Search

HIV incidence among African American (AA) young men who have sex with men (YMSM) has remained stable even though they made up the largest number of new HIV diagnoses among men who have sex with men (MSM) in 2017. HIV spreads at increased rates in dense sexual networks. Identifying the location of risk behaviors "activity spaces" could inform geographically circumscribed HIV prevention interventions. Utilizing the modified social ecological model we completed five semi-structured focus groups incorporating a modified social mapping technique, based on Singer et al.'s approach. Participants included 27 AA YMSM. Focus groups explored how and where HIV transmission happens in Jackson, Mississippi. Result themes included: 1) location of sexual behaviors, 2) knowledge of geographic hotspots of HIV infection in Jackson, and 3) traveling to meet partners: at home and away. HIV transmission or "activity spaces" may be occurring outside identified HIV hot spots. Mixed geospatial and qualitative methods offered a comprehensive assessment of where HIV transmission occurs, and suggests that geographically circumscribed interventions may need to focus on where individuals living with HIV reside and in specific geographic locations where they engage in behaviors that raise their HIV acquisition risks.

The Dominican Republic, situated on eastern Hispaniola Island in the Caribbean, is subject to moderate to high seismic hazard mostly controlled by oblique convergence at the Caribbean/North American plate boundary. Offshore of the island, the North Hispaniola Trench (NHT) and Los Muertos Trough (LMT) subduction-like structures accommodate shortening, while crustal faults both onshore and offshore also take up some deformation. Historically, the Dominican Republic’s large cities, as well as those in Haiti (which shares Hispaniola) have been damaged by earthquakes, the worst of which required the population to relocate (e.g. the 1562 Santiago de los Caballeros earthquake). Given the elevated hazard, the Dominican Republic was selected to engage in the Global Earthquake Model (GEM) Foundation coordinated USAID-funded “Training and Communication for Earthquake Risk Assessment” project, which aimed to improve earthquake risk assessment capacity in Latin American cities. This project and the collaborations that emerged were the basis for developing a seismic hazard model for the Dominican Republic.The seismic hazard model is implemented in the OpenQuake Engine, and mostly uses GEM’s model-building tools and state-of-practice. Two main datasets were used for the seismic source characterization: a homogenized earthquake catalogue that benefited from local seismicity records contributed by the Servicio Geológico Nacional (SGN) and Universidad Autónoma de Santo Domingo (UASD), and an active faults database that combines GEM’s global database and one compiled by SGN during recent seismic hazard projects. Together, these datasets were used to constrain seismic source geometries and rates for active shallow crustal earthquakes, subduction interfaces and subduction-like thrusts, and intraslab earthquakes. Active shallow crustal sources were characterized as a combination of fault ruptures and off-fault (distributed) smoothed seismicity. Fault rupture geometries were pre-defined using the Seismic Hazard and Earthquake Rate In Fault Systems (SHERIFS) method, which allows multi-fault ruptures, incorporating epistemic uncertainty in the magnitude scaling relationship (and thus maximum magnitude), portion of earthquakes modelled on and off faults, and slip rates of two major fault systems. Additional uncertainty was considered in the assumptions used to smooth distributed seismicity rates. The NHT and LMT were also modelled using the SHERIFS method, while the other subduction sources were modelled using GEM’s more standard approaches (i.e. a single fault with complex geometry for the interface and pre-defined ruptures constrained to the intraslab volume). Two end-member magnitude frequency distributions were used for the Puerto Rico Trench interface: one assigning more moment to large magnitudes, and one obeying the Gutenberg-Richter relationship. For intraslab sources, epistemic uncertainty was captured in the assumptions for smoothing rupture probabilities according to past earthquakes. The ground motion characterization relied on residual analyses performed in past GEM projects, but replacing outdated GMPEs on subduction sources with more recent counterparts.Hazard results generally reinforce former perceptions. In Santiago de los Caballeros, PGA reaches ~1g for 2% probability of exceedance in 50 years, controlled by the Septentrional Fault, while in the capital (Santo Domingo) PGA of ~0.5g is impacted by all tectonic region types, and includes contributions from moderate magnitude earthquakes (Mw 5-6).

Canada is exposed to rare but potentially destructive earthquakes that threaten densely settled metropolitan centers in many parts of the country. To assess the impacts and consequences of future natural-hazard events and help advance policy goals and objectives of the Sendai Framework for Disaster Risk Reduction, Natural Resources Canada, through a collaborative partnership with the Global Earthquake Model Foundation, produced a national seismic risk model. Developing this model has required the creation of a national exposure inventory, Canadian-specific fragility and vulnerability curves, and significant simplification of the Canadian Seismic Hazard Model which forms the basis for the design seismic hazard values of the National Building Code of Canada. Using the Global Earthquake Model Foundation’s OpenQuake Engine, probabilistic stochastic risk modeling is completed under baseline and simulated retrofit conditions to assess seismic risk at the neighborhood level for all settled areas in Canada. Output risk metrics include the expected immediate physical impacts of earthquake events such as building damage, casualties, and direct economic losses. This article documents the technical details of the modeling approach including a description of novel data sets in use, a summary of the extensive sensitivity testing undertaken, and characterization of quality control implemented in the absence of usable validating earthquake loss data. The results from this model, such as loss exceedance curves and annual average losses, provide an open, accessible and quantitative base of evidence for decision-making at local, regional, and national levels. As a large country with a complex seismic hazard model and dispersed populations, this Canadian study is unique. However, the challenges faced and solutions offered are likely to be of interest to other nations pursuing similar programs.

