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Purpose: The purpose of the current study was to conduct a comprehensive meta-analytic review of Cognitive Processing Therapy (CPT) for PTSD among military personnel and veterans. Additionally, we sought to examine potential moderators of treatment outcomes including type of comparison condition (e.g., active trauma-focused, active non-trauma-focused), CPT version (i.e., CPT with and without the written trauma account), sample type (veteran or military personnel), age, gender, and race. Methods: Nine articles with 1,804 participants were retained for this meta-analysis. Results: CPT, when compared to all comparison conditions, exhibited a medium effect on PTSD symptom reduction (Hedge's g = − 0.48, 95% CI: -1.05, 0.08). Regarding moderators, the effect was larger for non-trauma-focused active comparators versus trauma-focused active comparators (Qbetween = 16.69, pbetween < 0.001, Hedge's g = − 0.57 and − 0.14, respectively). Further, CPT with the written trauma account outperformed CPT without the written trauma account (Qbetween = 4.53, pbetween = 0.03, Hedge's g = − 0.86 and − 0.23, respectively), and veteran samples saw slightly more symptom reduction than military personnel (Qbetween = 15.50, pbetween < 0.001, Hedge's g = − 0.51 and − 0.45, respectively). Notably, age, gender, and race did not moderate the effect of CPT on PTSD. Conclusions: Findings support the continued use of CPT for PTSD symptoms among veterans and military personnel and call into question the removal of the written trauma account. [ABSTRACT FROM AUTHOR]

Previous suicide attempts, psychopathology symptoms, and pain significantly increase risk of suicide, a leading cause of death. It is possible that patients across these three groups exhibit key differences that could provide insights into unique interventions for suicide-related outcomes. Data were collected using a standardized form at 432 emergency departments (EDs; 14,018 participants [females, n = 8,042; 57.4%; males, n = 5,976; 42.6%]). We conducted a series of ANOVAs to investigate if patients presenting for (1) suicide attempts (n = 33; 0.2%), (2) psychopathology symptoms (n = 1,104; 7.9%), or (3) pain (n = 12,881; 91.9%) varied across a variety of healthcare-relevant variables. Findings indicated that patients presenting with suicide attempts were seen with more urgency (F[2,12054] = 66.41, p <.001) and were more likely to be admitted to hospitalization (F[2,14015] = 187.296, p <.001), observation unit overall (F[2,14015] = 78.572, p <.001), or transferred to another hospital (F[2,14015] = 406.568, p <.001); they also required longer visits (F [2, 12054] = 66.41, p <.001) as compared to patients with psychopathology symptoms or pain. Notably, potentially important similarities between groups emerged: groups did not differ across leaving without medical screening, leaving against medical advice, or contact with healthcare providers in the long-term (i.e., twelve months) or short-term (i.e., 72 hours) preceding ED admission. These findings in particular indicate that there could be ample time (1) prior to admission to intervene and (2) during care in EDs to connect patients to goal-oriented, time-limited evidence based psychotherapies at a time when they may be particularly willing to engage in care. [ABSTRACT FROM AUTHOR]

Traumatic events are a serious public health concern, linked cross-sectionally and longitudinally with post-traumatic stress disorder (PTSD) and suicidal ideation (SI). While much research has focused on broadly defined traumatic events as they relate to PTSD and SI, fewer projects have investigated the disparate associations that specific traumatic events have with PTSD and SI. In this study of 1,829 adolescents held at the Cook County Juvenile Temporary Detention Center (measured during adolescence and again nine years later during adulthood), the cross-sectional and prospective links between various traumatic events (i.e. being physically assaulted, threatened with a weapon, sexually assaulted, in a serious accident, seeing someone be killed, experiencing a natural disaster, seeing a dead body, or being forced to fight), PTSD symptoms, and SI were investigated. Findings indicate that every traumatic event endorsed at baseline was cross-sectionally associated with increased PTSD symptoms and SI. Experiencing sexual assault or a serious accident during adolescence predicted greater SI at follow-up. Moreover, the positive association between PTSD symptoms at baseline and SI at follow-up was stronger among individuals who experienced sexual assault or a serious accident versus those who were not trauma exposed. Implications for justice-involved adolescents are discussed. [ABSTRACT FROM AUTHOR]

