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1. Decolonising Education for Sustainable Development (ESD): The Case of The German Conceptual Framework for Secondary Schools

Author

Subin Nijhawan

Abstract

Purpose: The article offers a progressive reading of ESD with a teaching example to decolonise SSE despite constraints set by the school system. Design/methodology/approach: The article presents ESD's idea of thought within 'the big picture' of global education. After that, a description of an expert group is given, tasked with developing a conceptual framework for SSE, commissioned by the school administration in Germany and critically reflected on amidst system constraints. Findings: Full-fledged reforms to rethink schools in the 21st century from scratch to efficiently decolonise and integrate ESD are required. Research limitations/implications: The last part of the article is limited in its description and critical reflection of the federal German example. Practical implications: It is recommended that the big picture in terms of promoting global and decolonial dimensions of ESD and facilitating a sustainable transition of schools for achieving the SDGs is kept in sight.

Published
2024

2. Short-term and long-term management of caustic-induced gastrointestinal injury: An evidence-based practice guidelines

Author

Singh, Anupam Kumar, Gunjan, Deepak, Dash, Nihar Ranjan, Poddar, Ujjal, Gupta, Pankaj, Jain, Ajay Kumar, Lahoti, Deepak, Nayer, Jamshed, Goenka, Mahesh, Philip, Mathew, Chadda, Rakesh, Singh, Rajneesh Kumar, Appasani, Sreekanth, Zargar, Showkat Ali, Broor, Sohan Lal, Nijhawan, Sandeep, Shukla, Siddharth, Gupta, Vikas, Kate, Vikram, Makharia, Govind, and Kochhar, Rakesh

Published
2025
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3. 3DFlowRenderer: One-shot Face Re-enactment via Dense 3D Facial Flow Estimation

Author

Nijhawan, Siddharth, Yashima, Takuya, and Kojima, Tamaki

Subjects
Computer Science - Computer Vision and Pattern Recognition
Abstract

Performing facial expression transfer under one-shot setting has been increasing in popularity among research community with a focus on precise control of expressions. Existing techniques showcase compelling results in perceiving expressions, but they lack robustness with extreme head poses. They also struggle to accurately reconstruct background details, thus hindering the realism. In this paper, we propose a novel warping technology which integrates the advantages of both 2D and 3D methods to achieve robust face re-enactment. We generate dense 3D facial flow fields in feature space to warp an input image based on target expressions without depth information. This enables explicit 3D geometric control for re-enacting misaligned source and target faces. We regularize the motion estimation capability of the 3D flow prediction network through proposed "Cyclic warp loss" by converting warped 3D features back into 2D RGB space. To ensure the generation of finer facial region with natural-background, our framework only renders the facial foreground region first and learns to inpaint the blank area which needs to be filled due to source face translation, thus reconstructing the detailed background without any unwanted pixel motion. Extensive evaluation reveals that our method outperforms state-of-the-art techniques in rendering artifact-free facial images.

Published
2024

4. Perspectives on sustainability among surgeons: findings from the SAGES-EAES sustainability in surgical practice task force survey

Author

Sathe, Tejas S., Alseidi, Adnan, Bellato, Vittoria, Ganjouei, Amir Ashraf, Foroutani, Laleh, Hall, Ryan P., Potapov, Oleksii, Bello, Ricardo J., Johnson, Shaneeta M., Marconi, Stefania, Francis, Nader, Barach, Paul, Sanchez-Casalongue, Manuel, Nijhawan, Sheetal, Oslock, Wendelyn M., Miller, Benjamin, Samreen, Sarah, Chung, Jimmy, Marfo, Nana, Huo, Bright, Lim, Robert B., Vandeberg, Jonathan, Alimi, Yewande R., Pietrabissa, Andrea, Arezzo, Alberto, Frountzas, Maximos, Rems, Miran, Eussen, M. M. M., Bouvy, N. D., and Sylla, Patricia

Published
2024
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6. Sustainability in surgical practice: a collaborative call toward environmental sustainability in operating rooms

Author

Johnson, Shaneeta M., Marconi, Stefania, Sanchez-Casalongue, Manuel, Francis, Nader, Huo, Bright, Alseidi, Adnan, Alimi, Yewande R., Pietrabissa, Andrea, Arezzo, Alberto, Frountzas, Maximos, Bellato, Vittoria, Potapov, Oleksii, Barach, Paul, Rems, Miran, Bello, Ricardo J., Nijhawan, Sheetal, Oslock, Wendelyn M., Sathe, Tejas S., Hall, Ryan P., Miller, Benjamin, Samreen, Sarah, Chung, Jimmy, Marfo, Nana, Lim, Robert B., Vandeberg, Jonathan, Eussen, Myrthe M., Bouvy, Nicole D., and Sylla, Patricia

Published
2024
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13. Hospital Readmissions Among Persons With Human Immunodeficiency Virus in the United States and Canada, 2005–2018: A Collaboration of Cohort Studies