The well-established Bath's law states that the average magnitude difference between a mainshock and its strongest aftershock is roughly 1.2, independently of the size of the mainshock. The main challenge in calculating this value is the bias introduced by missing data points when the strongest aftershock is below the observed cut-off magnitude. Ignoring missing values leads to a systematic error, because the data points removed are those with particularly large magnitude differences $\Delta M$. The error is minimized, if we restrict the statistics to mainshocks at least two magnitude units above the cut-off, but then the sample size is strongly reduced. This work provides an innovative approach for modelling $\Delta M$ by adapting methods for time-to-event data, which often suffers from incomplete observation (censoring). In doing so, we adequately account for unobserved values and estimate a fully parametric distribution of the magnitude differences $\Delta M$ for $M>6$ mainshocks. Results show that magnitude differences are best modeled by the Gompertz distribution, and that larger $\Delta M$ are expected at increasing depths and higher heat flows. A simulation experiment suggests that $\Delta M$ is mainly driven by the number and the magnitude distribution of aftershocks. Therefore, in a second study, we modelled the variation of aftershock productivity in a stochastically declustered local catalog for New Zealand, using a generalized additive model approach. Results confirm that aftershock counts can be better modelled by a Negative Binomial than a Poisson distribution. Interestingly, there is indication that triggered earthquakes trigger themselves two to three times more aftershocks than comparable background events. This effect can either be an indicator for incorrect trigger pair assignments as a result of the declustering approach, or it may represent an actual effect due to a higher prevalent energy level in the tectonic system during on-going earthquake sequences. If confirmed, this effect must be carefully considered in forward simulations of earthquake sequences, as otherwise there is a risk of substantially underestimating cluster sizes and consequently overestimating $\Delta M$.

The well-established Bath's law states that the average magnitude difference between a mainshock and its strongest aftershock is roughly 1.2, independently of the size of the mainshock. The main challenge in calculating this value is the bias introduced by missing data points when the strongest aftershock is below the observed cut-off magnitude. Ignoring missing values leads to a systematic error, because the data points removed are those with particularly large magnitude differences $\Delta M$. The error is minimized, if we restrict the statistics to mainshocks at least two magnitude units above the cut-off, but then the sample size is strongly reduced. This work provides an innovative approach for modelling $\Delta M$ by adapting methods for time-to-event data, which often suffers from incomplete observation (censoring). In doing so, we adequately account for unobserved values and estimate a fully parametric distribution of the magnitude differences $\Delta M$ for $M>6$ mainshocks. Results show that magnitude differences are best modeled by the Gompertz distribution, and that larger $\Delta M$ are expected at increasing depths and higher heat flows. A simulation experiment suggests that $\Delta M$ is mainly driven by the number and the magnitude distribution of aftershocks. Therefore, in a second study, we modelled the variation of aftershock productivity in a stochastically declustered local catalog for New Zealand, using a generalized additive model approach. Results confirm that aftershock counts can be better modelled by a Negative Binomial than a Poisson distribution. Interestingly, there is indication that triggered earthquakes trigger themselves two to three times more aftershocks than comparable background events. This effect can either be an indicator for incorrect trigger pair assignments as a result of the declustering approach, or it may represent an actual effect due to a higher prevalent energy level in the tectonic system during on-going earthquake sequences. If confirmed, this effect must be carefully considered in forward simulations of earthquake sequences, as otherwise there is a risk of substantially underestimating cluster sizes and consequently overestimating $\Delta M$.

BACKGROUND Many US health departments now integrate HIV-related outcomes (e.g., relinkage to HIV care and preexposure prophylaxis [PrEP]) into sexually transmitted disease (STD) partner services (PS) programs. We sought to determine the barriers, facilitators, and cost of integrating these activities into PS. METHODS From 2016 to 2018, the Mississippi State Department of Health integrated 3 new activities into STD PS: HIV testing for partners of HIV-negative men who have sex with men with gonorrhea/chlamydia, relinkage to HIV care for STD PS recipients previously diagnosed with HIV, and PrEP referrals. We conducted direct observations and interviews with disease intervention specialists (DIS) in Jackson to assess barriers and facilitators to implementing these activities. We completed time and motion studies with 8 DIS and case tracking forms for 90 unique cases to estimate the incremental staff time and associated personnel cost of added services compared with a standard PS case. RESULTS Disease intervention specialists were optimistic about integrating HIV-related activities but noted disparate data systems, nonsystematic documentation, and lack of training as barriers. The mean time for a standard STD PS case without HIV-related activities was 195 minutes (cost, $77.69/case). The cost to conduct PS for HIV-negative men who have sex with men with gonorrhea/chlamydia was 36% higher than a standard case. Integrating relinkage to care and PrEP referrals resulted in a 44% and 20% increase in cost, respectively. CONCLUSIONS Integrating HIV care relinkage and PrEP referrals into STD partner services was generally acceptable by DIS and added marginal cost per case. Coupling these cost metrics with an assessment of the effectiveness of these activities can inform prioritization of partner services activities.

This work investigates a novel approach combining numerical modelling and machine learning, aimed at developing an efficient procedure that can be used for large scale tsunami hazard and risk studies. Probabilistic tsunami hazard and risk assessment are vital tools to understand the risk of tsunami and mitigate its impact, guiding the risk reduction and transfer activities. Such large-scale probabilistic tsunami hazard and risk assessment require many numerically intensive simulations of the possible tsunami events, involving the tsunami phases of generation, wave propagation and inundation on the coast, which are not always feasible without large computational resources like HPCs. In order to undertake such regional PTHA for a larger proportion of the coast, we need to develop concepts and algorithms for reducing the number of events simulated and more rapidly approximate the simulation results needed. This case study for a coastal region of Japan utilizes a limited number of tsunami simulations from submarine earthquakes along the subduction interface to generate a wave propagation database at different depths, and fits these simulation results to a machine learning model to predict the water depth or velocity of the tsunami wave at the coast. Such a hybrid ML-physical model can be further coupled with an inundation scheme to compute the probabilistic tsunami hazard and risk for the onshore region.

