The Partners Demonstration Project is studying the use of antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) to prevent HIV among heterosexual couples in Kenya and Uganda. An ancillary study is evaluating the acceptability of HIV self-testing among individuals using PrEP in Kenya. Preliminary findings show high uptake of self-testing, with 96% of expected tests reported as used. Qualitative feedback indicates self-testing reduces anxiety and empowers individuals. Continued research will provide more data on experiences with self-testing and its potential as a cost-effective component of PrEP programs.
Phillip Keen (NAPWA) provides an update on the state of rapid testing in Australia in the context of the UNPD targets. This presentation was given at the AFAO/NAPWA Gay Men's HIV Health Promotion Conference in May 2012.
Phillip Keen (NAPWA) provides an update on the state of rapid testing in Australia in the context of the UNPD targets. This presentation was given at the AFAO/NAPWA Gay Men's HIV Health Promotion Conference in May 2012.
Reducing sitting time at work: What's the evidence?Health Evidence™
Health Evidence hosted a 60 minute webinar examining the effectiveness of workplace interventions for reducing sitting at work. Click here for access to the audio recording for this webinar: https://youtu.be/psmac6jkbMM
Dr. Nipun Shrestha, MBBS, MPH, Postgraduate Student at Victoria University led the session and presented findings from his recent Cochrane review:
Shrestha N, Kukkonen-harjula KT, Verbeek JH, Ijaz S, Hermans V, & Bhaumik S. (2016). Workplace interventions for reducing sitting at work. Cochrane Database of Systematic Reviews, 2016(3), Art. No.: CD010912.
http://healthevidence.org/view-article.aspx?a=workplace-interventions-reducing-sitting-work-28404
Office work has become sedentary in nature. Increased sitting has been linked to increase in cardiovascular disease, obesity and overall mortality. This review examines the impact of workplace interventions to reduce sitting at work. Two cross-over randomized control trials, 11 cluster randomized trials and 4 controlled before-and-after studies, including 2180 participants are included in this review. Findings suggest that sit-stand desks may decrease workplace sitting. This webinar examined the effectiveness and components of interventions that reduce sitting at work.
Sara Mathieu-C of the University of Montreal higlights the tensions between ethical recommendations and research priorities in a research study that uses technology to provide sexual health information of youth aged 17-24 yrs in Quebec. Presented at YTH Live 2014 session "Calling all HIV Providers: Resources and New Media for You."
Electronic cigarettes for smoking cessation: What's the evidence?Health Evidence™
Health Evidence hosted a 90 minute webinar examining the effectiveness of electronic cigarettes for smoking cessation.
Muhannad Malas and Robert Schwartz led the session and presented findings from their recent review:
Malas M, van der Tempel J, Schwartz R, Minichiello A, Lightfoot C, Noormohamed A, et al. (2016). Electronic cigarettes for smoking cessation: A systematic review. Nicotine & Tobacco Research, 18(10), 1926-1936.
http://healthevidence.org/view-article.aspx?a=electronic-cigarettes-smoking-cessation-systematic-review-29830
Cigarette smoking is among the top causes of preventable death and disease. Electronic cigarettes have been increasing in popularity among smokers who report using them for quitting or reducing smoking. This review examines the effectiveness of electronic cigarettes as cessation aids. Sixty two articles, including RCTs, experimental, longitudinal and cross sectional studies are included in this review. Findings suggest there is inconclusive evidence due to low quality of research. This webinar provides a comprehensive overview of current literature examining the effectiveness of electronic cigarettes for smoking cessation.
Decision aids for people facing health treatment or screening decisions: What...Health Evidence™
Dr. Dawn Stacey, University Research Chair in Knowledge Translation to Patients, and Director, Patient Decision Aids Research Group, Ottawa Hospital Research Institute, University of Ottawa, provides an overview of findings from her recent Cochrane review examining use of decision aids for identifying and making decisions about health treatment or screening options:
Stacey D, Legare F, Col NF, Bennett CL, Barry MJ, Eden KB, et al. (2014). Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews, 2014(1), CD001431.
