Health Literacy and Demographic Disparities in HIV Care Continuum Outcomes

Studies evaluating the association between human immunodeficiency virus (HIV) infection continuum of care outcomes [antiretroviral (ART) adherence, retention in care, viral suppression] and health literacy have yielded conflicting results. Moreover, studies from the southern United States, a region of the country disproportionately affected by the HIV epidemic and low health literacy, are lacking. We conducted an observational cohort study among 575 people living with HIV (PLWH) at the Vanderbilt Comprehensive Care Clinic (Nashville, Tennessee). Health literacy was measured using the brief health literacy screen, a short tool which can be administered verbally by trained clinical personnel. Low health literacy was associated with a lack of viral suppression, but not with poor ART adherence or poor retention. Age and racial disparities in continuum of care outcomes persisted after accounting for health literacy, suggesting that factors in addition to health literacy must be addressed in order to improve outcomes for PLWH

Coordinated strategy for a model-based decision support tool for coronavirus disease, Utah, USA

The coronavirus disease pandemic has highlighted the key role epidemiologic models play in supporting public health decision-making. In particular, these models provide estimates of outbreak potential when data are scarce and decision-making is critical and urgent. We document the integrated modeling response used in the US state of Utah early in the coronavirus disease pandemic, which brought together a diverse set of technical experts and public health and healthcare officials and led to an evidence-based response to the pandemic. We describe how we adapted a standard epidemiologic model; harmonized the outputs across modeling groups; and maintained a constant dialogue with policymakers at multiple levels of government to produce timely, evidence-based, and coordinated public health recommendations and interventions during the first wave of the pandemic. This framework continues to support the state's response to ongoing outbreaks and can be applied in other settings to address unique public health challenges

Clinic-level factors associated with retention in care among people living with human immunodeficiency virus in a multisite US Cohort, 2010–2016

Background. Retention in care (RIC) leads to reduced HIV transmission and mortality. Few studies have investigated clinic services and RIC among people living with HIV (PLWH) in the United States. We conducted a multisite retrospective cohort study to identify clinic services associated with RIC from 2010–2016 in the United States. Methods. PLWH with ≥1 HIV primary care visit from 2010–2016 at 7 sites in the Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) were included. Clinic-level factors evaluated via site survey included patients per provider/ trainee, navigation, RIC posters/brochures, laboratory test timing, flexible scheduling, appointment reminder methods, and stigma support services. RIC was defined as ≥2 encounters per year, ≥90 days apart, observed until death, administrative censoring (31 December 2016), or loss to follow-up (censoring at first 12-month interval without a visit with no future visits). Poisson regression with robust error variance, clustered by site adjusting for calendar year, age, sex, race/ethnicity, and HIV transmission risk factor, estimated risk ratios (RRs) and 95% confidence intervals (CIs) for RIC. Results. Among 21 046 PLWH contributing 103 348 person-years, 67% of person-years were retained. Availability of text appointment reminders (RR, 1.13; 95% CI, 1.03–1.24) and stigma support services (RR, 1.11; 95% CI, 1.04–1.19) were associated with better RIC. Disparities persisted for age, sex, and race. Conclusions. Availability of text appointment reminders and stigma support services was associated with higher rates of RIC, indicating that these may be feasible and effective approaches for improving RIC

Handwashing adherence by visitors is poor: Is there a simple solution?

Available evidence suggests that handwashing adherence by visitors to hospital clinics is poor. In this investigation, an audit of 180 people showed that handwashing adherence by visitors to a hospital clinic was 25%, which was very low. Our active method to encourage handwashing led to a marked improvement in adherence from 25% to 68%, increasing to 77% for longer term visitors to the clinic (significance, P < .0001)

Improving port terminal operations through information sharing

Part IV: ICT and Emerging Technologies in Production ManagementInternational audiencePorts are integral parts of many supply chains and are as such a contributing factor to the overall efficiency of the supply chain. As the role of the ports is increasingly changing towards being more integrated into the supply chain, ports need to start focusing on optimising the activities and striving for low-lead time. Ports are also complex entities comprising of different companies. The dynamic nature of ports is also a problem when trying to optimise the utilisation of resources and ensure a low lead-time. Information sharing is crucial in the attempt to improve ports operations. This paper attempts to explain how information sharing is enabled in such an environment, and which considerations are relevant, both in regards to the information and required technology. The paper highlights trust, availability of data, and complexity of solutions and technology, as being the main hurdles