Author

Davy-Mendez, Thibaut, Napravnik, Sonia, Hogan, Brenna C, Eron, Joseph J, Gebo, Kelly A, Althoff, Keri N, Moore, Richard D, Silverberg, Michael J, Horberg, Michael A, Gill, M John, Rebeiro, Peter F, Karris, Maile Y, Klein, Marina B, Kitahata, Mari M, Crane, Heidi M, Nijhawan, Ank, McGinnis, Kathleen A, Thorne, Jennifer E, Lima, Viviane D, Bosch, Ronald J, Colasanti, Jonathan A, Rabkin, Charles S, Lang, Raynell, Berry, Stephen A, Benson, Constance A, Kirk, Gregory D, Greenberg, Alan E, Castel, Amanda D, Monroe, Anne K, Marconi, Vincent, Colasanti, Jonathan, Mayer, Kenneth H, Grasso, Chris, Hogg, Robert S, Montaner, Julio SG, Salters, Kate, Buchacz, Kate, Li, Jun, Jacobson, Jeffrey, Brown, Todd, Tien, Phyllis, D'Souza, Gypsyamber, Smith, Graham, Loutfy, Mona, Gupta, Meenakshi, Rabkin, Charles, Kroch, Abigail, Burchell, Ann, Betts, Adrian, Lindsay, Joanne, Mayor, Angel M, Martin, Jeffrey N, Deeks, Steven G, Brooks, John T, Saag, Michael S, Mugavero, Michael J, Burkholder, Greer, Bamford, Laura, Karris, Maile, Sterling, Timothy R, Haas, David, Rebeiro, Peter, Turner, Megan, McGinnis, Kathleen, Justice, Amy, Gange, Stephen J, Lee, Jennifer S, Hogan, Brenna, Humes, Elizabeth, Coburn, Sally, Gerace, Lucas, and Stewart, Cameron

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Infectious Diseases, Good Health and Well Being, Adult, Male, Humans, United States, Patient Readmission, HIV, HIV Infections, Cohort Studies, Canada, aging, healthcare utilization, hospitalization, readmission, North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of the International epidemiology Databases to Evaluate AIDS, Biological Sciences, Medical and Health Sciences, Microbiology, Biological sciences, Biomedical and clinical sciences, Health sciences
Abstract

BackgroundHospital readmission trends for persons with human immunodeficiency virus (PWH) in North America in the context of policy changes, improved antiretroviral therapy (ART), and aging are not well-known. We examined readmissions during 2005-2018 among adult PWH in NA-ACCORD.MethodsLinear risk regression estimated calendar trends in 30-day readmissions, adjusted for demographics, CD4 count, AIDS history, virologic suppression (

Published
2023

14. Deep learning for risk-based stratification of cognitively impaired individuals

Author

Romano, Michael F, Zhou, Xiao, Balachandra, Akshara R, Jadick, Michalina F, Qiu, Shangran, Nijhawan, Diya A, Joshi, Prajakta S, Mohammad, Shariq, Lee, Peter H, Smith, Maximilian J, Paul, Aaron B, Mian, Asim Z, Small, Juan E, Chin, Sang P, Au, Rhoda, and Kolachalama, Vijaya B

Subjects
Aging, Dementia, Alzheimer's Disease, Acquired Cognitive Impairment, Neurodegenerative, Brain Disorders, Neurosciences, Alzheimer's Disease including Alzheimer's Disease Related Dementias (AD/ADRD), Aetiology, 2.1 Biological and endogenous factors, Neurological
Published
2023

18. Efficient Joint Detection and Multiple Object Tracking with Spatially Aware Transformer

Author

Nijhawan, Siddharth Sagar, Hoshikawa, Leo, Irie, Atsushi, Yoshimura, Masakazu, Otsuka, Junji, and Ohashi, Takeshi

Subjects
Computer Science - Computer Vision and Pattern Recognition
Abstract

We propose a light-weight and highly efficient Joint Detection and Tracking pipeline for the task of Multi-Object Tracking using a fully-transformer architecture. It is a modified version of TransTrack, which overcomes the computational bottleneck associated with its design, and at the same time, achieves state-of-the-art MOTA score of 73.20%. The model design is driven by a transformer based backbone instead of CNN, which is highly scalable with the input resolution. We also propose a drop-in replacement for Feed Forward Network of transformer encoder layer, by using Butterfly Transform Operation to perform channel fusion and depth-wise convolution to learn spatial context within the feature maps, otherwise missing within the attention maps of the transformer. As a result of our modifications, we reduce the overall model size of TransTrack by 58.73% and the complexity by 78.72%. Therefore, we expect our design to provide novel perspectives for architecture optimization in future research related to multi-object tracking.

