A Randomized Clinical Trial: Patient Satisfaction of Paper Versus Electronic Provider Feedback.

IMPORTANCE: Minimal data compare patient satisfaction with completing paper versus electronic evaluations. OBJECTIVES: This study aimed to compare patient satisfaction with completing paper versus electronic evaluations. Secondary objectives were assessing age, education, and socioeconomic status with comfort with technology; preference for evaluation type; and timeliness of completing evaluations. STUDY DESIGN: This was a single-center randomized trial comparing paper versus electronic patient evaluations of health care providers. Study participation occurred at the end of clinic visits. RESULTS: Among 145 participants, 73 (50.3%) were analyzed as paper versus 72 (49.7%) as electronic. Groups were similar in age, race, education level, income, insurance type, technology comfort, and technology use. Groups were similar in finding ease (P = 0.99) and satisfaction (P = 0.76) with their randomized method. For participants randomized to paper, 34% preferred paper, 25% preferred electronic, and 41% had no preference. Electronic feedback took longer to complete (4.5 minutes vs 3.4 minutes, P < 0.001). Older participants took longer to complete the evaluation (4.5 minutes vs 3.2 minutes, P < 0.001), had less internet use (P = 0.01), and were less likely to own a computer (P = 0.03) than younger participants. There were differences by education level for comfort with technology (P = 0.007) and internet use (P = 0.016). There were no differences in ease of feedback completion or satisfaction when comparing age, education status, or income status. CONCLUSIONS: Patients were satisfied with paper and electronic health care provider evaluations, regardless of age or other demographics. Evaluations were completed quickly during visits. Requesting feedback from patients via multiple modalities is feasible in a varied patient population.

Preliminary Investigation on Hygienic-Sanitary Quality of Food Vending Machines.

The consumption of hot drinks dispensed from vending machines has become a common practice, both in workplaces and during free time. Every day, millions of bulk drinks are sold, but the quality of the products distributed may not always be guaranteed, as it is related to many factors such as the quality of the water, the raw materials used, and the effectiveness of the equipment's cleaning system. The purpose of this study is to evaluate the hygienic-sanitary requirements of hot drinks and vending machine surfaces. The investigation highlighted the microbial contamination of both coffee and vending machine surfaces. Although the "coffee break" is usually considered a moment of pleasure, apparently not subject to specific jurisdiction, the products dispensed can represent a health risk if the hygienic conditions are not fully respected. Therefore, official controls carried out by the Prevention Department represent a suitable way for evaluating and guaranteeing the hygienic-sanitary requirements, providing for corrective actions, when needed, to protect consumers.

A deep learning approach to fight illicit trafficking of antiquities using artefact instance classification.

We approach the task of detecting the illicit movement of cultural heritage from a machine learning perspective by presenting a framework for detecting a known artefact in a new and unseen image. To this end, we explore the machine learning problem of instance classification for large archaeological images datasets, i.e. where each individual object (instance) is itself a class that all of the multiple images of that object belongs. We focus on a wide variety of objects in the Durham Oriental Museum with which we build a dataset with over 24,502 images of 4332 unique object instances. We experiment with state-of-the-art convolutional neural network models, the smaller variations of which are suitable for deployment on mobile applications. We find the exact object instance of a given image can be predicted from among 4332 others with ~ 72% accuracy, showing how effectively machine learning can detect a known object from a new image. We demonstrate that accuracy significantly improves as the number of images-per-object instance increases (up to ~ 83%), with an ensemble of classifiers scoring as high as 84%. We find that the correct instance is found in the top 3, 5, or 10 predictions of our best models ~ 91%, ~ 93%, or ~ 95% of the time respectively. Our findings contribute to the emerging overlap of machine learning and cultural heritage, and highlights the potential available to future applications and research.

Isoform-specific regulation by N(G),N(G)-dimethylarginine dimethylaminohydrolase of rat serum asymmetric dimethylarginine and vascular endothelium-derived relaxing factor/NO.

Asymmetric dimethylarginine (ADMA), which inhibits NO synthase, is inactivated by N(G),N(G)-dimethylarginine dimethylaminohydrolase (DDAH). We tested whether DDAH-1 or -2 regulates serum ADMA (S(ADMA)) and/or endothelium-derived relaxing factor (EDRF)/NO. Small inhibitory (si)RNAs targeting DDAH-1 or -2, or an siRNA control were given intravenously to rats. After 72 hours, EDRF/NO was assessed from acetylcholine-induced, NO synthase-dependent relaxation and 4-amino-5-methylamino-2',7'-difluorofluorescein diacetate for NO activity in isolated mesenteric resistance vessels (MRVs). Expression of mRNA for DDAH-1 versus -2 was 2- and 7-fold higher in the kidney cortex and liver, respectively, whereas expression of DDAH-2 versus -1 was 5-fold higher in MRVs. The proteins and mRNAs for DDAH-1 or -2 were reduced selectively by 35% to 85% in the kidney cortex, liver, and MRVs 72 hours following the corresponding siRNA. S(ADMA) was increased only after siDDAH-1 (266+/-25 versus 342+/-39 [mean+/-SD] nmol x L(-1); P<0.005), whereas EDRF/NO responses and NO activity were not changed consistently by siDDAH-1 but were greatly reduced after siDDAH-2. Mean arterial pressure was not changed significantly by any siRNA. In conclusion, S(ADMA) is regulated by DDAH-1, which is expressed at sites of ADMA metabolism in the kidney cortex and liver, whereas EDRF/NO is regulated primarily by DDAH-2, which is expressed strongly in blood vessels. This implies specific functions of DDAH isoforms.

