Perspectives of people living with HIV age 50 and over regarding barriers and resources for care.

ABSTRACTWith early and effective antiretroviral therapy leading to improved life expectancy in people with HIV (PWH), PWH aged 50 or older face concerns and issues related to aging. Providers at the University of Colorado identified a need to assess the healthcare needs of PWH aged 50 and older at the UCHealth Infectious Diseases/Travel (TEAM) Clinic in Aurora, Colorado. A survey was developed to illuminate participants' general rating of their health, factors that made it challenging to get the healthcare needed prior to COVID-19 and during COVID-19, and types of healthcare appointments and providers that would make a difference in healthcare experience. Descriptive statistics and brief thematic analysis of open-ended questions found that most participants rated their current health as very good or good. Participants noted that connecting to resources and appointment scheduling were the top challenges prior to the COVID-19 pandemic, and during the COVID-19 pandemic, participants described challenges with resource connection, communication with providers, and wait times. To reduce these barriers, telehealth video appointments, healthcare visits with a provider who specializes in aging, and healthcare visits with providers who specialize in aging if co-located in the HIV clinic were recognized as beneficial resources from the perspectives of participants.

Strengths and Challenges of Various Models of Geriatric Consultation for Older Adults Living With Human Immunodeficiency Virus.

As care of persons living with human immunodeficiency virus (HIV; PWH) has transitioned from management of opportunistic infections to management of conditions associated with older age, new models of geriatric consultation are needed. The authors, who represent 9 clinics across North America and the United Kingdom, provided their insights on models of geriatric consultation for older PWH. Three models of geriatric consultation are delineated: outpatient referral/consultation, combined HIV/geriatric multidisciplinary clinic, and dually trained providers within 1 clinical setting. A patient-centered approach and the use of expertise across disciplines were universally identified as strengths. Logistical barriers and the reluctance of older PWH to see a geriatric care provider were identified as barriers to implementing these models. Although the optimal model of geriatric consultation depends on a region's resources, there is value in augmenting the training of infectious disease providers to include principles of geriatric care.

An evaluation of a pilot specialist smoking cessation clinic in a mental health setting.

OBJECTIVES: Smoking rates in people with mental illness in Australia remain alarmingly high whilst they have been declining in the general population. This study reviews a smoking cessation programme in a mental health service, as a pilot for future studies and program development. We aim to assess the effectiveness of this intervention and the ease of implementation after upskilling the clinical workforce. METHODS: Part A - a retrospective analysis of patients attending the Smokers' Clinic, (n = 44) over a period of 18 months. Part B - survey of ease of implementation and change in practice of the resident medical officers (RMOs; n = 8) following their clinical placement. RESULTS: For the entire clinic population, the mean reduction in expired carbon monoxide was approximately 43%, with 34% of patients achieving abstinence. Females were 3.4 times more likely to be successful than males. Seventy-five per cent of RMOs found learning about nicotine dependence and smoking cessation 'easy', and 88% continued to offer smoking cessation after their placement. CONCLUSIONS: The Smokers' Clinic was successful in helping tobacco smokers with mental illness to reduce or cease smoking. Specialist skill and experience is not required to manage smoking cessation in a mental health setting.

Alpha-synuclein aggregates are excluded from calbindin-D28k-positive neurons in dementia with Lewy bodies and a unilateral rotenone mouse model.

α-Synuclein (α-syn) aggregates (Lewy bodies) in Dementia with Lewy Bodies (DLB) may be associated with disturbed calcium homeostasis and oxidative stress. We investigated the interplay between α-syn aggregation, expression of the calbindin-D28k (CB) neuronal calcium-buffering protein and oxidative stress, combining immunofluorescence double labelling and Western analysis, and examining DLB and normal human cases and a unilateral oxidative stress lesion model of α-syn disease (rotenone mouse). DLB cases showed a greater proportion of CB+ cells in affected brain regions compared to normal cases with Lewy bodies largely present in CB- neurons and virtually undetected in CB+ neurons. The unilateral rotenone-lesioned mouse model showed a greater proportion of CB+ cells and α-syn aggregates within the lesioned hemisphere than the control hemisphere, especially proximal to the lesion site, and α-syn inclusions occurred primarily in CB- cells and were almost completely absent in CB+ cells. Consistent with the immunofluorescence data, Western analysis showed the total CB level was 25% higher in lesioned compared to control hemisphere in aged animals that are more sensitive to lesion and 20% higher in aged compared to young mice in lesioned hemisphere, but not significantly different between young and aged in the control hemisphere. Taken together, the findings show α-syn aggregation is excluded from CB+ neurons, although the increased sensitivity of aged animals to lesion was not related to differential CB expression.

