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Substance use in people with HIV (PWH) negatively impacts antiretroviral therapy (ART) adherence. However, less is known about this in the current treatment era and the impact of specific substances or severity of substance use. We examined the associations of alcohol, marijuana, and illicit drug use (methamphetamine/crystal, cocaine/crack, illicit opioids/heroin) and their severity of use with adherence using multivariable linear regression in adult PWH in care between 2016 and 2020 at 8 sites across the US. PWH completed assessments of alcohol use severity (AUDIT-C), drug use severity (modified ASSIST), and ART adherence (visual analogue scale). Among 9400 PWH, 16% reported current hazardous alcohol use, 31% current marijuana use, and 15% current use of ≥1 illicit drugs. In multivariable analysis, current methamphetamine/crystal use, particularly common among men who had sex with men, was associated with 10.1% lower mean ART adherence (p < 0.001) and 2.6% lower adherence per 5-point higher severity of use (ASSIST score) (p < 0.001). Current and more severe use of alcohol, marijuana, and other illicit drugs were also associated with lower adherence in a dose-dependent manner. In the current HIV treatment era, individualized substance use treatment, especially for methamphetamine/crystal, and ART adherence should be prioritized. [ABSTRACT FROM AUTHOR]

We aimed to examine the mediating role of alcohol use in the pathway from the interventions to depression and anxiety symptoms using data from a randomized controlled trial among people living with HIV (PWH) with hazardous alcohol use (n = 440) in Thai Nguyen, Vietnam. Participants were randomized into either a combined intervention (CoI), a brief intervention (BI) and a standard of care arm. Both interventions were based on cognitive behavioral therapy and motivational enhancement therapy. Alcohol use was measured as the percentage of days abstinent from alcohol in the last 30 days. Symptoms of depression and anxiety were measured with the Patient Health Questionnaire-9 and Generalized Anxiety Disorder-7 scales. Alcohol use was a significant mediator of the effects of two alcohol interventions on depression symptoms, but not anxiety symptoms. There were significant indirect effects via alcohol use of both interventions on depression symptoms at 12 months (CoI: mean difference (MD) = −0.134; 95%CI: −0.251, −0.035); (BI: MD = −0.141; 95%CI: −0.261, −0.038). There were no significant direct or total effects of the interventions on either symptoms at 12 months. Interventions with a dual focus on mental health and alcohol disorders are needed to determine optimal ways to tackle these common comorbidities among PWH. [ABSTRACT FROM AUTHOR]

Little is known about the potential mental health impacts of cognitive behavioral therapy and motivational interviewing interventions that focus on alcohol reduction among people with HIV (PWH). Our study aimed to assess the impact of two evidence-based alcohol reduction interventions on depression and anxiety symptoms of antiretroviral therapy (ART) clients with hazardous alcohol use. We conducted a secondary data analysis of data from a three-arm randomized controlled trial among ART clients in Thai Nguyen, Vietnam that evaluated the impacts of two alcohol reduction interventions in Vietnam. ART clients 18 years old or more with hazardous alcohol use (based on the Alcohol Use Disorders Identification Test-Consumption) were enrolled and randomized into one of three arms: Combined intervention, Brief intervention, and Standard of care (SOC). Symptoms of depression, measured with the Patient Health Questionnaire-9, and anxiety, measured with the Generalized Anxiety Disorder-7 scale, were assessed at baseline and 3, 6, and 12 months post-intervention. Generalized estimating equations were used to evaluate the effects of the interventions on depression and anxiety symptoms. The prevalence of depression and anxiety symptoms at baseline was 25.1% and 16.1%, respectively. Decreases in depression and anxiety symptoms were observed in all three arms from baseline to 12-month follow-up. There were no significant differences in depression and anxiety symptoms among participants receiving either intervention, relative to the SOC. Interventions with a dual focus on alcohol and mental health are needed to achieve more pronounced and sustainable improvements in depression and anxiety symptoms for PWH with hazardous alcohol use. [ABSTRACT FROM AUTHOR]

