How LGBTQ+ Young Adults Navigate Personal Risk in App-Based Hookups: The Safety Spectrum Theory.

Research on hooking up is rife with examinations of risky sexual health practices among LGBTQ+ young adults; yet, little has been written about the personal safety practices for this population. This omission is notable because safety practices can enhance the notable positive outcomes related to hooking up. Drawing on one-on-one interviews with 50 LGBTQ+ young adults (20 cismen, 20 ciswomen, two transmen, and eight others) in British Columbia, California, and Connecticut, we developed the safety spectrum theory, which used a spectral measurement to assess how LGBTQ+ young adults negotiate safety practices and implement safety rules. This spectrum was then applied to a three-step sequence of application (app)-based hookup rituals: online initiation, pre-meeting preparation, and in-person meetup. Results indicated that safety strategies may be dictated by situational factors, where individuals adapt to varying circumstances to be more in control of personal safety when hooking up. We further identified that participants move across the spectrum depending upon contextual factors, such as the gender of the potential hookup partner. This work suggests that LGBTQ+ young adults are mindful of their personal safety and deserve more credit than previously attributed in queer and sexual health research. From these findings, we provide evidence-based recommendations to make dating/hookup apps and public health campaigns more effective at mitigating hookup-related risks.

Performance of serum procalcitonin as a biochemical predictor of death in hematology patients with febrile neutropenia.

INTRODUCTION: Historically, the measurement of serum procalcitonin (PCT) levels in patients with leukopenia has been rejected without sufficient prospective evidence to justify this argument. On the other hand, the accumulated use of broad spectrum antibiotics in these patients and their consequences make the use of PCT attractive in an effort to reduce its use. PATIENTS AND METHODS: We conducted a prospective study between 2016 and 2018, recruiting newly diagnosed FN patients, evaluating them with PCT levels during the first 24 h. After this we evaluate them with overall survival throughout the follow-up. RESULTS: A total of 81 episodes of FN in 72 patients were included. We report a mortality of 27.2% in our cohort. The mean serum PCT in these patients was 4.01 ng/mL compared to 0.42 ng/mL in the survivors group (p < 0.01). Using ROC curves, we determined a cut-off point to predict septic shock/death at 0.46 ng/mL. Patients with a procalcitonin >0.46 ng/mL had an increased risk of death, with a HR of 4.43, (p = 0.048). CONCLUSION: In conclusion, in our trial a single PCT on admission at a cut-off value of 0.46 ng/mL was able to predict the occurrence of septic shock and death in FN patients.

Cyclosporine A for the Prevention of Ocular Graft versus Host Disease in Allogeneic Hematopoietic Stem Cell Transplant Recipients Is Safe and Feasible.

PURPOSE: To evaluate the safety and efficacy of ocular cyclosporine in the prevention of the development of ocular graft versus host disease (oGVHD) in patients undergoing allogeneic hematopoietic stem cell transplantation (AHSCT) in comparison with historic data. DESIGN: We developed a longitudinal, observational, prospective nonrandomized study. We evaluated the feasibility of prophylactic use of topical cyclosporine A (CsA) to prevent or decrease the incidence of oGVHD and compared this with historic data. METHODS: Patients undergoing AHSCT were treated with prophylactic topical CsA for 12 months after engraftment, followed by serial ophthalmic evaluations, including the Schirmer test. RESULTS: Twenty patients were included. No serious adverse effects were reported. Poor adherence was documented in 15% of patients. In spite of observing extra-ocular GVHD (acute and chronic GVHD incidence of 50 and 45%, respectively), only 1 in 20 patients developed oGVHD over the 20-month follow-up for the entire cohort. No statistically significant difference was observed in the incidence of oGVHD when compared to a historical cohort. CONCLUSIONS: Topical CsA as a prophylactic measure for oGVHD, administered over a period of 1 year after grafting, is safe and feasible and may decrease the incidence of ophthalmic manifestations of GVHD. These findings must be confirmed in a randomized trial.

Frame-invariant Fick diffusion matrices of multicomponent fluid mixtures.