Although suicide is a pervasive public health issue, strong predictors of suicidal thoughts and behaviors (STBs, e.g., passive or active suicidal ideation, suicide plans, suicide attempts, etc.) are lacking. Theory suggests that attentional processes, such as attentional bias and attentional control, may contribute to STBs. Specifically, among individuals with suicidal ideation, attentional biases towards suicide-related information may increase distress. This combined with the inability to disengage and shift attention away from suicidal thoughts (i.e., deficits in attentional control) might contribute to increased risk for negative outcomes (i.e., non-suicidal self-injury, suicidal behavior). Despite this notion, there has been limited research examining associations between attentional risk factors and STBs. Therefore, the purpose of this study was to conduct a meta-analysis to examine possible associations between attentional biases and STBs and attentional control and STBs. A comprehensive literature search was conducted and a total of 20 articles were retained for this meta-analysis. A small, but significant relationship was observed between attentional bias and STBs (r =.09, 95% CI:.06,.13), but not attentional control and STBs (r = -.04, 95% CI: -.21,.12). The limited number of studies identified, and therefore low power, precluded moderator analyses from being conducted. Moreover, additional experimental and longitudinal research with diverse assessments of attentional risk factors is needed. Despite these limitations, the present study provides preliminary evidence for the association between attentional bias and STBs. [ABSTRACT FROM AUTHOR]

Background: The North Carolina Community Research Partnership developed, implemented, and tested weCare, a 12-month bilingual mHealth social media intervention designed to reduce missed HIV care appointments and increase viral suppression among racially/ethnically diverse gay, bisexual, and other men who have sex with men (GBMSM) and transgender women living with HIV by harnessing established social media platforms (i.e., Facebook, texting, and dating apps). Methods: We randomized 198 GBMSM and transgender women (mean age = 26) living with HIV to the weCare intervention (n = 100) or usual-care (n = 98) group. Inclusion criteria included being newly diagnosed or not in care. Participants completed structured assessments at baseline and 6-month postintervention follow-up (18 months after baseline data collection). HIV care appointment and viral load data were abstracted from each participant's electronic health record at baseline and follow-up. Follow-up retention was 85.5%. Results: Among participants, 94% self-identified as cisgender men, 6% as transgender, 64% as African American/Black, and 13% as Latine. Participants in both groups significantly reduced missed HIV care appointments and increased viral suppression at follow-up compared with baseline. However, there were no significant differences between weCare and usual-care participants for either outcome at follow-up. Conclusions: An intervention effect was not identified for our two primary outcomes. Several factors may have influenced the lack of significant differences between weCare and usual-care participants at follow-up, including intervention implementation (e.g., staffing changes and lack of fidelity to the intervention as originally designed by the partnership), data collection (e.g., data collection time points and retention strategies), and clinical (e.g., contamination) factors. [ABSTRACT FROM AUTHOR]

Objectives: Suicidal ideation (SI) nearly always precedes lethal suicide attempts. Anger may play a role in SI, but this appears to vary by gender and nuances in this relationship are unclear. Method: We investigated whether levels of (a) anger and (b) SI vary by gender, (c) the cross‐sectional relationship between anger and SI, and (d) if gender moderates that relationship in two samples: adults seeking care for excessive anger (Study 1) and undergraduates endorsing previous suicide attempt (Study 2). Results: In Study 1, anger was more commonly endorsed in women; however, in Study 2, anger did not vary by gender. In both studies, SI did not vary by gender. Further, in both studies, anger and SI were positively related. The relationship between anger and SI did not vary by gender in either study. Conclusions: The strength of the relationship between anger and SI did not vary by gender. [ABSTRACT FROM AUTHOR]