Background: Standard procedure for large renal stones (>1.5cm) is percutaneous nephrolithotomy. This standard procedure of doing percutaneous nephrolithotomy incudes placing of nephrostomy and DJ Stent and has significant pain and morbidity, which are related to these tubes. Various modifications were done to PCNL to decrease the morbidity. We report an observational study of PCNL without placing nephrostomy tubes. Aim and objectives: Aim was to study the outcomes of tubeless PCNL, evaluate the outcomes and complications with tubeless PCNL and to compare the outcomes of tubeless percutaneous nephrolithotomy (PCNL) with standard PCNL. Materials and methods: A total of 90 cases were included initially in this study with following inclusion criteria on patients with renal and/or upper ureteric calculi of greater than 1.5cm, less than equal to 3.0cm, negative urine culture and no coagulopathy. Further selection of cases was done after the PCNL procedure depending on whether procedure went uneventful. Finally 72 cases were included and 18 cases were excluded at the time of the procedure. The 18 patients who were excluded, required more than 2 tracts and had significant perforation of the collecting system and significant intra operative bleeding. The outcomes measured were the Hb drop, septic complications, pain score and analgesic need and hospital stay. G Ravi Chander, N Rama Murthy, Saptagiri Prasad, K Gopikanth, Anna Manikantanan Suresh. A Prospective Observational Study of Tubeless Percutaneous Nephrolithotomy Procedure for Renal Stones. IAIM, 2020; 7(10): 51-60. Page 52 Results: There was no significant difference in mean operative time between standard and tubeless PCNL groups. Post-operative analgesic requirement was significantly low in our study group compared to Standard PCNL. No difference was found in the incidence of Sepsis, Hb drop. The incidence of urinary leak is significantly lower in our group. Hospital stay is shorter in our study which was statistically significant. Conclusions: Tubeless PCNL can be adopted in majority of patients especially when the procedure went uneventful without much bleeding, without PCS injury and where complete clearance of the stone done with single tract. Tubeless PCNL is equally safer procedure with bleeding and sepsis complications comparable to Standard PCNL, but it has definite advantage of less post-operative pain requiring less analgesic, less post op urinary leak and most important shorter hospital stay. [ABSTRACT FROM AUTHOR]

As the HIV-infected population ages and the burden of chronic comorbidities increases, adherence to medications for HIV and diabetes and hypertension is crucial to improve outcomes. We pilot-tested a pictorial aid intervention to improve medication adherence for both HIV and common chronic conditions. Adult patients with HIV and diabetes (DM) and/or hypertension (HTN) attending a clinic for underserved patients and at risk for poor health outcomes were enrolled. Patients were randomized to receive either a pictorial aid intervention (a photographic representation of their medications, the indications, and the dosing schedule) or a standard clinic visit discharge medication list. Adherence to antiretroviral therapy (ART) for HIV and therapy for DM or HTN was compared. Predictors of ART adherence at baseline were determined using logistic regression. Medication adherence was assessed using medication possession ratio (MPR) for the 6-month interval before and after the intervention. Change in adherence by treatment group was compared by ANOVA. Among the 46 participants, there was a trend towards higher adherence to medications for HIV compared with medications for hypertension/diabetes (baseline median MPR for ART 0.92; baseline median MPR for the medication for the comorbid condition 0.79,p = 0.07). The intervention was feasible to implement and satisfaction with the intervention was high. With a small sample size, the intervention did not demonstrate significant improvement in adherence to medications for HIV or comorbid conditions. Patients with HIV are often medically complex and may have multiple barriers to medication adherence. Medication adherence is a multifaceted process and adherence promotion interventions require an approach that targets patient-specific barriers. [ABSTRACT FROM PUBLISHER]

