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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.

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.

BackgroundPeople living with human immunodeficiency virus (HIV; PLWH) have a markedly elevated anal cancer risk, largely due to loss of immunoregulatory control of oncogenic human papillomavirus infection. To better understand anal cancer development and prevention, we determined whether recent, past, cumulative, or nadir/peak CD4+ T-cell count (CD4) and/or HIV-1 RNA level (HIV RNA) best predict anal cancer risk.MethodsWe studied 102 777 PLWH during 1996-2014 from 21 cohorts participating in the North American AIDS Cohort Collaboration on Research and Design. Using demographics-adjusted, cohort-stratified Cox models, we assessed associations between anal cancer risk and various time-updated CD4 and HIV RNA measures, including cumulative and nadir/peak measures during prespecified moving time windows. We compared models using the Akaike information criterion.ResultsCumulative and nadir/peak CD4 or HIV RNA measures from approximately 8.5 to 4.5 years in the past were generally better predictors for anal cancer risk than their corresponding more recent measures. However, the best model included CD4 nadir (ie, the lowest CD4) from approximately 8.5 years to 6 months in the past (hazard ratio [HR] for

BackgroundResearch is needed to better understand relations between immunosuppression and HIV viraemia and risk for non-Hodgkin lymphoma, a common cancer in people living with HIV. We aimed to identify key CD4 count and HIV RNA (viral load) predictors of risk for non-Hodgkin lymphoma, overall and by subtype.MethodsWe studied people living with HIV during 1996-2014 from 21 Canadian and US cohorts participating in the North American AIDS Cohort Collaboration on Research and Design. To determine key independent predictors of risk for non-Hodgkin lymphoma, we assessed associations with time-updated recent, past, cumulative, and nadir or peak measures of CD4 count and viral load, using demographics-adjusted, cohort-stratified Cox models, and we compared models using Akaike's information criterion.FindingsOf 102 131 people living with HIV during the study period, 712 people developed non-Hodgkin lymphoma. The key independent predictors of risk for overall non-Hodgkin lymphoma were recent CD4 count (ie, lagged by 6 months;

BackgroundThe United States National HIV/AIDS Strategy established goals to reduce disparities in retention in human immunodeficiency virus (HIV) care, antiretroviral therapy (ART) use, and viral suppression. The impact of sex, age, and sexual HIV acquisition risk (ie, heterosexual vs same-sex contact) on the magnitude of HIV-related racial/ethnic disparities is not well understood.MethodsWe estimated age-stratified racial/ethnic differences in the 5-year restricted mean percentage of person-time spent in care, on ART, and virally suppressed among 19 521 women (21.4%), men who have sex with men (MSM; 59.0%), and men who have sex with women (MSW; 19.6%) entering HIV care in the North American AIDS Cohort Collaboration on Research and Design between 2004 and 2014.ResultsAmong women aged 18-29 years, whites spent 12.0% (95% confidence interval [CI], 1.1%-20.2%), 9.2% (95% CI, .4%-20.4%), and 13.5% (95% CI, 2.7%-22.5%) less person-time in care, on ART, and virally suppressed, respectively, than Hispanics. Black MSM aged ≥50 years spent 6.3% (95% CI, 1.3%-11.7%), 11.0% (95% CI, 4.6%-18.1%), and 9.7% (95% CI, 3.6%-16.8%) less person-time in these stages, respectively, than white MSM ≥50 years of age. Among MSM aged 40-49 years, blacks spent 9.8% (95% CI, 2.4%-16.5%) and 11.9% (95% CI, 3.8%-19.3%) less person-time on ART and virally suppressed, respectively, than whites.ConclusionsRacial/ethnic differences in HIV care persist in specific populations defined by sex, age, and sexual HIV acquisition risk. Clinical and public health interventions that jointly target these demographic factors are needed.

As the world's climate continues to change, human populations are exposed to increasingly severe and extreme weather conditions that can promote migration. Here, we examine how extreme weather influences the likelihood of undocumented migration and return between Mexico and the United States. Weused data from 48,313 individuals observed between 1992 and 2018 in 84 Mexican agricultural communities. While controlling for regional and temporal confounding factors, we related individual decisions to migrate to the United States without documents and subsequently return to Mexico with lagged weather deviations from the historical norm during the corngrowing season (May to August). Undocumented migration was most likely from areas experiencing extreme drought, and migrants were less likely to return to their communities of origin when extreme weather persisted. These findings establish the role of weather shocks in undocumented Mexican migration to, and eventual settlement in, the United States. The findings also suggest that extreme weather conditions, which are likely to increase with climate change, promote clandestine mobility across borders and, thus, expose migrants to risks associated with crossing dangerous terrain and relying upon smugglers. [ABSTRACT FROM AUTHOR]

