Can community health workers improve adherence to highly active antiretroviral therapy in the USA? A review of the literature.

OBJECTIVES: Highly active antiretroviral therapy (HAART) has transformed HIV infection into a manageable chronic illness, yet AIDS mortality among ethnic minorities persists in the USA. HAART nonadherence is associated with increased HIV viral load, low CD4 cell count and racial disparities in HIV outcomes. While there is no universal consensus on how to improve medical adherence in HIV-positive populations, the community health worker (CHW) model is emerging as an effective strategy to overcome barriers to HAART adherence. Although utilized in international settings, there is little evidence regarding the effects of CHWs on HIV outcomes in the USA. METHODS: We performed a comprehensive search from May 2010 to November 2010 to identify studies carried out in the USA that utilized CHWs to improve HAART adherence and measured HIV viral loads and CD4 cell counts to assess intervention effects. Sixteen studies met the inclusion criteria and were reviewed for this article. All studies reported clinical HIV outcomes. RESULTS: Interventions that lasted at least 24 weeks, provided frequent contact with participants, and focused on medication management were associated with improved HAART adherence, as indicated by reduced HIV viral load and increased CD4 cell count. CONCLUSIONS: Compared with current standards of care, CHW programmes may offer a practical and cost-effective alternative to improve HAART adherence, which may lead to reduced HIV viral load and increased CD4 cell counts among HIV-positive populations in the USA.

The Rorschach butterfly, understanding bone biomechanics prior to using nomenclature in bone trauma interpretations.

Blunt traumas are the most common injuries observed and reported in medical examiner settings. Two common methods to describe bending bone fractures in the anthropological literature include the application of morphology nomenclature and describing characteristic fracture morphology. A nomenclature descriptor of blunt trauma, the butterfly fracture, is commonly used to describe broken long bones. In this paper, a case study of a fractured long bone in a pedestrian vehicle accident is used to highlight the complex interplay of factors involved in bone fracture formation. The application of a butterfly fracture pattern in trauma analysis is useful in establishing the bending direction of a bone, in identifying failure modes, and is valuable in teaching. Yet, butterfly fracture characteristics need to be examined in 3-dimensions for diagnosis of modes of failure, tension, shear and compression, and even then, the bending direction of a broken bone may not provide a reliable indicator of the point of impact (POI); this is especially true when a priori knowledge of the injury is unknown. Common fracture nomenclature, such as oblique, transverse and/or comminuted, as well as eponyms, are medical descriptions of an injury which are impractical to use for interpreting a broken bone from fleshed or skeletonized remains, in establishing a POI and in evaluating total bone trauma (TBT). The examination ofcharacteristic features on the surface of a broken bone associated with the modes of failure is the best approach for establishing the bending direction of a long bone.

First detection of bovine noroviruses and detection of bovine coronavirus in Australian dairy cattle.

BACKGROUND AND OBJECTIVE: Noroviruses have been recognised as a significant cause of neonatal enteritis in calves in many countries, but there has been no investigation of their occurrence in Australian cattle. This study aimed to establish whether bovine noroviruses could be detected in faecal samples from Australian dairy cattle. It also sought to determine whether bovine coronaviruses, also associated with neonatal enteritis in calves, could be detected in the same faecal samples. METHODS: A selection of faecal samples that were negative for rotaviruses from dairy farms located in three geographically distinct regions of Victoria were pooled and tested by reverse transcription-PCR for the presence of noroviruses (genogroup III), neboviruses and bovine coronaviruses. RESULTS AND CONCLUSION: Genetically distinct genogroup III noroviruses were detected in two sample pools from different geographic regions and bovine coronavirus was detected in a third pool of samples. This is the first report of bovine norovirus infection in Australian cattle and suggests that future work is required to determine the significance of these agents as a cause of bovine enteric disease in Australia.

Placental 11ß-Hydroxysteroid dehydrogenase type 2 expression: Correlations with birth weight and placental metal concentrations.