Extension of a description of mass diffusion in binary fluids based on Fick's law to multicomponent fluids requires introduction of diffusion matrices. A problem is that Fick diffusion matrices commonly adopted for multicomponent fluids depend on the velocity frame of reference. In this paper we show how one can define Fick diffusion matrices for multicomponent fluids that are frame invariant.

Definition of frame-invariant thermodiffusion and Soret coefficients for ternary mixtures.

The definitions of thermodiffusion and Soret coefficients for a binary mixture include a concentration prefactor x(1 - x), when mole fraction x is used, or w(1 - w), when mass fraction w is used. In this paper the physical reasons behind this choice are reviewed, emphasizing that the use of these prefactors makes the thermodiffusion and the Soret coefficients invariant upon changing in the concentration representation, using either mole fraction or mass faction. Then, it is shown how this invariance property can be extended to ternary mixtures by using appropriate concentration prefactors in matrix form. The paper is completed with some considerations about alternative definitions of thermodiffusion coefficients, binary limits of the concentration triangle, selection of the dependent concentration in a ternary mixture, use of molar concentrations and, finally, extension to multi-component mixtures.

Gravity effects on Soret-induced non-equilibrium fluctuations in ternary mixtures.

We discuss the gravity effects on the dynamics of composition fluctuations in a ternary mixture around the non-equilibrium quiescent state induced by thermodiffusion when subjected to a stationary temperature gradient. We found that the autocorrelation matrix of concentration fluctuations can be expressed as the sum of two exponentially decaying concentration modes. Without accounting for confinement, we obtained exact analytical expressions for the two decay rates which, as a consequence of gravity, display a wave-number-dependent mixing. The stability of the quiescent solution is also examined, as a function of the two solutal Rayleigh numbers used to express the decay rates. After having discussed the dynamics of the two concentration modes, we calculate the corresponding amplitudes. Consequences for optical experiments are discussed.

Dynamic analysis of the light scattered by the non-equilibrium fluctuations of a ternary mixture of polystyrene-toluene-n-hexane.

Dynamic analysis of the light scattered by non-equilibrium fluctuations in a thermodiffusion experiment has been performed on a sample of polystyrene-toluene-n -hexane, at 0.9-49.55-49.55% mass fraction. Time decays of the non-equilibrium fluctuations have been obtained revealing the accurate detectability of three modes. The slowest mode has been attributed to the mass diffusion of the polymer into the binary solvent; the intermediate one to mass diffusion of the two molecular components of the solvent; finally, the fastest one has been attributed to the thermal diffusivity of the overall mixture. The two eigenvalues of the mass diffusion matrix have been evaluated with accuracy in the order of 1%. Neglecting cross-diffusion effects we obtain a simplified expression for the relative amplitude of the two mass diffusion modes, allowing a parameterized determination of polystyrene and toluene Soret coefficients in the ternary mixture. We suggest that a two wavelength shadowgraph experiment is needed for a complete determination of all the coefficients.

Confinement effect on the dynamics of non-equilibrium concentration fluctuations far from the onset of convection.

In a recent letter (C. Giraudet et al., EPL 111, 60013 (2015)) we reported preliminary data showing evidence of a slowing-down of non-equilibrium fluctuations of the concentration in thermodiffusion experiments on a binary mixture of miscible fluids. The reason for this slowing-down was attributed to the effect of confinement. Such tentative explanation is here experimentally corroborated by new measurements and theoretically substantiated by studying analytically and numerically the relevant fluctuating hydrodynamics equations. In the new experiments presented here, the magnitude of the temperature gradient is changed, confirming that the system is controlled solely by the solutal Rayleigh number, and that the slowing-down is dominated by a combined effect of the driving force of buoyancy, the dissipating force of diffusion and the confinement provided by the vertical extension of the sample cell. Moreover, a compact phenomenological interpolating formula is proposed for easy analysis of experimental results.

The NEUF-DIX space project - Non-EquilibriUm Fluctuations during DIffusion in compleX liquids.