The aim of the study was to examine the association between levels of past and current alcohol consumption and all-cause and liver-related mortality among people living with HIV (PLWH). Methods A prospective cohort study of 1855 PLWH in Baltimore, MD was carried out from 2000 to 2013. We ascertained alcohol use by (1) self-report (SR) through a computer-assisted self interview, and (2) medical record abstraction of provider-documented (PD) alcohol use. SR alcohol consumption was categorized as heavy (men: > 4 drinks/day or > 14 drinks/week; women: > 3 drinks/day or > 7 drinks/week), moderate (any alcohol consumption less than heavy), and none. We calculated the cumulative incidence of liver-related mortality and fitted adjusted cause-specific regression models to account for competing risks. Results All-cause and liver-related mortality rates (MRs) were 43.0 and 7.2 per 1000 person-years (PY), respectively. All-cause mortality was highest among SR nondrinkers with PD recent (< 6 months) heavy drinking (MR = 85.4 deaths/1000 PY) and lowest among SR moderate drinkers with no PD history of heavy drinking (MR = 23.0 deaths/1000 PY). Compared with SR moderate drinkers with no PD history of heavy drinking, SR nondrinkers and moderate drinkers with PD recent heavy drinking had higher liver-related mortality [hazard ratio (HR) = 7.28 and 3.52, respectively]. However, SR nondrinkers and moderate drinkers with a PD drinking history of > 6 months ago showed similar rates of liver-related mortality (HR = 1.06 and 2.00, respectively). Conclusions Any heavy alcohol consumption was associated with all-cause mortality among HIV-infected individuals, while only recent heavy consumption was associated with liver-related mortality. Because mortality risk among nondrinkers varies substantially by drinking history, current consumption alone is insufficient to assess risk. [ABSTRACT FROM AUTHOR]

Background: India accounts for one-fifth of the global TB incidence. While the exact burden of childhood TB is not known, TB remains one of the leading causes of childhood mortality in India. Bacteriological confirmation of TB in children is challenging due to difficulty in obtaining quality specimens, in the absence of which diagnosis is largely based on clinical judgement. While testing multiple specimens can potentially contribute to higher proportion of laboratory confirmed paediatric TB cases, lack of high sensitivity tests adds to the diagnostic challenge. We describe here our experiences in piloting upfront Xpert MTB/RIF testing, for diagnosis of TB in paediatric population in respiratory and extra pulmonary specimens, as recently recommended by WHO. Method: Xpert MTB/RIF testing was offered to all paediatric (0–14 years) presumptive TB cases (both pulmonary and extra-pulmonary) seeking care at public and private health facilities in the project areas covering 4 cities of India. Results: Under this pilot project, 8,370 paediatric presumptive TB & presumptive DR-TB cases were tested between April and–November 2014. Overall, 9,149 specimens were tested, of which 4,445 (48.6%) were non-sputum specimens. Xpert MTB/RIF gave 9,083 (99.2%, CI 99.0–99.4) valid results. Of the 8,143 presumptive TB cases enrolled, 517 (6.3%, CI 5.8–6.9) were bacteriologically confirmed. TB detection rates were two fold higher with Xpert MTB/RIF as compared to smear microscopy. Further, a total of 60 rifampicin resistant TB cases were detected, of which 38 were detected among 512 presumptive TB cases while 22 were detected amongst 227 presumptive DR-TB cases tested under the project. Conclusion: Xpert MTB/RIF with advantages of quick turnaround testing-time, high proportion of interpretable results and feasibility of rapid rollout, substantially improved the diagnosis of bacteriologically confirmed TB in children, while simultaneously detecting rifampicin resistance. [ABSTRACT FROM AUTHOR]

To monitor land surface processes over a wide range of temporal and spatial scales, it is critical to have coordinated observations of the Earth's surface using imagery acquired from multiple spaceborne imaging sensors. The RapidEye (RE) satellite constellation acquires high-resolution satellite images covering the entire globe within a very short period of time by sensors identical in construction and cross-calibrated to each other. To evaluate the RE high-resolution Multi-spectral Imager (MSI) sensor capabilities, a cross-comparison between the RE constellation of sensors was performed first using image statistics based on large common areas observed over pseudo-invariant calibration sites (PICS) by the sensors and, second, by comparing the on-orbit radiometric calibration temporal trending over a large number of calibration sites. For any spectral band, the individual responses measured by the five satellites of the RE constellation were found to differ <2–3% from the average constellation response depending on the method used for evaluation. Geometric assessment was also performed to study the positional accuracy and relative band-to-band (B2B) alignment of the image data sets. The position accuracy was assessed by comparing the RE imagery against high-resolution aerial imagery, while the B2B characterization was performed by registering each band against every other band to ensure that the proper band alignment is provided for an image product. The B2B results indicate that the internal alignments of these five RE bands are in agreement, with bands typically registered to within 0.25 pixels of each other or better. [ABSTRACT FROM AUTHOR]