Targeting RSV-neutralizing B cell receptors with anti-idiotypic antibodies.

Respiratory syncytial virus (RSV) causes lower respiratory tract infections with significant morbidity and mortality at the extremes of age. Vaccines based on the viral fusion protein are approved for adults over 60, but infant protection relies on passive immunity via antibody transfer or maternal vaccination. An infant vaccine that rapidly elicits protective antibodies would fulfill a critical unmet need. Antibodies arising from the VH3-21/VL1-40 gene pairing can neutralize RSV without the need for affinity maturation, making them attractive to target through vaccination. Here, we develop an anti-idiotypic monoclonal antibody (ai-mAb) immunogen that is specific for unmutated VH3-21/VL1-40 B cell receptors (BCRs). The ai-mAb efficiently engages B cells with bona fide target BCRs and does not activate off-target non-neutralizing B cells, unlike recombinant pre-fusion (preF) protein used in current RSV vaccines. These results establish proof of concept for using an ai-mAb-derived vaccine to target B cells hardwired to produce RSV-neutralizing antibodies.

A gH/gL-encoding replicon vaccine elicits neutralizing antibodies that protect humanized mice against EBV challenge.

Epstein-Barr virus (EBV) is associated with several malignancies, neurodegenerative disorders and is the causative agent of infectious mononucleosis. A vaccine that prevents EBV-driven morbidity and mortality remains an unmet need. EBV is orally transmitted, infecting both B cells and epithelial cells. Several virally encoded proteins are involved in entry. The gH/gL glycoprotein complex is essential for infectivity irrespective of cell type, while gp42 is essential for infection of B cells. gp350 promotes viral attachment by binding to CD21 or CD35 and is the most abundant glycoprotein on the virion. gH/gL, gp42 and gp350, are known targets of neutralizing antibodies and therefore relevant immunogens for vaccine development. Here, we developed and optimized the delivery of several alphavirus-derived replicon RNA (repRNA) vaccine candidates encoding gH/gL, gH/gL/gp42 or gp350 delivered by a cationic nanocarrier termed LION™. The lead candidate, encoding full-length gH/gL, elicited high titers of neutralizing antibodies that persisted for at least 8 months and a vaccine-specific CD8+ T cell response. Transfer of vaccine-elicited IgG protected humanized mice from EBV-driven tumor formation and death following high-dose viral challenge. These data demonstrate that LION/repRNA-gH/gL is an ideal candidate vaccine for preventing EBV infection and/or related malignancies in humans.

Typed Operation Notes in Rural Western Australia: Improving Patient Care.

INTRODUCTION: Given the geographical area of the Kimberley region in Western Australia (WA) and the nomadic nature of its residents and medical staff, widespread access and clarity of surgical clinical information are necessary to provide accurate and timely post-surgical care. The aims of this project were: to evaluate the quality of operation notes and secondly, to evaluate multidisciplinary staff perceptions of the impact of the introduction of typed operation notes for general surgery in the Kimberley region from 2019 to 2020. METHODS: The quality of 100 general surgery operation notes (50 typed and 50 handwritten) were reviewed against the Royal College of Surgeons England (RCSEng) operation note guidelines. Cases were selected at random and reviewed by a resident medical officer. Multidisciplinary staff perceptions of communication were assessed through an anonymous electronic survey across emergency departments, general practices, nursing staff, and allied health staff members from the top three population centres: Broome, Derby and Kununurra. RESULTS: Typed operation notes with pre-loaded data (date, time, etc.) and mandatory fields (surgical count correct, etc.) increased recorded information and quality of content by 45% when compared to handwritten notes. When compared to RCSEng standards for free text, anticipated blood loss (one typed note) and abbreviation use (44 typed and 37 handwritten) showed ongoing user-dependent areas for improvement. A review of multidisciplinary staff perceptions (79 returned surveys) showed 60% of handwritten notes were seen to have a negative impact on timely post-operative care. Overall, typed notes increased legibility with a perceived improvement in acronyms/abbreviations and completeness of documentation. More than 90% of staff suggested an extension of typed notes for all surgical operations would be beneficial. CONCLUSION: The Kimberley region poses a unique set of challenges to the continuity of post-surgical care. This review shows typed operation notes improve legibility (100%) and increased congruence with established guidelines by 45%. It also shows a successful model for increased local and metropolitan multidisciplinary access across remote WA for timely post-operative care. In an unprecedented time where elective surgical procedures are being reduced to meet pandemic demands, now is the time to review, consider and institute practices that improve intra-operative and post-operative care.