Published
2022

20. Bi-LSTM Scoring Based Similarity Measurement with Agglomerative Hierarchical Clustering (AHC) for Speaker Diarization

Author

Nijhawan, Siddharth S. and Beigi, Homayoon

Subjects
Electrical Engineering and Systems Science - Audio and Speech Processing, Computer Science - Artificial Intelligence, Computer Science - Computation and Language, Computer Science - Computer Vision and Pattern Recognition, Computer Science - Machine Learning
Abstract

Majority of speech signals across different scenarios are never available with well-defined audio segments containing only a single speaker. A typical conversation between two speakers consists of segments where their voices overlap, interrupt each other or halt their speech in between multiple sentences. Recent advancements in diarization technology leverage neural network-based approaches to improvise multiple subsystems of speaker diarization system comprising of extracting segment-wise embedding features and detecting changes in the speaker during conversation. However, to identify speaker through clustering, models depend on methodologies like PLDA to generate similarity measure between two extracted segments from a given conversational audio. Since these algorithms ignore the temporal structure of conversations, they tend to achieve a higher Diarization Error Rate (DER), thus leading to misdetections both in terms of speaker and change identification. Therefore, to compare similarity of two speech segments both independently and sequentially, we propose a Bi-directional Long Short-term Memory network for estimating the elements present in the similarity matrix. Once the similarity matrix is generated, Agglomerative Hierarchical Clustering (AHC) is applied to further identify speaker segments based on thresholding. To evaluate the performance, Diarization Error Rate (DER%) metric is used. The proposed model achieves a low DER of 34.80% on a test set of audio samples derived from ICSI Meeting Corpus as compared to traditional PLDA based similarity measurement mechanism which achieved a DER of 39.90%., Comment: 8 pages, 3 figures, 2 tables, 1 algorithm, Technical Report: Recognition Technologies, Inc

Published
2022
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21. The Construction of Cosmopolitan Glocalities in Secondary Classrooms through Content and Language Integrated Learning (CLIL) in the Social Sciences

Author

Nijhawan, Subin, Elsner, Daniela, and Engartner, Tim

Abstract

Our article argues for content and language integrated learning (CLIL) in the social sciences, as part of a new literacy towards 21st century challenges at school. At first, we will show how multilingualism is closely juxtaposed with global discourses in a worldwide network of glocalities. Thereafter, for the conceptual framework of the suggested pedagogy, we explain why cosmopolitanism must constitute an integral part thereof, accompanying the genesis of classroom glocalities. The heart of our competence model for CLIL in the social sciences fosters the promotion of global discourse competence with adolescent students. In short, this learning aim is a hybrid of subject and language learning, incorporating the merits of language didactics as well as "21st century skills". Finally, in the last step, we will present #climonomics, a simulation of a multilingual EU parliamentary debate about climate change and climate action for secondary students. This example intends to demonstrate how multilingualism through CLIL amplifies the magnitude of global discourses during a simulation yet realistic setting. It should provide 'food for thought' for similar initiatives in research and teaching, to encourage the facilitation of cosmopolitan visions in classroom glocalities.

Published
2021

23. Discrimination and Calibration of the Veterans Aging Cohort Study Index 2.0 for Predicting Mortality Among People With Human Immunodeficiency Virus in North America

Author

McGinnis, Kathleen A, Justice, Amy C, Moore, Richard D, Silverberg, Michael J, Althoff, Keri N, Karris, Maile, Lima, Viviane D, Crane, Heidi M, Horberg, Michael A, Klein, Marina B, Gange, Stephen J, Gebo, Kelly A, Mayor, Angel, Tate, Janet P, Benson, Constance A, Bosch, Ronald J, Kirk, Gregory D, Marconi, Vincent, Colasanti, Jonathan, Mayer, Kenneth H, Grasso, Chris, Hogg, Robert S, Montaner, Julio SG, Sereda, Paul, Salters, Kate, Buchacz, Kate, Li, Jun, Jacobson, Jeffrey M, Thorne, Jennifer E, Brown, Todd, Tien, Phyllis, D’Souza, Gypsyamber, Smith, Graham, Loutfy, Mona, Gupta, Meenakshi, Rabkin, Charles, Kroch, Abigail, Burchell, Ann, Betts, Adrian, Lindsay, Joanne, Nijhawan, Ank, Mayor, Angel M, Gill, M John, Martin, Jeffrey N, Brooks, John T, Saag, Michael S, Mugavero, Michael J, Willig, James, Bamford, Laura, Eron, Joseph J, Napravnik, Sonia, Kitahata, Mari M, Sterling, Timothy R, Haas, David, Rebeiro, Peter, Turner, Megan, Lee, Jennifer S, McKaig, Rosemary G, Freeman, Aimee M, Van Rompaey, Stephen E, Morton, Liz, McReynolds, Justin, Lober, William B, Hogan, Brenna, You, Bin, Humes, Elizabeth, Gerace, Lucas, Stewart, Cameron, and Coburn, Sally

Subjects
Medical Microbiology, Biomedical and Clinical Sciences, Aging, Women's Health, Infectious Diseases, Sexually Transmitted Infections, HIV/AIDS, 2.4 Surveillance and distribution, Infection, Good Health and Well Being, Calibration, Cohort Studies, Female, HIV, HIV Infections, Humans, Male, Middle Aged, North America, Veterans, VACS Index 2.0, calibration, mortality, North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD)a of the International Epidemiologic Databases to Evaluate AIDS (IeDEA) and Veterans Aging Cohort Study, Biological Sciences, Medical and Health Sciences, Microbiology, Clinical sciences
Abstract

