PRIMARY AND SECONDARY PREVENTION OF HEPATITIS C VIRUS AMONG RURAL APPALACHIAN PEOPLE WHO USE DRUGS

Hepatitis C virus (HCV) remains a major cause of morbidity and mortality worldwide, with 3% of the global population chronically infected. Clinical impacts in the United States are projected to increase for two decades, and mortality attributed to HCV now exceeds HIV. Injection drug use (IDU) is the most common route of transmission in the developed world. Advances in treatment offer hope of mitigating HCV impacts, but substantial barriers obstruct people who inject drugs (PWID) from receiving care, particularly in medically underserved regions including Central Appalachia. This study assessed IDU paraphernalia sharing longitudinally over 24 months in a sample of 283 rural PWID recruited by respondent‐driven sampling. Medical follow‐up among 254 seropositive participants was also assessed using discrete‐time survival analysis. HCV‐positive screening was associated with reduced IDU sharing frequency 18 months after testing compared to seronegative participants (adjusted OR [aOR]=1.4, 95% confidence interval [CI]: 1.0‐1.9), but this effect was not sustained. HCV‐positive participants were less likely to cease IDU 6 months after testing (aOR=0.4, 95% CI: 0.2‐0.7). Predictors negatively associated with decreased IDU sharing included recent unprotected sex, sedative use, and frequency of prescription opioid IDU; protective associations included female gender and religious affiliation. IDU cessation was negatively associated with ever being incarcerated, recent unprotected sex with PWID, heavy alcohol use, lifetime use of OxyContin®, and baseline frequency of prescription opioid IDU; protective associations included number of dependents, receiving disability payments, and substance abuse treatment. Drug‐specific associations decreasing IDU cessation included recent illicit use of OxyContin®, other oxycodone, and cocaine. 150 of 254 (59%) seropositive participants saw a clinician after HCV‐positive screening and counseling, 35 (14%) sought treatment, and 21 (8%) received treatment. Positive predictors of following up with a clinician following testing and counseling included health insurance, internet access, past substance abuse treatment, generalized anxiety disorder, and recent marijuana use. Factors decreasing odds of follow‐up included major depression, lifetime illicit methadone use, and recent legal methadone. These analyses shed valuable light on determinants of behavior impacting primary and secondary HCV prevention. Integrated, multidisciplinary approaches are recommended to meaningfully impact epidemic levels of HCV among rural PWID in Eastern Kentucky

Healthcare Contact and Treatment Uptake Following Hepatitis C Virus Screening and Counseling Among Rural Appalachian People Who Use Drugs

Background—Hepatitis C virus (HCV) remains a major contributor to morbidity and mortality worldwide. Since 2009, Kentucky has led the United States in cases of acute HCV, driven largely by injection drug use in rural areas. Improved treatment regimens hold promise of mitigating the impact and transmission of HCV, but numerous barriers obstruct people who inject drugs (PWID) from receiving care, particularly in medically underserved settings. Methods—503 rural people who use drugs were recruited using respondent-driven sampling and received HCV screening and post-test counseling. Presence of HCV antibodies was assessed using enzyme immunoassay of dried blood samples. Sociodemographic and behavioral data were collected using computer-based questionnaires. Predictors of contacting a healthcare provider for follow-up following HCV-positive serotest and counseling were determined using discrete-time survival analysis. Results—150 (59%) of 254 participants reported contacting a healthcare provider within 18 months of positive serotest and counseling; the highest probability occurred within six months of serotesting. 35 participants (14%) reported they were seeking treatment, and 21 (8%) reported receiving treatment. In multivariate time-dependent modeling, health insurance, internet access, prior substance use treatment, meeting DSM-IV criteria for generalized anxiety disorder, and recent marijuana use increased the odds of making contact for follow-up. Participants meeting criteria for major depressive disorder and reporting prior methadone use, whether legal or illegal, were less likely to contact a provider. Conclusion—While only 8% received treatment after HCV-positive screening, contacting a healthcare provider was frequent in this sample of rural PWID, suggesting that the major barriers to care are likely further downstream. These findings offer insight into the determinants of engaging the cascade of medical treatment for HCV and ultimately, treatment-as-prevention. Further study and increased resources to support integrated interventions with effectiveness in other settings are recommended to mitigate the impact of HCV in this resource-deprived setting

Carbon Monitoring System Flux Net Biosphere Exchange 2020 (CMS-Flux NBE 2020)