Diffusion and thermal diffusion processes in a liquid mixture are accompanied by long-range non-equilibrium fluctuations, whose amplitude is orders of magnitude larger than that of equilibrium fluctuations. The mean-square amplitude of the non-equilibrium fluctuations presents a scale-free power law behavior q-4 as a function of the wave vector q, but the divergence of the amplitude of the fluctuations at small wave vectors is prevented by the presence of gravity. In microgravity conditions the non-equilibrium fluctuations are fully developed and span all the available length scales up to the macroscopic size of the systems in the direction parallel to the applied gradient. Available theoretical models are based on linearized hydrodynamics and provide an adequate description of the statics and dynamics of the fluctuations in the presence of small temperature/concentration gradients and under stationary or quasi-stationary conditions. We describe a project aimed at the investigation of Non-EquilibriUm Fluctuations during DIffusion in compleX liquids (NEUF-DIX). The focus of the project is on the investigation in micro-gravity conditions of the non-equilibrium fluctuations in complex liquids, trying to tackle several challenging problems that emerged during the latest years, such as the theoretical predictions of Casimir-like forces induced by non-equilibrium fluctuations; the understanding of the non-equilibrium fluctuations in multi-component mixtures including a polymer, both in relation to the transport coefficients and to their behavior close to a glass transition; the understanding of the non-equilibrium fluctuations in concentrated colloidal suspensions, a problem closely related with the detection of Casimir forces; and the investigation of the development of fluctuations during transient diffusion. We envision to parallel these experiments with state-of-the-art multi-scale simulations.

Non-equilibrium fluctuations induced by the Soret effect in a ternary mixture.

We present, based on fluctuating hydrodynamics, the theory of concentration fluctuations in a ternary mixture subjected to a stationary temperature gradient, so that composition gradients are present due to thermal diffusion (Soret effect). We neglect gravity and confinement (boundary conditions) but consider a completely generic diffusion matrix, including cross-diffusion effects. We find, as in the case of binary mixtures, an important non-equilibrium enhancement of the concentration fluctuations, which is proportional to the square of the gradient and inversely proportional to the fourth power of the fluctuations wave number, q(-4). The results of this paper are expected to be asymptotically correct for fluctuations of large q, while for shorter q gravity and confinement effects need to be incorporated. Comparison with previous work in the topic is included.

Lactate/Pyruvate Ratio as an Early Predictor of Mortality in Patients with Sepsis: A Cohort Study.

Background: The lactate/pyruvate (LP) ratio has been studied as an alternative to serum lactate to determine clinical prognosis. Despite its clinical utility, there is a paucity of evidence evaluating the role of the L/P ratio in patients with sepsis. Methods: We assessed the clinical utility of the L/P ratio in patients with sepsis. The L/P ratio was measured at baseline, 4 and 8 h after admission. Our primary outcome was to determine the prognostic utility of the L/P ratio on the 15-day mortality risk. Our secondary outcomes were to compare the L/P ratio across time and its prognostic utility against standard risk calculators such as APACHE-II and SOFA scores. Results: We had a total of 80 patients, with 18 (22.5%) survivors and 62 (77.5%) non-survivors. While we found that patients having higher L/P ratios at 8 h had an increased 30-mortality risk (OR 1.08, 95% CI 1.02-1.18), the model's performance showed no difference when compared to other measurements of the L/P ratio that showed no association with mortality (p-value: 0.45). For our secondary outcome, we found that the APACHE-II and SOFA scores have better performance and predictability than the L/P ratio (AUC 0.83 and AUC 0.80, respectively), but showed no association with mortality (OR 1.07, 95% CI 1.01-1.17 and OR 1.08, 95% CI 1.02-1.18). Conclusions: Based on our findings, the L/P ratio appears to function more effectively as an early predictor of mortality when used as an adjuvant biomarker with other clinical parameters.

Policies during COVID-19 and their impact on immigrant families' psychological well-being: A critically engaged practice.

