Cardiovirology Clinic for Primary Prevention in HIV Patients: a Quality Improvement Assessment

INTRODUCTION With effective highly active antiretroviral therapy (HAART), individuals with human immunodeficiency virus (HIV) infection now enjoy life expectancies approaching those of uninfected individuals. Prolonged longevity has increased the prevalence of non-communicable comorbidities within the HIV patient population. HIV is a known independent risk factor for atherosclerotic cardiovascular disease (ASCVD), imparting a 1.5-2 -fold higher incidence of major adverse cardiovascular events (MACE) on infected patients. Deaths from ASCVD have increased as a result, despite a decline in total mortality. The Center of Excellence for HIV/AIDS care established a Cardiovirology Clinic (CvC) focused on providing primary and secondary preventative cardiovascular care to its patients. To date, there are no known data on the efficacy of such an intervention. We sought to define the performance of this care model for primary prevention. METHODS Unique CvC patients (n=68) with a treatment delivery window between September 1, 2017 to August 31, 2018 were identified through billing records. All patients were receiving HAART as prescribed by their infectious disease provider. Those with established ASCVD (n=10) were excluded from analysis to limit the study to primary prevention patients. We collected data on ASCVD risk factors (family history of premature ASCVD and personal histories of smoking, diabetes, hypertension [with degree of control], dyslipidemia, drug and alcohol use, and exercise) from the electronic health record. Body-mass index and systolic (SBP) and diastolic (DBP) blood pressures were also collected. Laboratory values including CD4 cell count, HIV-1 viral load, proteinuria, glomerular filtration rate, total cholesterol (TC), triglycerides (TG), and high (HDL) and low density (LDL) lipoprotein were included in the data collection. Estimates of 5-year risk of cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, or need for major revascularization was calculated using the Data Collection on Adverse Events of Anti-HIV Drugs (D:A:D) equations. Patient data were de-identified. Two-tailed, paired T-testing was performed for each factor comparing the initial and most recent follow-up values. Significance was defined as p value \u3c0.05. RESULTS Using univariate analysis, reductions in D:A:D risk (relative 32.01%, absolute 1.49%, p CONCLUSION In this initial assessment, treated HIV patients appeared to enjoy meaningful reductions in MACE risk through the preventive care they received in this clinic, suggesting that CvCs could be a partial solution to the growing ASCVD morbidity and mortality among HIV-infected individuals. Limitations of this study include a small patient population (n=58) (limiting us to univariate analyses) and short duration of follow up (≤ 1 year). Data collection will continue annually for 4 additional years. With increasing subject numbers, multivariate analyses to determine if components of ASCVD risk reduction show interactions, and which factors, interactions and interventions impart the greatest risk reduction, will be performed in improve the quality of care

High-dimensional time series segmentation via factor-adjusted vector autoregressive modelling

Vector autoregressive (VAR) models are popularly adopted for modelling high-dimensional time series, and their piecewise extensions allow for structural changes in the data. In VAR modelling, the number of parameters grow quadratically with the dimensionality which necessitates the sparsity assumption in high dimensions. However, it is debatable whether such an assumption is adequate for handling datasets exhibiting strong serial and cross-sectional correlations. We propose a piecewise stationary time series model that simultaneously allows for strong correlations as well as structural changes, where pervasive serial and cross-sectional correlations are accounted for by a time-varying factor structure, and any remaining idiosyncratic dependence between the variables is handled by a piecewise stationary VAR model. We propose an accompanying two-stage data segmentation methodology which fully addresses the challenges arising from the latency of the component processes. Its consistency in estimating both the total number and the locations of the change points in the latent components, is established under conditions considerably more general than those in the existing literature. We demonstrate the competitive performance of the proposed methodology on simulated datasets and an application to US blue chip stocks data

Characterizing Teaching Assistants’ Knowledge and Beliefs Following Professional Development Activities within an Inquiry-Based General Chemistry Context