The present study directly compared three perspectives of suicidality: Interpersonal Theory of Suicide (IPTS), Hopelessness Theory, and a perspective emphasizing emotion dysregulation. 219 adults seeking outpatient psychological services completed questionnaires during intake between November 2015 and February 2019. Patients were included if they completed surveys related to thwarted belongingness (TB), perceived burdensomeness (PB), hopelessness, depressive symptoms, negative affect, and Borderline Personality Disorder (BPD) symptoms. Analyses tested the ability of TB, PB, depressive symptoms, hopelessness, and emotion dysregulation to relate to total scores on Beck Scale for Suicide Ideation. We employed Pearson's correlations and linear regressions to investigate these relations. Constructs related to emotion dysregulation—negative affect (r = 0.161, p <.05) and Borderline Personality Disorder symptoms (r = 0.284, p <.01)—were significantly correlated with suicidal ideation, as were those relevant to Hopelessness Theory—depressive symptoms (r = 0.46, p <.01) and hopelessness (r = 0.45, p <.01)— and IPTS—TB (r = 0.36, p <.01) and PB (r = 0.43, p <.01). Notably the combinations of constructs as proposed by theories were significantly associated with suicidal ideation, but did not improve upon single constructs. This indicated that theoretically relevant constructs alone were strongly associated with suicidal ideation, but were not bested by interactions. This project compared constructs relevant to three theories of suicidality among a sample of treatment seeking outpatients. Findings indicated that suicidal ideation assessment was similarly informed by Hopelessness Theory and IPTS, and to a lesser degree emotion dysregulation. The cross sectional nature of the data and the reliance upon self-report measures limit the inferences that can be made. [ABSTRACT FROM AUTHOR]

Suicide is the tenth leading cause of death in America. Particularly at risk, Veterans are 1.5 times more likely to die by suicide than non-Veterans, and the suicide rate among service members has risen over the last decade. In the present study, we (1) assessed risk factors for suicidal ideation, suicide attempts, and suicide death within and between Veterans and service members, (2) identified the most commonly studied and (3) the strongest risk factors for suicide-related outcomes among Veterans and service members, and (4) compared overall and risk factor-specific meta-analytic prediction of suicide-related outcomes in Veterans and service members, as determined in the present meta-analysis, to that of the general population. Authors harvested longitudinal effects predicting suicidal ideation, suicide attempts, or suicide deaths in Veterans or service members until May 1, 2020. Traumatic Brain Injury, substance/alcohol use disorders, prior Self-Injurious Thoughts and Behavior, PTSD, and depressive symptoms were among the most commonly studied risk factors. Anger/aggression was particularly strong risk factors, providing a source for future study and intervention efforts. When combined, risk factors conferred similar risk for suicide attempts and suicide death among Veterans, service members, and the general population. However, when analyzing p-values, factors conferred significantly more risk of suicidal ideation among Veterans and service members as compared to the general population. That is, p-values for risk factors were lower in an absolute sense but not necessarily to a statistically significant degree. [ABSTRACT FROM AUTHOR]