Food supplementation programmes for improving the health of socio-economicall...Health Evidence™
Health Evidence hosted a 90 minute webinar examining the effectiveness of food supplementation programmes for improving the physical and psychosocial health of socio-economically disadvantaged children.
Dr. Elizabeth Kristjansson, Professor, School of Psychology, University of Ottawa, led the session and presented findings from her latest Cochrane review:
Kristjansson E., Francis D.K., Liberato S., Benkhalti J.M., Welch V., Batal M., et al. (2015). Food supplementation for improving the physical and psychosocial health of socio‐economically disadvantaged children aged three months to five years. Cochrane Database of Systematic Reviews,2015(2), Art. No.: CD009924
Undernutrition has contributed to the deaths of more than three million children in 2011. Evidence about the effectiveness of food supplementation interventions for young children is fundamentally important for governments, funding agencies, and children themselves. This review examines the effectiveness of supplementary food programmes for improving the health of disadvantaged children. 32 (21 RCTs and 11 CBAs) studies from mostly low- and middle- income countries are included in this review. In low- and middle-income countries, providing additional food to children aged three months to five years led to small gains in weight (0.24kg/year in RCTs and CBAs) and height (0.54cm/year in RCTs only), and moderate increases in haemoglobin. This webinar highlighted factors that contribute to the effectiveness of child supplementation programmes as well as implications for practice.
Project ECHO (Extension for Community Health Outcomes)icornpresentations
Sanjeev Arora MD, Distinguished Professor of Medicine (Gastroenterology/Hepatology); Director of Project ECHO®
Department of Medicine, University of New Mexico Health Sciences Center
This session will investigate the Recommendations made in the Lower-Risk Nicotine Use Guidelines (LRNUG). We will describe the methods used in the development of Guidelines where there is a lack of primary evidence and explore the importance of multiple iterations to improve the work as new evidence emerges. Finally we will explore how the Recommendations may be applied in practice.
Presentation by Dr Martin Myers MBE, PhD, FRCPath, Consultant Clinical Biochemist, Lancashire Teaching Hospitals NHS Foundation Trust at ECO 19: Care closer to home on Tuesday 9 July at Deepdale Stadium.
Infectious disease emergencies are opportunities to test the efficacy of newly developed interventions (e.g. drugs, vaccines and treatment regimens), yet they raise many intertwined challenges of politics, logistics, ethics, and study design. Consistent with the efforts of CEPI, WHO, and others to encourage development and Phase I/II testing of candidate vaccines (the focus of this talk) in advance of emergencies, it is essential before the emergency strikes to advance the discussion of how such products can and should be tested. This can help to disentangle ethical from political and logistical concerns, reduce the time pressure to make a decision, and encourage rational deliberation by future stakeholders who at the time of deliberation do not know what role (which product, which field site) they may be supporting in an actual emergency.
At this luncheon, Professor Marc Lipsitch described his work on computer simulation of vaccine trials during epidemics to assess options for trial design, as well as some of his recent work on the ethics of trials in emergencies, with the aim to stimulate discussion on the intersection of these two topics.
For more, please see our website: http://petrieflom.law.harvard.edu/events/details/digital-health-harvard-series-november-2018
A different perspective on hybrid cloud. EMCSocial
Take a look at all of the hand-drawn sketches of current issues surrounding hybrid cloud adoption and the evolution of enterprise IT, to illustrate the #HybridCloudChat: https://www.crowdchat.net/HybridCloudChat
Reducing sitting time at work: What's the evidence?Health Evidence™
Health Evidence hosted a 60 minute webinar examining the effectiveness of workplace interventions for reducing sitting at work. Click here for access to the audio recording for this webinar: https://youtu.be/psmac6jkbMM
Dr. Nipun Shrestha, MBBS, MPH, Postgraduate Student at Victoria University led the session and presented findings from his recent Cochrane review:
Shrestha N, Kukkonen-harjula KT, Verbeek JH, Ijaz S, Hermans V, & Bhaumik S. (2016). Workplace interventions for reducing sitting at work. Cochrane Database of Systematic Reviews, 2016(3), Art. No.: CD010912.