Increased levels of asymmetric dimethylarginine are associated with pulmonary arterial hypertension in HIV infection.

OBJECTIVE: To examine the relationship between asymmetric dimethylarginine (ADMA) and HIV-associated pulmonary arterial hypertension (PAH). DESIGN: HIV infection is an independent risk factor for PAH, but the underlying pathogenesis remains unclear. Chronic inflammation resulting in nitric oxide-mediated endothelial dysfunction is a key mechanism underlying other types of PAH. ADMA is an endogenous inhibitor of endothelial nitric oxide synthase. Among uninfected individuals, ADMA is associated with PAH and predicts disease-related mortality. METHODS: We measured ADMA, high sensitivity C-reactive protein, interleukin-6 (IL-6), D-dimer, and pulmonary artery systolic pressure (PASP) using echocardiography in HIV-infected individuals. Right heart catheterization (RHC) was performed in individuals with a PASP at least 30  mmHg. We performed multivariable analysis to identify factors associated with high PASP by echocardiogram and PAH by RHC. RESULTS: Among 214 HIV-infected individuals, the median age was 50 years, 82% were men, 71% were on antiretroviral therapy, and 4.2% carried a prior diagnosis of PAH. ADMA and IL-6 were associated with increased values of PASP following multivariable adjustment (7.2% per 0.1 µmol/l, P = 0.0049 and 3.9% per doubling, P = 0.027, respectively). In adjusted analysis among the 85 participants who underwent RHC, ADMA and IL-6 were associated with higher values of mean PAP (14.2% per 0.1 µmol/l, P = 0.0014 and 5.8% per doubling, P = 0.038, respectively). However, only ADMA was associated with PAH (prevalence ratio = 1.74, P = 0.029). CONCLUSION: Elevated levels of ADMA are independently associated with PAH among HIV-infected individuals. Our findings suggest that chronic HIV-associated inflammation leading to an accumulation of ADMA and subsequent nitric oxide-mediated endothelial dysfunction may represent a novel mechanism for HIV-associated PAH.

Elevated levels of asymmetric dimethylarginine are associated with lower CD4+ count and higher viral load in HIV-infected individuals.

OBJECTIVES: To compare asymmetric dimethylarginine (ADMA) among HIV-infected and uninfected individuals and to evaluate predictors of ADMA in HIV infection. BACKGROUND: HIV-infected individuals have high rates of atherosclerosis. Endothelial dysfunction is central to atherogenesis and is one possible mechanism underlying this increased cardiovascular risk. ADMA is an endogenous inhibitor of endothelial nitric oxide synthase. Among uninfected individuals, higher ADMA levels predict cardiovascular events and mortality. The association between HIV infection, HIV-related factors, and ADMA has not been well described. METHODS: We compared ADMA in 248 HIV-infected individuals and 50 uninfected controls. We performed multivariable analysis using traditional cardiovascular and HIV-specific factors as covariates to identify factors associated with ADMA. RESULTS: HIV-infected men were older, less often Caucasian, more hypertensive, and had lower HDL than uninfected men. The median duration of HIV infection was 13 years, median CD4+ count was 592 cells/µL, 76% had an undetectable viral load, and 76% were on antiretroviral therapy. ADMA levels were modestly higher in HIV-infected individuals than controls [median (IQR): 0.46 µM (0.41-0.52) vs. 0.44 µM (0.38-0.46), p = 0.019], but the association lost statistical significance after controlling for cardiovascular risk factors (+0.028 µM, p = 0.054). Lower CD4+ count and both detectable and higher viral load were independently associated with increased ADMA. CONCLUSIONS: ADMA levels were modestly elevated in the setting of HIV infection. Notably, a greater HIV-associated inflammatory burden, as evidenced by lower CD4+ counts and higher viral loads, was associated with increased ADMA levels. Our findings suggest that HIV infection impairs endothelial function and predisposes to atherosclerosis through chronic inflammation and subsequent accumulation of ADMA.

Salt sensitivity in blacks: evidence that the initial pressor effect of NaCl involves inhibition of vasodilatation by asymmetrical dimethylarginine.