INTRODUCTION: The COVID-19 pandemic has exacerbated, and complicated stressors related to immigrant families' experience with U.S. immigration policies. METHOD: This article uses a critically engaged practice (CEP) framework to examine three policies and their implications for the health and well-being of immigrant families during the COVID-19 pandemic (a) Detention and Removal of Alien Parents or Legal Guardians policy, (b) Order Suspending the Right to Introduce Certain Persons from Countries where a Quarantinable Communicable Disease Exists, and (c) Field Guidance on Deportability and Inadmissibility on Public Charge Grounds. RESULTS: Our article presents a CEP framework to empower clinicians in integrated healthcare settings to better understand and communicate policies with their patients. DISCUSSION: Policy-informed CEP asks clinicians to (a) remain current with policy change; (b) have the ability to interpret policy and or policy change to clients; and (c) be aware of not only the primary effects of policy on the family but also the secondary impacts to their system. Clinical implications are provided. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Aphasia improvement without logotherapy during motor neurorehabilitation of post-stroke hemiparesis using virtual reality or modified constraint-induced movement therapy: A retrospective cohort.

BACKGROUND: Some research suggests that post-stroke aphasia can recover "on its own", however, there is evidence of a common neural substrate for motor and language systems. We hypothesize, that motor neurorehabilitation of hemiparesis could be related to simultaneous improvement in aphasia. OBJECTIVE: To measure changes in post-stroke aphasia and its relation with hemiparesis treated with different therapies. METHODS: Database information (n = 32) on post-stroke hemiparesis (Fugl-Meyer Scale evaluated) managed with virtual reality (VR) versus modified constraint-induced movement therapy (mCIMT) or regular therapy (rPT/OT) was analyzed. None received logotherapy (LT) by appointment at four months. INCLUSION CRITERIA: < 3 months after the stroke, aphasia severe (Boston Aphasia Intensity Scale), and all three evaluations. RESULTS: Twenty-one patient records met inclusion criteria (71,4% women and mean age 66,67±3,13 years) who received VR, mCIMT, or rPT/OT (n = 6, 8, and 7, respectively). There was continuous intra-groups improvement in aphasia (p < 0.05), but inter-groups the greater aphasia recovery (p = 0.05) and hemiparesis (p = 0.02) were in VR, with a high correlation in evolution between them (r = 0.73; p = 0.047). CONCLUSION: High clinical correlation between aphasia, without LT, and hemiparesis evolution during motor neurorehabilitation would support common neural connections stimulation. We will conduct a clinical trial, with a larger sample size to contrast our hypothesis.

Acute Leukemia Relapse after Hematopoietic Stem Cell Transplantation: The Good, the Bad, and the Ugly of Isolated Extramedullary Relapse in a Latin American Population.

Hematopoietic stem cell transplantation (HSCT) is an effective therapy for acute leukemia (AL). Relapse represents the main cause of mortality. Isolated extramedullary relapse (iEMR) is atypical and has been related to better outcomes. Here we describe the clinical characteristics and outcomes of AL relapse after HSCT in our study population and analyze the impacts of different types of relapse on survival outcomes. This retrospective, multicenter study included 124 patients age ≥15 years with AL who underwent HSCT between 2004 and 2019. At diagnosis, 66.1% of the patients had lymphocytic AL, 19.7% presented with high-risk features, and 18.5% had extramedullary disease (EMD). At HSCT, 83.1% of the patients were in complete remission (CR), and 44.8% had negative measurable residual disease (MRD). The vast majority of donors were related (96%), including 48.4% HLA-matched and 47.6% haploidentical. Myeloablative conditioning was provided to 80.6% of patients. The median overall survival (OS) was 15 months (95% confidence interval [CI] 9.9 to 20.1 months). Factors associated with improved OS were adolescent and young adult (AYA) patient (P = .035), first or second CR (P = .026), and chronic graft-versus-host disease (GVHD) (P < .001). Acute GVHD grade III-IV (P = .009) was associated with increased mortality. The median relapse-free survival was 13 months (95% CI, 7.17 to 18.8 months); early disease status (P = .017) and chronic GVHD (P < .001) had protective roles. Sixty-eight patients (55%) relapsed after HSCT, with a median time to relapse of 6 months (95% CI, 3.6 to 8.4 months). iEMR was reported in 16 patients (23.5%). The most commonly involved extramedullary sites were the central nervous system and skin. Compared to patients with bone marrow relapse, all patients with iEMR had a diagnosis of acute lymphoid leukemia (P = .008), and 93.8% belonged to the AYA group; regarding pre-HSCT characteristics, iEMR patients had higher rates of negative MRD (P = .06) and a history of EMD (P = .009). Seventy-seven percent of relapsed patients received additional treatment with curative intent. The median OS after relapse (OSr) was 4 months (95% CI, 2.6 to 5.4 months). Factors related to increased OSr included lymphoid phenotype (P = .03), iEMR (P = .0042), late relapse (≥6 months) (P = .014), receipt of systemic therapy including second HSCT (P < .001), and response to therapy (P < .001). Rates of relapse and iEMR were higher than those previously reported in other studies. Advanced disease, reduced-intensity conditioning, and a diminished graft-versus-leukemia effect were factors influencing these findings. At relapse, presenting with iEMR after 6 months and receiving intensive therapy with adequate response were associated with better outcomes. Our results strongly suggest that a personalized approach to treating patients with HSCT is needed to counterbalance specific adverse factors and can positively impact clinical outcomes.