INTRODUCTION: Infants born below 2500 g are classified as low birth weight. Excess in utero exposure to cortisol has been linked to restricted fetal growth. Placental production of 11ß-hydroxysteroid dehydrogenase type 2 (11ß-HSD2) inactivates cortisol before passage into the fetus. The present study tested the hypothesis that placental 11ß-HSD2 expression is positively correlated with an individualized birth weight centile and raw birth weight, and examines the relationship between metal concentrations in placental tissue and 11ß-HSD2 expression. METHODS: Placentae from 191 births were collected and samples preserved to maintain mRNA profile. Placental 11ß-HSD2 expression was measured via qRT-PCR. Addition samples were collected from placental tissues and uniformly dried in order to quantify 18 metals via ICP-MS (n = 160). RESULTS: A significant, positive correlation between 11ß-HSD2 expression and individualized birth weight centile (p = 0.0321) and birth weight (p = 0.0243) was found. Additionally, maternal age and gestational age were positivity correlated with each other (p = 0.0321). Birth weight was significantly different with race, marital status, education and maternal tobacco use. Four metals (Co, Mn, Ni, Zn) demonstrated significant positive correlations (p < 0.05) with 11ß-HSD2 expression. Sex specific differences were found; Co, Cu, Fe, Zn, and Ni were positively correlated with 11ß-HSD2 expression in males only, no significant correlations were found in the female only sample. CONCLUSION: These data indicate that the growth potential of a fetus is related to the 11ß-HSD2 expression in the placenta, and that 11ß-HSD2 expression is related to the trace metals status of the mother.

Aging and neuro-AIDS conditions and the changing spectrum of HIV-1-associated morbidity and mortality.

Older individuals (>50 years of age) now comprise over 11% of patients with AIDS in the United States. This percentage is expected to continue to grow, due both to the improved longevity of patients prescribed highly active antiretroviral therapy (HAART) and to new infections among older individuals. This review focuses on the neuropsychiatric and neurological conditions that are most likely to be affected by advancing age-HIV-1-associated cognitive-motor disorder, peripheral neuropathy, progressive multifocal leukoencephalopathy, primary CNS lymphoma, and risk for cerebrovascular accident. Age associations with incidence of these disorders and with treatment foci are specified. Implications for future changes in management are discussed.

Maxillary suture obliteration: aging the human skeleton based on intact or fragmentary maxilla.

Obliteration of the four sutures of the bony palate is examined to determine its value as an age indicator. Thirty-six maxillae from a predominately white series representing both sexes and a wide variety of ages are studied. It is concluded that the amount of obliteration of these sutures is useful in estimating general biological age.

Diameter of cranial gunshot wounds as a function of bullet caliber.

Determination of bullet caliber becomes increasingly important in homicides where the bullet is missing. In cases with entrance wounds to bone that are circular and well defined it may be tempting to measure the defect and offer suggestions about bullet caliber. For this reason, the relationship between wound diameter and bullet caliber was examined using cranial bones from autopsy cases. The minimum diameter of 35 cranial wounds produced by .22, .25, and .38-caliber bullet was measured. The relationship of minimum wound diameter to bullet caliber was examined using a one way analysis of variance. Fisher's least significant difference test revealed no significant difference between .22-caliber and .25-caliber wounds, while the .38-caliber wounds were significantly different (P < .001) from .22-caliber and .25-caliber wounds. Variation in wound size resulting from such factors as bullet shape, surface treatment, strength characteristics, loss of gyroscopic stability, intermediate targets, tangential impacts, and existing fractures are discussed. Also, the large variety of calibers available are noted as complicating the prediction of caliber from wound size. In view of these factors caution is recommended in any attempt to determine precise bullet caliber from the minimum dimensions of the cranial gunshot entrance wound.

Effects of human decomposition on bullet striations.

Five different types of bullets, representing the major materials used in centerfire handgun and rifle ammunition, were inserted into the cranial, chest and abdominal cavities, muscle and adipose tissues of a fresh cadaver. The bullets were retrieved after the body was 90% decomposed. Observation and comparison of before and after photographs let each bullet serve as its own control. Results indicate the reactivity of bullet materials and the body region are significant factors affecting the corrosion process and may obscure rifling striations.

The meaning of an accessory projectile.

A previously expended pistol casing was removed from a gunshot wound after an apparent accidental shooting. Examination of this foreign body indicated it had ridden the bore ahead of the bullet. Further investigation disclosed this as a deliberate but ignorant means to load an already loaded weapon. The assailants then fired at a passerby and killed him. Disclosure of the foreign body by X-ray, recovery and examination at autopsy were used to corroborate the circumstances and allowed charges of criminally negligent homicide to be placed.

Matching bullets to bone impact signatures.

When bone is penetrated or perforated by a bullet, the bullet's impacting surface is often uniquely modeled by the fractured bone. Reconstructing bone with simple super-imposition of the bullet's contour lines allows matching of a particular bullet to its specific bone defect.

Recognition of cemetery remains in the forensic setting.

Cemetery remains exposed through vandalism or natural phenomena are frequently brought to the attention of law enforcement agents or medical examiners. Although it is often difficult to distinguish cemetery remains from those of medicolegal significance, clues to their origin may exist. Characteristics consistent with cemetery remains include physical characteristics associated with the embalming process. Characteristics indicative of cemetery remains include functional or ornamental artifacts associated with the coffin, devices used in embalming the body, and elevated levels of embalming chemicals in the soft tissue.