Theoretically-driven models of suicide have long guided suicidology; however, an approach employing machine learning models has recently emerged in the field. Some have suggested that machine learning models yield improved prediction as compared to theoretical approaches, but to date, this has not been investigated in a systematic manner. The present work directly compares widely researched theories of suicide (i.e., BioSocial, Biological, Ideation-to-Action, and Hopelessness Theories) to machine learning models, comparing the accuracy between the two differing approaches. We conducted literature searches using PubMed, PsycINFO, and Google Scholar, gathering effect sizes from theoretically-relevant constructs and machine learning models. Eligible studies were longitudinal research articles that predicted suicide ideation, attempts, or death published prior to May 1, 2020. 124 studies met inclusion criteria, corresponding to 330 effect sizes. Theoretically-driven models demonstrated suboptimal prediction of ideation (wOR = 2.87; 95% CI, 2.65–3.09; k = 87), attempts (wOR = 1.43; 95% CI, 1.34–1.51; k = 98), and death (wOR = 1.08; 95% CI, 1.01–1.15; k = 78). Generally, Ideation-to-Action (wOR = 2.41, 95% CI = 2.21–2.64, k = 60) outperformed Hopelessness (wOR = 1.83, 95% CI 1.71–1.96, k = 98), Biological (wOR = 1.04; 95% CI.97–1.11, k = 100), and BioSocial (wOR = 1.32, 95% CI 1.11–1.58, k = 6) theories. Machine learning provided superior prediction of ideation (wOR = 13.84; 95% CI, 11.95–16.03; k = 33), attempts (wOR = 99.01; 95% CI, 68.10–142.54; k = 27), and death (wOR = 17.29; 95% CI, 12.85–23.27; k = 7). Findings from our study indicated that across all theoretically-driven models, prediction of suicide-related outcomes was suboptimal. Notably, among theories of suicide, theories within the Ideation-to-Action framework provided the most accurate prediction of suicide-related outcomes. When compared to theoretically-driven models, machine learning models provided superior prediction of suicide ideation, attempts, and death. [ABSTRACT FROM AUTHOR]

We discuss computational language analysis as it pertains to suicide prevention research, with an emphasis on providing non‐technologists with an understanding of key issues and, equally important, considering its relation to the broader enterprise of suicide prevention. Our emphasis here is on naturally occurring language in social media, motivated by its non‐intrusive ability to yield high‐value information that in the past has been largely unavailable to clinicians. [ABSTRACT FROM AUTHOR]

Background The impact of clinician specialty on cardiovascular disease risk factor outcomes among persons with HIV (PWH) is unclear. Methods PWH receiving care at 3 Southeastern US academic HIV clinics between January 2014 and December 2016 were retrospectively stratified into 5 groups based on the specialty of the clinician managing their hypertension or hyperlipidemia. Patients were followed until first atherosclerotic cardiovascular disease event, death, or end of study. Outcomes of interest were meeting 8th Joint National Commission (JNC-8) blood pressure (BP) goals and National Lipid Association (NLA) non–high-density lipoprotein (HDL) goals for hypertension and hyperlipidemia, respectively. Point estimates for associated risk factors were generated using modified Poisson regression with robust error variance. Results Of 1667 PWH in the analysis, 965 had hypertension, 205 had hyperlipidemia, and 497 had both diagnoses. At study start, the median patient age was 52 years, 66% were Black, and 65% identified as male. Among persons with hypertension, 24% were managed by an infectious diseases (ID) clinician alone, and 5% were co-managed by an ID clinician and a primary care clinician (PCC). Persons managed by an ID clinician were less likely to meet JNC-8 hypertension targets at the end of observation than the rest of the cohort (relative risk [RR], 0.84; 95% CI, 0.75–0.95), but when mean study blood pressure was considered, there was no difference between persons managed by ID and the rest of the cohort (RR, 0.96; 95% CI, 0.88–1.05). There was no significant association between the ID clinician managing hyperlipidemia and meeting NLA non-HDL goals (RR, 0.89; 95% CI, 0.68–1.15). Conclusions Clinician specialty may play a role in suboptimal hypertension outcomes in persons with HIV. [ABSTRACT FROM AUTHOR]

Young gay, bisexual, and other men who have sex with men and transgender women with HIV, particularly those who are racial or ethnic minorities, often have poor health outcomes. They also utilize a wide array of social media. Accordingly, we developed and implemented weCare, an mHealth (mobile health) intervention where cyberhealth educators utilize established social media platforms (e.g., Facebook, texting, and GPS-based mobile applications ["apps"]) designed for social and sexual networking) to improve HIV-related care engagement and health outcomes. As part of the process evaluation of weCare, we conducted 32 interviews with intervention participants (n = 18) and HIV clinic providers and staff (n = 14). This article highlights three key intervention characteristics that promoted care engagement, including that weCare is (1) targeted (e.g., using existing social media platforms, similarity between intervention participants and cyberhealth educator, and implementation within a supportive clinical environment), (2) tailored (e.g., bidirectional messaging and trusting relationship between participants and cyberhealth educators to direct interactions), and (3) personalized (e.g., addressing unique care needs through messaging content and flexibility in engagement with intervention). In addition, interviewees' recommendations for improving weCare focused on logistics, content, and the ways in which the intervention could be adapted to reach a larger audience. Quality improvement efforts to ensure that mHealth interventions are relevant for young gay, bisexual, and other men who have sex with men and transgender women are critical to ensure care engagement and support health outcomes. [ABSTRACT FROM AUTHOR]