Over the past 20 years, Nipah virus (NiV) has emerged as a significant, highly pathogenic bat-borne paramyxovirus causing severe respiratory disease and encephalitis in humans, and human-to-human transmission has been demonstrated in multiple outbreaks. In addition to causing serious illness in humans, NiV is a zoonotic pathogen capable of infecting a wide range of other mammalian species, including pigs and horses. While NiV has caused less than 700 human cases since its discovery in 1998/1999, the involvement of intermediate agricultural hosts can result in significant economic consequences. Owing to the severity of disease, capacity for human-to-human transmission, zoonotic potential, and lack of available approved therapeutic treatment options, NiV has been listed by the World Health Organization in their Blueprint list of priority pathogens as one of the eight most dangerous pathogens to monitor and prepare countermeasures to prevent a pandemic. Here, we discuss progress towards the development of therapeutic measures for the treatment of NiV infection and disease.

Rift Valley fever virus (RVFV) is a mosquito-borne bunyavirus with a wide host range including ruminants and humans. RVFV outbreaks have had devastating effects on public health and the livestock industry in African countries. However, there is no approved RVFV vaccine for human use in non-endemic countries and no FDA-approved antiviral drug for RVFV treatment. The RVFV 78kDa protein (P78), which is a membrane glycoprotein, plays a role in virus dissemination in the mosquito host, but its biological role in mammalian hosts remains unknown. We generated an attenuated RVFV MP-12 strain-derived P78-High virus and a virulent ZH501 strain-derived ZH501-P78-High virus, both of which expressed a higher level of P78 and carried higher levels of P78 in the virion compared to their parental viruses. We also generated another MP-12-derived mutant virus (P78-KO virus) that does not express P78. MP-12 and P78-KO virus replicated to similar levels in fibroblast cell lines and Huh7 cells, while P78-High virus replicated better than MP-12 in Vero E6 cells, fibroblast cell lines, and Huh7 cells. Notably, P78-High virus and P78-KO virus replicated less efficiently and more efficiently, respectively, than MP-12 in macrophage cell lines. ZH501-P78-High virus also replicated poorly in macrophage cell lines. Our data further suggest that inefficient binding of P78-High virus to the cells led to inefficient virus internalization, low virus infectivity and reduced virus replication in a macrophage cell line. P78-High virus and P78-KO virus showed lower and higher virulence than MP-12, respectively, in young mice. ZH501-P78-High virus also exhibited lower virulence than ZH501 in mice. These data suggest that high levels of P78 expression attenuate RVFV virulence by preventing efficient virus replication in macrophages. Genetic alteration leading to increased P78 expression may serve as a novel strategy for the attenuation of RVFV virulence and generation of safe RVFV vaccines., Author summary Rift Valley fever virus (RVFV) is the causative agent of Rift Valley fever, which is primarily endemic in African countries. The virus infects a wide variety of mammalian species, including ruminants and humans, and causes devastating effects on public health and the livestock industry. Because RVFV is transmitted by several mosquito species that are ubiquitous in non-endemic areas, there is a potential risk that the virus will spread outside of the current endemic areas. However, there are no effective therapeutics nor commercially available vaccines for human use. RVFV encodes a 78kDa protein (P78) of unidentified biological function in mammalian cells. We found that a mutant RVFV expressing a higher level of P78 (P78-High virus) showed lower infectivity and less efficient replication than parental RVFV in macrophage cell lines. P78-High virus and a mutant RVFV lacking P78 expression showed lower and higher virulence than the parental virus, respectively, in mice, suggesting that high levels of P78 expression prevent efficient virus replication in macrophages, leading to attenuation of virus virulence. Genetic alteration leading to increased P78 expression may serve as a novel strategy for the generation of attenuated RVFV as vaccine candidates.

Syphilis and HIV are important public health issues in the United States, especially in the southeastern region. This study aimed to determine and describe the co-infection pattern in Mississippi by using a case-controlled design to analyze cases diagnosed with syphilis or HIV from 2007 to 2016. Direct matching was employed to identify cases that were co-infected during the same calendar year, and binary logistic regression analysis was used to determine predictors of co-infection. Results showed that 1736 (34.0%) of syphilis and HIV cases were co-infected during the same calendar year. Binary logistic regression results demonstrated that race, gender, age group, and exposure category were independently associated with co-infection status. These analyses highlighted the progressive increase of co-infection rates in Mississippi. Collaboration between STI/HIV surveillance teams may identify high-risk individuals and reduce transmission of both diseases.

