Rethinking the Operational Blood Bank Dilemma: Out of the "Box" Blood Storage and Transportation Evaluation.

Background: Blood transfusion is critical in modern trauma care. However, unreliable access to robust blood banking in austere military and disaster medicine settings remains challenging. Stored whole blood and components have strict refrigeration guidelines; any cold-chain storage liability that results in blood products deviating from their target temperatures affects patient safety.

'We Should Not Be Quiet but We Should Talk': Qualitative Accounts of Community-Based Communication of HIV Pre-Exposure Prophylaxis.

Community leaders play an important role in the acceptance of public health services, but little is known about their willingness to facilitate HIV pre-exposure prophylaxis (PrEP) roll-out in Eswatini. We conducted in-depth interviews ( = 25) with purposefully selected male and female community leaders in Eswatini. We analysed our data inductively using a thematic analysis approach.

Client and healthcare worker experiences with differentiated HIV treatment models in Eswatini.

Introduction: Universal access to antiretroviral therapy (ART) is a cornerstone of Eswatini's national HIV strategy, and the number of people on ART in the country more than tripled between 2010 and 2019. Building on these achievements, the Ministry of Health (MOH) is scaling up differentiated service delivery, including less-intensive differentiated ART (DART) models for people doing well on treatment. We conducted a mixed-methods study to explore client and health care worker (HCW) perceptions of DART in Eswatini.

Patients' and family members' views on pacemaker reuse: An international survey.

Introduction: The reuse of cardiac implantable electronic devices may help increase access to these therapies in low- and middle-income countries (LMICs). No published data exist regarding the views of patients and family members in LMICs regarding this practice.

Methods And Results: An article questionnaire eliciting attitudes regarding pacemaker reuse was administered to ambulatory adult patients and patients' family members at outpatient clinics at Centro Nacional Cardiologia in Managua, Nicaragua, Indus Hospital in Karachi, Pakistan, Hospital Carlos Andrade Marín, and Hospital Eugenio Espejo in Quito, Ecuador, and American University of Beirut Medical Center in Beirut, Lebanon.

A stepped-wedge randomized trial and qualitative survey of HIV pre-exposure prophylaxis uptake in the Eswatini population.

Clinical trials have shown that antiretroviral drugs used as pre-exposure prophylaxis (PrEP) are highly effective for preventing HIV acquisition. PrEP efforts, including in sub-Saharan Africa, have almost exclusively focused on certain priority groups, particularly female sex workers, men having sex with men, pregnant women, serodiscordant couples, and young women. As part of a PrEP demonstration project involving the general population at six primary health care facilities in Eswatini (formerly Swaziland), we conducted a randomized trial of a health care facility-based PrEP promotion package designed to increase PrEP uptake.

Qualitative accounts of PrEP discontinuation from the general population in Eswatini.

People in receipt of pre-exposure prophylaxis (PrEP) for the prevention of HIV in Sub-Saharan Africa often discontinue taking the medication. We conducted 27 semi-structured interviews with men and women who had started PrEP but did not return to the clinic for a refill after a 1, 2 or 3-month period. These 'discontinuation' clients were enrolled in a PrEP demonstration project for the general population in nurse-led, public-sector, primary-care clinics in Eswatini.

"We know this will be hard at the beginning, but better in the long term": understanding PrEP uptake in the general population in Eswatini.

Information regarding HIV pre-exposure prophylaxis (PrEP) for the general population is largely lacking, because the majority of PrEP demonstration projects have focused on key populations. This qualitative study examines barriers and facilitators to PrEP uptake and adherence among the general population in Eswatini, where PrEP is offered through public-sector primary-care clinics. We analysed 106 semi-structured in-depth interviews with healthcare workers ( = 26), stakeholders ( = 30), and clients who initiated, continued, declined or discontinued PrEP ( = 50).

'This is mine, this is for me': preexposure prophylaxis as a source of resilience among women in Eswatini.

Objective: To understand the relationship between HIV preexposure prophylaxis (PrEP) and resilience among Emaswati women.

Design: A qualitative study using semistructured in-depth interviews.

Methods: We interviewed 24 women who recently initiated PrEP at one of six public-sector primary-care clinics participating in a government demonstration project for PrEP for the general population, as well as 30 PrEP stakeholders from HIV policy, implementation and donor sectors.

Warfarin for prevention of thromboembolism in atrial fibrillation: comparison of patient characteristics and outcomes of the "Real-World" Michigan Anticoagulation Quality Improvement Initiative (MAQI) registry to the RE-LY, ROCKET-AF, and ARISTOTLE trials.

Randomized controlled trials (RCTs) examining warfarin use for stroke prevention in atrial fibrillation (AF) may not accurately reflect real-world populations. We aimed to determine the representativeness of the RCT populations to real-world patients and to describe differences in the characteristics of trial populations from trial eligible patients in a real-world setting. We hypothesized that a significant fraction of real-world patients would not qualify for the RE-LY, ROCKET-AF, and ARISTOTLE trials and that real-world patients qualifying for the studies may have more strokes and bleeding events.

Preference for injectable over oral HIV pre-exposure prophylaxis in public-sector primary-care clinics in Swaziland.

