Predicting Pharmacist Dispensing Practices and Comfort Related to Pre-exposure Prophylaxis for HIV Prevention (PrEP).

To identify factors associated with pharmacist dispensing practice and comfort counseling patients about pre-exposure prophylaxis for HIV prevention (PrEP). Cross-sectional 2016 census of Indiana managing pharmacists measured PrEP awareness, comfort dispensing and counseling patients. Modified Poisson models with robust error variance estimated relative risks and confidence intervals. 15.8% of 284 pharmacists had dispensed PrEP and 11.6% had consulted about it. Dispensing and comfort counseling were associated with confidence in knowledge about PrEP medication adherence and adverse effects of PrEP medication; awareness about PrEP before the survey, number of full time pharmacists in their pharmacy, and increases in new HIV cases from 2015 to 2016 in communities served. Comfort counseling about PrEP was associated with the belief that pharmacists can be an important resource for HIV and HCV treatment.

Spectrum of findings in a family with nonsyndromic autosomal dominant supravalvular aortic stenosis: a Doppler echocardiographic study.

Nonsyndromic familial supravalvular aortic stenosis is an autosomal dominant disorder. However, for many reported families, systematic study of all family members with echocardiographic or hemodynamic techniques has not been performed and degree of penetrance has not been assessed. The supravalvular stenosis in these family members usually is not associated with mental retardation or other characteristics of Williams syndrome. Although some believe that autosomal dominant supravalvular aortic stenosis is part of the spectrum of Williams syndrome, others believe that these are separate entities. Doppler echocardiograms were analyzed on 23 members of a 34 member family with several known to have supravalvular aortic stenosis; 20 studies were performed by the authors and 3 were done elsewhere and made available for review. No family member had mental retardation, characteristic facies or other findings of Williams syndrome. Three of the 34 had supravalvular aortic stenosis requiring surgery. Of 22 members examined echocardiographically who had not had prior surgical repair, 13 had supravalvular aortic stenosis. Echocardiographic findings ranged widely, from calcification of the ascending aorta in a 71 year old man with minimally increased flow velocity (1.7 m/s) to mild narrowing with mildly increased flow velocity in six members to significant narrowing with impressively increased flow velocity (2 to 4 m/s) in seven. In addition, four patients had mild narrowing of pulmonary artery branches and eight had peak pulmonary artery flow velocity above normal. This study demonstrates complete penetrance with extremely variable expression in this family with autosomal dominant supravalvular aortic stenosis and emphasizes the importance of using echocardiographic techniques in studying the family members who are suspected of having an inherited cardiovascular disease.

Triglyceride and cholesterol concentrations in whole serum and in serum lipoproteins in Reye syndrome.

Triglyceride and cholesterol concentrations in whole serum and in the serum lipoprotein fractions were measured during the course of hospitalization in six patients with Reye syndrome, four of whom survived. Very low density lipoprotein (VLDL) triglycerides were significantly lower on admission than on the last day of hospitalization. However, no VLDL triglyceride value was below the normal range. Triglyceride transport was increased in low density lipoprotein (LDL) and high density lipoprotein (HDL) fractions. LDL and HDL cholesterol concentrations were low on admission and decreased further during hospitalization. The changes in LDL and HDL cholesterol concentrations were more severe among nonsurvivors. No HDL cholesterol was detected in nonsurvivors on the last day of hospitalization. These results suggest that decreased VLDL triglycerides may not play an important role in the development of fatty liver and that decreased LDL and HDL cholesterol concentrations may be of prognostic value in Reye syndrome.

Percutaneous carciac catheterization of the neonate.