We carried out a study of an instructional model that integrates flipped classroom with active learning, in-class activities into our biology course, using a mixed methods research design. According to the survey (n = 331), a majority of students found the flipped classroom engaging and helpful for class preparation and scheduling of learning. Student performance was assessed by pre- and postpeer discussion quizzes. We found that there was a significant number of students who obtained a full score with reduced response times (by an average of 81.3%) after peer discussion at week 9 and 13 of the term. There was also a noticeable difference in the normalized average scores obtained in the final examinations for 2017 as compared to 2015 (before the flip). In summary, the integration of instructional videos with conceptual questions and hands-on, in-class activities for an undergraduate biology course intended for nonmajors resulted in improved students' perceptions of engagement, biology, and scores to a moderate extent.

BackgroundCancer remains an important cause of morbidity and mortality in people with human immunodeficiency virus (PWHIV) on effective antiretroviral therapy (ART). Estimates of cancer-attributable mortality can inform public health efforts.MethodsWe evaluated 46956 PWHIV receiving ART in North American HIV cohorts (1995-2009). Using information on incident cancers and deaths, we calculated population-attributable fractions (PAFs), estimating the proportion of deaths due to cancer. Calculations were based on proportional hazards models adjusted for age, sex, race, HIV risk group, calendar year, cohort, CD4 count, and viral load.ResultsThere were 1997 incident cancers and 8956 deaths during 267145 person-years of follow-up, and 11.9% of decedents had a prior cancer. An estimated 9.8% of deaths were attributable to cancer (cancer-attributable mortality rate 327 per 100000 person-years). PAFs were 2.6% for AIDS-defining cancers (ADCs, including non-Hodgkin lymphoma, 2.0% of deaths) and 7.1% for non-AIDS-defining cancers (NADCs: lung cancer, 2.3%; liver cancer, 0.9%). PAFs for NADCs were higher in males and increased strongly with age, reaching 12.5% in PWHIV aged 55+ years. Mortality rates attributable to ADCs and NADCs were highest for PWHIV with CD4 counts

Objective: The goals of the 2005 National Institutes of Health (NIH) Roadmap of the Future of Pharmacy Colleges emphasized the importance of bidirectional information flow in translational research to enhance drug discovery and research. Many dual‐degree programs and pathways have been developed to meet this bidirectional information flow to enhance discovery and research, but limited data exists on the bibliometrics of these dual‐degree Department of Pharmacy Practice faculties. To determine whether dual‐degree programs enhance research, a four‐outcome bibliometric analysis of United States Departments of Pharmacy Practice tenure‐track (DPP‐TT) dual‐degree compared with DPP‐TT single terminal‐degree faculty was conducted over a 10‐year period. Methods: A search of PubMed of DPP‐TT single and dual‐degree faculty from January 10, 2010 to December 31, 2019 was performed. Faculty employed in DPP‐TT were determined through published rosters in the American Association of Colleges of Pharmacy (AACP) rosters or college/school internet sites. Department of Pharmacy Practice faculty members' number of publications, number of citations per publication, h‐index, and NIH iCite weighted Relative Citation Ratio (RCR) value were determined. Descriptive statistics and analysis of variance compared dual‐degree with single terminal‐degree DPP faculty data. Results: Ninety‐one institutions employed 348 DPP‐TT dual‐degree faculty that produced 7480 publications compared with 131 institutions with 1805 single terminal‐degree faculty of 12 670 publications. Dual‐degree DPP number of citations per publication (mean ± standard deviation [SD]) was 37.8 ± 86.8 with a journal impact factor (JIF) of 6.4 ± 14.3 compared to single‐degree of 24.7 ± 90.8 (p < 0.001) with a JIF of 4.7 ± 80.8 (p < 0.001). Dual‐degree faculty h‐index was 14.7 ± 12.5 with a mean iCite weighted RCR of 54.8 ± 87.6 compared to single‐degree faculty of 6.5 ± 8.9 (p < 0.001) with an RCR of 22.1 ± 65.3 (p < 0.001). Conclusion: Department of Pharmacy Practice dual‐degree faculty have significantly higher bibliometrics compared with single‐degree DPP faculty. [ABSTRACT FROM AUTHOR]

Epidemiological and pre-clinical studies support the anti-tumor effects of ω-3 PUFAs; however, the results from human trials are mixed, making it difficult to provide dietary guidelines or recommendations of ω-3 PUFAs for disease prevention or treatment. Understanding the molecular mechanisms by which ω-3 PUFAs inhibit cancer could lead to better nutritional paradigms and human trials to clarify their health effects. The ω-3 PUFAs exert their biological activities mainly through the formation of bioactive lipid metabolites. Here we discuss the biology of cyclooxygenase, lipoxygenase and cytochrome P450 enzymes-derived ω-3-series lipid metabolites on angiogenesis, inflammation and cancer.