Nonequilibrium velocity fluctuations and energy amplification in planar Couette flow.

In this paper we investigate intrinsic thermally excited nonequilibrium velocity fluctuations in laminar planar Couette flow. For this purpose we have complemented the solution of the stochastic Orr-Sommerfeld equation for the intensity of the fluctuations of the wall-normal velocity, presented in a previous publication, with a solution of the stochastic Squire equation for the intensity of the fluctuations of the wall-normal vorticity. We have obtained exact solutions of these equations without boundary conditions and solutions in a Galerkin approximation when appropriate boundary conditions are included. These results enable us to make a quantitative assessment of the intensity of these nonequilibrium fluctuations, as well as of the related energy amplification, which are always present, even in the absence of any externally imposed noise.

Propagating modes in a binary liquid mixture under thermal stress.

Nonequilibrium temperature and concentration fluctuations inside a binary liquid mixture under the action of a temperature gradient relax back to equilibrium either due to conduction and diffusion at large wave numbers, or due to the quenching determined by gravity at small wave numbers. We investigate the dynamics of nonequilibrium fluctuations in a binary liquid mixture of polystyrene and toluene heated from above under stationary conditions in a thermodiffusion experiment. We show that the strong gravitational stabilization at small wave numbers determines the appearance of propagating modes of nonequilibrium fluctuations as detected through the structure function of shadowgraph images. The propagating modes are the combined effect of temperature and velocity nonequilibrium fluctuations induced by the buoyancy force. The experimental results are in good agreement with a fluctuating hydrodynamics theroretical model including the coupling of fluctuations of velocity, temperature and concentration.

Transverse-velocity fluctuations in a liquid under steady shear.

We present an analysis of the transverse-velocity fluctuations in an isothermal liquid layer with a uniform shear rate between two parallel horizontal boundaries as a function of the wave number and the Reynolds number. The results were obtained by solving a stochastic version of the Orr-Sommerfeld equation subject to no-slip boundary conditions in a second-order Galerkin approximation. We find that the spatial Fourier transform of the transverse-velocity fluctuations exhibits a maximum as a function of the (horizontal) wave number q(parallels). This maximum is associated with a crossover from a q(parallels)(-4) dependence for larger q(parallels) to a q(parallels)(2) dependence for small q(parallels). The q(parallels)(-4) dependence at larger wave numbers is independent of the boundary conditions, but the small- q(parallels) behavior is strongly affected by the boundary conditions. The nonequilibrium enhancement of the intensity of the transverse-velocity fluctuations remains finite for all values of the Reynolds number, but increases approximately with the square of the Reynolds number. The relation between our results and those obtained by previous authors in the absence of boundary conditions is elucidated.

Experiencia en bypass gástrico reseccional laparoscópico en pacientes con obesidad mórbida. Primer estudio en Venezuela / Experience in laparoscopic resectional gastric bypass in patients with morbid obesity. First study in Venezuela