For decades, our ability to predict suicide has remained at near-chance levels. Machine learning has recently emerged as a promising tool for advancing suicide science, particularly in the domain of suicide prediction. The present review provides an introduction to machine learning and its potential application to open questions in suicide research. Although only a few studies have implemented machine learning for suicide prediction, results to date indicate considerable improvement in accuracy and positive predictive value. Potential barriers to algorithm integration into clinical practice are discussed, as well as attendant ethical issues. Overall, machine learning approaches hold promise for accurate, scalable, and effective suicide risk detection; however, many critical questions and issues remain unexplored. [ABSTRACT FROM AUTHOR]

Background With the emergence of antiretroviral therapy (ART), Treatment as Prevention (TasP) has become the cornerstone of both HIV clinical care and HIV prevention. However, despite the efficacy of treatment-based programs and policies, structural barriers to ART initiation, adherence and viral suppression have the potential to reduce TasP effectiveness. These barriers have been studied using Geographic Information Systems (GIS). While previous reviews have examined the use of GIS for HIV testing - an essential antecedent to clinical care - to date, no reviews have summarised the research with respect to other ART-related outcomes.Methods: Therefore, the present review leveraged the PubMed database to identify studies that leveraged GIS to examine the barriers to ART initiation, adherence and viral suppression, with the overall goal of understanding how GIS has been used (and might continue to be used) to better study TasP outcomes. Joanna Briggs Institute criteria were used for the critical appraisal of included studies.Results: In total, 33 relevant studies were identified, excluding those not utilising explicit GIS methodology or not examining TasP-related outcomes.Conclusions: Findings highlight geospatial variation in ART success and inequitable distribution of HIV care in racially segregated, economically disadvantaged, and, by some accounts, increasingly rural areas - particularly in the United States. Furthermore, this review highlights the utility and current limitations of using GIS to monitor health outcomes related to ART and the need for careful planning of resources with respect to the geospatial movement and location of people living with HIV (PLWH). [ABSTRACT FROM AUTHOR]

Young racial/ethnic minority men who have sex with men (MSM) and transgender women with HIV often have poor health outcomes. They also utilize a wide array of social media. Accordingly, we developed and implemented weCare, a social media intervention utilizing Facebook, texting, and GPS-based mobile social and sexual networking applications to improve HIV-related care engagement and health outcomes. We compared viral load suppression and clinic appointment attendance among 91 participants during the 12-month period before and after weCare implementation. McNemar's chi-square test analyses were conducted comparing the pre- and postintervention difference using paired data. Since February 2016, intervention staff and 91 intervention participants (79.1% African American and 13.2% Latino, mean age = 25) exchanged 13,830 messages during 3,758 conversations (average: 41.3 conversations per participant) across a variety of topics, including appointment reminders, medication adherence, problem solving, and reducing barriers. There were significant reductions in missed HIV care appointments (68.0% vs. 53.3%, p = 0.04) and increases in viral load suppression (61.3% vs. 88.8%, p < 0.0001) 12 months postimplementation. Our results highlight the initial success of weCare in improving care engagement and viral suppression. Social media is an important tool, especially for young MSM and transgender women, to support individual- (e.g., viral suppression) and community- (e.g., reduced transmission efficiency) level health. It may also be a useful tool for improving engagement with biomedical HIV prevention tools (e.g., PrEP use). [ABSTRACT FROM AUTHOR]

