Histone Deacetylase Inhibitor Romidepsin Induces HIV Expression in CD4 T Cells from Patients on Suppressive Antiretroviral Therapy at Concentrations Achieved by Clinical Dosing

Persistent latent reservoir of replication-competent proviruses in memory CD4 T cells is a major obstacle to curing HIV infection. Pharmacological activation of HIV expression in latently infected cells is being explored as one of the strategies to deplete the latent HIV reservoir. In this study, we characterized the ability of romidepsin (RMD), a histone deacetylase inhibitor approved for the treatment of T-cell lymphomas, to activate the expression of latent HIV. In an in vitro T-cell model of HIV latency, RMD was the most potent inducer of HIV (EC50 = 4.5 nM) compared with vorinostat (VOR; EC50 = 3,950 nM) and other histone deacetylase (HDAC) inhibitors in clinical development including panobinostat (PNB; EC50 = 10 nM). The HIV induction potencies of RMD, VOR, and PNB paralleled their inhibitory activities against multiple human HDAC isoenzymes. In both resting and memory CD4 T cells isolated from HIV-infected patients on suppressive combination antiretroviral therapy (cART), a 4-hour exposure to 40 nM RMD induced a mean 6-fold increase in intracellular HIV RNA levels, whereas a 24-hour treatment with 1 μM VOR resulted in 2- to 3-fold increases. RMD-induced intracellular HIV RNA expression persisted for 48 hours and correlated with sustained inhibition of cell-associated HDAC activity. By comparison, the induction of HIV RNA by VOR and PNB was transient and diminished after 24 hours. RMD also increased levels of extracellular HIV RNA and virions from both memory and resting CD4 T-cell cultures. The activation of HIV expression was observed at RMD concentrations below the drug plasma levels achieved by doses used in patients treated for T-cell lymphomas. In conclusion, RMD induces HIV expression ex vivo at concentrations that can be achieved clinically, indicating that the drug may reactivate latent HIV in patients on suppressive cART

Intensive Care Unit and Acute Care Unit Length of Stay After Congenital Heart Surgery

BackgroundPostoperative length of stay (LOS) is an important quality metric and is known to vary widely across hospitals after congenital heart surgery. Whether this variability is explained by factors associated with the intensive care unit (ICU) or acute care unit (ACU) remains unclear. We evaluated the relationship between ICU and ACU LOS and the impact of ACU characteristics on postoperative LOS.MethodsHospitalizations for congenital heart surgery within the Pediatric Cardiac Critical Care Consortium (PC4) registry (August 2014 to February 2018) were included. Models were developed for ICU, ACU, and postoperative LOS by adjusting for differences in case-mix across hospitals. PC4 hospitals participating in the Pediatric Acute Care Cardiology Collaborative (PAC3) were also surveyed on ACU organizational factors and practice patterns.ResultsOverall, 19,674 hospitalizations across 27 hospitals were included. There was significant variation in ICU and ACU LOS. Postperative LOS appeared to be most closely related to ICU LOS; 75% (6 of 8) of hospitals with shorter than expected postoperative LOS also had shorter than expected ICU LOS. A clear relationship between postoperative and ACU LOS was not observed. Hospitals with an ACU able to provide higher-acuity care as indexed according to the PAC3 survey were more likely to have shorter postoperative LOS (P < .01).ConclusionsFor hospitals that achieve shorter than expected postoperative LOS after congenital heart surgery, ICU LOS appears to be the primary driver. Higher-acuity resources in the ACU may be an important factor facilitating earlier transfer from the ICU. These data are key to informing quality improvement initiatives geared toward reducing postoperative LOS

Surface Dipoles Influence the Wettability of Terminally Fluorinated Organic Films

AbstractThe correlation of differences in the wettabilities of partially fluorinated self-assembled monolayers (SAMs) to changes in the chemical structure and composition of the films was explored by contact angle goniometry and polarization modulation infrared reflection absorption spectroscopy (PM-IRRAS). SAMs of simple alkanethiols (CH3(CH2)nSH with n = 9-15) and their CF3-terminated analogs (CF3(CH2)nSH with n = 9-15) were prepared by adsorption from solution onto evaporated gold. Advancing contact angles of hexadecane were measured on both the terminally fluorinated surfaces and the hydrocarbon surfaces. These data were compared to those obtained using a series of polar aprotic contacting liquids. As expected, the contact angles of hexadecane were higher on the CF3-terminated SAMs than on the CH3-terminated SAMs. The contact angles of the polar aprotic solvents, however, were measurably lower on the CF3- terminated SAMs than on the CH3-terminated SAMs. These observations were rationalized on the basis that the introduction of the CF3 terminal groups yields oriented surface dipoles that interact with the dipoles of the polar contacting liquids. Further support for this model was provided by the observation of an inverse parity (“odd-even”) effect in the wettabilities of the polar aprotic solvents on the CF3-terminated surfaces. Analysis by PM-IRRAS revealed that both types of films consist of predominately trans-extended alkyl chains with relatively few gauche defects in a densely packed arrangement. The high degree of order is consistent with the detection of the parity effect, where small changes in the orientation of the tail groups can be sensed by contact angle measurements only in highly ordered organic thin films. The significance of the dipole-oriented dipole interaction in describing interfacial wettabilities is discussed.</jats:p

Innovation Amidst Turmoil: A SenseMaker Study of Managerial Responses to the COVID-19 Crisis in Germany

We present the results of an exploratory study of transformation processes in wicked problem situations, faced by 623 German managers due to the COVID-19 crisis during summer 2021. Our study draws on a fruitful combination of sustainability transitions research, complexity theory, cognition in economics, meme theory, and sensemaking by using the SenseMaker (R) software platform as a data collection and analysis tool on patterns of meaning in managerial self-signification and interpretation of their own decisions. We contribute to current interdisciplinary debates by presenting an empirical study on sensemaking during the COVID-19 pandemic that uncovers the narrative patterns of managers during uncertain decision situations. Our results suggest that while new habits have emerged and human ingenuity and creativity is acknowledged, participants of our study appear to lack a strong vision of a sustainable future beyond green growth and the dominant technoeconomic paradigm