The Association of Mental Health and Substance Use With Retention in HIV Care Among Black Women in Washington, District of Columbia.

BACKGROUND: Black women with HIV are impacted by mental health and substance use disorders alongside barriers to care. The impact of these disorders on retention in care, a crucial step of the HIV care continuum, has not been well-studied. We examined the association between these disorders and retention in care over a 2-year period. METHODS: Data from January 1, 2011, to June 30, 2019, were obtained from the DC Cohort, an observational HIV study in Washington, District of Columbia. We examined the associations between mental health (i.e., mood-related or trauma-related) or substance use disorders, separately, on not being retained in HIV care over a 2-year interval post-enrollment among non-Hispanic Black women with HIV. Multivariate logistic regression with adjusted odds ratios (aORs) for sociodemographic and clinical variables was used to quantify the association of 1) having a confirmed mental health or substance use disorder and 2) not being retained in care. RESULTS: Among the 2,181 women in this analysis, 690 (31.64%) were not retained in care. The prevalence of a mood-related disorder (39.84%) was higher compared with a substance use (16.19%) or trauma-related disorder (7.75%). Age per a 10-year increase (aOR 0.87; confidence interval [CI] 0.80, 0.94) and a mood-related disorder diagnosis (aOR 0.72; CI: 0.59, 0.88) were inversely associated with not being retained in care. CONCLUSION: Mood-related disorders were prevalent among Black women with HIV in Washington, District of Columbia, but were not associated with worse retention in care. Future studies should examine key facilitators for Black women with HIV and coexisting mood-related disorders and how they impact retention in care.

Retrospective analysis of comorbidities in stroke patients with a history of obstructive sleep apnea treated with thrombolytic therapy.

BACKGROUND: The eligibility criteria for thrombolytic therapy may differ between acute ischemic stroke patients (AIS) patients with and without incidence of obstructive sleep apnea (OSA). In this study, we determine the effect of specific comorbidities in the exclusion and inclusion for recombinant tissue plasminogen activator (rtPA) administration in the AIS population with OSA. METHODS: Retrospective data from a stroke registry were analyzed for baseline clinical and demographic factors in AIS patients with OSA for rtPA therapy from January 2010 to June 2016. The logistic regression model was developed to identify each of the variables predicting inclusion for or exclusion from rtPA. We estimated the odds of the inclusion or exclusion of a particular demographic and clinical risk factor in AIS with and without OSA for rtPA therapy. The validity of the model was tested using a Hosmer-Lemeshow test and the sensitivity of the model was determined using a Receiver Operating Curve (ROC). RESULTS: A total of 170 AIS patients with OSA were identified, of which, 125 did not receive rtPA while 45 received rtPA. Adjusted analysis showed that in the AIS population with OSA, administration of rtPA was associated with a history of dyslipidemia (OR=3.192, 95% CI, 1.148-8.88, p=0.026), direct admission into a Comprehensive Stroke Center (OR=3.248, 95% CI, 1.06-9.95, p=0.039), and ambulatory improvement (OR=3.556, 95% CI, 1.428-8.86, p=0.006). There were no significant factors associated with rtPA exclusion in the AIS population with OSA. CONCLUSION: The prevalence of OSA in our AIS population was low and no clinical risk factor was associated with the exclusion of patients with AIS and OSA from thrombolytic therapy. Future studies are necessary to explore the effect of OSA in AIS patients to improve eligibility for rtPA therapy for more patients.

Carrier surface modification for enhanced attachment and growth of anammox biofilm.