The purpose of this investigation was to explore changes in undergraduate and graduate teaching assistants’ (TAs’) content knowledge and beliefs about teaching within the context of an inquiry-based laboratory course. TAs received professional development (PD), which was informed by the TA training literature base and was designed for TAs implementing a guided inquiry approach to general chemistry laboratory instruction. TAs engaged in ∼20 h of presemester PD and ∼30 h of weekly follow-up PD during the semester. The study utilized a multiple-methods approach within a social constructivist framework to assess changes in the TAs. Participants included eight graduate TAs and five undergraduate TAs. Data collection included TA pre-PD, post-PD, and semester-end surveys and two interviews of a subset of participants. The quantitative data were analyzed using descriptive and nonparametric statistics, and the qualitative data were analyzed using systematic data analysis. The results indicate that TAs’ content knowledge significantly improved following the PD (mean = 80.22, standard deviation = 11.80) (Z = −2.346, p = 0.019) and was maintained over the semester. Following PD, the TAs shifted their beliefs to be more aligned with inquiry-based instruction. The results of this investigation suggest that TA previous experience and teaching students in an inquiry-based lab may influence TAs’ beliefs. Future research will focus on examining the impact of TAs on student outcomes within a guided inquiry approach to general chemistry laboratory instruction

Teacher\u27s Toolkit: Differentiating Inquiry

Differentiated instruction and teaching science as inquiry are two pedagogical approaches frequently discussed among science teachers. Teachers know these approaches are important but often have difficulty translating them into their classroom science instruction. This article describes how to differentiate a density investigation for variations in student readiness by varying the level of inquiry using an approach that is easily translated to experiments in any science content area

Exploring practices of science coordinators participating in targeted professional development

This study describes how district science coordinators supported teachers and implemented professional development in their districts following participation in the Science Coordinator Academy. This qualitative descriptive case study comprised three district science coordinators from three districts in a mid‐Atlantic state, as well as principals and teachers from those districts. Data sources, including observations, surveys, artifacts, and interviews, were analyzed using the framework method (Gale, Heath, Cameron, Rashid, & Redwood, 2013). District context, science coordinator background, and collaboration were salient factors that influenced coordinator practices and coordinators’ abilities to impact teacher change. We hypothesize that the development of a coaching relationship, facilitating collaboration among teachers, utilizing the characteristics of effective professional development, and promoting reflection through modeling and feedback may be the most important reflection‐growth model of instructional leadership (Blase & Blase, 1999) practices for science coordinators to enact when working with teachers

Investigating the role of a district science coordinator

This study explored the professional responsibilities of district science coordinators, their professional development (PD) experiences, the relationship between their role, responsibilities, district context, and background, and barriers encountered in their work. A national sample (n = 122) of self‐identified science coordinators completed a Science Coordinator Role Survey. Participants’ responses were analyzed using descriptive and correlational statistics. Following analysis of survey data, 16 participants (13.1%) were purposefully selected for semi‐structured follow‐up interviews. Results indicated the majority of respondents identified themselves as Caucasian, female, and had served in their position for less than 10 years. The typical science coordinator held a degree in a science content area and was a former science teacher. Respondents without science degrees tended to hold positions at small, remote, or rural school districts with responsibilities in multiple content areas. Participants also reported barriers of not having enough PD opportunities, lack of time, lack of emphasis on science instruction, and a lack of power to enforce policies within a district. Results characterize the professional responsibilities of coordinators, provide insight into the role of a science coordinator, and into how to create targeted PD for coordinators

Situating Computer Simulation Professional Development: Does It Promote Inquiry-Based Simulation Use?

This mixed-methods study sought to identify professional development implementation variables that may influence participant (a) adoption of simulations, and (b) use for inquiry-based science instruction. Two groups (Cohort 1, N = 52; Cohort 2, N = 104) received different professional development. Cohort 1 was focused on Web site use mechanics. Cohort 2 was situated in nature and provided three additional elements: (a) modeling simulation use within inquiry-based instruction; (b) collaboration; and (c) provision of content-relevant lesson planning time. There was no difference in the extent of simulation use between cohorts, χ2(1) = 0.878, p = .349, φ = −0.075. Results were inconclusive for a difference in observed inquiry instruction as Fisher\u27s Exact Test was insignificant but had a medium effect size, p = .228, φ = 0.283. Computer-based standardized tests emerged as a novel technology integration barrier. These findings have implications for school policy, professional development, and future research

