Mode of delivery among HIV-Infected pregnant women in Philadelphia, 2005-2013

Objective Current guidelines call for HIV-infected women to deliver via scheduled Caesarean when the maternal HIV viral load (VL) is >1,000 copies/ml. We describe the mode of delivery among HIV-infected women and evaluate adherence to relevant recommendations. Study Design We performed a population-based surveillance analysis of HIV-infected pregnant women in Philadelphia from 2005 to 2013, comparing mode of delivery (vaginal, scheduled Caesarean, or emergent Caesarean) by VL during pregnancy, closest to the time of delivery (≤1,000 copies/ml versus an unknown VL or VL >1,000 copies/ml) and associated factors in multivariable analysis. Results Our cohort included 824 deliveries from 648 HIV-infected women, of whom 69.4% had a VL ≤1,000 copies/ml and 30.6% lacked a VL or had a VL >1,000 copies/ml during pregnancy, closest to the time of delivery. Mode of delivery varied by VL: 56.6% of births were vaginal, 30.1% scheduled Caesarean, and 13.3% emergent Caesarean when the VL was ≤1,000 copies/ml; when the VL was unknown or >1,000 copies/ml, 32.9% of births were vaginal, 49.9% scheduled Caesarean and 17.5% emergent Caesarean. In multivariable analyses, Hispanic women (adjusted odds ratio (AOR) 0.17, 95% Confidence Interval (CI) 0.04–0.76) and non-Hispanic black women (AOR 0.27, 95% CI 0.10–0.77) were less to likely to deliver via scheduled Caesarean compared to non-Hispanic white women. Women who delivered prior to 38 weeks’ gestation (AOR 0.37, 95% CI 0.18–0.76) were also less likely to deliver via scheduled Caesarean compared to women who delivered after 38 weeks’ gestation. An interaction term for race and gestational age at delivery was significant in multivariable analysis. Non-Hispanic black (AOR 0.06, 95% CI 0.01–0.36) and Hispanic women (AOR 0.03, 95% CI 0.00–0.59) were more likely to deliver prematurely and less likely to deliver via scheduled C-section compared to non-Hispanic white women. Having a previous Caesarean (AOR 27.77, 95% CI 8.94–86.18) increased the odds of scheduled Caesarean delivery. Conclusions Only half of deliveries for women with an unknown VL or VL >1,000 copies/ml occurred via scheduled Caesarean. Delivery prior to 38 weeks, particularly among minority women, resulted in a missed opportunity to receive a scheduled Caesarean. However, even when delivering at or after 38 weeks’ gestation, a significant proportion of women did not get a scheduled Caesarean when indicated, suggesting a need for focused public health interventions to increase the proportion of women achieving viral suppression during pregnancy and delivering via scheduled Caesarean when indicated

Patient acceptance of universal screening for hepatitis C virus infection

<p>Abstract</p> <p>Background</p> <p>In the United States, about 70% of 2.9-3.7 million people with hepatitis C (HCV) are unaware of their infection. Although universal screening might be a cost-effective way to identify infections, prevent morbidity, and reduce transmission, few efforts have been made to determine patient opinions about new approaches to screening.</p> <p>Methods</p> <p>We surveyed 200 patients in August 2010 at five outpatient clinics of a major public urban medical center in Seattle, WA, with an 85.8% response rate.</p> <p>Results</p> <p>The sample was 55.3% women, median 47 years of age, and 56.3% white and 32.7% African or African-American; 9.5% and 2.5% reported testing positive for HCV and HIV, respectively. The vast majority of patients supported universal screening for HCV. When presented with three options for screening, 48% preferred universal testing without being informed that they were being tested or provided with negative results, 37% preferred testing with the chance to "opt-out" of being tested and without being provided with negative results, and 15% preferred testing based on clinician judgment. Results were similar for HIV screening.</p> <p>Conclusions</p> <p>Patients support universal screening for HCV, even if that screening involves testing without prior consent or the routine provision of negative test results. Current screening guidelines and procedures should be reconsidered in light of patient priorities.</p

Segmentation and kinematics of the North America-Caribbean plate boundary offshore Hispaniola

We explored the submarine portions of the Enriquillo–Plantain Garden Fault zone (EPGFZ) and the Septentrional–Oriente Fault zone (SOFZ) along the Northern Caribbean plate boundary using high-resolution multibeam echo-sounding and shallow seismic reflection. The bathymetric data shed light on poorly documented or previously unknown submarine fault zones running over 200 km between Haiti and Jamaica (EPGFZ) and 300 km between the Dominican Republic and Cuba (SOFZ). The primary plate-boundary structures are a series of strike-slip fault segments associated with pressure ridges, restraining bends, step overs and dogleg offsets indicating very active tectonics. Several distinct segments 50–100 km long cut across pre-existing structures inherited from former tectonic regimes or bypass recent morphologies formed under the current strike-slip regime. Along the most recent trace of the SOFZ, we measured a strike-slip offset of 16.5 km, which indicates steady activity for the past ~1.8 Ma if its current GPS-derived motion of 9.8 ± 2 mm a−1 has remained stable during the entire Quaternary.Depto. de Geodinámica, Estratigrafía y PaleontologíaFac. de Ciencias GeológicasTRUEpu

D’Andrea MR. Molecular cloning and characterization of the human voltage-gated calcium channel alpha(2)delta-4 subunit. Mol Pharmacol