BACKGROUND Mississippi has the 10th highest rate of new human immunodeficiency virus (HIV) infections in the United States. The Mississippi State Department of Health (MSDH) integrated partner HIV testing into syphilis partner services (PS) in 2014, but the effectiveness of this as an HIV case finding strategy has not been evaluated. METHODS We identified all early syphilis (primary, secondary, and early latent) case records reported from July 1, 2014, to December 31, 2016, excluding case records for people concurrently newly diagnosed with HIV. Among sex partners of these people, we identified new diagnoses of early syphilis and HIV. We calculated the number needed to interview as the number of syphilis index case patients interviewed divided by the number of partners newly diagnosed with early syphilis or HIV. RESULTS A total of 1535 (95%) of the 1619 early syphilis index case patients were interviewed for PS. These case patients named 2267 partners, of whom 1868 (82%) were contacted by MSDH. Among partners, 1508 (81%) tested for syphilis and 745 (56%) of 1321 partners not previously diagnosed with HIV were tested for HIV. Partner services identified 696 new early syphilis case patients (46%) and 24 (3.2%) new HIV case patients among partners. Sixty-four index case patient interviews were needed to identify 1 new case of HIV, and 2 interviews were needed to identify 1 new case of syphilis among partners. CONCLUSIONS Syphilis PS allowed MSDH to interact with 1592 men who have sex with men over a 30-month period and was effective for identifying people newly infected with early syphilis and HIV. Increasing HIV testing among partners of syphilis case patients could increase HIV case finding in Mississippi.

Several members of the tripartite motif (TRIM) family of E3 ubiquitin ligases regulate immune pathways, including the antiviral type I interferon (IFN-I) system. Previously, we demonstrated that TRIM6 is involved in IFN-I induction and signaling. In the absence of TRIM6, optimal IFN-I signaling is reduced, allowing increased replication of interferon-sensitive viruses. Despite having evolved numerous mechanisms to restrict the vertebrate host’s IFN-I response, West Nile virus (WNV) replication is sensitive to pretreatment with IFN-I. However, the regulators and products of the IFN-I pathway that are important in regulating WNV replication are incompletely defined. Consistent with WNV’s sensitivity to IFN-I, we found that in TRIM6 knockout (TRIM6-KO) A549 cells, WNV replication is significantly increased and IFN-I induction and signaling are impaired compared to wild-type (wt) cells. IFN-β pretreatment was more effective in protecting against subsequent WNV infection in wt cells than TRIM6-KO, indicating that TRIM6 contributes to the establishment of an IFN-induced antiviral response against WNV. Using next-generation sequencing, we identified VAMP8 as a potential factor involved in this TRIM6-mediated antiviral response. VAMP8 knockdown resulted in reduced JAK1 and STAT1 phosphorylation and impaired induction of several interferon-stimulated genes (ISGs) following WNV infection or IFN-β treatment. Furthermore, VAMP8-mediated STAT1 phosphorylation required the presence of TRIM6. Therefore, the VAMP8 protein is a novel regulator of IFN-I signaling, and its expression and function are dependent on TRIM6 activity. Overall, these results provide evidence that TRIM6 contributes to the antiviral response against WNV and identify VAMP8 as a novel regulator of the IFN-I system. IMPORTANCE WNV is a mosquito-borne flavivirus that poses a threat to human health across large discontinuous areas throughout the world. Infection with WNV results in febrile illness, which can progress to severe neurological disease. Currently, there are no approved treatment options to control WNV infection. Understanding the cellular immune responses that regulate viral replication is important in diversifying the resources available to control WNV. Here, we show that the elimination of TRIM6 in human cells results in an increase in WNV replication and alters the expression and function of other components of the IFN-I pathway through VAMP8. Dissecting the interactions between WNV and host defenses both informs basic molecular virology and promotes the development of host- and virus-targeted antiviral strategies.

Researchers have long investigated the conditions that promote the unambiguous communication of issues in political campaigns; however, previous research has been largely theoretic or has only tested ambiguous communication on a limited range of issues. We address these gaps, making three principal contributions. First, we provide an extensive empirical test of ambiguous communication, scoring every issue addressed on website “issues pages” from House candidates in 2014. Second, we accomplish this by using a supervised learning content analysis procedure that allows us to score a large volume of text based on a smaller subset of hand-coded text. This allows us to not only examine whether candidates comment on an issue but also the clarity of their message. Third, this article provides empirical support for how candidates’ communication strategies are shaped not only by the candidates’ personal characteristics but also the characteristics of the district. We find that district heterogeneity is an important predictor of ambiguous communication. Evidence also indicates that issue ownership and ideological extremity play a decisive role in the decision to “go vague.”

Background Academic and public health partnerships are a critical component of the Ending the HIV Epidemic: A Plan for America (EHE). The Enhanced HIV/AIDS Reporting System (eHARS) is a standardized document-based surveillance database used by state health departments to collect and manage case reports, lab reports, and other documentation on persons living with HIV. Innovative analysis of this data can inform targeted, evidence-based interventions to achieve EHE objectives. We describe the development of a distributed data network strategy at an academic institution in partnership with public health departments to identify geographic differences in time to HIV viral suppression after HIV diagnosis using eHARS data. Figure 1. Distributed Data Network Methods This project was an outgrowth of work developed at the University of Alabama at Birmingham Center for AIDS Research (UAB CFAR) and existing relationships with the state health departments of Alabama, Louisiana, and Mississippi. At a project start-up meeting which included study investigators and state epidemiologists, core objectives and outcome measures were established, key eHARS variables were identified, and regulatory and confidentiality procedures were examined. The study methods were approved by the UAB Institutional Review Board (IRB) and all three state health department IRBs. Results A common data structure and data dictionary across the three states were developed. Detailed analysis protocols and statistical code were developed by investigators in collaboration with state health departments. Over the course of multiple in-person and virtual meetings, the program code was successfully piloted with one state health department. This generated initial summary statistics, including measures of central tendency, dispersion, and preliminary survival analysis. Conclusion We developed a successful academic and public health partnership creating a distributed data network that allows for innovative research using eHARS surveillance data while protecting sensitive health information. Next, state health departments will transmit summary statistics to UAB for combination using meta-analytic techniques. This approach can be adapted to inform delivery of targeted interventions at a regional and national level. Disclosures All Authors: No reported disclosures