Elementary science teachers’ integration of engineering design into science instruction: results from a randomised controlled trial

This randomised controlled trial used a mixed-methods approach to investigate the frequency and how elementary teachers integrated engineering design (ED) principles into their science instruction following professional development (PD). The ED components of the PD were aligned with Cunningham and Carlsen’s [(2014). Teaching engineering practices. Journal of Science Teacher Education, 25, 197–210] guidelines for ED PD and promoted inclusion of ED within science teaching. The treatment group included 219 teachers from 83 schools. Participants in the control group included 145 teachers from 60 schools in a mid-Atlantic state. Data sources, including lesson overviews and videotaped classroom observations, were analysed quantitatively to determine the frequency of ED integration and qualitatively to describe how teachers incorporated ED into instruction after attending the PD. Results indicated more participants who attended the PD (55%) incorporated ED into instruction compared with the control participants (24%), χ2(1, n = 401) = 33.225, p \u3c .001,  = 0.308. Treatment and control teachers taught similar science content (p’s \u3e .05) through ED lessons. In ED lessons, students typically conducted research and created and tested initial designs. The results suggest the PD supported teachers in implementing ED into their science instruction and support the efficacy of using Cunningham and Carlsen’s (2014) guidelines to inform ED PD design

Strategies for developing and optimizing cancer vaccines [version 1; peer review: 2 approved]

With the spotlight on cancer immunotherapy and the expanding use of immune checkpoint inhibitors, strategies to improve the response rate and duration of current cancer immunotherapeutics are highly sought. In that sense, investigators around the globe have been putting spurs on the development of effective cancer vaccines in humans after decades of efforts that led to limited clinical success. In more than three decades of research in pursuit of targeted and personalized immunotherapy, several platforms have been incorporated into the list of cancer vaccines from live viral or bacterial agents harboring antigens to synthetic peptides with the hope of stronger and durable immune responses that will tackle cancers better. Unlike adoptive cell therapy, cancer vaccines can take advantage of using a patient’s entire immune system that can include more than engineered receptors or ligands in developing antigen-specific responses. Advances in molecular technology also secured the use of genetically modified genes or proteins of interest to enhance the chance of stronger immune responses. The formulation of vaccines to increase chances of immune recognition such as nanoparticles for peptide delivery is another area of great interest. Studies indicate that cancer vaccines alone may elicit tumor-specific cellular or humoral responses in immunologic assays and even regression or shrinkage of the cancer in select trials, but novel strategies, especially in combination with other cancer therapies, are under study and are likely to be critical to achieve and optimize reliable objective responses and survival benefit. In this review, cancer vaccine platforms with different approaches to deliver tumor antigens and boost immunity are discussed with the intention of summarizing what we know and what we need to improve in the clinical trial setting

QuantumATK: An integrated platform of electronic and atomic-scale modelling tools

QuantumATK is an integrated set of atomic-scale modelling tools developed since 2003 by professional software engineers in collaboration with academic researchers. While different aspects and individual modules of the platform have been previously presented, the purpose of this paper is to give a general overview of the platform. The QuantumATK simulation engines enable electronic-structure calculations using density functional theory or tight-binding model Hamiltonians, and also offers bonded or reactive empirical force fields in many different parametrizations. Density functional theory is implemented using either a plane-wave basis or expansion of electronic states in a linear combination of atomic orbitals. The platform includes a long list of advanced modules, including Green's-function methods for electron transport simulations and surface calculations, first-principles electron-phonon and electron-photon couplings, simulation of atomic-scale heat transport, ion dynamics, spintronics, optical properties of materials, static polarization, and more. Seamless integration of the different simulation engines into a common platform allows for easy combination of different simulation methods into complex workflows. Besides giving a general overview and presenting a number of implementation details not previously published, we also present four different application examples. These are calculations of the phonon-limited mobility of Cu, Ag and Au, electron transport in a gated 2D device, multi-model simulation of lithium ion drift through a battery cathode in an external electric field, and electronic-structure calculations of the composition-dependent band gap of SiGe alloys.Comment: Submitted to Journal of Physics: Condensed Matte