The Acquired Immunodeficiency Syndrome in New England: An Epidemiological Review of the First Six Years

Between 1981 and 1987 — the six-year period following initial recognition of the acquired immunodeficiency syndrome (AIDS) — 1,475 cases were reported among residents of the six New England states. Of nearly 40,000 cases nationwide, 3.8 percent occurred among New England residents, though the region \u27s population represents 5.5 percent ofthe total United States population. The groups most affected include homosexual or bisexual men (65 percent) and intravenous drug users (20 percent). However, in the two southernmost states — Rhode Island and Connecticut — 32 to 40 percent of all cases have used intravenous drugs. In these states, the male:female ratio of adult cases is 6:1, compared to 12:1 in the remainder of the region. In Massachusetts, the disease incidence rate is equivalent to that of Connecticut (144 cases per 1 million population); however, a greater proportion of cases (69 percent versus 45 percent) are homosexual and bisexual men, and the incidence rate for adult females is lower (49 versus 100 cases/million). Maine, New Hampshire, and Vermont have low cumulative incidence rates (\u3c50 cases/million), and no cases among adult females or associated with blood transfusion. In northern New England, 2 percent of adults with AIDS became infected through heterosexual contact, compared to 10 percent in the southern half of the region. Sources of other data, resulting from serologic testing for human immunodeficiency virus (HIV), confirm the predominance of infection in southern New England. Rates of HIV seropositivity in military recruits, blood donors, and specific high-risk populations are uniformly lower in New England than in high-incidence regions. This review is based on statistics provided by AIDS surveillance programs operated by the Departments of Public Health in the six New England states

Space Weather Nowcasting of Atmospheric Ionizing Radiation for Aviation Safety

There is a growing concern for the health and safety of commercial aircrew and passengers due to their exposure to ionizing radiation with high linear energy transfer (LET), particularly at high latitudes. The International Commission of Radiobiological Protection (ICRP), the EPA, and the FAA consider the crews of commercial aircraft as radiation workers. During solar energetic particle (SEP) events, radiation exposure can exceed annual limits, and the number of serious health effects is expected to be quite high if precautions are not taken. There is a need for a capability to monitor the real-time, global background radiations levels, from galactic cosmic rays (GCR), at commercial airline altitudes and to provide analytical input for airline operations decisions for altering flight paths and altitudes for the mitigation and reduction of radiation exposure levels during a SEP event. The Nowcast of Atmospheric Ionizing Radiation for Aviation Safety (NAIRAS) model is new initiative to provide a global, real-time radiation dosimetry package for archiving and assessing the biologically harmful radiation exposure levels at commercial airline altitudes. The NAIRAS model brings to bear the best available suite of Sun-Earth observations and models for simulating the atmospheric ionizing radiation environment. Observations are utilized from ground (neutron monitors), from the atmosphere (the METO analysis), and from space (NASA/ACE and NOAA/GOES). Atmospheric observations provide the overhead shielding information and the ground- and space-based observations provide boundary conditions on the GCR and SEP energy flux distributions for transport and dosimetry simulations. Dose rates are calculated using the parametric AIR (Atmospheric Ionizing Radiation) model and the physics-based HZETRN (High Charge and Energy Transport) code. Empirical models of the near-Earth radiation environment (GCR/SEP energy flux distributions and geomagnetic cut-off rigidity) are benchmarked against the physics-based CMIT (Coupled Magnetosphere- Ionosphere-Thermosphere) and SEP-trajectory models

Virologic Failure of Protease Inhibitor-Based Second-Line Antiretroviral Therapy without Resistance in a Large HIV Treatment Program in South Africa

Background: We investigated the prevalence of wild-type virus (no major drug resistance) and drug resistance mutations at second-line antiretroviral treatment (ART) failure in a large HIV treatment program in South Africa. Methodology/ Principal Findings HIV-infected patients $\geq$15 years of age who had failed protease inhibitor (PI)-based second-line ART (2 consecutive HIV RNA tests >1000 copies/ml on lopinavir/ritonavir, didanosine, and zidovudine) were identified retrospectively. Patients with virologic failure were continued on second-line ART. Genotypic testing for drug resistance was performed on frozen plasma samples obtained closest to and after the date of laboratory confirmed second-line ART failure. Of 322 HIV-infected patients on second-line ART, 43 were adults with confirmed virologic failure, and 33 had available plasma for viral sequencing. HIV-1 RNA subtype C predominated (n = 32, 97%). Mean duration on ART (SD) prior to initiation of second-line ART was 23 (17) months, and time from second-line ART initiation to failure was 10 (9) months. Plasma samples were obtained 7(9) months from confirmed failure. At second-line failure, 22 patients (67%) had wild-type virus. There was no major resistance to PIs found. Eleven of 33 patients had a second plasma sample taken 8 (5.5) months after the first. Median HIV-1 RNA and the genotypic resistance profile were unchanged. Conclusions/ Significance: Most patients who failed second-line ART had wild-type virus. We did not observe evolution of resistance despite continuation of PI-based ART after failure. Interventions that successfully improve adherence could allow patients to continue to benefit from second-line ART therapy even after initial failure

Communicating hospital infection data to the public: a study of consumer responses and preferences

There is growing interest in public reporting of health care performance data relating to healthcare-associated infections (HAIs). This study evaluated different approaches for reporting hospital-level comparative data on HAIs and the extent to which such data might influence hospital choice. Eight versions of a report were developed, varying whether data were consistent across indicators, whether data were presented in text or graphs, and whether confidence intervals were included. A report and a questionnaire were mailed to a randomly selected sample of local residents. Findings provide no evidence that consistency of indicators, data presentation, report format, or inclusion of confidence intervals significantly impacted consumers\u27 understanding. More educated consumers reported greater understanding of the reports. Responses suggested that public reporting of comparative data on HAIs could influence hospital choice, but other factors including prior experience, reputation, physicians\u27 recommendations, and insurance coverage are also influential. Most consumers understand information on HAIs when it is presented in a short, simple report, and most correctly select the best or worst hospital. Consumers may be influenced by such data, but other factors are likely to be as or more important