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Long-term hepatitis B and liver outcomes among adults taking tenofovir-containing antiretroviral therapy for HBV/HIV coinfection in Zambia.
No full textBACKGROUND
Long-term outcomes of tenofovir-containing antiretroviral therapy (ART) for HBV/HIV coinfection were evaluated in Zambia.
METHODS
A prospective cohort of adults with HIV and hepatitis B surface antigen (HBsAg)-positivity was enrolled at ART (included tenofovir DF + lamivudine) initiation. On therapy, we ascertained HBV viral load (VL) non-suppression, ALT elevation, serologic end-points, progression of liver fibrosis, based on elastography, and hepatocellular carcinoma (HCC) incidence. We also described a subgroup (low HBV VL and no/minimal fibrosis at baseline) that, under current international guidelines, would not have been treated in the absence of their HIV infection.
RESULTS
Among 289 participants, at ART start, median age was 34 years, 40·1% were women, median CD4 count was 191 cells/mm3, 44·2% were hepatitis B e antigen-positive, and 28·4% had liver fibrosis/cirrhosis. Over median 5.91 years of ART, 13·6% developed HBV viral non-suppression, which was associated with advanced HIV disease. ALT elevation on ART was linked with HBV VL non-suppression. Regression of fibrosis and cirrhosis were common, progression to cirrhosis was absent, and no cases of HCC were ascertained. HBsAg seroclearance was 9·4% at 2 and 15·4% at 5 years, with higher rates among patients with low baseline HBV replication markers.
DISCUSSION
Reassuring long-term liver outcomes were ascertained during tenofovir-based ART for HBV/HIV coinfection in Zambia. Higher than expected HBsAg seroclearance during ART underscores the need to include people with HIV in HBV cure research
We're implementing AI now, so why not ask us what to do? - How AI providers perceive and navigate the spread of diagnostic AI in complex healthcare systems.
Get PDFDespite high expectations of artificial intelligence (AI) in medical diagnostics, predictions of its extensive and rapid adoption have so far not been matched by reality. AI providers seeking to promote and perpetuate the use of this technology are faced with the complex reality of embedding AI-enabled diagnostics across variable implementation contexts. In this study, we draw upon a complexity science approach and qualitative methodology to understand how AI providers perceive and navigate the spread of AI in complex healthcare systems. Using semi-structured, one-to-one interviews, we collected qualitative data from 14 providers of AI-enabled diagnostics. We triangulated the data by complementing the interviews with multiple sources, including a focus group of physicians with experience using these technologies. The notion of embedding allowed us to connect local implementation efforts with systemic diffusion. Our study reveals that AI providers self-organise to increase their adaptability when navigating the variable conditions and unpredictability of complex healthcare contexts. In addition to the tensions perceived by AI providers within the sociocultural, technological, and institutional subsystems of healthcare, we illustrate the practices emerging among them to mitigate these tensions: stealth science, agility, and digital ambidexterity. Our study contributes to the growing body of literature on the spread of AI in healthcare by capturing the view of technology providers and adding a new theoretical perspective through the lens of complexity science
A general framework to quantify the event importance in multi-event contests
Get PDFWe propose a statistical framework for quantifying the importance of single events that do not
provide intermediate rewards but offer implicit incentives through scheduling and the reward
structure at the end of a multi-event contest. Applying the framework to primary elections in
the US, where earlier elections have greater importance and influence, we show that schedule
variations can mitigate the problem of front-loading elections. When applied to European
football, we demonstrate the utility and meaningfulness of quantified event importance in
relation to the in-match performance of contestants to improve outcome prediction and to
provide an early indication of public interest
Reproductive geopolitics: Governing in/fertile bodies in Mexico’s past and present
No full textBuilding on work in feminist geopolitics, we discuss how the governance of in/fertility affects the
value assigned to different bodies and the question whose bodies and lives are considered as worthy
of reproducing in Mexico. To reveal the geopolitical entanglements of past and present forms of
reproductive governance, we investigate the transnational connections of Mexico’s fertility network
with Spain and the United States of America. We juxtapose visual materials from political
campaigns of the past with advertisements for present-day fertility clinics to trace the reproductive
geopolitics of (post)colonialism that shape current developments, practices, and discourses in this
transnational fertility network. Each pair of visuals exemplifies particular times and spaces of
reproductive geopolitics. The paper reveals how the contemporary Mexican fertility market is
shaped by transnational forms of reproductive governance. We employ visual juxtaposition to
provoke readers to think about the entanglement of present-day fertility markets with past reproductive
geopolitics
The 'Surprise question' in heart failure: a prospective cohort study.