In healthy, mostly normotensive blacks, 19 salt-sensitive (SS) and 18 salt-resistant (SR), we tested the hypothesis that, in SS subjects, dietary NaCl loading induces its initial pressor effect by inducing a normal increase of cardiac output, while failing to induce a normal pressor-offsetting vasodilatation, consequent to its inhibition by asymmetrical dimethylarginine that is abnormally increased by NaCl. In SS and SR subjects, dietary NaCl loading, 250 from 30 mmol/d, over a 7-day period, induced similar, immediate increases in external Na(+) balance (by day 2, ≈360 mmol), plasma volume (+11%), and cardiac output (+8%). In SR subjects, from day 1, transient decreases occurred in both systemic vascular resistance (nadir: -13%, day 2) and mean arterial pressure (nadir: -5%, day 2). In SS subjects, systemic vascular resistance did not change over days 1 to 3, whereas mean arterial pressure increased progressively after day 1, ultimately by 10 mm Hg. Failure of systemic vascular resistance to normally decrease, while cardiac output normally increased, accounted for salt's initial pressor effect in the SS subjects. In SS subjects, baseline plasma levels of asymmetrical dimethylarginine (0.76 µmol/L) and symmetrical dimethylarginine (0.60 µmol/L), which does not affect vasodilatation, approximated those in SR subjects. In SS but not SR subjects, NaCl loading induced increases in asymmetrical dimethylarginine on both days 2 (+38%, median) and 7 (+14%, median). Symmetrical dimethylarginine changed in neither group. For all of the subjects combined, changes in asymmetrical dimethylarginine on day 2 predicted changes in systemic vascular resistance (R=0.751; P<0.001) and mean arterial pressure (R=0.527; P=0.006) on day 2 and similarly on day 7. These observations support the hypothesis tested.

Total and available soil trace element concentrations in two Mediterranean agricultural systems treated with municipal waste compost or conventional mineral fertilizers.

The temporal dynamics of some trace elements in two different types of Mediterranean soils were studied in order to evaluate the possible long-term contamination following compost amendments. Total and available (DTPA-extractable) concentrations of Cd, Cu, Pb and Zn were determined. The study was carried out on two agricultural soils in Campania region (southern Italy), a Sandy Loam Calcaric Cambisol (SG) and a Clay Gleyc Luvisol (CO), during 3 years of organic amendment with compost. The compost, produced from the organic fraction of municipal solid waste and urban yard trimmings, in accordance with the Italian law for agricultural use, was applied at annually rates of 15, 30, and 45 t ha(-1) (on dry weight basis). Wide variations in total and available Cd, Cu, Pb and Zn concentrations were observed over time, but appeared to be in many cases unrelated to the treatments, occurring also in control plots. After 3 years of compost application the amended SG soil showed the highest and significant increase in total Cd and Zn concentrations; in addition, the available Cd, Pb and Zn concentrations increased in accordance with the compost rates. The CO soil, characterized by a higher clay content, lower organic matter content and lower cation exchange capacity, exhibited a lower increase in available metal fractions. Our findings show that compost amendment affects more the available than the total metal concentrations in the two types of soils studied and thus it is important into legislation that metal "bioavailability" may be considered in defining threshold metal values.

A case of HIV-associated facial lipoatrophy treated with 1000-cs liquid injectable silicone.

BACKGROUND: Patients infected with the HIV may experience HIV-associated lipodystrophy, a symptom of which is facial lipoatrophy, a dramatic loss of subcutaneous facial tissue. This visible manifestation of HIV infection causes significant psychosocial pain for patients and has been associated with impaired compliance with medical regimens. OBJECTIVE: To improve the appearance of facial lipoatrophy in a safe, long-lasting, expeditious, and relatively economical manner. METHODS: An HIV-associated lipodystrophy patient with facial lipoatrophy underwent multiple sessions of soft-tissue augmentation therapy with liquid injectable silicone (LIS) using the microdroplet serial puncture technique. RESULTS: Administration of LIS by the microdroplet serial puncture technique produced satisfactory improvement of areas of facial atrophy. The treatment time is limited, the patient discomfort and morbidity are minimal, and results are long lasting. Patients report significant satisfaction with treatment. CONCLUSION: LIS administered by the microdroplet serial puncture technique is a safe and effective method for treating HIV-associated facial lipoatrophy and compares favorably with other methods of tissue augmentation.

Melatonin increases survival and inhibits oxidative and amyloid pathology in a transgenic model of Alzheimer's disease.

Increased levels of a 40-42 amino-acid peptide called the amyloid beta protein (A beta) and evidence of oxidative damage are early neuropathological markers of Alzheimer's disease (AD). Previous investigations have demonstrated that melatonin is decreased during the aging process and that patients with AD have more profound reductions of this hormone. It has also been recently shown that melatonin protects neuronal cells from A beta-mediated oxidative damage and inhibits the formation of amyloid fibrils in vitro. However, a direct relationship between melatonin and the biochemical pathology of AD had not been demonstrated. We used a transgenic mouse model of Alzheimer's amyloidosis and monitored over time the effects of administering melatonin on brain levels of A beta, abnormal protein nitration, and survival of the mice. We report here that administration of melatonin partially inhibited the expected time-dependent elevation of beta-amyloid, reduced abnormal nitration of proteins, and increased survival in the treated transgenic mice. These findings may bear relevance to the pathogenesis and therapy of AD.