Objective: Theory suggests that attentional processes, such as attentional bias and attentional control, may contribute to suicidal thoughts and behaviors (STBs). Specifically, among individuals with suicidal ideation, attentional biases towards suicide-related information may increase distress. This combined with the inability to disengage and shift attention away from suicidal thoughts (i.e., deficits in attentional control) might contribute to increased risk for suicidal behavior. Despite this, there has been limited research examining associations between attentional biases and STBs or attentional control and STBs. Method: We conducted a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Search terms used to identify articles included: ("attention* bias" or "attentional control") AND (suicid*). The search returned 77 articles, 49 when duplicates were removed. Following full text reviews, a total of 16 articles were retained for meta-analysis. Results: A significant relationship was observed between attentional bias and STBs (r = 0.10, 95% CI: 0.05, 0.15), but not attentional control and STBs (r = −0.07, 95% CI: −0.24, 0.10). The funnel plot for attentional bias and STBs suggested low risk of publication bias. The limited number of studies identified, and therefore low power, precluded moderator analyses from being conducted. Conclusions: Additional experimental and longitudinal research with diverse assessments of attentional risk factors (e.g., dot probe, eye tracking) is needed. Despite these limitations, the present study provides preliminary evidence for the association between attentional bias and STBs. [ABSTRACT FROM AUTHOR]

The article discusses the establishment of processes to facilitate the use of mifepristone for early pregnancy loss (EPL) within a large healthcare system, with the goal of expanding access to medication abortion in a post-Roe environment. The process involved collaboration with various stakeholders, including pharmacy purchasing teams, clinic management, education teams, and information technology.

People living with HIV (PLWH) have distinct needs when it comes to reproductive health, specifically regarding fertility, family planning, and pregnancy, and these needs are often complicated by HIV status. While there is ample research that focuses on reproductive health in PLWH through a quantitative lens, there is a lack of research using qualitative methods, namely, the narrative interview model. We searched PubMed and relevant abstracts to identify 72 articles published from 1997 to 2016 that described a qualitative framework for exploring the behaviors and perceptions regarding family planning, abortion, pregnancy, parenthood, fertility, and forced sterility in PLWH. The inclusion criteria initially showed 147 articles, which were further screened to exclude those that did not address fertility and family planning specifically. Our final sample of articles included articles related to qualitative research on reproductive attitudes, beliefs, and behaviors of PLWH. Several of these articles were mixed-methods analyses, but our focus was on the qualitative portion only. Further qualitative works in this area will not only contribute to gaps quantitative research in the field cannot capture by design, but also inform clinical practice, policy, and interventions through systematic, in-depth evaluation. [ABSTRACT FROM AUTHOR]

For 5 years, our family medicine clinic's physician-pharmacy team managed anticoagulation onsite. Now, against our recommendations and desires as a clinic, anticoagulation at our site is no longer managed by our local interdisciplinary team. Instead, it is being managed by our system's centralized anticoagulation team. Although some may point out that anticoagulation management is one small element of our practice, we believe eliminating this could open the door to other changes to our scope of practice. Anticoagulation belongs in primary care where comprehensive care, ongoing relationships between patients and care teams, and flexible office visit agendas optimize this service. [ABSTRACT FROM AUTHOR]

The article focuses on weCARE, a social media-based intervention that aims to increase HIV care linkage, retention, and health outcomes for racially and ethnically diverse young men who have sex with men (MSM). Topics covered include how weCare uses community-based participatory research (CBPR) to improve its quality and validity and the need for support of youth in overcoming structural obstacles to HIV care such as access to health insurance and transportation.