El Bypass Gástrico Reseccional, consiste en realizar gastrectomía casi total más anastomosis gastro-yeyunal, con las desventajas de no ser reversible, y disminuir la absorción de los elementos que requieren ácidos gástricos. Objetivo: Describir la experiencia en Bypass Gástrico Reseccional Laparoscópico en pacientes con Obesidad Mórbida, intervenidos en el Centro Quirúrgico Carabobo 200 y en el Instituto Docente de Urología, Carabobo ­ Venezuela, durante el periodo comprendido entre enero ­ diciembre 2.021. Materiales: Investigación descriptiva, retrospectiva, longitudinal y multicéntrica, no probabilístico, comprendiendo 3 pacientes. Se utilizó una ficha de recolección de datos confeccionada para tal fin que incluyó datos clínicos y de laboratorio, previos y posterior a la cirugía, siendo evaluados a los 3, 6 y 12 meses respectivamente. Resultados: Causa más frecuente: presencia de lesiones gástricas benignas en 66.66% de los casos, y falla de técnica bariátrica primaria en 33.33%. Todos los pacientes del estudio presentaban comorbilidades cardiovasculares y metabólicas, siendo las más relevantes; Hipertensión Arterial Sistémica 100%, resistencia a insulina 66.66%, apnea del sueño 66.66% y Diabetes Mellitus tipo 2, en 33.33%. Conclusiones: El Bypass Gástrico Reseccional Laparoscópico tiene buenos resultados en pacientes obesos, con riesgo a desarrollar cáncer gástrico y en fallo de técnica primaria. No hubo complicación transoperatoria. La pérdida de exceso de peso fue exitosa (promedio 85.78% al año). Solo 1 caso presentó complicación postoperatoria tardía de anemia leve con diagnóstico y resolución oportuna. No se evidenciaron otras complicaciones(AU)

The Resectional Gastric Bypass consists of performing almost total gastrectomy plus gastro-jejunal anastomosis, with the disadvantages of not being reversible, and decreasing the absorption of elements that require gastric acids. Objective: To describe the experience in Laparoscopic Resectional Gastric Bypass in patients with Morbid Obesity, operated on at the Carabobo 200 Surgical Center and at the Teaching Institute of Urology, Carabobo - Venezuela, during the period between January - December 2021. Materials: Descriptive, retrospective, longitudinal, and multicenter, non-probabilistic research, involving 3 patients. A data collection sheet prepared for this purpose was drawn up, which included clinical and laboratory data, before and after surgery, being evaluated at 3, 6 and 12 months respectively. Results: Most frequent cause: presence of benign gastric lesions in 66.66% of cases, and primary bariatric technique failure in 33.33%. All the patients in the study presented cardiovascular and metabolic comorbidities, being the most relevant; Systemic Arterial Hypertension 100%, insulin resistance 66.66%, sleep apnea 66.66% and Diabetes Mellitus type 2, in 33.33%. Conclusions: Laparoscopic Resectional Gastric Bypass has good results in obese patients, at risk of developing gastric cancer and in primary technique failure. There were no intraoperative complications. Excess weight loss was successful (average 85.78% per year). Only 1 case presented late postoperative complication of mild anemia with timely diagnosis and resolution. No other complications were found(AU)

Thermodiffusion in multicomponent n-alkane mixtures.

Compositional grading within a mixture has a strong impact on the evaluation of the pre-exploitation distribution of hydrocarbons in underground layers and sediments. Thermodiffusion, which leads to a partial diffusive separation of species in a mixture due to the geothermal gradient, is thought to play an important role in determining the distribution of species in a reservoir. However, despite recent progress, thermodiffusion is still difficult to measure and model in multicomponent mixtures. In this work, we report on experimental investigations of the thermodiffusion of multicomponent n-alkane mixtures at pressure above 30 MPa. The experiments have been conducted in space onboard the Shi Jian 10 spacecraft so as to isolate the studied phenomena from convection. For the two exploitable cells, containing a ternary liquid mixture and a condensate gas, measurements have shown that the lightest and heaviest species had a tendency to migrate, relatively to the rest of the species, to the hot and cold region, respectively. These trends have been confirmed by molecular dynamics simulations. The measured condensate gas data have been used to quantify the influence of thermodiffusion on the initial fluid distribution of an idealised one dimension reservoir. The results obtained indicate that thermodiffusion tends to noticeably counteract the influence of gravitational segregation on the vertical distribution of species, which could result in an unstable fluid column. This confirms that, in oil and gas reservoirs, the availability of thermodiffusion data for multicomponent mixtures is crucial for a correct evaluation of the initial state fluid distribution.