Treating Hepatitis C Virus Infection in Jails as an Offset to Declines in Treatment Activity in the Community, New York City, NY, 2014-2020.

Introduction: There are scant data on implementation of large-scale direct-acting antiviral treatment for hepatitis C virus in jails in the U.S. New York City Health + Hospitals/Correctional Health Services aimed to scale up hepatitis C virus treatment in the New York City jail system. This study describes the trends in annual hepatitis C virus treatment in New York City jails compared with those in Medicaid-funded treatment in the New York City community from 2014 to 2020. Methods: In this observational study, we extracted annual counts of direct-acting antiviral prescriptions for hepatitis C virus for those (1) in the New York City community who were covered by Medicaid and (2) those detained in New York City jails for 2014-2020. Data sources were New York City Department of Health and Mental Hygiene annual reports and Correctional Health Services treatment records, respectively. We used linear regression analysis to test for significant trends in annual treatment in these 2 cohorts during 2015-2019. Results: From 2015 to 2019, treatments started in New York City jails increased annually (p=0.001), whereas Medicaid-funded prescriptions in the New York City community declined since a peak in 2015 (p<0.001). In 2019, New York City jail-based treatment initiations totaled the equivalent of 10% of treatment covered by Medicaid in New York City, up from 0.3% in 2015. Conclusions: Scale up of jail-based hepatitis C virus treatment is an important strategy to offset declines observed in the community. Addressing barriers to care in jail, such as improving testing, linkage to care, and affordability of direct-acting antivirals for jail-based health services, can help sustain high levels of treatment in U.S. jails and other carceral facilities.

Urinary flow through urethras with a rough lumen.

AIMS: This study investigates how lumen roughness and urethral length influence urinary flow speed. METHODS: We used micro-computed tomography scans to measure the lumen roughness and dimensions for rabbits, cats, and pigs. We designed and fabricated three-dimensional-printed urethra mimics of varying roughness and length to perform flow experiments. We also developed a corresponding mathematical model to rationalize the observed flow speed. RESULTS: We update the previously reported relationship between body mass and urethra length and diameter, now including 41 measurements for urethra length and 10 measurements for diameter. We report the relationship between lumen diameter and roughness as a function of position down the urethra for rabbits, cats, and pigs. The time course of urinary speed from our mimics is reported, as well as the average speed as a function of urethra length. CONCLUSIONS: Based on the behavior of our mimics, we conclude that the lumen roughness in mammals reduces flow speed by up to 25% compared to smooth urethras. Urine flows fastest when the urethra length exceeds 25 times its diameter. Longer urethras do not drain faster due to viscous effects counteracting the additional gravitational head. However, flows with our urethra mimics are still 6 times faster than those observed in nature, suggesting that further work is needed to understand flow resistance in the urethra.

Drying dynamics of pellet feces.

Pellet feces are generated by a number of animals important to science or agriculture, including mice, rats, goats, and wombats. Understanding the factors that lead to fecal shape may provide a better understanding of animal health and diet. In this combined experimental and theoretical study, we test the hypothesis that pellet feces are formed by drying processes in the intestine. Inspirational to our work is the formation of hexagonal columnar jointings in cooling lava beds, in which the width L of the hexagon scales as L ∼ J-1 where J is the heat flux from the bed. Across 22 species of mammals, we report a transition from cylindrical to pellet feces if fecal water content drops below 0.65. Using a mathematical model that accounts for water intake rate and intestinal dimensions, we show pellet feces length L scales as L ∼ J-2.08 where J is the flux of water absorbed by the intestines. We build a mimic of the mammalian intestine using a corn starch cake drying in an open trough, finding that corn starch pellet length scales with water flux-0.46. The range of exponents does not permit us to conclude that formation of columnar jointings is similar to the formation of pellet feces. Nevertheless, the methods and physical picture shown here may be of use to physicians and veterinarians interested in using feces length as a marker of intestinal health.

Stochastic modelling of bird flocks: accounting for the cohesiveness of collective motion.

Collective behaviour can be difficult to discern because it is not limited to animal aggregations such as flocks of birds and schools of fish wherein individuals spontaneously move in the same way despite the absence of leadership. Insect swarms are, for example, a form of collective behaviour, albeit one lacking the global order seen in bird flocks and fish schools. Their collective behaviour is evident in their emergent macroscopic properties. These properties are predicted by close relatives of Okubo's 1986 [Adv. Biophys.22, 1-94. (doi:10.1016/0065-227X(86)90003-1)] stochastic model. Here, we argue that Okubo's stochastic model also encapsulates the cohesiveness mechanism at play in bird flocks, namely the fact that birds within a flock behave on average as if they are trapped in an elastic potential well. That is, each bird effectively behaves as if it is bound to the flock by a force that on average increases linearly as the distance from the flock centre increases. We uncover this key, but until now overlooked, feature of flocking in empirical data. This gives us a means of identifying what makes a given system collective. We show how the model can be extended to account for intrinsic velocity correlations and differentiated social relationships.

Global Thrombosis Test: Occlusion by Coagulation or SIPA?

