of choice. From April 2011 till January 2013 IL was introduced and became the standard procedure. PRIMARY OUTCOMES WERE: success rate of (peri-) operative localization and radicality of the excision. Secondary outcomes were duration of operation and volumes of the excised tissue specimen. RESULTS: A total of 236 women were included; 149 women underwent WL and 87 women IL. The overall success rate for WL was 93.3%. In 10 patients (6.7%) WL failed because of peri-operative dislocation of the wire compared to only one failure to locate the seed in de postoperative specimen in the IL-group (1.1%, p = 0.098). Radical resection was obtained in 126/149 (84.6%) of the WL-patients, in comparison with 81/87 (93.1%) in the IL-group (p = 0.054). Median operation time and volume of the specimen was not significantly different between both groups. CONCLUSION: Localization of non-palpable breast cancer using Iodine-125 seeds is, at least, as good as the standard wire localization procedure.

Cisplatin and oxaliplatin surface contamination in intensive care units (ICUs) and hospital wards during attendance of HIPEC patients.

PURPOSE: The aim of this pilot study was to evaluate surface contamination by platinum drugs in the environment of patients in ICUs and wards treated by hyperthermic intraperitoneal chemotherapy (HIPEC). METHODS: The monitoring included 12 HIPEC treatments from four hospitals during the following 3 days after perfusion. A total of 33 urine and 33 drainage fluids from HIPEC patients and 160 wipe samples from several surfaces (urine/drainage bags, floors, gloves) were taken during the study period. RESULTS: In urine, the highest platinum concentrations were measured on the first day after perfusion. Median platinum concentrations were 1260 ng/ml for patients after cisplatin perfusion and 11,000 ng/ml for oxaliplatin treatment. Concentrations decreased until day three to 413 ng/ml cisplatin and 529 ng/ml oxaliplatin, respectively. In drainage liquids, platinum concentrations were generally lower. Platinum concentrations from surfaces of bags and floors ranged from 0.01 to 439 pg/cm(2) (median: urine bag 2.77 pg/cm(2), drainage bag 0.22 pg/cm(2), floor left 0.14 pg/cm(2), floor right 0.24 pg/cm(2)), with the highest contamination found on the outer surface of the urine bags. Samples from nurses' protective gloves ranged between 0.03 and 12 pg/cm(2) (median: 0.2 pg/cm(2)). CONCLUSIONS: High platinum-drug concentrations in urine and drainage liquids are the main source of contamination. Therefore, safe handling of these liquids is the best way to avoid cross-contamination on surfaces in wards and ICUs. Our results show that it is possible to take care of HIPEC patients without high contaminations during the first 3 days.

[Implantation of a Salto 2 total ankle prosthesis]. / Implantation einer Sprunggelenktotalendoprothese vom Typ Salto 2.

AIM OF SURGERY: Operative treatment of advanced primary and secondary arthritis of the ankle was carried out with the aim of achieving pain-free movement and retention of mobility. INDICATIONS: Surgery is indicated when conservative therapy is no longer sufficient for treatment of arthritis of the ankle with painful limited movement, sufficient bony joint conditions and correctable instability or axis malpositioning. CONTRAINDICATIONS: Surgery is not recommended with general surgical or anesthesiological contraindications, rampant infections, severe disturbances of peripheral perfusion, bony defects in areas relevant for anchoring, unstable soft tissue conditions, talus necrosis >30 %, manifest osteoporosis and severe non-correctable instability or malpositioning. OPERATION TECHNIQUE: Tibial and talar bone resection was carried out via ventral access to the ankle through an incision and if present, soft tissue correction of instability after insertion of test components. Cement-free implantation of the original implants followed by subtle reconstruction of the extensor retinaculum and layer for layer closure of the wound. ADDITIONAL INTERVENTIONS: Additional measures were necessary on the periarticular soft tissues, the hindfoot and lower leg due to movement restrictions, instability and axis malpositioning which could be carried out in a one or two stage procedure depending on the extent and morphology. RESULTS: Between February 2009 and February 2010 a total of 115 patients (52 % with posttraumatic arthritis) received a cement-free implantation with a Salto 2 prosthesis. Additional corrective interventions were carried out in the presence of varus and valgus deformities. The degree of movement for dorsal extension and plantar flexion could be increased by an average of 8.3°. The interventions resulted in a significant reduction in pain from an average preoperative visual analogue pain scale (VAS) score of 7.8 (range 5-10) to an average postoperative score of 1.9 (range 0-6.1).