http://healthevidence.org/view-article.aspx?a=workplace-interventions-reducing-sitting-work-28404
Office work has become sedentary in nature. Increased sitting has been linked to increase in cardiovascular disease, obesity and overall mortality. This review examines the impact of workplace interventions to reduce sitting at work. Two cross-over randomized control trials, 11 cluster randomized trials and 4 controlled before-and-after studies, including 2180 participants are included in this review. Findings suggest that sit-stand desks may decrease workplace sitting. This webinar examined the effectiveness and components of interventions that reduce sitting at work.
Sara Mathieu-C of the University of Montreal higlights the tensions between ethical recommendations and research priorities in a research study that uses technology to provide sexual health information of youth aged 17-24 yrs in Quebec. Presented at YTH Live 2014 session "Calling all HIV Providers: Resources and New Media for You."
Electronic cigarettes for smoking cessation: What's the evidence?Health Evidence™
Health Evidence hosted a 90 minute webinar examining the effectiveness of electronic cigarettes for smoking cessation.
Muhannad Malas and Robert Schwartz led the session and presented findings from their recent review:
Malas M, van der Tempel J, Schwartz R, Minichiello A, Lightfoot C, Noormohamed A, et al. (2016). Electronic cigarettes for smoking cessation: A systematic review. Nicotine & Tobacco Research, 18(10), 1926-1936.
http://healthevidence.org/view-article.aspx?a=electronic-cigarettes-smoking-cessation-systematic-review-29830
Cigarette smoking is among the top causes of preventable death and disease. Electronic cigarettes have been increasing in popularity among smokers who report using them for quitting or reducing smoking. This review examines the effectiveness of electronic cigarettes as cessation aids. Sixty two articles, including RCTs, experimental, longitudinal and cross sectional studies are included in this review. Findings suggest there is inconclusive evidence due to low quality of research. This webinar provides a comprehensive overview of current literature examining the effectiveness of electronic cigarettes for smoking cessation.
Decision aids for people facing health treatment or screening decisions: What...Health Evidence™
Dr. Dawn Stacey, University Research Chair in Knowledge Translation to Patients, and Director, Patient Decision Aids Research Group, Ottawa Hospital Research Institute, University of Ottawa, provides an overview of findings from her recent Cochrane review examining use of decision aids for identifying and making decisions about health treatment or screening options:
Stacey D, Legare F, Col NF, Bennett CL, Barry MJ, Eden KB, et al. (2014). Decision aids for people facing health treatment or screening decisions. Cochrane Database of Systematic Reviews, 2014(1), CD001431.
Food supplementation programmes for improving the health of socio-economicall...Health Evidence™
Health Evidence hosted a 90 minute webinar examining the effectiveness of food supplementation programmes for improving the physical and psychosocial health of socio-economically disadvantaged children.
Dr. Elizabeth Kristjansson, Professor, School of Psychology, University of Ottawa, led the session and presented findings from her latest Cochrane review:
Kristjansson E., Francis D.K., Liberato S., Benkhalti J.M., Welch V., Batal M., et al. (2015). Food supplementation for improving the physical and psychosocial health of socio‐economically disadvantaged children aged three months to five years. Cochrane Database of Systematic Reviews,2015(2), Art. No.: CD009924
Undernutrition has contributed to the deaths of more than three million children in 2011. Evidence about the effectiveness of food supplementation interventions for young children is fundamentally important for governments, funding agencies, and children themselves. This review examines the effectiveness of supplementary food programmes for improving the health of disadvantaged children. 32 (21 RCTs and 11 CBAs) studies from mostly low- and middle- income countries are included in this review. In low- and middle-income countries, providing additional food to children aged three months to five years led to small gains in weight (0.24kg/year in RCTs and CBAs) and height (0.54cm/year in RCTs only), and moderate increases in haemoglobin. This webinar highlighted factors that contribute to the effectiveness of child supplementation programmes as well as implications for practice.