Get PDFOBJECTIVE
The Surprise Question (SQ) is a prognostic screening tool used to identify patients with limited life expectancy. We assessed the SQ's performance predicting 1-year mortality among patients in ambulatory heart failure (HF) clinics. We determined that the SQ's performance changes according to sex and other demographic (age) and clinical characteristics, mainly left ventricular ejection fraction (LVEF) and the New York Heart Association (NYHA) functional classifications.
METHODS
We conducted a prospective cohort study in two HF clinics. To assess the performance of the SQ in predicting 1-year mortality, we calculated the sensitivity, specificity, positive and negative likelihood ratios, and the positive and negative predictive values. To illustrate if the results of the SQ changes the probability that a patient dies within 1 year, we created Fagan's nomograms. We report the results from the overall sample and for subgroups according to sex, age, LVEF and NYHA functional class.
RESULTS
We observed that the SQ showed a sensitivity of 85% identifying ambulatory patients with HF who are in the last year of life. We determined that the SQ's performance predicting 1-year mortality was similar among women and men. The SQ performed better for patients aged under 70 years, for patients with reduced or mildly reduced ejection fraction, and for patients NYHA class III/IV.
CONCLUSIONS
We consider the tool an easy and fast first step to identify patients with HF who might benefit from an advance care planning discussion or a referral to palliative care due to limited life expectancy
Breaking out of the ‘prisoner of love’ dilemma: Infrastructures of solidarity for live-in care workers in Switzerland
No full textIn this chapter, I take the situation of live-in care workers in Switzerland as a starting point to explore the conditions under which collective forms of claiming rights and self-organization can become possible. I therefore examine practices of solidarity, relationships and the transfer of knowledge (for instance, concerning rights) in specific spaces in Switzerland. To analyse the convergence of practices of solidarity, I propose the concept of an ‘infrastructure of solidarity’ (Schilliger, 2020) and highlight four components that are key to the examined concept: a) spatial configurations and the creation of counter-spaces, b) political practices of solidarity work and alliance building, c) the formation of (often invisible) solidarity-based relations and care practices in everyday life, and d) mental infrastructures, that is, the sharing of knowledge and the production of collective awareness. This concept provides a way of exploring how practices of solidarity may become sedimented in time and space, and how broader relationships, networks and alliances with civil society actors, social movements and institutions can be built. Thus, my theoretically informed empirical analysis tries to identify elements and conditions for successful solidarity and collective action in the field of transnational care work in private households. It contributes to a better understanding of how unions and activists can draw on existing forms of solidarity and community to potentially adjust or start their organizing and campaigning work within this sector
Effect of incisal preparation design on the fracture strength of monolithic zirconia-reinforced lithium silicate laminate veneers.
Get PDFPURPOSE
This study aimed to assess the fracture resistance of monolithic zirconia reinforced-lithium silicate laminate veneers (LV) fabricated on various incisal preparation designs.
MATERIALS AND METHODS
Sixty maxillary central incisors with various preparation designs were 3D-printed, 15 each, including preparation for: 1) LV with feathered edge design; 2) LV with butt joint design; 3) LV with palatal chamfer; and 4) full-coverage crown. Restorations were then designed and manufactured from zirconia-reinforced lithium silicate (ZLS) following the contour of a pre-operation scan. Restorations were bonded to the assigned preparation using resin cement and following the manufacturer's instructions. Specimens were then subjected to 10,000 thermocycles at 5°C to 55°C with a dwell time of 30 seconds. The fracture strength of specimens was then assessed using a universal testing machine at a crosshead speed of 1.0 mm/min. One-way ANOVA and Bonferroni correction multiple comparisons were used to assess the fracture strength differences between the test groups (α = 0.001). Descriptive fractographic analysis of specimens was carried out with SEM images.
RESULTS
Complete coverage crown and LV with palatal chamfer design had the highest fracture resistance values (781.4 ± 151.4 N and 618.2 ± 112.6 N, respectively). Single crown and LV with palatal chamfer had no significant difference in fracture strength (p>.05). LV with feathered edge and butt joint designs provided significantly (p<.05) lower fracture resistance than complete coverage crown and LV with palatal chamfer design.