Effects of massage under hypoxic conditions on exercise-induced muscle damage and physical strain indices in professional soccer players.

Reports based on experiences from masseurs and players, mostly without any scientific background, suggest that the combination of a classical regeneration method (i.e. massage) with exposure to hypoxia may enhance regeneration in soccer. The aim of this study was to evaluate whether this specific combination could affect blood parameters related to muscle damage and physical strain after a soccer game. Approximately 15 hours after two separate championship games, 10 professional male outfield players of the first Austrian division were exposed to normobaric hypoxia (FiO2 13.5% ∼ 4000m) or normoxia for 1 hour (30 minutes rest followed by 30 min massage) (cross-over design). Creatine kinase (CK), urea and uric acid (UA) were measured 4 days before the first game, and 15 and 63 hours after the two games. Match play increased CK values independently of the intervention. No effect of the massage in combination with hypoxia was seen. A trend was found between Δ UA ([UA] 48 hours after exposure minus [UA] before exposure) in response to hypoxia and SaO2 measured in hypoxia (r=0.612, p=0.06). Results show that massage under hypoxic conditions had no additional positive effect on the measured parameters compared to massage alone. Solely the trend of a relationship for Δ UA and SaO2 might indicate that redox alterations are a potential consequence of hypoxic exposure.

Surfactant protein D and KL-6 serum levels in systemic sclerosis: correlation with lung and systemic involvement.

OBJECTIVE: The aim of this study was to investigate the relationship between SP-D and KL-6 serum concentrations and the extent of interstitial lung involvement, as measured by a quantitative HRCT score and the functional impairment, in patients with systemic sclerosis (SSc). Moreover we analysed the association between these lung-specific biomarkers and skin involvement, anti-Scl-70 antibody titres and an index of disease activity. METHODS: Serum SP-D, KL-6 and anti-Scl-70 concentrations were determined by ELISA in 25 SSc patients. Disease activity and lung function parameters were assessed, and the extent of ILD was measured by a HRCT score. RESULTS: SP-D and KL-6 concentrations were higher in patients with SSc and lung fibrosis than in healthy controls. KL-6 correlated positively with the HRCT-fibrosis score (r=0.68, p<0.001), SP-D showed a weaker correlation (r=0.44, p=0.025). Increased KL-6 concentrations were associated with decreased DLCO and decreased FVC in SSc patients, SP-D showed no association. Furthermore KL-6, but not SP-D, showed a strong association with skin involvement as expressed by the modified Rodnan skin score (r=0.71, p<0.0001) and a disease activity index (r=0.73, p<0.0001). CONCLUSION: KL-6 is more strongly associated than SP-D with the HRCT-fibrosis score, and, different from SP-D, it correlates with skin involvement and disease activity. We suggest that KL-6 may be a useful biomarker in the assessment of scleroderma patients.

Nonlinear optical response in single alkaline niobate nanowires.

We have synthesized and characterized three types of perovskite alkaline niobate nanowires: NaNbO(3), KNbO(3), and LiNbO(3) (XNbO(3)). All three types of nanowires exhibit strong nonlinear response. Confocal imaging has been employed to quantitatively compare the efficiency of synthesized nanowires to generate second harmonic signal and to show that LiNbO(3) nanowires exhibit the strongest nonlinear response. We also investigated the polarization response of the second harmonic generation (SHG) signal in all three types of alkaline nanowires for the two geometries tractable by our optical trapping setup. The SHG signal is highly influenced by the nanowire crystallinity and experimental geometry. We also demonstrate for the first time wave-guiding of SHG signal in all three types of alkaline niobate nanowires. By carefully examining nonlinear properties of (XNbO(3)) nanowires we suggest which type of wires are best suited for the given application.

Changes in hydration status of soccer players competing in the 2008 European Championship.