Project ECHO (Extension for Community Health Outcomes)icornpresentations
Sanjeev Arora MD, Distinguished Professor of Medicine (Gastroenterology/Hepatology); Director of Project ECHO®
Department of Medicine, University of New Mexico Health Sciences Center
This session will investigate the Recommendations made in the Lower-Risk Nicotine Use Guidelines (LRNUG). We will describe the methods used in the development of Guidelines where there is a lack of primary evidence and explore the importance of multiple iterations to improve the work as new evidence emerges. Finally we will explore how the Recommendations may be applied in practice.
Presentation by Dr Martin Myers MBE, PhD, FRCPath, Consultant Clinical Biochemist, Lancashire Teaching Hospitals NHS Foundation Trust at ECO 19: Care closer to home on Tuesday 9 July at Deepdale Stadium.
Infectious disease emergencies are opportunities to test the efficacy of newly developed interventions (e.g. drugs, vaccines and treatment regimens), yet they raise many intertwined challenges of politics, logistics, ethics, and study design. Consistent with the efforts of CEPI, WHO, and others to encourage development and Phase I/II testing of candidate vaccines (the focus of this talk) in advance of emergencies, it is essential before the emergency strikes to advance the discussion of how such products can and should be tested. This can help to disentangle ethical from political and logistical concerns, reduce the time pressure to make a decision, and encourage rational deliberation by future stakeholders who at the time of deliberation do not know what role (which product, which field site) they may be supporting in an actual emergency.
At this luncheon, Professor Marc Lipsitch described his work on computer simulation of vaccine trials during epidemics to assess options for trial design, as well as some of his recent work on the ethics of trials in emergencies, with the aim to stimulate discussion on the intersection of these two topics.
For more, please see our website: http://petrieflom.law.harvard.edu/events/details/digital-health-harvard-series-november-2018
A different perspective on hybrid cloud. EMCSocial
Take a look at all of the hand-drawn sketches of current issues surrounding hybrid cloud adoption and the evolution of enterprise IT, to illustrate the #HybridCloudChat: https://www.crowdchat.net/HybridCloudChat
Release: Blog2Social Pro. Die Lösung für effizientes BloggenADENION GmbH
Blog2Social Pro richtet sich mit seinen erweiterten Funktionen noch mehr an die Bedürfnisse der Blogger aus. Ob persönliche Blogs, professionelle Blogs oder Corporate Blogs: für jede Zielgruppe gibt es maßgeschneiderte Lösungen für individuelles Blogging.
Presentada por el Dr. Jorge Téllez Fuentes, Director Ejecutivo de ÁPICE, durante el acto de instalación de la Primera Cátedra Internacional de Crédito Educativo, Gabriel Betancur Mejia, realizada en la ciudad de Bogotá, D.C., Colombia, abril del 2012
Die wichtigsten Social Media mit Blog2Social bedienenADENION GmbH
Ohne Social Media geht nichts mehr. Mit Blog2Social haben Sie die Möglichkeit Ihre Blogbeiträge mit einem Klick auf den 10 besten und beliebtesten Social Media zu teilen. Mit dabei sind Business-, Dokumenten und soziale Netzwerke.
Project RSP! Training on PrEP for HIV PreventionJim Pickett
June 11 - UPDATED training on PrEP for HIV prevention from Chicago's Project Ready, Set, PrEP! (RSP!). Visit the Project RSP!'s My PrEP Experience blog at www.myprepexperience.blogspot.com for more informational resources, including the personal stories of individuals who have chosen to use PrEP.