Purpose: To explore what, when, and how Lean methods and tools can add value during the programming phase of design through providing additional resources and support to project leadership and the architectural design team. Background: This case study–based research took place at one large academic hospital during design efforts of a surgical tower to house 19 operating rooms (ORs) and support spaces including pre- and postop, central processing and distribution, and materials management. Surgical services project leadership asked for support from Lean practitioners during the design process. Methods: Lean exploration loops (LELs) were conducted to generate evidence to support stakeholders, as they made important decisions about the new building design. The analyses conducted during LELs were primarily focused on the relative advantages of a large footprint with few floors or a smaller footprint with more floors and support spaces not collocated adjacent to ORs on the same floor. Results: LELs resulted in quantifications of key operational and design features (e.g., design preferences of employees and patients, horizontal distance travel, and elevator utilization studies), which in turn complemented the architectural design process and created an opportunities to gain buy-in and consensus from stakeholders through their active participation in many of the analyses. Conclusions: We found Lean tools and methods to be of most value during programming phase when focused on the high-level operational and design issues to help establish buy-in and consensus among stakeholders, while acknowledging that there is often not enough design detail to perform accurate analysis.

Purpose: To explore how Lean can add value during the schematic phase of design through providing additional resources and support to project leadership and the architectural design team. Background: This case study–based research took place at one large academic hospital during design efforts of surgical tower to house 19 operating rooms (ORs) and support spaces including pre- and post-op, central processing and distribution, and materials management. Surgical services project leadership asked for Lean practitioners’ support during the design process. Methods: Lean Exploration Loops (LELs) were conducted to generate evidence to support stakeholders, as they made important decisions about the new building design. The analyses conducted during LELs during the schematic phase were primarily conducted using express workouts (EWOs) and were focused on the flow of patients, staff, and family throughout the pavilion. Results: LELs resulted in recommendations for key design features (e.g., number of pre- and post-op bays per OR floor, location of doors, scrub sinks, stretcher alcoves, equipment storage, and sterile core areas). Two-sided pre- and post-op bays with an inner clinical workspace and an outer patient transport corridor were recommended. Communicating elevator and a centrally located stairwell for staff to alleviate stress on the main bank of elevators at peak usage times were also suggested. Conclusions: We found Lean tools and methods to be of most value during schematic phase when focused on detailed process and layout analysis, while acknowledging the usefulness of focused EWOs to generate the evidence needed for the decision-making.

Background La Crosse virus (LACV) causes pediatric encephalitis in the USA. LACV induces severe inflammation in the central nervous system, but the recruitment of inflammatory cells is poorly understood. A deeper understanding of LACV-induced neural pathology is needed in order to develop treatment options. However, there is a severe limitation of relevant human neuronal cell models of LACV infection. Methods We utilized human neural stem cell (hNSC)-derived neuron/astrocyte co-cultures to study LACV infection in disease-relevant primary cells. hNSCs were differentiated into neurons and astrocytes and infected with LACV. To characterize susceptibility and responses to infection, we measured viral titers and levels of viral RNA, performed immunofluorescence analysis to determine the cell types infected, performed apoptosis and cytotoxicity assays, and evaluated cellular responses to infection using qRT-PCR and Bioplex assays. Results hNSC-derived neuron/astrocyte co-cultures were susceptible to LACV infection and displayed apoptotic responses as reported in previous in vitro and in vivo studies. Neurons and astrocytes are both targets of LACV infection, with neurons becoming the predominant target later in infection possibly due to astrocytic responses to IFN. Additionally, neuron/astrocyte co-cultures responded to LACV infection with strong proinflammatory cytokine, chemokine, as well as MMP-2, MMP-7, and TIMP-1 responses. Conclusions hNSC-derived neuron/astrocyte co-cultures reproduce key aspects of LACV infection in humans and mice and are useful models to study encephalitic viruses. Specifically, we show astrocytes to be susceptible to LACV infection and that neurons and astrocytes are important drivers of the inflammatory responses seen in LACV infection through the production of proinflammatory cytokines and chemokines. Electronic supplementary material The online version of this article (10.1186/s12974-018-1356-5) contains supplementary material, which is available to authorized users.

BACKGROUND In recent years, more than half of new HIV infections in the United States occur among African Americans in the Southeastern United States. Spatial epidemiological analyses can inform public health responses in the Deep South by identifying HIV hotspots and community-level factors associated with clustering. OBJECTIVE The goal of this study was to identify and characterize HIV clusters in Mississippi through analysis of state-level HIV surveillance data. METHODS We used a combination of spatial epidemiology and statistical modeling to identify and characterize HIV hotspots in Mississippi census tracts (n=658) from 2008 to 2014. We conducted spatial analyses of all HIV infections, infections among men who have sex with men (MSM), and infections among African Americans. Multivariable logistic regression analyses identified community-level sociodemographic factors associated with HIV hotspots considering all cases. RESULTS There were HIV hotspots for the entire population, MSM, and African American MSM identified in the Mississippi Delta region, Southern Mississippi, and in greater Jackson, including surrounding rural counties (P CONCLUSIONS We used spatial epidemiology and statistical modeling to identify and characterize HIV hotspots for the general population, MSM, and African Americans. HIV clusters concentrated in Jackson and the Mississippi Delta. African American race and urban location were positively associated with clusters, whereas having less than a high school education and having a higher percentage of the population living below the poverty level were negatively associated with clusters. Spatial epidemiological analyses can inform implementation science and public health response strategies, including improved HIV testing, targeted prevention and risk reduction education, and tailored preexposure prophylaxis to address HIV disparities in the South.