AIM: Body composition is highly modifiable through exercise and may be changed by the physical stress of soccer training and competition. Especially body water as a constituent of body composition is assumed to be subjected to changes. It is speculated that during the most important soccer championship the combination of heat and the strenuous competitive program could lead to the development of a chronic state of hypohydration. However, no one tested this hypothesis. Therefore, the purpose of present work was to investigate the impact of the European Soccer Championship 2008 on players' body composition. METHODS: Participants were 14 players of one team, split into Starters (N.=7) and Non-Starters (N.=7). Starters participated in the games, while Non-Starters served as substitutes, with marginal playing times. Body composition was examined by bioelectrical impedance analysis before the championship and 36 hours after the first and second game. RESULTS: After the first game, Starters and Non-Starters showed decreased extra-cellular mass (-3.3% and -5.5%) and body cell mass (-4.1% and -6.1%) compared to prechampionship measurements. The impedance vector graph showed a significant lengthening in both groups (Starters T²=30.5, P=0.000; Non Starters T²=39.0, P=0.000). After the second game, extra-cellular mass (-3.4%) and body weight (-1.1%) decreased in Starters only. ANOVA revealed a significant difference in extra-cellular mass between Starters and Non-Starters (P=0.027). The impedance vector graph was lengthened in the Starters only (T²=17.5, P=0.000). The distance covered during the games was correlated to the percent drop in extra-cellular mass between the end of games 1 and 2 (r=-0.602; P=0.023). CONCLUSION: Players competing in the European championship games experienced a decrease in extra-cellular mass and body weight. The impedance vector graph showed a lengthening, indicating fluid loss. Therefore, proper hydration of players requires diligent attention.

Effects of intermittent hypoxia on running economy.

We investigated the effects of two 5-wk periods of intermittent hypoxia on running economy (RE). 11 male and female middle-distance runners were randomly assigned to the intermittent hypoxia group (IHG) or to the control group (CG). All athletes trained for a 13-wk period starting at pre-season until the competition season. The IHG spent additionally 2 h at rest on 3 days/wk for the first and the last 5 weeks in normobaric hypoxia (15-11% FiO2). RE, haematological parameters and body composition were determined at low altitude (600 m) at baseline, after the 5 (th), the 8 (th) and the 13 (th) week of training. RE, determined by the relative oxygen consumption during submaximal running, (-2.3+/-1.2 vs. -0.3+/-0.7 ml/min/kg, P<0.05) and total running time (+1.0+/-0.9 vs. +0.4+/-0.5 min, P<0.05) changed significantly between the IHG and CG only during the first 5-wk period. Haematological and cardiorespiratory changes indicate that the improved RE was associated with decreased cardiorespiratory costs and greater reliance on carbohydrate. Intermittent hypoxia did not affect RE during the second 5-wk period. These findings suggest that the effects of intermittent hypoxia on RE strongly depend on the training phase.

Supporting orphans and vulnerable children affected by AIDS: using community-generated definitions to explore patterns of children's vulnerability in Zambia.

This study explores how communities in Zambia characterize vulnerable children in the context of HIV; demonstrates how estimates of vulnerability vary depending on definitions; and discusses the implications of these estimates for program delivery. Baseline research conducted in 2005 included cross-sectional community-based household surveys at six locations using multi-stage random sampling (totalling 1,503 households, reporting on 5,009 children) and participatory qualitative research (focus group and in-depth interviews) with adults and youth at four locations. Between 14 and 27% of children in the sample had experienced a parental death (2-5% maternal orphans, 7-13% paternal orphans, 4-10% double orphans). In addition, other characteristics that communities associated with children's vulnerability were prevalent: 26-34% had been taken into another household, 15-27% were living in female-headed households, and 11-28% were living in a household with someone who is chronically ill. Overall, 58-73% of children had one or more community-defined characteristics of vulnerability. This study highlights the need to carefully consider the meaning of "vulnerability" when targeting programmes to support children affected by HIV and AIDS. Local community input is vital to inform context-specific criteria for distributing programme resources. If used, eligibility criteria should be context-specific yet flexible to evolving community realities. In settings such as rural Zambia where levels of HIV-related vulnerability are high, it may be more efficient to target at the level of communities rather than assess individual households.

[Dislocation after total elbow arthroplasty]. / Luxation nach Ellenbogentotalendoprothese.