Fragmentation of tissue-resident macrophages during isolation confounds analysis of single-cell preparations from mouse hematopoietic tissues

Mouse hematopoietic tissues contain abundant tissue-resident macrophages that support immunity, hematopoiesis, and bone homeostasis. A systematic strategy to characterize macrophage subsets in mouse bone marrow (BM), spleen, and lymph node unexpectedly reveals that macrophage surface marker staining emanates from membrane-bound subcellular remnants associated with unrelated cells. Intact macrophages are not present within these cell preparations. The macrophage remnant binding profile reflects interactions between macrophages and other cell types in vivo. Depletion of CD169+ macrophages in vivo eliminates F4/80+ remnant attachment. Remnant-restricted macrophage-specific membrane markers, cytoplasmic fluorescent reporters, and mRNA are all detected in non-macrophage cells including isolated stem and progenitor cells. Analysis of RNA sequencing (RNA-seq) data, including publicly available datasets, indicates that macrophage fragmentation is a general phenomenon that confounds bulk and single-cell analysis of disaggregated hematopoietic tissues. Hematopoietic tissue macrophage fragmentation undermines the accuracy of macrophage ex vivo molecular profiling and creates opportunity for misattribution of macrophage-expressed genes to non-macrophage cells.Susan M. Millard, Ostyn Heng, Khatora S. Opperman, Anuj Sehgal, Katharine M. Irvine, Simranpreet Kaur, Cheyenne J. Sandrock, Andy C. Wu, Graham W. Magor, Lena Batoon, Andrew C. Perkins, Jacqueline E. Noll, Andrew C.W. Zannettino, David P. Sester, Jean-Pierre Levesque, David A. Hume, Liza J. Raggatt, Kim M. Summers, and Allison R. Petti

CHRM2, parental monitoring, and adolescent externalizing behavior: eidence for gene-environment interaction

Psychologists, with their long-standing tradition of studying mechanistic processes, can make important contributions to further characterizing the risk associated with genes identified as influencing risk for psychiatric disorders. We report one such effort with respect to CHRM2, which codes for the cholinergic muscarinic 2 receptor and was of interest originally for its association with alcohol dependence. We tested for association between CHRM2 and prospectively measured externalizing behavior in a longitudinal, community-based sample of adolescents, as well as for moderation of this association by parental monitoring. We found evidence for an interaction in which the association between the genotype and externalizing behavior was stronger in environments with lower parental monitoring. There was also suggestion of a crossover effect, in which the genotype associated with the highest levels of externalizing behavior under low parental monitoring had the lowest levels of externalizing behavior at the extreme high end of parental monitoring. The difficulties involved in distinguishing mechanisms of gene-environment interaction are discussed

Sustainable management of urban pollution: an integrated approach

This paper presents a new decision-support framework and software platform for an integrated assessment of options for sustainable management of urban pollution. The framework involves three steps: (1) mapping the flow of pollutants associated with human activities in the urban environment; (2) modelling the fate and transport of pollutants; and (3) quantifying the environmental, health and socio-economic impacts of urban pollution. It comprises a suite of different models and tools to support sustainability appraisals including life cycle assessment, substance flow analysis, source and pollutants characterisation, pollutant fate and transport modelling, health impact analysis, ecological impact assessment, and multi-criteria decision analysis. The framework can be used at different levels, from simple screening studies to more detailed assessments. The paper describes the decision-support framework and outlines several case studies to demonstrate its application. The software tool is available free of charge at www.pureframework.org. Practical applications: The PUrE framework and software platform can be applied to assess and compare the sustainability of different technologies, products, human activities or policies. Example applications of the framework have so far included sustainability comparisons of technologies for thermal treatment of municipal solid waste; generation of electricity from coal and biomass; environmental and health impacts of a mixture of pollutants in Sheffield; the role of urban green space in reducing the levels of particulate matter in London and the impacts of environmental policy on legacy pollution in Avenmouth. </jats:p