Risk Factors for Suboptimal Adherence Identified by Patient-Reported Outcomes Assessments in Routine HIV Care at 2 North American Clinics.

Purpose: Use of patient-reported outcomes assessments (PROs) can improve patient-provider communication and focus provider attention on current health issues. This analysis examines the association between suboptimal antiretroviral therapy (ART) adherence and factors obtained through PROs among people with HIV (PWH) at 2 North American outpatient clinics. Patients and Methods: Immediately before a clinic visit, PWH completed self-administered PROs. Unadjusted and adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated from logistic regression models to identify sociodemographic and health-related factors (satisfaction with ART, difficulty meeting housing costs, depression, intimate partner violence, risk of malnutrition, smoking status, alcohol use, and substance use) associated with suboptimal adherence (defined as self-reporting <95% or <80% adherence). Multiple imputation was performed to account for missing data in the multivariate analyses. Results: Of 1632 PWH, 1239 (76%) responded to the adherence assessment; of these, 268 (22%) and 106 (9%) reported <95% and <80% adherence, respectively. Of 1580 PWH who responded, 354 (22%) were dissatisfied with their HIV medication. Of responding PWH, 19% reported moderate-to-severe depression, 23% indicated they were at risk of malnutrition, 34% were current smokers, and 62% reported substance use in the past 3 months. Dissatisfaction with ART was significantly associated with <95% and <80% adherence in the unadjusted analysis (unadjusted OR [95% CI], 3.38 [2.51-4.56] and 4.26 [2.82-6.42], respectively) and adjusted analysis (adjusted OR [95% CI], 2.76 [1.91-4.00] and 3.28 [1.95-5.52], respectively); significance remained after multiple imputation. In adjusted analyses, no risk of malnutrition was significantly associated with reduced odds of <95% adherence after multiple imputation (adjusted OR [95% CI], 0.714 [0.511-0.997]); no other factors were associated with <95% or <80% adherence. Conclusion: These results suggest that implementation of PROs evaluating treatment satisfaction may provide value to adherence management in routine HIV care.

Utility and Impact of the Implementation of Same-Day, Self-administered Electronic Patient-Reported Outcomes Assessments in Routine HIV Care in two North American Clinics.

The PROgress study assessed the value and feasibility of implementing web-based patient-reported outcomes assessments (PROs) within routine HIV care at two North American outpatient clinics. People with HIV (PWH) completed PROs on a tablet computer in clinic before their routine care visit. Data collection included PROs from 1632 unique PWH, 596 chart reviews, 200 patient questionnaires, and 16 provider/staff questionnaires. During an initial setup phase involving 200 patients, PRO results were not delivered to providers; for all subsequent patients, providers received PRO results before the consultation. Chart review demonstrated that delivery of PRO results to providers improved patient-provider communication and increased the number of complex health and behavioral issues identified, recorded, and acted on, including suicidal ideation (88% with vs 38% without PRO feedback) and anxiety (54% with vs 24% without PRO feedback). In post-visit questionnaires, PWH (82%) and providers (82%) indicated that the PRO added value to the visit.

Jaw Rotation in Dysarthria Measured With a Single Electromagnetic Articulography Sensor.

PURPOSE: This study evaluated a novel method for characterizing jaw rotation using orientation data from a single electromagnetic articulography sensor. This method was optimized for clinical application, and a preliminary examination of clinical feasibility and value was undertaken. METHOD: The computational adequacy of the single-sensor orientation method was evaluated through comparisons of jaw-rotation histories calculated from dual-sensor positional data for 16 typical talkers. The clinical feasibility and potential value of single-sensor jaw rotation were assessed through comparisons of 7 talkers with dysarthria and 19 typical talkers in connected speech. RESULTS: The single-sensor orientation method allowed faster and safer participant preparation, required lower data-acquisition costs, and generated less high-frequency artifact than the dual-sensor positional approach. All talkers with dysarthria, regardless of severity, demonstrated jaw-rotation histories with more numerous changes in movement direction and reduced smoothness compared with typical talkers. CONCLUSIONS: Results suggest that the single-sensor orientation method for calculating jaw rotation during speech is clinically feasible. Given the preliminary nature of this study and the small participant pool, the clinical value of such measures remains an open question. Further work must address the potential confound of reduced speaking rate on movement smoothness.

One on One with Guillermo Chacón.

Since its founding in 1990, the Latino Commission on AIDS has become the largest organization in the U.S. advocating for the health needs of the Latino community in response to the HIV/AIDS epidemic. Also known as Latino AIDS, the commission works with community organizations in developing HIV education, prevention programs, and capacity building. The commission, which began in New York City, now serves Latino communities in more than 40 states and Puerto Rico. Guillermo Chacón has been president of Latino AIDS since 2009.

Case report: median arcuate ligament syndrome diagnosed with computed tomography and Doppler ultrasonography.

BACKGROUND: Median arcuate ligament syndrome is a condition in which the median arcuate ligament crosses the aorta in a lower than normal position and compresses the celiac artery during respiration. The effects of compression are most notable during suspended expiration and when the patient is supine. Patients with median arcuate ligament syndrome present with postprandial abdominal pain, nausea, vomiting, weight loss, and abdominal bruit. The compression leads to a narrowing of the artery, which could cause bowel ischemia, although this theory is controversial. Alternately, the median arcuate ligament could compress the celiac plexus, causing an inflammatory reaction from the nerves and producing a pain pattern that is similar to ischemia. DISCUSSION: Computed tomography and Doppler ultrasonography have high sensitivity and specificity to detect and monitor median arcuate ligament syndrome. Neither imaging modality shows superiority to the other, and the selection of either to image median arcuate ligament syndrome should be based on the patient's needs. CONCLUSION: Treatment for median arcuate ligament syndrome ranges from stenting to open celiac artery decompression with revascularization and results in only a fair degree of long-term symptom relief.

Case report: Multimodality imaging of a cystic nephroma.

Cystic nephroma is a rare, benign, cystic neoplasm of the kidney. Its defining features include a discrete, complex cystic mass with multiple thin septations. Cystic nephroma often is confused with many different complex cystic masses of the kidney such as mixed epithelial stromal tumors, Wilms tumors, and cystic renal cell carcinoma. Patients typically do not present with symptoms, and it is often an incidental finding on imaging procedures for other diagnoses. Treatment for cystic nephroma can vary from frequent follow-up to nephrectomy or kidney-sparing surgery.

Speaking rate effects on locus equation slope.

A locus equation describes a 1st order regression fit to a scatter of vowel steady-state frequency values predicting vowel onset frequency values. Locus equation coefficients are often interpreted as indices of coarticulation. Speaking rate variations with a constant consonant-vowel form are thought to induce changes in the degree of coarticulation. In the current work, the hypothesis that locus slope is a transparent index of coarticulation is examined through the analysis of acoustic samples of large-scale, nearly continuous variations in speaking rate. Following the methodological conventions for locus equation derivation, data pooled across ten vowels yield locus equation slopes that are mostly consistent with the hypothesis that locus equations vary systematically with coarticulation. Comparable analyses between different four-vowel pools reveal variations in the locus slope range and changes in locus slope sensitivity to rate change. Analyses across rate but within vowels are substantially less consistent with the locus hypothesis. Taken together, these findings suggest that the practice of vowel pooling exerts a non-negligible influence on locus outcomes. Results are discussed within the context of articulatory accounts of locus equations and the effects of speaking rate change.