For HIV-infected patients, experiencing multiple traumas is associated with AIDS-related and all-cause mortality, increased opportunistic infections, progression to AIDS, and decreased adherence to therapy. The impact of intimate partner violence (IPV) on adherence and HIV outcomes is unknown. HIV-infected patients recruited from a public HIV clinic participated in this observational cohort study ( n=251). Participants completed interviews evaluating IPV and covariates. CD4 count <200 (CD4<200), detectable HIV viral load (VL), and engagement in care ('no show rate' [NSR]) were the outcomes of interest. Medication adherence was not measured. Univariate and multivariate regression analyses were performed with covariates included if p<0.3 in the univariate phase. Seventy-four percent of the participants were male, 55% Caucasian, and 52.2% self-identified as 'men who have sex with men.' IPV prevalence was 33.1% with no difference by gender or sexual orientation. In univariate analysis, IPV exposure predicted having a CD4<200 ( p=0.005) and a detectable VL ( p=0.04) but trended toward significance with a high NSR ( p=0.077). Being threatened by a partner was associated with a CD4<200 ( p=0.005), a detectable VL ( p=0.011), and high NSR ( p=0.019) in univariate analysis. In multivariate analysis, IPV predicted having a CD4<200 ( p=0.005) and detectable VL ( p=0.035). Being threatened by a partner predicted having a CD4<200 ( p=0.020), a detectable VL ( p=0.007), and a high NSR ( p=0.020). Our results suggest IPV impacts biologic outcomes and engagement in care for HIV-infected patients. IPV alone predicts worse biologic outcomes, whereas the specific experience of being threatened by a partner was associated with all three outcomes in univariate and multivariate analyses. [ABSTRACT FROM AUTHOR]

Background: Hospitals are increasingly compared based on clinical outcomes adjusted for severity of illness. Multiple methods exist to adjust for differences between patients. The challenge for consumers of this information, both the public and healthcare providers, is interpreting differences in risk adjustment models particularly when models differ in their use of administrative and physiologic data. We set to examine how administrative and physiologic models compare to each when applied to critically ill patients. Methods: We prospectively abstracted variables for a physiologic and administrative model of mortality from two intensive care units in the United States. Predicted mortality was compared through the Pearsons Product coefficient and Bland- Altman analysis. A subgroup of patients admitted directly from the emergency department was analyzed to remove potential confounding changes in condition prior to ICU admission. Results: We included 556 patients from two academic medical centers in this analysis. The administrative model and physiologic models predicted mortalities for the combined cohort were 15.3% (95% CI 13.7%, 16.8%) and 24.6% (95% CI 22.7%, 26.5%) (t-test p-value<0.001). The r2 for these models was 0.297. The Bland-Atlman plot suggests that at low predicted mortality there was good agreement; however, as mortality increased the models diverged. Similar results were found when analyzing a subgroup of patients admitted directly from the emergency department. When comparing the two hospitals, there was a statistical difference when using the administrative model but not the physiologic model. Unexplained mortality, defined as those patients who died who had a predicted mortality less than 10%, was a rare event by either model. Conclusions: In conclusion, while it has been shown that administrative models provide estimates of mortality that are similar to physiologic models in non-critically ill patients with pneumonia, our results suggest this finding can not be applied globally to patients admitted to intensive care units. As patients and providers increasingly use publicly reported information in making health care decisions and referrals, it is critical that the provided information be understood. Our results suggest that severity of illness may influence the mortality index in administrative models. We suggest that when interpreting "report cards" or metrics, health care providers determine how the risk adjustment was made and compares to other risk adjustment models. [ABSTRACT FROM AUTHOR]

Steady-state excitation anisotropy, lifetimes, and time-resolved emission spectra of new 2-photon absorbing fluorene derivatives were measured in aprotic solvents at room temperature. Excitation anisotropy spectra in viscous silicon oil allowed the determination of the spectral position of three electronic transitions S[sub 0] → S[sub 1], S[sub 0] → S[sub 2], S[sub 0] → S[sub 3] (S[sub i], i = 1, 2, 3 are the singlet electronic states) and the angles (≈ 30°) between absorption S[sub 0] → S[sub 1] and emission S[sub 1] → S[sub 0] dipole moments for the first electronic transition. Solvate relaxation processes in the first excited state of the investigated fluorene molecules affect the lifetimes of these states, τ[sub 1], so that experimental values of τ[sub 1] do not correspond to those calculated by Strickler and Berg theory. The influence of the molecular concentration on the fluorescence quantum yields and τ[sub 1] have been investigated. [ABSTRACT FROM AUTHOR]