CONCLUSION
The fracture resistance of chairside milled ZLS veneers was significantly influenced by the incisal preparation designs tested. Within the limitation of this study, when excessive occlusal forces are expected, LV with palatal chamfer display is the most conservative method of fabricating an indirect restoration. This article is protected by copyright. All rights reserved
Differential outcomes of outpatient only versus combined inpatient/outpatient treatment in early intervention for adolescent borderline personality disorder.
Get PDFClinical guidelines for adults with borderline personality disorder (BPD) recommend outpatient psychotherapy as first-line treatment. Little is known whether this recommendation is also applicable to adolescents. The current study examined the relationship between treatment setting and the outcome of early intervention for adolescents with BPD pathology. One-hundred and seventy-eight adolescents from a specialized outpatient clinic were assessed at baseline, and at 1- and 2-year follow-up. Sixty-three participants who received inpatient treatment during the first year were assigned to the "combined inpatient/outpatient group", 115 participants to the "outpatient only group". Generalized linear and mixed models with inverted probability weights to adjust for baseline differences were applied to examine the impact of group on clinical changes over time. Both groups demonstrated a significant decrease in BPD features, depressive symptoms, psychopathological distress, non-suicidal self-injury (NSSI), suicidal thoughts, suicide attempts, and overall illness severity, and a significant increase in quality of life and psychosocial functioning from baseline to follow-up 2. The decrease in NSSI and overall illness severity, and the increase in psychosocial functioning from baseline to follow-up 1 were greater in the outpatient only group, with comparable improvements between groups from follow-up 1 to follow-up 2. Both outpatient treatment and combined outpatient/inpatient treatment resulted in clinical improvements over time, with some indication for faster changes in the outpatient only setting. The findings provide preliminary evidence that the recommendation of outpatient psychotherapy as the first-line treatment for BPD also holds true for adolescents
Fragility in the Encounter with the Divine: from Plato to Gregory of Nyssa and Augustine
No full textThis paper investigates the epistemic fragility in different renderings of the ascension to the divine, starting from Plato’s simile of the cave (Republic 514a–520a), and Plotinus’s ascension to the One (Enn. VI.9.2 – VI.9.4), which will be compared with the descriptions of visions in Gregory of Nyssa (The Life of Moses 373B-377C) and Augustine (Confessions VII.10.16 and IX.10.23-24). I focus on images of human weakness, failure and instability before the overwhelming and blinding light, and on the difficulty of communicating such an experience. I question how the epistemic fallibility is grounded in anthropological fragility and relates to moral impurity or imperfection; and compare and contrast the individual or communitarian aspects of these “ascensions” and their respective influence on the failure or stability of the vision
MRI 3D simulation of hip motion in female patients with and without ischiofemoral impingement.
No full textOBJECTIVE
To utilize hip MRI 3D models for demonstration of location and frequency of impingement during simulated range-of-motion in ischiofemoral impingement (IFI) compared to non-IFI hips.
MATERIALS AND METHODS
Sixteen hips (N = 7 IFI, 9 non-IFI) from 8 females were examined with high-resolution MRI. We performed image segmentation and generated 3D bone models and simulated hip range-of-motion and impingement. We examined the frequency and location of bone contact in early external rotation and early extension (0-20°), isolated maximum external rotation, and isolated maximum extension. Frequency and location of impingement at varied combinations of external rotation and extension and areas of simulated bone impingement at early external rotation and extension were compared between IFI and non-IFI.
RESULTS
Higher frequency of bony impingement occurred more often in IFI hips at each simulated range-of-motion combination (P < 0.05). Impingement involved the lesser trochanter more often in IFI hips (P < 0.001) and occurred at early degrees of external rotation and extension. In isolated maximum external rotation, only the greater trochanter, intertrochanteric area, or both combined were involved, in 14%, 57%, and 29% in IFI hips. In isolated maximum extension, the lesser trochanter, intertrochanteric area, or both combined were involved in 71%, 14%, and 14% in IFI hips. The simulated area of bone impingement was significantly higher in IFI hips (P = 0.02).
CONCLUSION
Hip MRI 3D models are feasible for simulated range-of-motion and show a higher frequency of extra-articular impingement at early stages of external rotation and extension in IFI compared to non-IFI hips
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