Sexual Risk, Substance Use and Undiagnosed Seropositivity among Men Who Have Sex with Men and Women in Miami, Florida

This paper utilizes the National HIV Behavioral Surveillance data in Miami for the men who have sex with men cycle (NHBS-MSM2) in 2008. We analyzed sexual risk, substance use and undiagnosed seropositivity in a diverse sample of men who have sex with men and women (MSMW) and compared them with MSM. Of 152 MSMW, 15.1% tested HIV positive with 73.9% previously undiagnosed. Almost half (44.1%) of the MSMW reported unprotected sex with male and female partners in the past year. More MSMW than MSM had undiagnosed HIV infection, exchanged sex for money or drugs, used crack and cocaine, been high during sex, and had not received HIV treatment if HIV positive. Undiagnosed HIV infection among MSMW was associated with Black race, older age, non-alcohol use and Ecstasy use. Our findings indicate that MSMW represent a unique population at risk of acquiring and transmitting HIV in Miami

Trends in the HIV Epidemic among Men Who Have Sex with Men in Miami-Dade County, Florida, 2004-2014

Miami, Florida has a large population of Hispanic and black men who have sex with men (MSM), a population more likely to become HIV infected than white MSM. We present here HIV behavioral trends in this population that reflect the effects of public health prevention in Miami over a 10-year period. Using National HIV Behavioral Surveillance (NHBS) data of MSM in Miami-Dade County, Florida, in 2004-05, 2008, 2011 and 2014, chi-square trend analyses were used to assess the epidemiologic trends related to HIV infection rates, HIV testing rates, undiagnosed HIV infection, use antiretroviral therapy (ART) and access to HIV care. Of 258, 527, 511, and 536 MSM, HIV rates have remained steady between 22.5% (95% CI 17.4-27.6) in 2004-05 to a high of 25.9% (95% CI 22.2-29.6) in MSM4 in 2014, with no significant trend. There was an increase in HIV testing in the past six months between 2004 (48.4%;95% CI 41.8-55.0) and 2014 (55.8;95% CI 51.3-60.3), p \u3c .001; and a decrease in unrecognized HIV infection from 48.3% (95% CI 35.4- 61.2) in 2004 to 31.4% (95% CI 23.7-39.1) in 2014, p = .004, over the same period. Being currently on ART and knowledge of pre-exposure prophylaxis (PrEP) also increased significantly during this 10-year period. HIV surveillance is providing valuable information, notably, as HIV testing rates have gone up unrecognized infections have decreased. Continued use of the NHBS system should provide insights into the epidemic and assist in reaching public health goals for the control of HIV infections

Clouds in the Coldest Brown Dwarfs: FIRE Spectroscopy of Ross 458C

Condensate clouds are a salient feature of L dwarf atmospheres, but have been assumed to play little role in shaping the spectra of the coldest T-type brown dwarfs. Here we report evidence of condensate opacity in the near-infrared spectrum of the brown dwarf candidate Ross 458C, obtained with the Folded-Port Infrared Echellette (FIRE) spectrograph at the Magellan Telescopes. These data verify the low-temperature nature of this source, indicating a T8 spectral classification, log Lbol/Lsun = -5.62+/-0.03, Teff = 650+/-25 K, and a mass at or below the deuterium burning limit. The data also reveal enhanced emission at K-band associated with youth (low surface gravity) and supersolar metallicity, reflecting the properties of the Ross 458 system (age = 150-800 Myr, [Fe/H] = +0.2 to +0.3). We present fits of FIRE data for Ross 458C, the T9 dwarf ULAS J133553.45+113005.2, and the blue T7.5 dwarf SDSS J141624.08+134826.7B, to cloudless and cloudy spectral models from Saumon & Marley. For Ross 458C we confirm a low surface gravity and supersolar metallicity, while the temperature differs depending on the presence (635 [+25,-35] K) or absence (760 [+70,-45] K) of cloud extinction. ULAS J1335+1130 and SDSS J1416+1348B have similar temperatures (595 [+25,-45] K), but distinct surface gravities (log g = 4.0-4.5 cgs versus 5.0-5.5 cgs) and metallicities ([M/H] ~ +0.2 versus -0.2). In all three cases, cloudy models provide better fits to the spectral data, significantly so for Ross 458C. These results indicate that clouds are an important opacity source in the spectra of young cold T dwarfs, and should be considered when characterizing the spectra of planetary-mass objects in young clusters and directly-imaged exoplanets. The characteristics of Ross 458C suggest it could itself be regarded as a planet, albeit one whose cosmogony does not conform with current planet formation theories.Comment: Accepted for publication to ApJ: 18 pages, 11 figures in emulateapj forma