BackgroundThe updated Veterans Aging Cohort Study (VACS) Index 2.0 combines general and human immunodeficiency virus (HIV)-specific biomarkers to generate a continuous score that accurately discriminates risk of mortality in diverse cohorts of persons with HIV (PWH), but a score alone is difficult to interpret. Using data from the North American AIDS Cohort Collaboration (NA-ACCORD), we translate VACS Index 2.0 scores into validated probability estimates of mortality.MethodsBecause complete mortality ascertainment is essential for accurate calibration, we restricted analyses to cohorts with mortality from the National Death Index or equivalent sources. VACS Index 2.0 components were ascertained from October 1999 to April 2018. Mortality was observed up to March 2019. Calibration curves compared predicted (estimated by fitting a gamma model to the score) to observed mortality overall and within subgroups: cohort (VACS/NA-ACCORD subset), sex, age 500 copies/mL, CD4 count

Published
2022

24. Guidelines on optimizing the use of proton pump inhibitors: PPI stewardship

Author

Dutta, Amit Kumar, Jain, Abhinav, Jearth, Vaneet, Mahajan, Ramit, Panigrahi, Manas Kumar, Sharma, Vishal, Goenka, Mahesh Kumar, Kochhar, Rakesh, Makharia, Govind, Reddy, Duvvur Nageshwar, Kirubakaran, Richard, Ahuja, Vineet, Berry, Neha, Bhat, Naresh, Dutta, Usha, Ghoshal, Uday Chand, Jain, Ajay, Jalihal, Umesh, Jayanthi, V., Kumar, Ajay, Nijhawan, Sandeep, Poddar, Ujjal, Ramesh, G. N., Singh, Shivram P, Zargar, Showkat, and Bhatia, Shobna

Published
2023
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25. Comparative outcomes for mature T-cell and NK/T-cell lymphomas in people with and without HIV and to AIDS-defining lymphomas

Author

Koh, Min Jung, Merrill, Mwanasha H, Koh, Min Ji, Stuver, Robert, Alonso, Carolyn D, Foss, Francine M, Mayor, Angel M, Gill, John, Epeldegui, Marta, Cachay, Edward, Thorne, Jennifer E, Silverberg, Michael J, Horberg, Michael A, Althoff, Keri N, Nijhawan, Ank E, McGinnis, Kathleen A, Lee, Jennifer S, Rabkin, Charles S, Napravnik, Sonia, Li, Jun, Castilho, Jessica L, Shen, Changyu, and Jain, Salvia

Subjects
Biomedical and Clinical Sciences, Cardiovascular Medicine and Haematology, Oncology and Carcinogenesis, HIV/AIDS, Cancer, Lymphatic Research, Hematology, Rare Diseases, Lymphoma, Sexually Transmitted Infections, Infectious Diseases, 2.1 Biological and endogenous factors, Acquired Immunodeficiency Syndrome, Hodgkin Disease, Humans, Lymphoma, AIDS-Related, Lymphoma, Large B-Cell, Diffuse, Lymphoma, T-Cell, Peripheral, T-Lymphocytes, Cardiovascular medicine and haematology
Abstract

There are no studies comparing the prognosis for mature T-cell lymphoma (TCL) in people with HIV (PWH) to people without HIV (PWoH) and to AIDS-defining B-cell lymphomas (A-BCLs) in the modern antiretroviral therapy era. North American AIDS Cohort Collaboration on Research and Design and Comprehensive Oncology Measures for Peripheral T-cell Lymphoma Treatment are cohorts that enroll patients diagnosed with HIV and TCL, respectively. In our study, 52, 64, 101, 500, and 246 PWH with histologic confirmation of TCL, primary central nervous system lymphoma, Burkitt's lymphoma, diffuse large B-cell lymphoma (DLBCL), and Hodgkin's lymphoma (HL), respectively, and 450 TCLs without HIV were eligible for analysis. At the time of TCL diagnosis, anaplastic large-cell lymphoma (ALCL) was the most common TCL subtype within PWH. Although PWH with TCL diagnosed between 1996 and 2009 experienced a low 5-year survival probability at 0.23 (95% confidence interval [CI]: 0.13, 0.41), we observed a marked improvement in their survival when diagnosed between 2010 and 2016 (0.69; 95% CI: 0.48, 1; P = .04) in contrast to TCLs among PWoH (0.45; 95% CI: 0.41, 0.51; P = .53). Similarly, PWH with ALCLs diagnosed between 1996 and 2009 were associated with a conspicuously inferior 5-year survival probability (0.17; 95% CI: 0.07, 0.42) and consistently lagged behind A-BCL subtypes such as Burkitt's (0.43; 95% CI:0.33, 0.57; P = .09) and DLBCL (0.17; 95% CI: 0.06, 0.46; P = .11) and behind HL (0.57; 95% CI: 0.50, 0.65; P < .0001). Despite a small number, those diagnosed between 2010 and 2016 experienced a remarkable improvement in survival (0.67; 95% CI: 0.3, 1) in comparison with PWoH (0.76; 95% CI: 0.66, 0.87; P = .58). Thus, our analysis confirms improved overall survival for aggressive B- and T-cell malignancies among PWH in the last decade.

