Black race as a predictor of poor health outcomes among a national cohort of HIV/AIDS patients admitted to US hospitals: a cohort study

BACKGROUND: In general, the Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS) population has begun to experience the benefits of highly active antiretroviral therapy (HAART); unfortunately, these benefits have not extended equally to Blacks in the United States, possibly due to differences in patient comorbidities and demographics. These differences include rates of hepatitis B and C infection, substance use, and socioeconomic status. To investigate the impact of these factors, we compared hospital mortality and length of stay (LOS) between Blacks and Whites with HIV/AIDS while adjusting for differences in these key characteristics. METHODS: The 1996-2006 National Hospital Discharge Surveys were used to identify HIV/AIDS patients admitted to US hospitals. Survey weights were incorporated to provide national estimates. Patients < 18 years of age, those who left against medical advice, those with an unknown discharge disposition and those with a LOS < 1 day were excluded. Patients were stratified into subgroups by race (Black or White). Two multivariable logistic regression models were constructed with race as the independent variable and outcomes (mortality and LOS > 10 days) as the dependent variables. Factors that were significantly different between Blacks and Whites at baseline via bivariable statistical tests were included as covariates. RESULTS: In the general US population, there are approximately 5 times fewer Blacks than Whites. In the present study, 1.5 million HIV/AIDS hospital discharges were identified and Blacks were 6 times more likely to be hospitalized than Whites. Notably, Blacks had higher rates of substance use (30% vs. 24%; P < 0.001), opportunistic infections (27% vs. 26%; P < 0.001) and cocaine use (13% vs. 5%; P < 0.001). Conversely, fewer Blacks were co-infected with hepatitis C virus (8% vs. 12%; P < 0.001). Hepatitis B virus was relatively infrequent (3% for both groups). Crude mortality rates were similar for both cohorts (5%); however, a greater proportion of Blacks had a LOS > 10 days (21% vs. 19%; P < 0.001). Black race, in the presence of comorbidities, was correlated with a higher odds of LOS > 10 days (OR, 95% CI = 1.20 [1.10-1.30]), but was not significantly correlated with a higher odds of mortality (OR, 95% CI = 1.07 [0.93-1.25]). CONCLUSION: Black race is a predictor of LOS > 10 days, but not mortality, among HIV/AIDS patients admitted to US hospitals. It is possible that racial disparities in hospital outcomes may be closing with time

Soil-Aggregate-Scale Heterogeneity in Microbial Selenium Reduction

Given the role of Se as both an environmental contaminant and a micronutrient, the microbial reduction and subsequent sequestration of bioavailable Se in soils are of great ecological interest. Primary particles in surface soils are typically bound into loosely packed, microporous aggregates, which may be critical spatial units in determining the fate of Se in soils. Surrounded by macropores where preferential flow rapidly advects dissolved compounds, soil aggregates are domains of slow diffusive transport where spatial variations in chemical concentrations and biogeochemical reactions can prevail. We conducted a series of controlled flow-through experiments utilizing three-dimensional, artificial soil aggregates (2.5-cm i.d.) surrounded by a macropore. Aggregates were composed of either quartz sand or ferrihydrite-coated sand inoculated with one of two Se-reducing bacteria (Thauera selenatis or Enterobacter cloacae SLD1a-1). Selenite export rates varied between 0.02 ± 0.01 and 3.4 ± 0.2 nmol h−1 g−1 as a function of aeration condition and input solution composition (higher SeO4 2− or C-source concentrations led to higher SeO3 2− export). Oxic input conditions significantly decreased Se reduction; however, the detection of SeO3 2− in effluent samples indicates the occurrence of anoxic microzones within aggregates. Furthermore, we found that solid-phase concentrations of reduced Se increased toward the core of aggregates and are estimated to at least double within the first millimeter into the aggregate under all conditions investigated. This indicates that concentrations of reduced Se may generally be expected to increase with distance from the advection boundary (macropore) inside aggregates, which would imply that soils with larger aggregates retain more Se