Fast-track the end of AIDS in the EU - practical evidence-based interventions.
Presentation by: Karen Champenois, Maison Blanche Hospital, Paris
In a two-day meeting under the auspices of the Maltese Presidency of the Council of the European Union (30-31 January 2017), HIV experts from across the European Union discussed how to reverse this trend and how to prepare Europe to achieve the set target of ending AIDS by 2030.
Gabriel Wagner, MD
Associate Clinical Professor
Division of Infectious Diseases & Global Public Health
Department of Medicine
University of California, San Diego
Speakers discuss PrEP eligibility, management, and other topics covered in training modules one and two. During this webinar, expert speakers will review key highlights from the first two modules, share Nigeria specific guidance, and respond to questions from participants.
Part 2: https://www.slideshare.net/jsi/prep-elearning-discussion-2
Representatives from the Philadelphia Department of Public Health (PDPH) presented an update on their strategic plan for sexual health at the February 2015 meeting of the Philadelphia Ryan White Part A Planning Council.
HIV Prevention: Combating PrEP Implementation ChallengesCHC Connecticut
Expert faculty present case-based scenarios illustrating common challenges to integrating HIV PrEP in primary care. As part of improving clinical workforce development, this session will delve into a variety of specific PrEP implementation challenges. Participants will leave with strategies to overcome these obstacles to establish or strengthen their PrEP program.
Panelists:
• Marwan Haddad, MD, MPH, AAHIVS, Medical Director, Center for Key Populations, Community Health Center, Inc.,
• Jeannie McIntosh, APRN, FNP-C, AAHIVS, Family Nurse Practitioner, Center for Key Populations, Community Health Center, Inc.
Philadelphia Department of Public Health HIV Prevention ActivitiesOffice of HIV Planning
Coleman Terrell of the Philadelphia Department of Public Health presented on the PDPH's HIV Prevention Activities at the Philadelphia HIV Prevention Planning Group's December 2014 meeting.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
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Partners Demonstration Project - HIV self testing update - Feb 2015
1. PARTNERS DEMONSTRATION PROJECT
Acceptability and Uptake of
HIV-1 Self-Testing among Individuals using
Pre-Exposure Prophylaxis in Kenya
An ancillary study to the Partners Demonstration Project
Jared Baeten MD PhD
University of Washington
Bill & Melinda Gates Foundation Meeting on Self-Testing
February 2015
2. Outline
• Goals and status of the Partners
Demonstration Project
• Implementation and preliminary findings
from the HIV-1 self-testing ancillary study
within the Partners Demonstration Project
3. Partners Demonstration Project
• The Partners Demonstration Project is an open-label,
prospective interventional study of ART and PrEP for HIV
prevention among heterosexual HIV serodiscordant couples
• The project is being conducted at 4 clinical care sites:
Kisumu & Thika in Kenya and Kabwohe & Kampala in Uganda
• The overall goal is to evaluate, using implementation science
methods, a scalable delivery system for PrEP and ART for HIV
prevention in couples
4. PrEP as a bridge to ART
• For couples initiating ART at enrollment, PrEP is offered
through 6 months, then stopped:
• For couples in which the infected partner delays or declines
ART, PrEP is continued until 6 months after ART initiation:
• This strategy is supported by mathematical modeling as
potentially highly effective and cost-effective (Hallett et al. PLoS Med 2011;
Ying et al. CROI 2015, abstract #1106)
ART
PrEP Stop
ART
PrEP Stop
ART delayed……………..
5. Results: Participant Characteristics
• Between Nov 2012 and Aug 2014, 1013 couples were
enrolled. Characteristics are consistent with elevated HIV risk:
Characteristic % or median (IQR)
Gender, HIV- partner 33% female / 67% male
Age
Median 30 years (IQR 26-36),
with 20% <25 years
No children with study partner 56%
Unprotected sex in the prior month 65%
CD4 count, HIV+ partner
Median 436 (IQR 272-638),
with 41% >500 cells/µL
Plasma HIV RNA, HIV+ partner
Median 37,095 (IQR 7058-104,462),
with 41% >50,000 copies/mL
6. HIV incidence
0
1
2
3
4
5
6
EXPECTED
• Based on the risk
profile of enrolled
couples, nearly 40
HIV infections are
expected to date.