Published
2022

28. CD4 Count at Entry into Care and at Antiretroviral Therapy Prescription among Adults with Human Immunodeficiency Virus in the United States, 2005-2018

Author

Lee, Jennifer S, Humes, Elizabeth A, Hogan, Brenna C, Buchacz, Kate, Eron, Joseph J, Gill, M John, Sterling, Timothy R, Rebeiro, Peter F, Lima, Viviane Dias, Mayor, Angel, Silverberg, Michael J, Horberg, Michael A, Moore, Richard D, Althoff, Keri N, Benson, Constance A, Bosch, Ronald J, Emory-Grady, Gregory D Kirk, Mayer, Kenneth H, Grasso, Chris, Hogg, Robert S, Harrigan, P Richard, Montaner, Julio SG, Yip, Benita, Zhu, Julia, Salters, Kate, Gabler, Karyn, Li, Jun, Gebo, Kelly A, Johns, Richard D Moore, Carey, John T, Rodriguez, Benigno, Thorne, Jennifer E, Brown, Todd, Tien, Phyllis, D’Souza, Gypsyamber, Crouzat, Frederic, Loutfy, Mona, Smith, Graham, Gupta, Meenakshi, Klein, Marina B, Rabkin, Charles, Kroch, Abigail, Burchell, Ann, Betts, Adrian, Lindsay, Joanne, Nijhawan, Ank, Hunter-Mellado, Robert F, Mayor, Angel M, Martin, Jeffrey N, Brooks, John T, Saag, Michael S, Mugavero, Michael J, Willig, James, Bamford, Laura, Karris, Maile, Napravnik, Sonia, Kitahata, Mari M, Crane, Heidi M, Haas, David, Rebeiro, Peter, Turner, Megan, Park, Lesley, Justice, Amy, Gange, Stephen J, McKaig, Rosemary G, Freeman, Aimee M, Van Rompaey, Stephen E, Morton, Liz, McReynolds, Justin, Lober, William B, Hogan, Brenna, You, Bin, Humes, Elizabeth, Gerace, Lucas, Stewart, Cameron, and Coburn, Sally

Subjects
Medical Microbiology, Biomedical and Clinical Sciences, Infection, Adult, Anti-HIV Agents, Antiretroviral Therapy, Highly Active, CD4 Lymphocyte Count, HIV, HIV Infections, Humans, Prescriptions, United States, North American AIDS Cohort Collaboration on Research and Design, CD4 count, antiretroviral therapy, treat all, universal treatment, Biological Sciences, Medical and Health Sciences, Microbiology, Clinical sciences
Abstract

From 2005 to 2018, among 32013 adults with human immunodeficiency virus entering care, median time to antiretroviral therapy (ART) prescription declined from 69 to 6 days, CD4 count at entry into care increased from 300 to 362 cells/μL, and CD4 count at ART prescription increased from 160 to 364 cells/μL.

Published
2021

29. Current and Past Immunodeficiency Are Associated With Higher Hospitalization Rates Among Persons on Virologically Suppressive Antiretroviral Therapy for up to 11 Years

Author

Davy-Mendez, Thibaut, Napravnik, Sonia, Eron, Joseph J, Cole, Stephen R, van Duin, David, Wohl, David A, Hogan, Brenna C, Althoff, Keri N, Gebo, Kelly A, Moore, Richard D, Silverberg, Michael J, Horberg, Michael A, Gill, M John, Mathews, W Christopher, Klein, Marina B, Colasanti, Jonathan A, Sterling, Timothy R, Mayor, Angel M, Rebeiro, Peter F, Buchacz, Kate, Li, Jun, Nanditha, Ni Gusti Ayu, Thorne, Jennifer E, Nijhawan, Ank, Berry, Stephen A, Benson, Constance A, Bosch, Ronald J, Kirk, Gregory D, Mayer, Kenneth H, Grasso, Chris, Hogg, Robert S, Montaner, Julio SG, Salters, Kate, Lima, Viviane D, Sereda, Paul, Trigg, Jason, Rodriguez, Benigno, Brown, Todd, Tien, Phyllis, D’Souza, Gypsyamber, Rabkin, Charles, Kroch, Abigail, Burchell, Ann, Betts, Adrian, Lindsay, oanne, Hunter-Mellado, Robert F, Martin, Jeffrey N, Brooks, John T, Saag, Michael S, Mugavero, Michael J, Willig, James, Mathews, William C, Kitahata, Mari M, Crane, Heidi M, Haas, David, Rebeiro, Peter, Turner, Megan, Tate, Janet, Dubrow, Robert, Fiellin, David, Gange, Stephen J, McKaig, Rosemary G, Freeman, Aimee M, Van Rompaey, Stephen E, Morton, Liz, McReynolds, Justin, Lober, William B, Lee, Jennifer S, You, Bin, Hogan, Brenna, Zhang, Jinbing, and Jing, Jerry