The global thrombosis test (GTT) is a point of care device that tests thrombotic and thrombolytic status. The device exposes whole blood flow to a combination of both high and low shear stress past and between ball bearings potentially causing thrombin and fibrin formation. The question arises as to whether thrombosis in the GTT is dominated by coagulation-triggered red clot or high shear-induced white clot. We investigated the nature of the thrombus formed in the GTT, the device efficacy, human factors use, and limitations. The GTT formed clots that were histologically fibrin-rich with trapped red blood cells. The occlusion time (OT) was more consistent with coagulation than high shear white clot and was strongly lengthened by heparin and citrate, two common anticoagulants. The clot was lysed by tissue plasminogen activator (tPA), also consistent with a fibrin-rich red clot. Changing the bead to a collagen-coated surface and eliminating the low shear zone between the beads induced a rapid OT consistent with a platelet-rich thrombus that was relatively resistant to heparin or tPA. The evidence points to the GTT as occluding primarily due to fibrin-rich red clot from coagulation rather than high shear platelet aggregation and occlusion associated with arterial thrombosis.

COVID-19 in the New York City Jail System: Epidemiology and Health Care Response, March-April 2020.

OBJECTIVES: People detained in correctional facilities are at high risk for infection with severe acute respiratory syndrome coronavirus 2, the virus that causes coronavirus disease 2019 (COVID-19). We described the epidemiology of the COVID-19 outbreak in a large urban jail system, including signs and symptoms at time of testing and risk factors for hospitalization. METHODS: This retrospective observational cohort study included all patients aged ≥18 years who were tested for COVID-19 during March 11-April 28, 2020, while in custody in the New York City jail system (N = 978). We described demographic characteristics and signs and symptoms at the time of testing and performed Cox regression analysis to identify factors associated with hospitalization among those with a positive test result. RESULTS: Of 978 people tested for COVID-19, 568 received a positive test result. Among symptomatic patients, the most common symptoms among those who received a positive test result were cough (n = 293 of 510, 57%) and objective fever (n = 288 of 510, 56%). Of 257 asymptomatic patients who were tested, 58 (23%) received a positive test result. Forty-five (8%) people who received a positive test result were hospitalized for COVID-19. Older age (aged ≥55 vs 18-34) (adjusted hazard ratio [aHR] = 13.41; 95% CI, 3.80-47.33) and diabetes mellitus (aHR = 1.99; 95% CI, 1.00-3.95) were significantly associated with hospitalization. CONCLUSIONS: A substantial proportion of people tested in New York City jails received a positive test result for COVID-19, including a large proportion of people tested while asymptomatic. During periods of ongoing transmission, asymptomatic screening should complement symptom-driven COVID-19 testing in correctional facilities. Older patients and people with diabetes mellitus should be closely monitored after COVID-19 diagnosis because of their increased risk for hospitalization.

Intestines of non-uniform stiffness mold the corners of wombat feces.

The bare-nosed wombat (Vombatus ursinus) is a fossorial, herbivorous, Australian marsupial, renowned for its cubic feces. However, the ability of the wombat's soft intestine to sculpt flat faces and sharp corners in feces is poorly understood. In this combined experimental and numerical study, we show one mechanism for the formation of corners in a highly damped environment. Wombat dissections show that cubes are formed within the last 17 percent of the intestine. Using histology and tensile testing, we discover that the cross-section of the intestine exhibits regions with a two-fold increase in thickness and a four-fold increase in stiffness, which we hypothesize facilitates the formation of corners by contractions of the intestine. Using a mathematical model, we simulate a series of azimuthal contractions of a damped elastic ring composed of alternating stiff and soft regions. Increased stiffness ratio and higher Reynolds number yield shapes that are more square. The corners arise from faster contraction in the stiff regions and relatively slower movement in the center of the soft regions. These results may have applications in manufacturing, clinical pathology, and digestive health.

The hepatitis C virus care cascade in the New York City jail system during the direct acting antiviral treatment era, 2014-2017.

BACKGROUND: High patient turnover presents challenges and opportunity to provide hepatitis C virus (HCV) care in US jails (remand facilities). This study describes the HCV care cascade in the New York City (NYC) jail system during the direct-acting antiviral (DAA) treatment era. METHODS: Patients admitted to the NYC jail system from January 2014 through December 2017 were included in this retrospective cohort analysis. We describe rates of screening, diagnosis, linkage to jail-based care, and treatment among the overall cohort, and among subgroups with long jail stays (≥120 days) or frequent stays (≥10 admissions). The study protocol was approved by a third-party institutional review board (BRANY, Lake Success, NY). FINDINGS: Among the 121,371 patients in our analysis, HCV screening was performed in 40,219 (33%), 4665 (12%) of whom were viremic, 1813 (39%) seen by an HCV clinician in jail, and 248 (5% of viremic patients) started on treatment in jail. Having a long stay (adjusted risk ratio [aRR] 8·11, 95% confidence interval [CI] 6·98, 9·42) or frequent stays (aRR 1·51, 95% CI 1·04, 2·18) were significantly associated with being seen by an HCV clinician. Patients with long stays had a higher rate of treatment (14% of viremic patients). Sustained virologic response at 12 weeks was achieved in 147/164 (90%) of patients with available virologic data. INTERPRETATION: Jail health systems can reach large numbers of HCV-infected individuals. The high burden of HCV argues for universal screening in jail settings. Length of stay was strongly associated with being seen by an HCV clinician in jail. Treatment is feasible among those with longer lengths of stay. FUNDING: None.