Bone marrow augmentation of donor-cell chimerism in kidney, liver, heart, and pancreas islet transplantation

We have previously postulated that donor cell chimerism in organ transplantation is needed to attain a tolerant state. Here we show that donor cell chimerism can be augmented in organ recipients if they are infused perioperatively with 3 × 10 8 per kg of unmodified donor bone marrow cells and are kept on a conventional immunosuppressive regimen of tacrolimus (FK506) and prednisolone. 36 patients took part, of whom the first 18 patients have good transplanted kidney (n = 10), liver (n = 7), and heart (n = 7) function when followed up between 4 and 16 months. All patients are well. We found persistent multilineage leucocyte chimerism in blood of 17 recipients by flow cytometry and PCR techniques to detect donor alleles or Y chromosomes in female recipients of male organs. The use of the 5-antigen HLA matched same sex donor precluded detection of chimerism in one patient

Combined bone marrow and whole organ transplantation from the same donor.

The recognition that after transplantation resident bone marrow-derived cells migrate out of the graft into the recipient has led to an increasing acceptance that the consequent establishment of chimerism is a seminal event in whole organ allograft acceptance, and the first step towards subsequent induction of donor-specific nonreactivity.1–6 Because the migratory interstitial cells are of hematolymphoid origin, the next logical attempt was to augment this natural phenomenon by infusing donor bone marrow cells at the time of whole organ transplantation. The goal of this study was to induce a higher level of chimerism in unmodified recipients of liver, kidneys, heart, and pancreatic islets by perioperative infusion of unaltered bone marrow from the same donor, in an attempt to either enhance graft survival and/or decrease or ultimately eliminate the requirement for chronic nonspecific immunosuppression

Long-Term Survival After Liver Transplantation in 4,000 Consecutive Patients at a Single Center

OBJECTIVE: To evaluate the long-term survival outcomes of a large cohort of liver transplant recipients and to identify static and changing factors that influenced these outcomes over time. SUMMARY BACKGROUND DATA: Liver transplantation has been accepted as a therapeutic option for patients with end-stage liver disease since 1983, with continual improvements in patient survival as a result of advances in immunosuppression and medical management, technical achievements, and improvements in procurement and preservation. Although many reports, including registry data, have delineated short-term factors that influence survival, few reports have examined factors that affect long-term survival after liver transplantation. METHODS: Four thousand consecutive patients who underwent liver transplantation between February 1981 and April 1998 were included in this analysis and were followed up to March 2000. The effect of donor and recipient age at the time of transplantation, recipient gender, diagnosis, and year of transplantation were compared. Rates of retransplantation, causes of retransplantation, and cause of death were also examined. RESULTS: The overall patient survival for the entire cohort was 59%; the actuarial 18-year survival was 48%. Patient survival was significantly better in children, in female recipients, and in patients who received transplants after 1990. The rates of retransplantation for acute or chronic rejection were significantly lower with tacrolimus-based immunosuppression. The risk of graft failure and death was relatively stable after the first year, with recurrence of disease, malignancies, and age-related complications being the major factors for loss. CONCLUSION: Significantly improved patient and graft survival has been observed over time, and graft loss from acute or chronic rejection has emerged as a rarity. Age-related and disease-related causes of graft loss represent the greatest threat to long-term survival