A modified Seldinger percutaneous approach for catheterization was used for cardiac evaluation and monitoring of infants weighing less than 4,520 gm. From January 1968, through April 1971, 160 left- and 230 right-sided cardiac procedures were done. After July 1969 81% of all left-and 42% of all right-sided procedures were done percutaneously. After October 1969 catheters were also inserted percutaneously in 20 infants for intensive care monitoring. During this period three children were noted to have dimished pulse on discharge, two were noted to have vascular thrombosis, and two had episodes of bleeding from the catheter site requiring transfusion of fresh blood. Both instances of vascular thrombosis occurred in infants with monitoring catheters. The percutaneous method of catheter insertion into the femoral vessels offers a safe method for cardiac catheterization of the neonate and of insertion of monitoring catheters where the umbilical route is not feasible. Vessel continuity is also preserved, providing a route for repeated studies if necessary.

Deletion of the distal long arm of chromosome 1: a definable syndrome.

Based on analysis of 15 cases, there appears to be a characteristic facial appearance and pattern of associated malformations that would allow clinical delineation of deletion of the distal bands of 1q. Characteristic manifestations include round face with prominent "cupid's bow" and downturned corners of the mouth, thin vermilion borders of lips, long upper lip with smooth philtrum, short and broad nose, epicanthal folds, apparently low-set ears, micrognathia, microcephaly, abnormal hands and feet, variable cardiac, genital, and other anomalies, moderate to severe mental retardation, and growth retardation. The deletion includes 1q42 or 1q43----qter and was a de novo defect in nine of 15 cases.

Autosomal dominant supravalvular aortic stenosis: large three-generation family.

Supravalvular aortic stenosis (SVAS) can be inherited as an isolated autosomal dominant trait or can be a component manifestation of the Williams syndrome. Some consider the Williams syndrome to be due to more severe expression of the gene defect that causes isolated SVAS. We describe a family with isolated SVAS that is the largest thoroughly studied family with this disorder to our knowledge; no patients in this family had Williams syndrome. Five members of this family were reported by Lewis et al. (Dis Chest 55:372-379, 1969). We reevaluated this family and now include examinations of the parents, additional sibs and children of the original 5 patients. Twenty relatives had physical and echocardiographic examinations. In addition, information from outside sources was obtained on 7 relatives not personally evaluated. The SVAS showed marked variability of expression and was not associated with mental retardation or with the facial manifestations of Williams syndrome. We think that previous reports of Williams syndrome reputedly occurring within the same family as isolated autosomal dominant SVAS were inadequately documented. Based on our family and review of the literature, we suggest that isolated SVAS and Williams syndrome represent clinically distinct entities.

Aortitis and large vessel arteritis in a newborn.

Disseminated arteritis with extensive involvement of the aorta, as well as involvement of the arch vessels, coronary arteries, and pulmonary arteries, but not of the arteries within the liver, spleen, kidneys, or other organs, is unusual in a newborn. The presence of both acute and chronic inflammation with fibrosis, as well as calcification and focal ossification in the aorta, would suggest that the process had been present for some time before birth. This lesion should be described rather than designated by an eponym or included with such entities as Takayasu's disease. An additional finding of interest was widespread calcification in Bowman's capsules of numerous glomeruli.

Autumn stomatal closure in six conifer species of the Central Rocky Mountains.

Environmental and water relations parameters during fall were monitored for six conifer tree species common to the central Rocky Mountains growing naturally at the same location (Pinus contorta, Pinus ponderosa, Pinus flexilus, Pseudotsuga menziesii, Abies lasiocarpa, Picea engelmannii). Subsequent to what appeared to be the beginning of seasonal stomatal closure, leaf conductance to water vapor declined sharply following the onset of freezing air temperatures at night. A coincident rapid decline in morning xylem pressure potentials (ψp) also occurred which resulted in values that were considerably below afternoon ψp. Continuing decreases in maximum leaf conductance during the day were highly correlated with corresponding decreases in minimum nocturnal air temperatures of the preceding night. By mid-December, morning ψp returned to values very near afternoon ψp and were only slightly lower than before the onset of subfreezing nights. A preliminary model is proposed which interprets the qualitative interaction between air and soil temperatures, soil and plant water potentials, and leaf conductance during seasonal stomatal closure in fall.