: Long-acting injectable (LAI) HIV pre-exposure prophylaxis (PrEP) may mitigate adherence challenges reported by young women in Southern Africa. We assessed preferences for PrEP in public-sector, primary care clinics in Swaziland. Among surveyed respondents, 75% (95% confidence interval = 65-83%) stated preference for LAI over oral PrEP; with no differences by sex, age, or sexual behavior (all P > 0.

Cleaning and Sterilization of Used Cardiac Implantable Electronic Devices With Process Validation: The Next Hurdle in Device Recycling.

Objectives: This study sought to develop a validated, reproducible sterilization protocol, which could be used in the reprocessing of cardiac implantable electronic devices (CIEDs).

Background: Access to cardiac CIED therapy in high-income and in low- and middle-income countries varies greatly. CIED reuse may reduce this disparity.

Postoperative Atrial Fibrillation: Incidence, Mechanisms, and Clinical Correlates.

Atrial fibrillation is the most commonly encountered arrhythmia after cardiac surgery. Although usually self-limiting, it represents an important predictor of increased patient morbidity, mortality, and health care costs. Numerous studies have attempted to determine the underlying mechanisms of postoperative atrial fibrillation (POAF) with varied success.

Nationwide Trends in Reported Incidence of Takotsubo Cardiomyopathy from 2006 to 2012.

Takotsubo cardiomyopathy (TC) is believed to be an increasingly diagnosed syndrome; however, data on its incidence are limited. The purpose of this study was to determine the reported incidence of TC in the United States and to examine its trend over several years. Data was obtained from the Nationwide Inpatient Sample, created by the Agency for Healthcare Research and Quality, for each of the years from 2006 to 2012.

Postoperative atrial fibrillation: incidence, mechanisms, and clinical correlates.

Atrial fibrillation is the most commonly encountered arrhythmia after cardiac surgery. Although usually self-limiting, it represents an important predictor of increased patient morbidity, mortality, and health care costs. Numerous studies have attempted to determine the underlying mechanisms of postoperative atrial fibrillation (POAF) with varied success.

Heart Rhythm Society members' views on pacemaker and implantable cardioverter-defibrillator reuse.

Background: Reuse of cardiac implantable electronic devices (CIEDs) may help address the unmet need among patients in low- and middle-income countries (LMICs).

Methods: To examine Heart Rhythm Society (HRS) physicians' opinions regarding CIED reuse, an online survey eliciting attitudes toward CIED reuse was sent to all 3,380 HRS physician members.

Results: There were 429 responses (response rate 13%).

Seroprevalence of hepatitis B in a cohort of HIV-infected children and adults in Swaziland.

Hepatitis B virus (HBV) is an important co-morbidity in the HIV epidemic. A retrospective chart review was performed of HIV-infected patients with no previous antiretroviral history enrolled in a Swaziland clinic from January 2009 to May 2011. The seroprevalence of HBV surface antigen (HBsAg) was calculated and the data were analyzed using Mann-Whitney U and Fisher's exact tests.

Stevens-Johnson syndrome and HIV in children in Swaziland.

Background: Stevens-Johnson syndrome (SJS) can be a severe and life-threatening reaction with many potential causes, including multiple medications used in HIV care and treatment. Specific risk factors, especially in children, are not currently well-understood.

Methods: We describe a series of cases of SJS that occurred from 2006 to 2010 in an HIV-focused clinic in Mbabane, Swaziland.

Daily context matters: predictors of missed oral contraceptive pills among college and graduate students.

Objective: The purpose of this study was to understand the relationship between daily contextual factors and oral contraceptive (OC) adherence among students who attend college or graduate school.

Study Design: Data on OC adherence, demographics, contextual factors, and side-effects were collected as part of the acceptability of the NuvaRing (Merck & Co, Whitehouse Station, NJ) vs OC study, in which students were assigned randomly to the contraceptive vaginal ring or to a low-dose OC. We performed bivariate and multivariable analyses to create an explanatory model for nonperfect OC adherence (missed at least 1 pill during 3 months of use).

What will anesthesiologists be anesthetizing? Trends in neurosurgical procedure usage.

Background: To anticipate future changes to the practice of neuroanesthesia, we examined the nationwide trends in frequently performed operative neurosurgery.

Methods: We used the Nationwide Inpatient Sample, a random sampling of approximately 20% of United States hospitals from 1993 to 2007. Eight categories of operative neurosurgery were developed, based on procedure codes from the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM).

Comparative effects of exercise reduction and relaxation training on mood states and Type A scores in habitual aerobic exercisers.

The comparative effects of exercise reduction and relaxation training on dysphoric mood states and Type A scores in persons who exercise beyond the American College of Sports Medicine's recommended guidelines for cardiovascular fitness were investigated. Using their scores on the Profile of Mood States and the Jenkins Activity Survey, 57 subjects were randomly divided into 3 matched groups based on age, gender, and exercise regimen. Subjects assigned to the control group maintained their current exercise regimen, those in the second group reduced their exercise regimen to include no more than 5 hours of aerobic activity per week, and those in the third group maintained their current exercise regimen and attended 5 1 1/2-hr.