This study investigates and compares the ammonia removal kinetics, attachment, biofilm development and anammox bacteria enrichment on various surface modified carriers throughout the 163 days of start-up of an MBBR system: virgin, dextran-functionalized carriers, silica-functionalized and pre-seeded denitrifying carriers. Silica-functionalized carriers along with pre-seeded denitrifying carriers induced significant higher kinetics, faster biofilm growth and greater anammox bacteria enrichment during the 64 days of operation compared to non-modified virgin and dextran-functionalized carriers. The elevated anammox bacteria counts along with the elevated kinetics of all carriers measured at day 106 indicated that the completed biofilm growth and biofilm maturation are achieved prior to or at day 106 of start-up. The NH4+-N removal rate for virgin, dextran-functionalized, silica-functionalized and pre-seeded denitrifying carriers were achieved 0.684 ± 0.019, 0.608 ± 0.016, 0.634 ± 0.017 and 0.665 ± 0.018 g NH4+-N/m2/d, respectively, at day 106. The results demonstrate that the silica-functionalized and pre-seeded denitrifying carriers offer advantages during the early stage of start-up while the dextran-functionalized carriers did not reduce the start-up period for anammox biofilm.

Anammox attachment and biofilm development on surface-modified carriers with planktonic- and biofilm-based inoculation.

This study investigates the kinetics, attachment, biofilm development and anammox bacteria enrichment of a novel detached anammox biofilm inoculation method on non-modified virgin MBBR carriers and pre-seeded denitrifying carriers. The study compares these results to the more common use of attached anammox carriers for anammox MBBR inoculation. The anammox bacteria specific attachment-growth rates for virgin carriers inoculated with detached anammox biofilm mass were 38.1% greater for the first 25 days, leading to approximately 30% less time required to achieve complete biofilm coverage than those measured in attached biofilm carrier inoculated systems during the attachment and early biofilm growth stages. The biofilm thickness increase rate was also 52.3% higher for virgin carriers with detached biofilm inoculum. Further, inoculation using pre-seeded denitrifying carriers compared to virgin carriers demonstrated a 13.8% preferential increase in anammox bacteria specific attachment-growth rate and a corresponding 47.2% higher NH4+-N removal rate at the time of biofilm maturation.

Impact and educational outcomes of a small group self-directed teaching strategy in a clinical neuroscience curriculum.

The complexity of the material being taught in clinical neuroscience within the medical school curriculum requires creative pedagogies to teach medical students effectively. Many clinical teaching strategies have been developed and are well described to address these challenges. However, only a few have been evaluated to determine their impact on the performance of students studying clinical neuroscience. Interactive, 2-hour, self-directed small-group interactive clinical case-based learning sessions were conducted weekly for 4 weeks to integrate concepts learned in the corresponding didactic lectures. Students in the small groups analyzed cases of patients suffering from neurological disease that were based on eight learning objectives that allowed them to evaluate neuroanatomical data and clinical findings before presenting their case analysis to the larger group. Students' performances on the formative quizzes and summative tests were compared to those of first-year medical students in the previous year for whom the self-directed, small-group interactive clinical sessions were not available. There was a significant improvement in the summative performance of first-year medical students with self-directed clinical case learning in the second year (Y2) of teaching clinical neuroscience (P < 0.05) when compared with first-year students in the first year (Y1) for whom the self-directed learning approach was not available. Student performance in the formative assessments between Y1 and Y2 was not significantly different (P = 0.803). A target of ≥70% student scoring above 80% in the final summative examination was met. The current study revealed evidence for the impact and educational outcomes of a self-directed, clinical teaching strategy in a clinical neuroscience curriculum for first-year medical students. Anat Sci Educ 11: 478-487. © 2017 American Association of Anatomists.

A new insight into the ability to resist Ischemic brain injury: Does hibernation matter?: An Editorial comment for 'Arctic ground squirrel hippocampus tolerates oxygen glucose deprivation independent of hibernation season even when not hibernating and after ATP depletion, acidosis and glutamate efflux'.

Read the commented article 'Arctic ground squirrel hippocampus tolerates oxygen glucose deprivation independent of hibernation season even when not hibernating and after ATP depletion, acidosis and glutamate efflux' on doi: 10.1111/jnc.13996.