Obtaining the four-chamber view to diagnose fetal cardiac anomalies.

Four-chamber view screening of the fetal heart was greeted with significant optimism in the mid-1980s. This screening technique was initially expected to detect most congenital heart disease in utero; however, recent studies demonstrate a 4% to 40% sensitivity of four-chamber view screening. It is therefore probable that the dream of antepartum diagnosis of most congenital heart disease in utero will remain unfulfilled. This is particularly true with increasing funding constraints for health care provision imposed by both the federal government and third-party payors.

The microcomputer as a clinical research tool.

A microcomputer system has been developed for clinical perinatal-neonatal research. This system is composed of commercially available hardware and software that is readily available, relatively inexpensive, and easy to learn to use. Systems like this permit compilation of data, statistical analysis, and the possibility of intercommunication with other microcomputers and mainframe systems in collaborative research endeavors. Further, microcomputer systems allow investigators immediate access to data and data analysis within their own offices.

Retrograde catheterization of the pulmonary veins following surgical correction of transposition of the great vessels.

Prior to a Mustard repair for transposition of the great vessels, complete physiologic data of the pulmonary bed can be obtained by catheterization of the pulmonary artery with a "J" formed wire, and direct catheterization of the pulmonary veins via an atrial septal defect. Following "physiologic" repair ready access to the pulmonary veins is denied. Evaluation of the pulmonary venous pressure is of great importance, however, in differentiating pulmonary vascular disease from pulmonary hypertension secondary to patch obstruction of pulmonary venous return. This paper describes a technique of catheterization of the pulmonary veins following a Mustard repair for TGV.

Persistent left superior vena cava and associated structural and functional considerations.

Potentially significant associations are presented between anomalous systemic venous return (including both left superior vena cava and left hepatic venous drainage to the coronary sinus), a history of atrial fibrillation and a forme fruste of cor triatriatum in an elderly woman. Lack of associated structural defects or functional deficits makes it difficult to assess the frequency of occurrence in the general population of bilateral superior venae cavae in association with a persistent left hepatic vein draining into the coronary sinus. However, the potential for these systemic venous anomalies needs to be considered when unexplained arrhythmias are encountered. More specifically, the size of the coronary sinus needs to be assessed in patients with arrhythmia.

Flowers produce variations in color saturation by arranging petals at oblique and varying angles.

Large color variations can be observed across the face of a flower even when individual petals are the same color. We investigated whether these color variations could be explained by a model that incorporates multiple reflections of light between petals and transmissions of light through petals before the light returns to the observer. The three flowers that we selected for the study exhibited large color variations across the face of the intact flower but had no significant observable difference in color saturation across a single petal or between petals when petals were removed from the flower. We used a spectroradiometer to measure the spectrum across the faces of intact flowers and across individual petals. The measured spectra for all of the flowers were consistent with the proposed model.

Longitudinal dental arch changes in adults.

This study examined changes in the dental arches that occur in untreated persons between late adolescence and the fifth or sixth decade of life. Longitudinal dental casts from 82 subjects were obtained as part of a recall study of subjects from the University of Michigan Elementary and Secondary School Growth Study. From the parent sample, three groups were identified. The untreated sample comprised 53 subjects (27 males and 26 females). A midadult sample of 10 persons, who had an additional set of records taken on average during their fourth decade of life also was analyzed, as was a sample of 13 subjects who received orthodontic treatment as adolescents and were about 30 years posttreatment. Measures of dental arch width, arch depth, and arch perimeter were evaluated with the aid of digital-imaging hardware and software. Incisor irregularity, curve of Spee, overjet, and overbite were measured directly from the dental casts. Statistically significant decrements occurred in arch width, depth, and perimeter. The mean decrement in any one dimension was less than 3 mm. At all times, males displayed significantly more mandibular incisor irregularity than females. In addition, the increase in mandibular incisor irregularity that occurred in male and female subjects was the same. However, irregularity did not increase in all subjects; it decreased in 3% of the males and 7% of the females. In general, overbite, overjet, and curve of Spee were stable during adulthood. Statistically significant correlations between the changes in dental arch measures could not be established.