Identification of gunpowder in healed wounds.

A woman received a contact gunshot wound to the abdomen from a .22 caliber revolver. She recovered only to succumb to another gunshot wound six months later. The initial wound was dissected and multiple intact granules of round flake gunpowder were recovered. Cross sections of granules were clearly identifiable in histologic slides. Recovery of intact powder in remote wounds has not been previously described and may help classify the ammunition and weapon used to produce the injury.

Characteristic features of entrance wounds from hollow-point bullets.

Several cases of gunshot wounds produced by hollow-point bullets showed characteristic central tags. These apparently arise from sparing of the skin surface by the hollow point cavity when the bullet strikes the skin tangentially. This unique feature may be helpful in assessing entrances of perforating wound tracks or other cases where the bullet is either not available or unknown.

Atypical gunshot exit defects to the cranial vault.

Cranial exit wounds typically display external beveling, however, variation has been noted in the literature due to keyhole phenomena and pre-existent fractures. Two cases of atypical exit morphology are presented with features mimicking blunt trauma. In both instances radial fractures created by the exiting impact allowed passage without producing exit beveling. A working knowledge of the biomechanics of bone fracture, radiographs and low power microscopy are essential elements for the proper interpretation of such exit wound fractures.

Blood supply to the bladder during filling.

Amongst other features of bladder physiology, the mechanics of cyclic filling and emptying make the blood supply of the bladder unique with respect to other organs of the body. Blood vessels are required to lengthen and shorten, whilst maintaining sufficient perfusion of the smooth muscle. Interruption of the blood supply may result in ischaemia and, ultimately reperfusion, resulting in bladder pathologies. The blood flow is also likely to be affected by factors such as increased intra-abdominal pressure. In this article, several features of the blood supply to the bladder- and also the urethra--are discussed.

Placental concentrations of bisphenol A and birth weight from births in the Southeastern U.S.

INTRODUCTION: Bisphenol A (BPA) is a weakly estrogenic compound that has been detected in a wide variety of food products and biological matrices (saliva, blood, urine, etc). Despite the potential risk of human exposure to BPA, little information exists concerning maternal and fetal exposure to BPA during pregnancy. The aim of this study is to evaluate the correlation between placental BPA concentration, infant birth weight and calculated birth weight centile, and several other maternal and infant parameters. METHODS: Placental sample were collected from 200 subjects. BPA levels were measured by isotope dilution GC-MS. Additional maternal and infant data were gathered from medical charts and were potential correlates with placental BPA levels. RESULTS: Placental BPA concentrations ranged from 4.4 ng/g to 273.9 ng/g in oven-dried tissue (average 103.4 ± 61.8 ng/g). There was a significant negative correlation between calculated birth weight centile and levels of placental BPA (p < 0.05). Low birth weight and small for gestational age infants also had significantly greater placental BPA concentrations as compared to normal weight infants and average/large for gestational age infants. Infants born to African American mothers also had greater placental BPA concentrations as compared to infants born to Hispanic mothers. DISCUSSION: Placental BPA concentrations are correlated with the growth potential of the fetus and may play a role in reduced fetal growth.

Norovirus mixed infection in an oyster-associated outbreak: an opportunity for recombination.

We describe an outbreak of gastroenteritis in which the nucleic acid of three distinct noroviruses was amplified from the same fecal sample. To enable the separate amplification of each virus, an inclusion/exclusion RT-PCR primer design strategy was developed. This paired a virus-specific exclusion primer (designed with the exact sequence of one virus in a region displaying low conservation among the three viruses) with a virus-nonspecific inclusion primer (designed in a conserved region). Thus, in each reaction the exclusion primer provided specificity for a single virus, and the inclusion primer increased the sensitivity and allowed hybridization in a region of unknown sequence. Analysis of the partial genomic sequences of the three viruses (3.6-3.8 kb) indicated that each virus belonged to a separate genogroup II cluster, and each displayed evidence of a potential recombination event when the sequences were compared with other published norovirus sequences. Our results, which show a mixed norovirus infection in a single individual, confirm the need to be aware of the possibility of mixed norovirus infections, and of the possibility of genomic recombination causing anomalies in phylogenetic analyses in such instances.

Characteristics of child abuse by anteroposterior manual compression versus cardiopulmonary resuscitation: case reports.

Lethal and sublethal injuries to infants caused by anteroposterior manual compression can be accompanied by lateral rib fractures, hemorrhage into the viscera, and when severe, rupture of large vessels and solid organs. Abusers may claim that these injuries were sustained in an attempt to perform cardiopulmonary resuscitation (CPR). The difference between injuries caused by CPR and injuries caused by inflicted anteroposterior compression is examined in one sublethal and two lethal cases.