ABSTRACT The voltage-gated calcium channel is composed of a poreforming ␣ 1 subunit and several regulatory subunits: ␣ 2 ␦, ␤, and ␥. We report here the identification of a novel ␣ 2 ␦ subunit, ␣ 2 ␦-4, from the expressed sequence tag database followed by its cloning and characterization. The novel ␣ 2 ␦-4 subunit gene contains 39 exons spanning about 130 kilobases and is colocalized with the CHCNA1C gene (␣ 1C subunit) on human chromosome 12p13.3. Alternative splicing of the ␣ 2 ␦-4 gene gives rise to four potential variants, a through d. The open reading frame of human ␣ 2 ␦-4a is composed of 3363 base pairs encoding a protein with 1120 residues and a calculated molecular mass of 126 kDa. The ␣ 2 ␦-4a subunit shares 30, 32, and 61% identity with the human calcium channel ␣ 2 ␦-1, ␣ 2 ␦-2, and ␣ 2 ␦-3 subunits, respectively. Primary sequence comparison suggests that ␣ 2 ␦-4 lacks the gabapentin binding motifs characterized for ␣ 2 ␦-1 and ␣ 2 ␦-2; this was confirmed by a [ 3 H]gabapentin-binding assay. In human embryonic kidney 293 cells, the ␣ 2 ␦-4 subunit associated with Ca V 1.2 and ␤ 3 subunits and significantly increased Ca V 1.2/␤ 3 -mediated Ca 2ϩ influx. Immunohistochemical study revealed that the ␣ 2 ␦-4 subunit has limited distribution in special cell types of the pituitary, adrenal gland, colon, and fetal liver. Whether the ␣ 2 ␦-4 subunit plays a distinct physiological role in select endocrine tissues remains to be demonstrated

The tectonics and active faulting of Haiti from seismicity and tomography

International audienceOblique convergence of the Caribbean and North American plates has partitioned strain across a major transpressional fault system that bisects the island of Hispaniola. The devastating M W 7.0, 2010 earthquake that struck southern Haiti, rupturing an unknown fault, highlighted our limited understanding of regional fault segmentation and its link to plate boundary deformation. Here we assess seismic activity and fault structures across Haiti using data from 33 broadband seismic stations deployed for 16 months. We use traveltime tomography to obtain relocated hypocenters and models of V p and V p /V s crustal structure. Earthquake locations reveal two clusters of seismic activity. The first corresponds to aftershocks of the 2010 earthquake and delineates faults associated with that rupture. The second cluster shows shallow activity north of Lake Enriquillo (Dominican Republic), interpreted to have occurred on a north-dipping thrust fault. Crustal seismic velocities show a narrow low-velocity region with an increased V p /V s ratio (1.80-1.85) dipping underneath the Massif de la Selle, which coincides with a southward-dipping zone of hypocenters to a depth of 20 km beneath southern Haiti. Our observations of seismicity and crustal structure in southern Haiti suggests a transition in the Enriquillo fault system from a near vertical strike-slip fault along the Southern Peninsula to a southward-dipping oblique-slip fault along the southern border of the Cul-de-Sac-Enriquillo basin. This result, consistent with recent geodetic results but at odds with the classical seismotectonic interpretation of the Enriquillo fault system, is an important constraint in our understanding of regional seismic hazard

Is the local seismicity in western Hispaniola (Haiti) capable of imaging northern Caribbean subduction?

International audienc

Time of HIV Diagnosis and Engagement in Prenatal Care Impact Virologic Outcomes of Pregnant Women with HIV

<div><p>Background</p><p>HIV suppression at parturition is beneficial for maternal, fetal and public health. To eliminate mother-to-child transmission of HIV, an understanding of missed opportunities for antiretroviral therapy (ART) use during pregnancy and HIV suppression at delivery is required.</p><p>Methodology</p><p>We performed a retrospective analysis of 836 mother-to-child pairs involving 656 HIV-infected women in Philadelphia, 2005-2013. Multivariable regression examined associations between patient (age, race/ethnicity, insurance status, drug use) and clinical factors such as adequacy of prenatal care measured by the Kessner index which classifies prenatal care as inadequate, intermediate, or adequate prenatal care; timing of HIV diagnosis; and the outcomes: receipt of ART during pregnancy and viral suppression at delivery.</p><p>Results</p><p>Overall, 25% of the sample was diagnosed with HIV during pregnancy; 39%, 38%, and 23% were adequately, intermediately, and inadequately engaged in prenatal care. Eight-five percent of mother-to-child pairs received ART during pregnancy but only 52% achieved suppression at delivery. Adjusting for patient factors, pairs diagnosed with HIV during pregnancy were less likely to receive ART (AOR 0.39, 95% CI 0.25-0.61) and achieve viral suppression (AOR 0.70, 95% CI 0.49-1.00) than those diagnosed before pregnancy. Similarly, women with inadequate prenatal care were less likely to receive ART (AOR 0.06, 95% CI 0.03-0.11) and achieve viral suppression (AOR 0.31, 95% CI 0.20-0.47) than those with adequate prenatal care.</p><p>Conclusions</p><p>Targeted interventions to diagnose HIV prior to pregnancy and engage HIV-infected women in prenatal care have the potential to improve HIV related outcomes in the perinatal period.</p></div

Time of HIV Diagnosis and Engagement in Prenatal Care Impact Virologic Outcomes of Pregnant Women with HIV - Fig 1

<p>Receipt of ART and Viral Suppression by A) Timing of HIV Diagnosis and B) Quality of Prenatal Care. Adequacy of prenatal care was measured using the Kessner Index, a validated index of quality of prenatal care which takes into account timing of entry in prenatal care, the number of prenatal visits and gestational age at infant delivery; ART: antiretroviral; VL: viral load; dx: diagnosis.</p