However, only 2
incident HIV
transmissions have
been observed, a
96% reduction.
N=39.7 infections
incidence = 5.2
(95% CI 3.7-6.9)
OBSERVED
N=2 infections
incidence = 0.2
(95% CI 0.0-0.9)
IRR observed vs. expected =
0.04
(95% CI 0.01-0.19)
or a
96% reduction
(95% CI 81-99%)
P<0.0001
7. HIV-1 self-testing in a PrEP
demonstration project: rationale
• HIV-1 testing is integral to PrEP delivery – for persons who
acquire HIV-1 while on PrEP, prompt testing and
discontinuation of PrEP may reduce the risk of antiretroviral
resistance
• Self-testing for HIV-1 for persons on PrEP could provide an
efficient method to identify new infections between in-clinic
tests and reduce PrEP exposure among persons who acquire
HIV-1 in spite of PrEP without increasing PrEP clinical delivery
costs and participant burden
– Plus, frequent HIV-1 testing itself may have behavioral benefits
in terms of risk reduction and PrEP adherence
8. HIV-1 self-testing in a PrEP
demonstration project: aims
1. Evaluate acceptability and uptake of HIV-1 self-
testing among HIV-1 uninfected persons in HIV-1
serodiscordant relationships receiving PrEP.
2. Evaluate the performance of HIV-1 self-testing
when used by HIV-1 uninfected persons receiving
PrEP.
3. Explore the barriers and challenges to self-testing
among HIV-1 uninfected persons receiving PrEP.
9. HIV-1 self-testing in a PrEP
demonstration project: setting
• Setting: Thika, Kenya site (a couples-oriented HIV
prevention, care, and research center), conducting
the Partners Demonstration Project
10. HIV-1 self-testing in a PrEP
demonstration project: mechanics
• HIV-1 self-testing is integrated with Partners
Demonstration Project:
– scheduled clinic visits occur quarterly and OraQuick self-
testing has been inserted between clinic visits to increase
frequency of HIV-1 testing:
• Partners Demonstration Project
– Months 1, 3, 6, 9, 12, 15, 18, 21, 24 after enrollment
• HIV-1 self-testing:
– Months 2, 4, 5, 7, 8, 10, 11, 13, 14, 16, 17, 19, 20, 22, 23 after
enrollment
• Result: HIV-1 testing can occur monthly (as it was in
the clinical trials of PrEP), without monthly clinic visits
11. HIV-1 self-testing in a PrEP
demonstration project: key elements
• Key elements of
implementation:
– informed consent
– training in test execution
and observed episode of
testing
– pictorial information sheet
– 24 hour helpline for
counseling and questions http://www.oraquick.com/What-is-OraQuick/How-Oral-
Testing-Works
Swabbing procedure Interpretation of
results
Non-reactive
Reactive
12. HIV-1 self-testing in a PrEP
demonstration project: data collection
• Number of tests performed
• Ease of performing the test
• Confidentiality of test results
• Sharing of self test kits
• Use of the 24 hour helpline
• Preference oral versus finger prick for testing
• Preference self testing versus provider testing
13. HIV-1 self-testing in a PrEP
demonstration project: results
HIV uninfected partners at Thika site
N=332
self‐testing study initiated November 2013
Enrolled – 220 Ineligible – 88 Pending – 24
• Not on PrEP
• Declined PrEP
• Stopped PrEP
• Seroconverter
• Pregnant
• Declined self‐testing =5
Reasons for declining self-testing: not wanting to do testing
alone, already goes for monthly rapid testing at VCT
14. Results: Follow-up Data
Description N
Total number of self tests dispensed 1190
Proportion of expected tests reported as used 96 %
Ngure et al R4P Oct 2014 and updated to January 2015
15. Results : Test Performance
• 79.6% of participants report conducting HIVST at least once & 93.0%
reported using the kit was easy.