Dissimilar joints between austenitic stainless steel and low alloy steel are extensively used in many high temperature applications in the energy conversion systems. In the present investigation, emphasis is made on the influence of process parameters on the impact toughness and hardness of the friction welded joints between these two materials. The important process parameters in friction welding such as friction force, forge force, and burn-off lengths are considered for optimization by Taguchi method using L 2 orthogonal array. It is found that under low friction force, forging force, and burn-off conditions, the impact toughness is high due to the observed acicular martensite. Low impact toughness is reported for the welds made at higher levels of the parameters. Carbon depletion is also observed close to interface in low alloy steel side. Microhardness at the weld center is less than the microhardness on either side at the interface of low alloy steel and austenitic stainless steel close to weld center. The contribution of each parameter and significance of interactions of these parameters is determined by Taguchi method. Among these parameters, friction force has significant influence and forging force has negligible influence on microhardness. The burn-off has maximum influence while forge force has minimum effect on toughness of the welds. Statistical analysis of variance is carried out, optimum process parameters are evaluated, and regression equations are obtained. [ABSTRACT FROM AUTHOR]

Multispectral data from the Landsat 5 (L5) Thematic Mapper (TM) sensor provide the backbone of the extensive archive of moderate-resolution Earth imagery. Even after more than 24 years of service, the L5 TM is still operational. Given the longevity of the satellite, the detectors have aged and the sensor's radiometric characteristics have changed since launch. The calibration procedures and parameters in the National Land Archive Production System (NLAPS) have also changed with time. Revised radiometric calibrations in 2003 and 2007 have improved the radiometric accuracy of recently processed data. This letter uses the Normalized Difference Vegetation Index (NDVI) as a metric to evaluate the radiometric calibration. The calibration change has improved absolute calibration accuracy, consistency over time, and consistency with Landsat 7 (L7) Enhanced Thematic radiometry and will provide the basis for continued long-term studies of the Earth's land surfaces. [ABSTRACT FROM AUTHOR]

Objectives The aim of the study was to determine the relationship between alcohol consumption and liver fibrosis as assessed by aspartate aminotransferase to platelet ratio index (APRI) in HIV-infected adults and to explore the relative contributions of alcohol and hepatitis C virus (HCV) to APRI among HIV/HCV-coinfected adults. Methods We performed a cross-sectional analysis of data from an observational clinical cohort. Alcohol consumption was categorized according to National Institute on Alcohol Abuse and Alcoholism guidelines. We defined significant liver disease as APRI>1.5, and used multinomial logistic regression to identify correlates of increased APRI. Results Among 1358 participants, 10.4% reported hazardous drinking. It was found that 11.6% had APRI>1.5, indicating liver fibrosis. Hazardous drinking was associated with increased APRI [adjusted relative risk ratio (RRR) 2.30; 95% confidence interval (CI) 1.26–4.17]. Other factors associated with increased APRI were male gender, viral hepatitis, and HIV transmission category of injecting drug use. Among coinfected individuals, 18.3% had APRI>1.5, and hazardous drinking was not associated with APRI. Among non-HCV-infected individuals, 5.3% had APRI>1.5 and hazardous drinking was associated with increased APRI (adjusted RRR 3.72; 95% CI 1.40–9.87). Conclusions Hazardous drinking is an important modifiable risk factor for liver fibrosis, particularly among non-HCV-infected patients. Clinicians and researchers must address alcohol use as the burden of liver disease increases among HIV-positive individuals. [ABSTRACT FROM AUTHOR]

A 36 years old female presented with symmetrical polyarthritis diagnosed as Rheumatoid Arthritis (RA). After six months, she developed tender thyroid swelling diagnosed as autoimmune thyroiditis with hypothyroidism. Another six months later, she developed butterfly rash over the face with exacerbation of polyarthritis and a diagnosis of Systemic Lupus Erythematosus (SLE) with anti- ds- DNA positive was made. She was diagnosed with rheumatoid arthritis overlapping with systemic lupus erythematosus (Rhupus syndrome) with hypothyroidism. [ABSTRACT FROM AUTHOR]