Here we present a global and regionally resolved terrestrial net biosphere exchange (NBE) dataset with corresponding uncertainties between 2010-2018: Carbon Monitoring System Flux Net Biosphere Exchange 2020 (CMS-Flux NBE 2020). It is estimated using the NASA Carbon Monitoring System Flux (CMS-Flux) top-down flux inversion system that assimilates column CO2 observations from the Greenhouse Gases Observing Satellite (GOSAT) and NASA\u27s Observing Carbon Observatory 2 (OCO-2). The regional monthly fluxes are readily accessible as tabular files, and the gridded fluxes are available in NetCDF format. The fluxes and their uncertainties are evaluated by extensively comparing the posterior CO2 mole fractions with CO2 observations from aircraft and the NOAA marine boundary layer reference sites. We describe the characteristics of the dataset as the global total, regional climatological mean, and regional annual fluxes and seasonal cycles. We find that the global total fluxes of the dataset agree with atmospheric CO2 growth observed by the surface-observation network within uncertainty. Averaged between 2010 and 2018, the tropical regions range from close to neutral in tropical South America to a net source in Africa; these contrast with the extra-tropics, which are a net sink of 2.5±0.3 Gt C/year. The regional satellite-constrained NBE estimates provide a unique perspective for understanding the terrestrial biosphere carbon dynamics and monitoring changes in regional contributions to the changes of atmospheric CO2 growth rate. The gridded and regional aggregated dataset can be accessed at http://doi.org/10.25966/4v02-c391 (Liu et al., 2020).

The Future of the Academic Cardiothoracic Surgeon: Results of the TSRA/TSDA In-Training Examination Survey.

BACKGROUND: Traditionally cardiothoracic residents spent dedicated research time during general surgery equipping them for a potential academic career. Recent changes in training paradigms, including integrated programs that may not include research time, could affect the development of future academic cardiothoracic surgeons. METHODS: Responses to the 2015 Thoracic Surgery Directors\u27 Association/Thoracic Surgery Residents\u27 Association survey accompanying the in-training examination taken by current cardiothoracic surgery residents were analyzed. Three hundred fifty-four residents were surveyed with a response rate of 100%, although one was excluded from the analysis because of inconsistencies in responses. Statistical analysis included χ(2), Fisher\u27s exact test, and multinomial logistic regression with significance set at a probability value of 0.05. RESULTS: Two hundred sixty-seven of 353 residents (76%) intended on performing research as part of their careers. Integrated residents as opposed to traditional residents (85% versus 69%; p = 0.003), males (78% versus 65%; p = 0.02), those pursuing additional training (85% versus 69%; p = 0.003), and those interested in academic careers (93% versus 33%; p \u3c 0.001) were more likely to pursue research. Differences were also noted in specialty interest, with congenital and heart failure specialties most likely to pursue research careers (92% and 100%, respectively; p \u3c 0.05). Residents intending on research careers were more likely to have had previous research experience, and the most common type of intended research was clinical outcomes (78%). On multinomial logistic regression, previous clinical outcomes research and academic practice were identified as predictors of a research career (odd ratios of 9.7 and 4.1, respectively; each p \u3c 0.05). CONCLUSIONS: The majority of residents plan on pursuing research during their careers. Previous research experience appears to be a key determinant as well as specialty interest

Gender and Cardiothoracic Surgery Training: Specialty Interests, Satisfaction, and Career Pathways.

BACKGROUND: The cardiothoracic surgical workforce is changing. Although 5% of practicing surgeons are women, 20% of current cardiothoracic surgery residents are women. The purpose of this study was to evaluate the influence of gender on specialty interest, satisfaction, and career pathways of current residents. METHODS: Responses to the mandatory 2015 Thoracic Surgery Residents Association/Thoracic Surgery Directors Association in-training examination survey taken by 354 residents (100% response rate) were evaluated. The influence of gender was assessed with the use of standard univariate analyses. RESULTS: Women accounted for 20% of residents, and the percentage did not vary with postgraduate year or program type (traditional versus integrated). Although no differences were found between the genders related to specialty interest, academic versus private practice career, or pursuit of additional training, women were more likely to pursue additional training in minimally invasive thoracic surgery (10% versus 2.5%, p = 0.001) and less likely to perform research in their careers (65% versus 88%, p = 0.043). Although women were equally satisfied with their career choice, had similar numbers of interviews and job offers, and felt equally prepared for their boards, graduating women felt less prepared technically (77% versus 90%, p = 0.01) and for practicing independently (71% versus 87%, p = 0.01). Women were less likely to be married (26% versus 62%, p \u3c 0.001) and have children (19% versus 49%, p \u3c 0.001). CONCLUSIONS: Although career satisfaction and specialty interest were similar between the genders, women were less likely to intend to perform research during their careers despite similar previous research experience. Women also demonstrated lower rates of marriage and childbearing compared with their male counterparts