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Clinical Research, Infectious Diseases, Sexually Transmitted Infections, Anti-HIV Agents, CD4 Lymphocyte Count, Canada, Cohort Studies, Female, HIV Infections, Hospitalization, Humans, Male, Viral Load, HIV/AIDS, 6.1 Pharmaceuticals, HIV, hospitalization, CD4 lymphocyte count, sustained virologic response, cohort studies, North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) of IeDEA, Biological Sciences, Medical and Health Sciences, Microbiology, Biological sciences, Biomedical and clinical sciences, Health sciences
Abstract

BackgroundPersons with HIV (PWH) with persistently low CD4 counts despite efficacious antiretroviral therapy could have higher hospitalization risk.MethodsIn six US and Canadian clinical cohorts, PWH with virologic suppression for ≥1 year in 2005-2015 were followed until virologic failure, loss to follow-up, death, or study end. Stratified by early (Years 2-5) and long-term (Years 6-11) suppression and lowest pre-suppression CD4 count 500 cells/μL had an aIRR of 1.44 during early suppression (95% CI 1.01-2.06), and 1.67 (1.03-2.72) during long-term suppression. Among patients with lowest pre-suppression CD4 ≥200 (56%), patients with current CD4 351-500 versus >500 cells/μL had an aIRR of 1.22 (0.93-1.60) during early suppression and 2.09 (1.18-3.70) during long-term suppression.ConclusionsVirologically suppressed patients with lower CD4 counts experienced higher hospitalization rates, and could potentially benefit from targeted clinical management strategies.

Published
2021

30. Hospitalization Rates and Causes Among Persons With HIV in the United States and Canada, 2005–2015

Author

Davy-Mendez, Thibaut, Napravnik, Sonia, Hogan, Brenna C, Althoff, Keri N, Gebo, Kelly A, Moore, Richard D, Horberg, Michael A, Silverberg, Michael J, Gill, M John, Crane, Heidi M, Marconi, Vincent C, Bosch, Ronald J, Colasanti, Jonathan A, Sterling, Timothy R, Mathews, W Christopher, Mayor, Angel M, Nanditha, Ni Gusti Ayu, Buchacz, Kate, Li, Jun, Rebeiro, Peter F, Thorne, Jennifer E, Nijhawan, Ank, van Duin, David, Wohl, David A, Eron, Joseph J, Berry, Stephen A, Benson, Constance A, Kirk, Gregory D, Mayer, Kenneth H, Grasso, Chris, Hogg, Robert S, Harrigan, P Richard, Montaner, Julio SG, Yip, Benita, Zhu, Julia, Salters, Kate, Gabler, Karyn, Carey, John T, Rodriguez, Benigno, Brown, Todd, Tien, Phyllis, D’Souza, Gypsyamber, Rabkin, Charles, Klein, Marina B, Kroch, Abigail, Burchell, Ann, Betts, Adrian, Lindsay, Joanne, Hunter-Mellado, Robert F, Martin, Jeffrey N, Brooks, John T, Saag, Michael S, Mugavero, Michael J, Willig, James, Mathews, William C, Kitahata, Mari M, Haas, David, Rebeiro, Peter, Turner, Megan, Tate, Janet, Dubrow, Robert, Fiellin, David, Gange, Stephen J, McKaig, Rosemary G, Freeman, Aimee M, Van Rompaey, Stephen E, Morton, Liz, McReynolds, Justin, Lober, William B, Lee, Jennifer S, and You, Bin

Subjects
Biomedical and Clinical Sciences, Public Health, Health Sciences, Clinical Sciences, Medical Microbiology, Infectious Diseases, HIV/AIDS, Prevention, Sexually Transmitted Infections, Aging, Infection, Good Health and Well Being, Acquired Immunodeficiency Syndrome, Anti-HIV Agents, CD4 Lymphocyte Count, Canada, Comorbidity, HIV Infections, Hospitalization, Humans, Risk Factors, United States, Viral Load, HIV, hospitalization, cohort studies, North American AIDS Cohort Collaboration on Research and Design of IeDEA, Biological Sciences, Medical and Health Sciences, Microbiology, Biological sciences, Biomedical and clinical sciences, Health sciences
Abstract

BackgroundTo assess the possible impact of antiretroviral therapy improvements, aging, and comorbidities, we examined trends in all-cause and cause-specific hospitalization rates among persons with HIV (PWH) from 2005 to 2015.MethodsIn 6 clinical cohorts, we followed PWH in care (≥1 outpatient CD4 count or HIV load [VL] every 12 months) and categorized ICD codes of primary discharge diagnoses using modified Clinical Classifications Software. Poisson regression estimated hospitalization rate ratios for calendar time trends, adjusted for demographics, HIV risk factor, and annually updated age, CD4, and VL.ResultsAmong 28 057 patients (125 724 person-years), from 2005 to 2015, the median CD4 increased from 389 to 580 cells/µL and virologic suppression from 55% to 85% of patients. Unadjusted all-cause hospitalization rates decreased from 22.3 per 100 person-years in 2005 (95% confidence interval [CI], 20.6-24.1) to 13.0 in 2015 (95% CI, 12.2-14.0). Unadjusted rates decreased for almost all diagnostic categories. Adjusted rates decreased for all-cause, cardiovascular, and AIDS-defining conditions, increased for non-AIDS-defining infection, and were stable for most other categories.ConclusionsAmong PWH with increasing CD4 counts and viral suppression, unadjusted hospitalization rates decreased for all-cause and most cause-specific hospitalizations, despite the potential effects of aging, comorbidities, and cumulative exposure to HIV and antiretrovirals.