Introduction Increase in CD4 count and achieving viral suppression are the ultimate goals of the HIV care, yet disparities in these outcomes exist among subpopulations of HIV-infected persons. We aimed to assess potential disparities in viral suppression and normal CD4 count among HIV-infected persons in care in Mississippi. Methods We used Mississippi Medical Monitoring Project (MMP) data from 2009 to 2014 (n=1,233) in this study. MMP is a nationally representative surveillance system designed to assess and monitor the behavioural and clinical characteristics of HIV-infected adults receiving outpatient medical care in the United States. Outcome variables in this study were suppressed recent and durable viral load ( 3 ). Patients’ characteristics in this study were race, gender, age, annual income, education, insurance, and length of diagnosis. Descriptive analysis, Chi-square tests, and multiple logistic regression were conducted, accounting for the complex sample design. Results Our findings indicate that suppressed recent viral load prevalence was significantly higher among whites (72.8%), those aged ≥50 years (74.3%), those who had annual income ≥$20 000 (76%), public insurance (68.3%), or those were diagnosed ≥5 years (67.4%). The prevalence of suppressed durable viral load was significantly higher among those who aged ≥50 years (71.7%), and were diagnosed ≥5 years ago (61.4%), and the prevalence of normal CD4 was significantly higher among females (46%). Multivariable analysis show that those aged ≥50 years were more likely to have suppressed recent (aOR=2.4) and durable viral load (aOR=2.9) compared to those aged 18–24 years, and women were more likely to have normal CD4 count than men (aOR=1.4), after controlling for the confounders. Conclusion Our findings identified age and gender disparities in the HIV clinical outcomes, which may be used to develop and implement multifaceted interventions to improve health equity among all HIV-infected patients.

Introduction Internalisation of HIV-related stigma may affect a person’s disease management and his\her accessibility to services. However, little is known about HIV-related stigma and its associated factors in patients with HIV. We aimed to examine HIV-related stigma and its associated factors. Methods We used Mississippi Medical Monitoring Project (MMP) data from 2011 to 2014 (n=793). MMP is a cross-sectional surveillance system designed to assess the behavioural and clinical characteristics of HIV-infected adults at least 18 years of age receiving outpatient care in the United States. Dependent variable was HIV-related stigma. Our independent variables were gender, sexual orientation, race, age, education, poverty level, smoking, binge drinking, drug abuse, length of time diagnosed with HIV, and insurance. T-test, one-way ANOVA, and multiple linear regression were conducted (p Results Overall, 75% of respondents reported at least one internalised HIV-related stigma experience. The average stigma score overall was 2.3 (out of 6), with a standard error of 0.07. Our finding showed that stigma was significantly higher among females (M=2.6, t=2.9, p=0.003), patients aged 18–24 (M=2.9, F=4.6, p=0.003), those with less than high school education (M=2.7, t=2.4, p=0.02), binge drinker (M=2.8, t=2.3, p=0.02), drug abuser (M=2.7, t=2.3, p=0.02 ), those who have been diagnosed with HIV since Conclusion The findings indicate that HIV-related stigma is very common among HIV patients, and is significantly associated with gender, education, drug abuse and insurance status, highlighting a need for stigma reduction interventions, with a focus on population at risk.

Background Little is known about the lifetime risk of human immunodeficiency virus (HIV) diagnosis among US men who have sex with men (MSM), trends in risk and how risk varies between populations. Methods We used census and HIV surveillance data to construct life tables to estimate the cumulative risk of HIV diagnosis among cohorts of MSM born 1940 to 1994 in King County, Washington (KC) and Mississippi (MS). Results The cumulative risk of HIV diagnosis progressed in 3 phases. In phase 1, risk increased among MSM in successive cohorts born 1940 to 1964. Among men born 1955 to 1965 (the peak risk cohort), by age 55 years, 45% of white KC MSM, 65% of black KC MSM, 22% of white MS MSM, and 51% of black MS MSM had been diagnosed with HIV. In phase 2, men born 1965 to 1984, risk of diagnosis among KC MSM declined almost 60% relative to the peak risk cohort. A similar pattern of decline occurred in white MS MSM, with a somewhat smaller decline observed in black MS MSM. In phase 3, men born 1985 to 1994, the pattern of risk diverged. Among white KC MSM, black KC MSM, and white MS MSM, HIV risk increased slightly compared with men born 1975 to 1984, with 6%, 14%, and 2% diagnosed by age 27 years, respectively. Among black MS MSM born 1985 to 1994, HIV risk rose dramatically, with 35% HIV diagnosed by age 27 years. Conclusions The lifetime risk of HIV diagnosis has substantially declined among MSM in KC and among white MSM in MS, but is rising dramatically among black MSM in MS.