BACKGROUND: Instabilities and dislocations after elbow arthroplasty, in particular in surface or unlinked prostheses, may cause functional impairments occasionally with the need for surgical revision. We provide a review of the literature about the frequency and causes of these complications and present some of our results obtained with the GSB III prosthesis. PATIENTS AND METHODS: We examined the trigger mechanisms and frequency of joint instabilities as well as treatment strategies by studying five internationally used types of prostheses on the basis of published results. We evaluated 160 GSB III prostheses regarding the above complications and determined the causes for uncoupling. RESULTS: Unlinked prostheses dislocate in 0-15% of cases, accounting for about 25% of the total complication rate described. All surface prosthesis models, including GSB III, were affected with variable frequency. For 160 GSB III prostheses, the dislocation rate was 7.4%. Frequent causes were errors of rotation of parts of the prostheses and displacements of the centre of rotation. CONCLUSION: Elbow arthroplasty requires demanding surgery, which is still associated with a comparatively high rate of complications. With correct indication, adequate choice of the type of prosthesis used and sufficient experience gained in surgery techniques, it is possible to considerably lower the rate of disassembling.

'We are no longer called club members but caregivers': Involving youth in HIV and AIDS caregiving in rural Zambia.

This study assessed the strategy of building young people's capacity to provide care and support to people living with HIV and AIDS in rural Zambia. Members of youth anti-AIDS clubs in schools and communities were trained as adjunct caregivers using a locally developed curriculum that allowed them to explore and challenge gendered notions of caregiving and emphasized networking with existing resources. Results show that caregiving increased among males (47% to 82%) and females (41% to 78%). Both sexes provided similar caregiving services, including help with household chores and personal care tasks. Youth also undertook activities with children to decrease their isolation, help them stay in school, and reach additional services. While clients and caregivers reported positive aspects of the programme, both reported frustration with the youths' inability to meet material needs. This study demonstrates that trained youth already involved in anti-AIDS efforts can meet a range of care needs and be valuable assets to their community. It also highlights the importance of communicating clearly what youth can and cannot do, ongoing monitoring and support of youth caregivers, and involving community leaders to give youth credibility and access to local resources.

Quantitative process evaluation of a community-based HIV/AIDS behavioural intervention in rural Uganda.

This paper describes the implementation of a large community-based HIV/AIDS behavioural intervention in rural Uganda and presents 4 years' worth of quantitative process data. The intervention involved 560 field-based workers (57% male, 76% subsistence farmers, mean age 35 years), supervised by six central staff. Intervention channels included drama and video shows, Community Educators (CEs), as well as leaflet and condom distribution. Activities focused on one or more of 16 key topics. In total, 392 000 attendances (51% female) were recorded--a mean of over 6 for each of the 64 000 target adults--at 81 000 activities, with CEs attracting 71% of the total attendance; 164 000 leaflets and 242 000 condoms were also distributed. The annual cost of the intervention per target individual was approximately US$1.76. Our voluntary workforce experienced an annual attrition rate of 11%, with 'stable' workers more likely to be older, married or opinion leaders in their community than those who dropped out. We calculate that even a significant increase in the proportion of female field workers would have made little difference either to the sex ratio of attendees or to overall attendance. In spite of some initial resistance to the intervention, particularly in relation to condoms, we have demonstrated that people in rural Africa can accept and actively participate in the dissemination of HIV/AIDS prevention messages throughout their own communities.

Development of a new carbon-carbon bond forming reaction. new organic chemistry of sulfur dioxide. Asymmetric four-component synthesis of polyfunctional sulfones.

At low temperature 1-alkoxy-1,3-dienes add to sulfur dioxide activated by a Lewis or Brønstedt acid and generate zwitterionic intermediates that can be quenched by enoxysilanes. The resulting beta,gamma-unsaturated silyl sulfinates can be desilylated and reacted with methyl iodide to provide polyfunctional sulfones. Exploratory studies of this four-component synthesis of sulfones are reported. Enantiomerically pure derivatives containing up to three new stereogenic centers can be obtained using enantiomerically pure (E,E)-1-alkoxy-2-methylpenta-1,3-dienes derived from alpha-methyl benzyl alcohols, including the Greene's chiral auxiliary. The stereochemistry of the reactions is consistent with a mechanism involving the suprafacial hetero-Diels-Alder addition of sulfur dioxide to the 1-alkoxy-1,3-dienes that are rapidly ionized into zwitterionic intermediates.