Background Trauma—emotional, physical, and psychological—is common and associated with increased risk behaviors, low rates of care engagement and viral suppression, and overall poor health outcomes for people living with HIV (PLWH). In the United States, there are limited data on how trauma affects reproductive health beliefs for PLWH and even less data on HIV providers' understanding and consideration of these experiences in their approach to patients. Methods Fifteen semi-structured interviews were conducted with PLWH and nine semi-structured interviews were conducted with HIV care and service providers at an academic medical center in the Southeastern United States. Transcripts were analyzed using thematic analysis. Each transcript was coded by two investigators and discussed to ensure consensus. Results Participants' narratives described diverse traumas, including sexual abuse (n = 6), the loss of a loved one (n = 8), and personal illness (n = 7). Types of trauma shared with providers included physical, sexual, illness, loss, and psychological. For patients, trauma was both a motivation for having children and a reason to stop having children. Providers perceived a variety of effects of trauma on both sexual behaviors and reproductive intentions. Reproductive counseling by HIV care providers (n = 5) focused on maintaining a healthy pregnancy and less on reproductive intentions prior to pregnancy. Reproductive discussions with pregnant female patients typically centered on reducing the risk of transmission in utero (including the importance of medication adherence to maintain viral suppression), what will happen during delivery, and breastfeeding risks. Reproductive discussions with males typically centered on preventing infection or re-infection of the mother. Conclusion PLWH interpret their trauma experiences differently, particularly when considering reproduction. Providers may not incorporate this information in counseling around reproductive health, highlighting the need fora trauma-informed healthcare practice that promotes awareness, education on the effect of past traumas on health, and access to appropriate resources. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]

Background People aging with HIV (PAWH) are living longer with effective antiretroviral therapy and new HIV diagnoses are rising in older populations. Concurrent with trends in age, the epidemiology of HIV infection in the United States has shifted geographically and racially; the Southeast and African Americans now have the highest HIV incidence and prevalence. Although there are marked health disparities for rural and African American PAWH, limited data exist comparing aging phenotypes between rural and urban PAWH, and no data exist comparing mechanistic pathways between these populations. Among African American PAWH, we hypothesize that rural PAWH will be more likely than urban PAWH to have a molecular profile of advanced aging associated with chronic disease burden and shorter health span. Methods Demographics, clinical data, and RNA were collected from 14 matched pairs from rural (Wake Forest University, Winston-Salem, NC) and urban cohorts (ALiVE cohort, Johns Hopkins University, Baltimore, MD) matched on age, sex, Short Physical Performance Battery score, smoking status, and sample collection date. Raw sequences were examined for quality, aligned using STAR, and normalized using DESeq2. DESeq2 tested matched pair differential gene expression. Genes with an average read count threshold > 5, a genomic control adjusted P-value < 0.01 and a fold change > 1.3 were retained for further analysis using STRING, MCODE, and IPA to find functional and biological patterns. Results Of the 399 genes meeting significance criteria, 212 showed higher expression in the rural group; the remaining 187 genes showed lower expression in the rural group. Top enriched canonical pathways in the IPA analysis identified differential estrogen signaling (P < 0.0001), inflammation (P < 0.001), and cytokine production (p = 0.005). Protein–protein interactions involved in cell–cell signaling and intracellular trafficking were also differentially identified between the 2 populations. Conclusion Urban and rural PAWH have differential gene expression, particularly centered around estrogen signaling and inflammatory cytokine production. These findings merit further investigation to determine clinical significance, including correlation with phenotypes and healthspan between rural and urban PAWH. Disclosures All authors: No reported disclosures. [ABSTRACT FROM AUTHOR]