Objective We sought to determine the prevalence of any alcohol use and hazardous alcohol consumption among HIV-infected individuals engaged in care and to identify factors associated with hazardous alcohol use. Methods During 2003, 951 patients were interviewed at 14 HIV primary care sites in the USA. Hazardous drinking was defined as >14 drinks/week or ≥5 drinks/occasion for men and >7 drinks/week or ≥4 drinks/occasion for women. Moderate alcohol use was consumption at less than hazardous levels. We used logistic regression to identify factors associated with any alcohol use and hazardous alcohol use. Results Forty per cent of the sample reported any alcohol use in the 4 weeks prior to the interview; 11% reported hazardous use. In multivariate regression, male sex [adjusted odds ratio (AOR) 1.52 (95% confidence interval, CI, 1.07–2.16)], a college education (compared to

High levels of adherence to highly active antiretroviral therapy (HAART) are essential for virologic suppression and longer survival in patients with HIV. We examined the effects of substance abuse treatment, current versus former substance use, and hazardous/binge drinking on adherence to HAART. During 2003, 659 HIV patients on HAART in primary care were interviewed. Adherence was defined as ≥95% adherence to all antiretroviral medications. Current substance users used illicit drugs and/or hazardous/binge drinking within the past six months, while former users had not used substances for at least six months. Logistic regression analyses of adherence to HAART included demographic, clinical and substance abuse variables. Sixty-seven percent of the sample reported 95% adherence or greater. However, current users (60%) were significantly less likely to be adherent than former (68%) or never users (77%). In multivariate analysis, former users in substance abuse treatment were as adherent to HAART as never users (Adjusted Odds Ratio (AOR)=0.82; p>0.5). In contrast, former users who had not received recent substance abuse treatment were significantly less adherent than never users (AOR=0.61; p=0.05). Current substance users were significantly less adherent than never users, regardless of substance abuse treatment (p<0.01). Substance abuse treatment interacts with current versus former drug use status to affect adherence to HAART. Substance abuse treatment may improve HAART adherence for former substance users. [ABSTRACT FROM AUTHOR]

Effective April 2, 2007, the radiometric calibration of Landsat-5 (L5) Thematic Mapper (TM) data that are processed and distributed by the U.S. Geological Survey (USGS) Center for Earth Resources Observation and Science (EROS) will be updated. The lifetime gain model that was implemented on May 5, 2003, for the reflective bands (1-5, 7) will be replaced by a new lifetime radiometric-calibration curve that is derived from the instrument's response to pseudoinvariant desert sites and from cross calibration with the Landsat-7 (L7) Enhanced TM Plus (ETM+). Although this calibration update applies to all archived and future L5 TM data, the principal improvements in the calibration are for the data acquired during the first eight years of the mission (1984-1991), where the changes in the instrument-gain values are as much as 15%. The radiometric scaling coefficients for bands 1 and 2 for approximately the first eight years of the mission have also been changed. Users will need to apply these new coefficients to convert the calibrated data product digital numbers to radiance. The scaling coefficients for the other bands have not changed. [ABSTRACT FROM PUBLISHER]

The adsorption of sodium oleate and various ethoxylated nonylphenol surfactants and their mixtures at air/liquid interface was investigated by equilibrium and dynamic surface tension experiments. Synergism was determined by observing the lowering of surface tension of water by single surfactants and their mixtures. The results showed that the addition of nonionic surfactant reduced both the equilibrium and dynamic surface tension of sodium oleate solutions. The effect of molecular weight, HLB, and degree of ethoxylation of the surfactant was studied. Interaction between anionic and nonionic surfactant mixtures was calculated by using an interaction parameter. The interaction parameter between oleate and NP‐4 (a nonionic surfactant) was calculated to be -0.21, showing attraction between the two surfactant molecules. [ABSTRACT FROM AUTHOR]

A response by Armina A. Chaudhry to a letter to the editor about the Aspartate aminotransferase to platelet radio index (APRI) score which is inappropriate for assessment of liver fibrosis in HIV-infected patients with hazardous drinking.