Published
2021

31. Brief Report: Hospitalization Rates Among Persons With HIV Who Gained Medicaid or Private Insurance After the Affordable Care Act in 2014

Author

Chow, Jeremy Y, Nijhawan, Ank E, Mathews, W Christopher, Raifman, Julia, Fleming, Julia, Gebo, Kelly A, Moore, Richard D, and Berry, Stephen A

Subjects
Biomedical and Clinical Sciences, Public Health, Health Sciences, HIV/AIDS, Infectious Diseases, Sexually Transmitted Infections, 8.1 Organisation and delivery of services, Infection, Good Health and Well Being, Adolescent, Adult, Female, HIV Infections, Hospitalization, Hospitals, Humans, Male, Medicaid, Middle Aged, Patient Acceptance of Health Care, Patient Protection and Affordable Care Act, United States, Young Adult, HIV, hospitalizations, Affordable Care Act, Clinical Sciences, Public Health and Health Services, Virology, Clinical sciences, Epidemiology, Public health
Abstract

BackgroundIt is unknown whether gaining inpatient health care coverage had an effect on hospitalization rates among persons with HIV (PWH) after implementation of the Affordable Care Act in 2014.MethodsHospitalization data from 2015 were obtained for 1634 adults receiving longitudinal HIV care at 3 US HIV clinics within the HIV Research Network. All patients were engaged in care and previously uninsured and supported by the Ryan White HIV/AIDS Program in 2013. We evaluated whether PWH who transitioned to either Medicaid or private insurance in 2014 tended to have a change in hospitalization rate compared with PWH who remained uncovered and Ryan White HIV/AIDS Program supported. Analyses were performed by negative binomial regression with robust standard errors, adjusting for gender, race/ethnicity, age, HIV risk factor, CD4 count, viral load, clinic site, and 2013 hospitalization rate.ResultsAmong PWH without inpatient health care coverage in 2013, transitioning to Medicaid [adjusted incidence rate ratio 1.26, (0.71, 2.23)] or to private insurance [0.48 (0.18, 1.28)] in 2014 was not associated with 2015 hospitalization rates, after accounting for demographics, HIV characteristics, and prior hospitalization rates. The factors significantly associated with higher hospitalization rates include age 55-64, CD4 400 copies/mL, and 2013 hospitalization rate.ConclusionsAcquiring inpatient coverage was not associated with a change in hospitalization rates. These results provide some evidence to allay the concern that acquiring inpatient coverage would lead to increased inpatient utilization.

Published
2021

32. Position statement from the Indian Society of Gastroenterology, Cardiological Society of India, Indian Academy of Neurology and Vascular Society of India on gastrointestinal bleeding and endoscopic procedures in patients on antiplatelet and/or anticoagulant therapy

Author

Arora, Anil, Kumar, Ashish, Anand, Anil C., Kumar, Ajay, Yadav, Ajay, Bhagwat, Ajit, Mullasari, Ajit S., Satwik, Ambarish, Saraya, Anoop, Mehta, Ashwani, Roy, Debabrata, Reddy, Duvvur Nageshwar, Makharia, Govind, Murthy, Jagarapudi M. K., Roy, Jayanta, Sawhney, Jitendra P. S., Prasad, Kameshwar, Goenka, Mahesh, Philip, Mathew, Umaiorubahan, Meenakshisundaram, Sinha, Nakul, Mohanan, Padinhare P., Sylaja, Padmavathy N., Ramakrishna, Pinjala, Kerkar, Prafulla, Rai, Praveer, Kochhar, Rakesh, Yadav, Rakesh, Nijhawan, Sandeep, Sinha, Saroj K., Hastak, Shirish M., Viswanathan, Sidharth, Ghoshal, Uday C., Madathipat, Unnikrishnan, Thakore, Vijay, Dhir, Vinay, Saraswat, Vivek A., and Nabi, Zaheer

Published
2023
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34. Pink nodule of the chin: an unusual presentation of metastatic carcinoma

Author

Chelliah, Priya, Shah, Kishan M, Vandergriff, Travis, and Nijhawan, Rajiv I

Subjects
metastasis, oncology, renal cell cancer
Abstract

Renal cell carcinoma (RCC) is the most lethal urological tumor, often because it is widely metastasized at the time of diagnosis. There are reports of cutaneous metastases, most commonly to the head and neck, presenting late after RCC is diagnosed. This case presentation explores a 45-year old female patient with a growing skin lesion on her chin, previously treated as an epidermoid cyst before presenting to dermatology clinic. We present a case of cutaneous metastatic clear cell renal cell carcinoma presenting 7 years after initial diagnosis.