Outcomes of Hepatitis C Virus Treatment in the New York City Jail Population: Successes and Challenges Facing Scale up of Care.

BACKGROUND: The population detained in the New York City (NYC) jail system bears a high burden of hepatitis C virus (HCV) infection. Challenges to scaling up treatment include short and unpredictable lengths of stay. We report on the clinical outcomes of direct-acting antiviral (DAA) treatment delivered by NYC Health + Hospitals/Correctional Health Services in NYC jails from 2014 to 2017. METHODS: We performed a retrospective observational cohort study of HCV patients with detectable HCV ribonucleic acid treated with DAA therapy while in NYC jails. Some patients initiated treatment in jail, whereas others initiated treatment in the community and were later incarcerated. Our primary outcome was sustained virologic response at 12 weeks (SVR12). RESULTS: There were 269 patients included in our cohort, with 181 (67%) initiating treatment in jail and 88 (33%) continuing treatment started in the community. The SVR12 virologic outcome data were available for 195 (72%) individuals. Of these, 172 (88%) achieved SVR12. Patients who completed treatment in jail were more likely to achieve SVR12 relative to those who were released on treatment (adjusted risk ratio, 2.93; 95% confidence interval, 1.35-6.34). Of those who achieved SVR12, 114 (66%) had a subsequent viral load checked. We detected recurrent viremia in 18 (16%) of these individuals, which corresponded to 10.6 cases per 100 person-years of follow-up. CONCLUSIONS: Hepatitis C virus treatment with DAA therapy is effective in a jail environment. Future work should address challenges related to discharging patients while they are on treatment, loss to follow-up, and a high incidence of probable reinfection.

Estimation of global recoverable human and animal fecal biomass.

Human and animal feces present persistent threats to global public health and also opportunities for recovery of resources. We present the first global-scale accounting of recoverable feces (livestock animal and human) -from 2003-2030-using country-specific human and animal population estimates and estimated species-specific feces production by human or animal body mass. We also examine global coverage of domestic livestock animals and sanitation facilities to describe the distribution of onsite vs. offsite hazards from animal and human feces. In 2014, the total mass of feces was 3.9 trillion kg/year, increasing by >52 billion kg/year since 2003 and anticipated to reach at least 4.6 trillion kg in 2030. Annual global production of feces from animals-primarily cattle, chickens, and sheep-was about four times that from humans, and ratios of animal:human feces continue to increase (geometric mean of 4.2:1 (2003) vs. 5.0:1 (2014) vs. a projected 6.0:1 (2030)). Low-income populations bear the greatest burden of onsite feces, mostly from animals in or near the domestic environment. This analysis highlights the challenges of resource recovery from concentrated and dispersed sources of feces, and the global public health policy need for safe management of animal feces.

Hydrodynamics of defecation.

Animals discharge feces within a range of sizes and shapes. Such variation has long been used to track animals as well as to diagnose illnesses in both humans and animals. However, the physics by which feces are discharged remain poorly understood. In this combined experimental and theoretical study, we investigate the defecation of mammals from cats to elephants using the dimensions of large intestines and feces, videography at Zoo Atlanta, cone-on-plate rheological measurements of feces and mucus, and a mathematical model of defecation. The diameter of feces is comparable to that of the rectum, but the length is double that of the rectum, indicating that not only the rectum but also the colon is a storage facility for feces. Despite the length of rectum ranging from 4 to 40 cm, mammals from cats to elephants defecate within a nearly constant duration of 12 ± 7 seconds (N = 23). We rationalize this surprising trend by our mathematical model, which shows that feces slide along the large intestine by a layer of mucus, similar to a sled sliding down a chute. Larger animals have not only more feces but also thicker mucus layers, which facilitate their ejection. Our model accounts for the shorter and longer defecation times associated with diarrhea and constipation, respectively. This study may support clinicians use of non-invasive procedures such as defecation time in the diagnoses of ailments of the digestive system.

Duration of urination does not change with body size.

Many urological studies rely on models of animals, such as rats and pigs, but their relation to the human urinary system is poorly understood. Here, we elucidate the hydrodynamics of urination across five orders of magnitude in body mass. Using high-speed videography and flow-rate measurement obtained at Zoo Atlanta, we discover that all mammals above 3 kg in weight empty their bladders over nearly constant duration of 21 ± 13 s. This feat is possible, because larger animals have longer urethras and thus, higher gravitational force and higher flow speed. Smaller mammals are challenged during urination by high viscous and capillary forces that limit their urine to single drops. Our findings reveal that the urethra is a flow-enhancing device, enabling the urinary system to be scaled up by a factor of 3,600 in volume without compromising its function. This study may help to diagnose urinary problems in animals as well as inspire the design of scalable hydrodynamic systems based on those in nature.