Pre-exposure prophylaxis (PrEP) is a biomedical intervention that can reduce rates of HIV transmission when taken once daily by HIV-negative individuals. Little is understood about PrEP uptake and retention in care among the populations most heavily impacted by the HIV epidemic, particularly among young men who have sex with men (YMSM) in the Deep South. Therefore, this study explored the structural, social, behavioral, and clinical factors that affect PrEP use and retention in care among YMSM in Jackson, Mississippi. Thirty MSM who were prescribed PrEP at an outpatient primary care clinic were interviewed and included 23 men who had been retained in PrEP care and seven who had not been retained. The mean age of participants was 26.6 years. Most (23) participants were African American. Major factors affecting PrEP use and retention in PrEP care included 1) structural factors such as cost and access to financial assistance for medications and clinical services; 2) social factors such as stigma and relationship status; 3) behavioral factors including sexual risk behaviors; and 4) clinical factors such as perceived and actual side effects. Many participants also discussed the positive spillover effects of PrEP use and reported that PrEP had a positive impact on their health. Four of the seven individuals who had not been retained re-enrolled in PrEP care after completing their interviews, suggesting that case management and ongoing outreach can enhance retention in PrEP care. Interventions to enhance retention in PrEP care among MSM in the Deep South will be most effective if they address the complex structural, social, clinical, and behavioral factors that influence PrEP uptake and retention in PrEP care.

The Medical Monitoring Project (MMP) is an HIV surveillance system that provides national estimates of HIV-related behaviors and clinical outcomes. When first implemented, MMP excluded persons living with HIV not receiving HIV care. This analysis will describe new case-surveillance-based methods to identify and recruit persons living with HIV who are out of care and at elevated risk for mortality and ongoing HIV transmission. Stratified random samples of all persons living with HIV were selected from the National HIV Surveillance System in five public health jurisdictions from 2012-2014. Sampled persons were located and contacted through seven different data sources and five methods of contact to collect interviews and medical record abstractions. Data were weighted for non-response and case reporting delay. The modified sampling methodology yielded 1159 interviews (adjusted response rate, 44.5%) and matching medical record abstractions for 1087 (93.8%). Of persons with both interview and medical record data, 264 (24.3%) would not have been included using prior MMP methods. Significant predictors were identified for successful contact (e.g., retention in care, adjusted Odds Ratio [aOR] 5.02; 95% Confidence Interval [CI] 1.98-12.73), interview (e.g. moving out of jurisdiction, aOR 0.24; 95% CI: 0.12-0.46) and case reporting delay (e.g. rural residence, aOR 3.18; 95% CI: 2.09-4.85). Case-surveillance-based sampling resulted in a comparable response rate to existing MMP methods while providing information on an important new population. These methods have since been adopted by the nationally representative MMP surveillance system, offering a model for public health program, research and surveillance endeavors seeking inclusion of all persons living with HIV.

To explore how Lean can add value during the schematic phase of design through providing additional resources and support to project leadership and the architectural design team.This case study-based research took place at one large academic hospital during design efforts of surgical tower to house 19 operating rooms (ORs) and support spaces including pre- and post-op, central processing and distribution, and materials management. Surgical services project leadership asked for Lean practitioners' support during the design process.Lean Exploration Loops (LELs) were conducted to generate evidence to support stakeholders, as they made important decisions about the new building design. The analyses conducted during LELs during the schematic phase were primarily conducted using express workouts (EWOs) and were focused on the flow of patients, staff, and family throughout the pavilion.LELs resulted in recommendations for key design features (e.g., number of pre- and post-op bays per OR floor, location of doors, scrub sinks, stretcher alcoves, equipment storage, and sterile core areas). Two-sided pre- and post-op bays with an inner clinical workspace and an outer patient transport corridor were recommended. Communicating elevator and a centrally located stairwell for staff to alleviate stress on the main bank of elevators at peak usage times were also suggested.We found Lean tools and methods to be of most value during schematic phase when focused on detailed process and layout analysis, while acknowledging the usefulness of focused EWOs to generate the evidence needed for the decision-making.

The objective of this pilot study was to assess the inter-rater reliability of a newly developed A3 Quality Assessment (QA) rubric to evaluate the quality of completed Plan-Do-Study-Act (PDSA) projects that used an A3 Thinking Tool (A3) for problem solving. One A3 was independently reviewed by 7 PDSA experts using 5 main levels and 22 sublevels. Evaluations were compared and coded for agreement and used for statistical analysis. Fleiss’ kappa statistics was performed to test for inter-rater reliability between experts across 5 main and 22 sublevels. Preliminary results suggest that the A3 QA rubric meets reliability criteria with a moderate level of agreement beyond chance alone (κ = 0.44) and it is applicable to measure progress on problem solving abilities spearheaded via PDSA cycles. Additional verification testing is needed across multiple A3 improvement projects completed in multiple A3 Thinking templates.

The Chermak–Delgado measure of a subgroup [math] of a finite group [math] is defined as [math] . The subgroups with maximal Chermak–Delgado measure form a poset and corresponding lattice, known as the CD-lattice of [math] . We describe the symmetric nature of CD-lattices in general, and use information about centrally large subgroups to determine the CD-lattices of split metacyclic [math] -groups in particular. We also describe a rank-symmetric sublattice of the CD-lattice of split metacyclic [math] -groups.