Bryant's sign as a manifestation of a retroperitoneal paraduodenal bleed and subsequent small bowel obstruction.

Bryant's sign is defined as ecchymosis at the base of the penis and scrotum and is usually associated with a retroperitoneal bleed or ruptured aortic aneurysm. We report the case of a retroperitoneal paraduodenal bleed which presented with Bryant's sign. Imaging confirmed a pancreaticoduodenal arcade microaneurysm and associated low-grade coeliac artery stenosis (Sutton-Kadir syndrome). Retroperitoneal bleeding can be life threatening and requires prompt diagnosis and management. However, diagnosis can be challenging due to the clinical variation in presentation. The rarity of presentation in this case caused significant uncertainty necessitating a multidisciplinary approach for diagnostic clarity and safe patient care.

Optimization of a Larval Sampling Method for Monitoring Drosophila suzukii (Diptera: Drosophilidae) in Blueberries.

Managing spotted-wing drosophila, Drosophila suzukii (Matsumura), in fruit crops is complicated by the unreliability of currently available traps for monitoring adult flies, combined with the difficulty of detecting larval infestation before fruit damage is apparent. A simple method to extract larvae from fruit in liquid, strain the solution, then count them in a coffee filter was developed recently for use in integrated pest management programs. Here, we present a series of experiments conducted to improve fruit sampling by making it faster, less expensive, and more accurate. The volume of blueberries sampled (59-473 ml) did not significantly affect the detection of second and third instars, but we found that 118-ml samples were best for detecting the smallest larvae. These small instars were more detectable when berries were lightly squeezed before immersion, whereas larger instars were similarly detectable without using this step. We also found that immersing fruit for 30 min was sufficient before counting larvae, and similar numbers of larvae were found in the filter using room temperature water rather than a salt solution. The process of filtering, detection, and counting larvae took only 2-4 min per sample to process, depending on larval density. Using a microscope to count the larvae was consistently the best approach for detecting D. suzukii larvae. Based on these results, we discuss how fruit sampling can be streamlined within IPM programs, so growers and their advisors can improve control and reduce the cost of monitoring this invasive pest.

HIV and COVID-19: review of clinical course and outcomes.

Background:Understanding the relationship between HIV and SARS-CoV-2 has important public health implications.Objective:To summarize current research on COVID-19 among people with HIV (PWH) as published through 15 July 2021.Methods: We conducted a search of PubMed, Scopus, preprint databases (medRxiv, bioRxiv), and the references of publications found using key terms relevant to COVID-19 ('COVID-19' OR 'SARS-CoV-2' OR 'coronavirus') AND to HIV ('HIV' OR 'Human Immunodeficiency Virus' OR 'AIDS' OR 'Acquired Immunodeficiency Syndrome'). We summarized all articles that reported data or opinions on SARS-CoV-2 and HIV coinfection.Conclusions: Although many initial case series and cohort studies found no increased risk for SARS-CoV-2 infection or severe COVID-19 outcomes among PWH, recent studies have signaled an increased risk for severe COVID-19 disease progression even in the setting of well-controlled HIV. Whether this is due to the increased prevalence of comorbidities in PWH and other social determinants of health is unknown. These conflicting findings highlight the continued need for COVID-19 related research among PWH that addresses COVID-19 disease course as well as exacerbation of existing comorbidities already disproportionately represented among PWH.

Rehabilitation following regenerative medicine treatment for knee osteoarthritis-current concept review.