Published
2021

37. Targeting neddylation sensitizes colorectal cancer to topoisomerase I inhibitors by inactivating the DCAF13-CRL4 ubiquitin ligase complex

Author

Sun, Yilun, Baechler, Simone A., Zhang, Xiaohu, Kumar, Suresh, Factor, Valentina M., Arakawa, Yasuhiro, Chau, Cindy H., Okamoto, Kanako, Parikh, Anup, Walker, Bob, Su, Yijun P., Chen, Jiji, Ting, Tabitha, Huang, Shar-yin N., Beck, Erin, Itkin, Zina, McKnight, Crystal, Xie, Changqing, Roper, Nitin, Nijhawan, Deepak, Figg, William Douglas, Meltzer, Paul S., Yang, James C., Thomas, Craig J., and Pommier, Yves

Published
2023
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46. Combined estimation of disease progression and retention on antiretroviral therapy among treated individuals with HIV in the USA: a modelling study

Author

Wang, Linwei, Krebs, Emanuel, Min, Jeong E, Mathews, W Christopher, Nijhawan, Ank, Somboonwit, Charurut, Aberg, Judith A, Moore, Richard D, Gebo, Kelly A, Nosyk, Bohdan, Network, HIV Research, Edelstein, Howard, Rutstein, Richard, Baranoski, Amy, Allen, Sara, Boswell, Stephen, Mayer, Kenneth, Agwu, Allison, Beil, Robert, Felsen, Uriel, Urbina, Antonio, Korthuis, P Todd, Akbar, Muhammad, Gaur, Aditya, Valenti, William, Hellinger, Fred, Fleishman, John, Mills, Robert, Keruly, Jeanne, Voss, Cindy, Collins, Charles, and Diaz-Reyes, Rebeca

Subjects
Medical Microbiology, Biomedical and Clinical Sciences, Public Health, Health Sciences, HIV/AIDS, Health Services, Infectious Diseases, Clinical Research, Infection, Good Health and Well Being, Adult, Anti-Retroviral Agents, CD4 Lymphocyte Count, Cohort Studies, Disease Progression, Female, Follow-Up Studies, HIV Infections, Homosexuality, Male, Humans, Male, Markov Chains, Middle Aged, Patient Compliance, Proportional Hazards Models, Retention in Care, Risk Factors, Sexual and Gender Minorities, United States, HIV Research Network, Medical and Health Sciences, Biomedical and clinical sciences, Health sciences
Abstract

BackgroundAccurately estimating HIV disease progression and retention on antiretroviral therapy (ART) can help inform interventions to control HIV microepidemics and mathematical models used to inform health-resource allocation decisions. Our objective was to estimate the monthly probabilities of on-ART CD4 T-cell count progression, mortality, ART dropout, and ART reinitiation using a continuous-time multistate Markov model. We also aimed to validate health-state transition probability estimates to ensure they accurately reproduced the regional HIV microepidemics across the USA.MethodsIn our modelling study, we considered a cohort of patients from the HIV Research Network, a consortium of 17 adult and paediatric HIV-care providers located in the northeastern (n=8), southern (n=5), and western (n=4) regions of the USA. Individuals aged 15 years or older who were in HIV care (defined as one CD4 test and one HIV-care visit in a calendar year period) with at least one ART prescription between Jan 1, 2010, and Dec 31, 2015, were included in the analysis. We used continuous-time multistate Markov models to estimate transitions between CD4 strata and between on-ART and off-ART states. We examined and adjusted for differences in probability of transition by region, race or ethnicity, sex, HIV risk group, and other baseline clinical indicators.FindingsThe median age of the 32 242 individuals included in the analysis was 44 years (interquartile range 35-51). Over a median follow-up of 4·9 years (2·6-6·0), 8614 (26·7%) of 32 242 people interrupted ART and 1325 (4·1%) of 32 242 people died. Women, men who have sex with men, and individuals with no previous ART experience had greater increases in CD4 cell counts, whereas black people and people who inject drugs had increased probabilities of ART dropout and faster disease progression. Regardless of CD4 strata, individuals had increased hazard for ART dropout if they were from the south (adjusted hazard ratio [aHR] range from 1·91, 95% CI 1·71-2·13, to 2·45, 2·29-2·62) or the west (aHR range from 1·29, 1·10-1·51, to 1·66, 1·51-1·82) of the USA, compared with individuals from the northeast USA.InterpretationOur results show heterogeneities in disease progression during ART and probability of ART retention across race and ethnicity, HIV risk groups, and regions. These differences should be viewed as targets for intervention and should be incorporated in mathematical models of regional HIV microepidemics in the USA.FundingUS National Institutes of Health, Agency for Healthcare Research and Quality, and Health Resources and Services Administration.

Published
2019

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