Objective: To understand patterns of HIV transmission among young black MSM and others in Mississippi. Design: Phylogenetic analysis of HIV-1 polymerase (pol) sequences from 799 antiretroviral-naive persons newly diagnosed with HIV infection in Mississippi during 2005–2008, 130 (16%) of whom were black MSM aged 16–25 years. Methods: We identified phylogenetic clusters and used surveillance data to evaluate demographic attributes and risk factors of all persons in clusters that included black MSM aged 16–25 years. Results: We identified 82 phylogenetic clusters, 21 (26%) of which included HIV strains from at least one young black MSM. Of the 69 persons in these clusters, 59 were black MSM and seven were black men with unknown transmission category; the remaining three were MSM of white or Hispanic race/ethnicity. Of these 21 clusters, 10 included residents of one geographic region of Mississippi, whereas 11 included residents of multiple regions or outside of the state. Conclusion: Phylogenetic clusters involving HIV-infected young black MSM were homogeneous with respect to demographic and risk characteristics, suggesting insularity of this population with respect to HIV transmission, but were geographically heterogeneous. Reducing HIV transmission among young black MSM in Mississippi may require prevention strategies that are tailored to young black MSM and those in their sexual networks, and prevention interventions should be delivered in a manner to reach young black MSM throughout the state. Phylogenetic analysis can be a tool for local jurisdictions to understand the transmission dynamics in their areas. 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins AIDS 2011, 25:2157–2165

Mississippi has some of the most pro­nounced racial disparities in HIV infection in the country; African Americans com­prised 37% of the Mississippi population but represented 80% of new HIV cases in 2015. Improving outcomes along the HIV care continuum, including linking and retaining more individuals and enhancing adherence to medication, may reduce the disparities faced by African Americans in Mississippi. Little is understood about clergy’s views about the HIV care continuum. We assessed knowledge of African American pastors and ministers in Jackson, Mississippi about HIV and the HIV care continuum. We also assessed their willingness to promote HIV screening and biomedical prevention technologies as well as efforts to enhance linkage and retention in care with their congregations. Four focus groups were conducted with 19 African American clergy. Clergy noted pervasive stigma associated with HIV and believed they had a moral imperative to promote HIV awareness and testing; they provided recommendations on how to normalize conversations related to HIV testing and treatment. Overall, clergy were willing to promote and help assist with linking and retaining HIV positive individu­als in care but knew little about how HIV treatment can enhance prevention or new biomedical technologies such as pre-expo­sure prophylaxis (PrEP). Clergy underscored the importance of building coalitions to promote a collective local response to the epidemic. The results of this study highlight important public health opportunities to engage African American clergy in the HIV care continuum in order to reduce racial disparities in HIV infection. Ethn Dis.2018; 28(2): 85-92; doi:10.18865/ed.28.2.85.

Background: In recent years, more than half of new HIV infections in the United States occur among African Americans in the Southeastern United States. Spatial epidemiological analyses can inform public health responses in the Deep South by identifying HIV hotspots and community-level factors associated with clustering. Objective: The goal of this study was to identify and characterize HIV clusters in Mississippi through analysis of state-level HIV surveillance data. Methods: We used a combination of spatial epidemiology and statistical modeling to identify and characterize HIV hotspots in Mississippi census tracts (n=658) from 2008 to 2014. We conducted spatial analyses of all HIV infections, infections among men who have sex with men (MSM), and infections among African Americans. Multivariable logistic regression analyses identified community-level sociodemographic factors associated with HIV hotspots considering all cases. Results: There were HIV hotspots for the entire population, MSM, and African American MSM identified in the Mississippi Delta region, Southern Mississippi, and in greater Jackson, including surrounding rural counties (P

According to the Centers for Disease Control and Prevention, more than 1.1 million people in the United States are living, with HIV infection, and approximately 1 in 6 (18%) are unaware of their infection. People living with undiagnosed HIV are more likely to progress to AIDS, transmit the virus to others, and have poorer overall health outcomes. In 2013, Mississippi had the 6th highest estimated AIDS diagnoses rate among adults and adolescents in the United States and when comparing persons living with AIDS, the Jackson, MS metropolitan area had the tenth highest rate among all MSAs.The objective of this study is to describe people who are diagnosed with HIV late in their course of illness and to identify characteristics associated with late diagnoses.Demographic data was obtained for all Mississippi residents who were diagnosed with HIV infection between Janary 1, 2004 and December 31,2014. Late diagnoses of HIV infection is defined as an AIDS diagnosis made within 12 months from an initial HIV diagnosis. Prevalence trends, demographics, and predictors of late diagnoses were measured. Results: Among 4,864 cases of -IV disease, 35% (1,682) were late diagnoses. Late diagnoses were more likely to occur among males, individuals over the age of 34, and individuals who were diagnosed outside of Mississippi State Department of Health clinics.A large proportion of individuals had late diagnoses of HIV infection and this proportion has slightly declined in recent years. Routine testing in medical settings and in areas with high morbidity may increase early HIV diagnosis.

Purpose To present our approach and results from our quality and safety program and to report their possible impact on our culture of patient safety. Methods and materials We created an event learning system (termed a "good catch" program) and encouraged staff to report any quality or safety concerns in real time. Events were analyzed to assess the utility of safety barriers. A formal continuous quality improvement program was created to address these reported events and make improvements. Data on perceptions of the culture of patient safety were collected using the Agency for Health Care Research and Quality survey administered before, during, and after the initiatives. Results Of 560 good catches reported, 367 could be ascribed to a specific step on our process map. The calculated utility of safety barriers was highest for those embedded into the pretreatment quality assurance checks performed by physicists and dosimetrists (utility score 0.53; 93 of 174) and routine checks done by therapists on the initial day of therapy. Therapists and physicists reported the highest number of good catches (24% each). Sixty-four percent of events were caused by performance issues (eg, not following standardized processes, including suboptimal communications). Of 31 initiated formal improvement events, 26 were successfully implemented and sustained, 4 were discontinued, and 1 was not implemented. Most of the continuous quality improvement program was conducted by nurses (14) and therapists (7). Percentages of positive responses in the patient safety culture survey appear to have increased on all dimensions ( p Conclusions Results suggest that event learning and continuous quality improvement programs can be successfully implemented and that there are contemporaneous improvements in the culture of safety.