The purpose of this manuscript is to provide a current concept review for the rehabilitative management of knee osteoarthritis (KOA) following regenerative medicine intervention. A proposed comprehensive regenerative rehabilitative program has been created, based on a literature review of the current best practices of rehabilitative methods and non-operative management in KOA patients with an emphasis on the goals of regenerative medicine: to optimize self-healing and functional tissue recovery. Regenerative medicine promotes regeneration and joint restoration by using blood-based procedures such as platelet rich plasma, stem cell and cell-based or tissue engineering. Regenerative medicine procedures are variable and lack of standardization in product preparation, administration, and different treatment protocols. The lack of standardization imposes challenges in regenerative rehabilitation. Over the last decade, there is growing evidence in regenerative medicine and its uses in non-operative management of various pathologies. Advances in regenerative medicine technologies brings radical innovations to establish new and effective rehabilitation protocols promoting restoration of function through tissue regeneration and repair optimizing the standard of care, specifically in rehabilitation when combined with regenerative protocols for patients with KOA is the most common degenerative disease in the knee and can affect any synovial joint in the body. It is a leading cause of disability affecting the quality of lives of millions of people world-wide. Conventional methods of mild to moderate KOA are focused on short-term symptomatic relief and do not promote joint homeostasis or regeneration of injured tissue. Regenerative medicine emphasizes a paradigm shift in patient-centered care promoting regeneration and joint restoration by using blood-based procedures such as platelet rich plasma, stem cell and cell-based or tissue engineering. The purpose of this current concept review is to outline a comprehensive post-regenerative rehabilitative program in the management of KOA based on the best available evidence. Our proposed regenerative rehabilitation program is intended to align the goals of regenerative medicine with the current, high-level evidence of non-operative management for KOA, to optimize self-healing and functional tissue recovery.

Unusual case of unilateral conductive hearing loss: chronic lymphocytic leukaemia.

This presentation reports a novel case of chronic lymphocytic leukaemia (CLL), presenting with an early cutaneous lesion within the external auditory canal, in a patient being assessed for conductive hearing loss. It has previously been reported that infiltrative CLL can involve the head and neck; however, isolated external ear canal involvement is rare. Given that the incidence of CLL in Australia is rising, this case highlights the importance of considering CLL as a differential diagnosis for presentations of unilateral conductive hearing loss.

A case study of anorexia nervosa driven by religious sacrifice.

Anorexia nervosa (AN) is considered a relatively "modern" disorder; however, a number of scholarly works have cited examples of voluntary self-starvation dating back to several centuries. In particular, there are many examples of female starvation for religious reasons during the medieval period, with many being elevated to sainthood. We present a case of an elderly woman with AN who began restricting her diet when she was 13-years old while studying to be a nun at a Catholic convent. She reports that, during the development of her disease, she had no mirrors and, rather than restricting her diet to be thin or attractive, she restricted her diet to be closer to God in hopes of becoming a Saint. This unique case presents an opportunity to deepen our understanding of AN and the cultural context that affects its development.

Severe anorexia nervosa in a 20-year-old male with pericardial effusion and cortical atrophy.

This case report describes a 20-year-old man with a severe presentation of anorexia nervosa. His case is unique in that he presented at 49% of his ideal body weight and had a body mass index (BMI) of 11.59. In addition, he had cognitive slowing on exam and had cortical atrophy on a head CT. Other medical complications included pericardial tamponade that was treated with an open window pericardiocentesis, hepatitis, and anemia. He was treated nutritionally, first with a Dobb-Hoff tube and then with oral feedings, as well as had group, individual, and family therapies. He responded well to treatment, his labs normalized and he was discharged at 75% of his ideal body weight after a weight increase of 40 pounds and after 106 days of hospitalization at our facility. In addition, a head CT was repeated and the cortical atrophy had resolved.

Synthesis, solid-state crystal structure, and reactivity of a monomeric copper(I) anilido complex.

Synthesis and isolation of the Cu(I) amido complex (dtbpe)Cu(NHPh) (dtbpe = 1,2-bis(di-tert-butylphosphino)ethane) is accomplished upon reaction of [(dtbpe)Cu(mu-Cl)](2) with LiNHPh. The anilido complex has been fully characterized by IR spectroscopy and multinuclear NMR spectroscopy as well as by single-crystal X-ray diffraction study. Salient features of the solid-state structure include an amido orientation that allows pi-interaction of the nitrogen-based lone pair with both the empty copper p-orbital and the pi-system of the phenyl substituent. A solid-state X-ray diffraction study of [(dtbpe)Cu(NH(2)Ph)][BF(4)] has allowed a direct comparison of the structural features upon conversion of the amine ligand to an amido. The reactivity of the amido ligand of (dtbpe)Cu(NHPh) is consistent with nucleophilic character. For example, the formation of Ph(3)CNHPh is observed upon treatment with [Ph(3)C][BF(4)], and reaction at room temperature with EtX (X = Br or I) yields N-ethylaniline. The reactivity of (dtbpe)Cu(NHPh) is compared to that of the octahedral and d(6) complex TpRu(PMe(3))(2)(NHPh) (Tp = hydridotris(pyrazolyl)borate).