• 19.2% reported that they self-test when they opened a new bottle of PrEP—
but most did self-testing at a different time.
– Often to have partner present (or not present), generally same day or within a few
days
• 56.7% self-tested alone and 41.1% study partner was present
• 52.5% shared their HIVST results with study partner, while 44.0% did not
share the results with anyone.
• 95% of participants did not use the help line
16. Results: Qualitative
• Quotes from 4 focus group discussions conducted so far:
– Reduced anxiety
• “Every day, every time thinking to yourself, “How will it be when I go back there
[clinic]? When you test yourself, you know your status, you relax”
– Testing alone versus with others:
• “Sometimes I call my husband. Like the last time I tested, I called my husband
and told him “Come you see mine is okay until now “.
• “Like me, I hide myself… (All the participants laugh) I go to the bedroom.”
– Remembering to test:
• “I put a reminder on my phone.”
• “What makes me remember is putting it together with these medication
(Truvada).”
17. Results: Counselor Observations
• Self testing is empowering
• Majority report that the self testing is easy to perform and does not require
the presence of the health provider.
• The new technology is exciting, real time and efficient as it enables them to
learn their status in their homes and at their own convenience.
• A number of clients report getting support from their partners during the
procedure.
• It is the most preferred choice for testing in that there is no blood sample
required to perform the test.
• It reduces anxiety associated with 3-monthly waiting for testing.
18. HIV-1 self-testing in a PrEP
demonstration project: summary
• HIV-1 self-testing appears to be an
acceptable and feasible adjunct to PrEP
delivery among high-risk Kenyan HIV-1
serodiscordant couples
• Continuing work will provide increased
sample size, costing analyses, continued
exploration of positive/negative experiences
with testing
19. The Partners Demonstration Project is made possible by the United States National Institutes of Health, the Bill and Melinda Gates Foundation, and the generous
support of the American people through the United States Agency for International Development. The contents are the responsibility of the University of Washington and
study partners and do not necessarily reflect the views of any of the study sponsors or the United States Government.
Investigative Team
– University of Washington: Jared Baeten (protocol chair), Connie Celum (protocol chair), Renee Heffron
(project director), Deborah Donnell (statistician), Ruanne Barnabas, Justin Brantley, Benjamin Browning-
Roberts, Lynn Harr, Harald Haugen, Lara Kidoguchi, Toni Maddox, Susan Morrison, Jennifer Morton, Kelly
Moutsos, Andrew Mujugira, Caitlin Scoville, Bettina Shell-Duncan, Kathy Thomas, Kerry Thomson
– Kabwohe, Uganda (KCRC): Steven Asiimwe, Edna Tindimwebwa, Elioda Tumwesigye
– Kampala, Uganda (Makerere University): Elly Katabira, Nulu Bulya
– Kisumu, Kenya (KEMRI): Elizabeth Bukusi, Josephine Odoyo
– Thika, Kenya (KEMRI/JKUAT): Nelly Mugo, Kenneth Ngure
– MGH/Harvard University: Jessica Haberer, David Bangsberg, Norma Ware, Monique Wyatt
– Johns Hopkins University: Craig Hendrix, Mark Marzinke
– Fred Hutchinson Cancer Research Center: Dara Lehman
– DF/Net Research (data management); Gilead Sciences (PrEP donation)
Project participants
Funders
– NIH (R01MH095507, R01MH100940, R01MH101027, R21AI104449, R21TW009908, K99/R00HD076679)
– Bill & Melinda Gates Foundation (OPP1056051, OPP47674)
– USAID (AID-OAA-A-12-00023)
Partners Demonstration Project