Leaf optical properties in higher plants: linking spectral characteristics to stress and chlorophyll concentration.

A number of studies have linked responses in leaf spectral reflectance, transmittance, or absorptance to physiological stress. A variety of stressors including dehydration, flooding, freezing, ozone, herbicides, competition, disease, insects, and deficiencies in ectomycorrhizal development and N fertilization have been imposed on species ranging from grasses to conifers and deciduous trees. In all cases, the maximum difference in reflectance within the 400-850 nm wavelength range between control and stressed states occurred as a reflectance increase at wavelengths near 700 nm. In studies that included transmittance and absorptance as well as reflectance, maximum differences occurred as increases and decreases, respectively, near 700 nm. This common optical response to stress could be simulated closely by varying the chlorophyll concentration of model leaves (fiberglass filter pads) and by the natural variability in leaf chlorophyll concentrations in senescent leaves of five species. The optical response to stress near 700 nm, as well as corresponding changes in reflectance that occur in the green-yellow spectrum, can be explained by the general tendency of stress to reduce leaf chlorophyll concentration.

Influence of shoot structure on light interception and photosynthesis in conifers.

The influence of shoot structure on net photosynthesis was evaluated under field conditions for the central Rocky Mountain (United States) conifers Picea engelmannii (Parry ex Engelm.), Abies lasiocarpa ([Hook] Nutt.), and Pinus contorta (Engelm.). In all species, the greater number of needles per unit stem length on sun shoots correlated with a smaller silhouette leaf area to total leaf area ratio (STAR). Decreased STAR was due primarily to greater needle inclination toward the vertical, plus some needle mutual shading. However, photosynthesis expressed on a total leaf area basis did not decrease in sun shoots (lower STAR) but remained nearly constant at approximately 3 micromoles per square meter per second over a wide range of STAR (0.1 to 0.3). Relatively low light saturation levels of 200 to 1400 microeinsteins per square meter per second and diffuse light to 350 microeinsteins per meter per second maintained photosynthetic flux densities in inclined and/or shaded needles at levels comparable to those in unshaded needles oriented perpendicular to the solar beam. As a result, net CO(2) uptake per unit stem length increased as much as 2-fold in sun shoots (low STAR) in direct proportion to increasing needle density.

The cholesterol turnover, synthesis, and absorption in two sisters with familial hypercholesterolemia (type IIa).

To explore the mechanisms of the profound plasma cholesterol elevations in familial homozygous hypercholesterolemia (type IIa), cholesterol turnover, sterol balance, cholesterol absorption, and low density lipoprotein studies were carried out under controlled dietary conditions in two sisters (aged 13 and 16). Cholesterol turnover was prolonged. The half-life of the first exponential of the plasma cholesterol specific activity decay curve was double that of normal adults. The rate constants for the removal of cholesterol from pool A (KAA = 0.0652) and for the excretion of cholesterol from the system (Kaa = 0.0197) were less than half of normal. The production rates of cholesterol were low, only 6.30 and 6.86 mg/kg per day as measured by cholesterol turnover and sterol balance techniques, respectively. Fecal neutral steroid and bile acid excretion were 5.22 and 1.64 mg/kg per day, which is remarkably low in comparison to those of normal and heterozygous children. Cholesterol absorption was within the upper limit of the values reported for normal adults. THE HDL cholesterol values were extremely low (27 mg/dl) in contrast to profoundly elevated LDL levels. The fractional catabolic rate of LDL (0.127 per day) and the rate of synthesis and catabolism of apo-LDL (15 mg/kg per day) were low in comparison to previously reported values in homozygotes. These composite data indicated that the definable metabolic defects of these two sisters with homozygous familial hypercholesterolemia were the sluggish clearance of cholesterol from the body coupled with low total body synthesis of cholesterol.