Recently, novel biotechnologies to quantify RNA modifications became an increasingly popular choice for researchers who study epitranscriptome. When studying RNA methylations such as N6-methyladenosine (m6A), researchers need to make several decisions in its experimental design, especially the sample size and a proper statistical power. Due to the complexity and high-throughput nature of m6A sequencing measurements, methods for power calculation and study design are still currently unavailable. In this work, we propose a statistical power assessment tool, magpie, for power calculation and experimental design for epitranscriptome studies using m6A sequencing data. Our simulation-based power assessment tool will borrow information from real pilot data, and inspect various influential factors including sample size, sequencing depth, effect size, and basal expression ranges. We integrate two modules in magpie: (i) a flexible and realistic simulator module to synthesize m6A sequencing data based on real data; and (ii) a power assessment module to examine a set of comprehensive evaluation metrics. Author summary: Sample size and sequencing depth are two essential quantitative factors determined prior to high throughput sequencing experiments, for statistical power maximization with limited budget. Due to the complex structure of data from m6A RNA methylation sequencing, analytical derivations for both quantities remain challenging in experimental designs. In response to this challenge, we propose a simulation-based statistical framework, together with a user-friendly R/Bioconductor package magpie, to comprehensively assess the power of the differential m6A methylation detection at varied sample sizes, effect sizes, baseline expression levels, and sequencing depths. Using in-silico synthetic data that mimic real data well, magpie provides several major evaluation metrics to assist users in study design and statistical power evaluation. [ABSTRACT FROM AUTHOR]

Background: United States solid waste workers suffer a high fatal injury rate due to their frequent exposures to refuse‐vehicle‐related hazards. The Occupational Safety and Health Administration (OSHA) allows workers to ride on the rear steps of a garbage truck (exterior riding) if employers abide by American National Standard Z245.1 (ANSI Z245.1). The State of California (CA) has banned exterior riding since 1984, and the City of New York (NYC) has implemented its own initiatives to prevent exterior riding deaths. Methods: Fatal exterior riding incidents were identified from two online databases. Variables relating to deceased workers, employers, and injury circumstances were analyzed. Results: The study identified 181 exterior riding deaths from 604 refuse‐vehicle‐related fatal incidents (deaths either directly caused by a refuse vehicle or one in which the victim was performing a refuse‐vehicle‐related task) in the United States (1984–2020). A total of 50 (27.6%) of the exterior riding deaths had no ANSI Z245.1 violations. Risk factors other than those addressed by ANSI Z245.1 contributed to these worker deaths. Conclusions: Exterior riding deaths identified by this study were all preventable. Temporary workers and workers in the public sector may be at higher risk for exterior riding deaths. Both CA and NYC had taken measures to prohibit the practice of exterior riding, and both had lower numbers of exterior riding deaths. ANSI Z245.1 and current OSHA enforcement policy do not address the inherent dangers of falling off a moving heavy vehicle while standing on a small and elevated platform, and are not effective in preventing fatal exterior riding incidents. [ABSTRACT FROM AUTHOR]

Physicians may be called upon to counsel male patients or parents of newborn males regarding their decision to circumcise their newborn sons. The purpose of the present study was to describe physicians who do not understand the benefits and risks associated with male circumcision well enough to counsel parents of newborn male infants and adult men. A self-administered, cross-sectional electronic survey of physicians was conducted in 2008. We analyzed responses from 1,500 physicians (510 family practitioners, 490 internists, 250 pediatricians, and 250 obstetricians/gynecologists). Nearly 22% (n = 327/1500) reported they did not understand the risks and benefits of newborn male circumcision well enough to counsel parents and 40.3% (n = 504/1250) reported not understanding the risks and benefits well enough to counsel adult men. A substantial minority of physicians may need additional training and/or information about current male circumcision research to feel comfortable counseling parents of newborn male infants or adult men.