Publications by authors named "Daniel Williams"

250 Publications

Optimizing community linkage to care and antiretroviral therapy Initiation: Lessons from the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS) and their adaptation in Nigeria ART Surge.

PLoS One 2021 20;16(9):e0257476. Epub 2021 Sep 20.

Centers for Disease Control and Prevention-Nigeria Country Office, Abuja, Federal Capital Territory, Nigeria.

Background: Ineffective linkage to care (LTC) is a known challenge for community HIV testing. To overcome this challenge, a robust linkage to care strategy was adopted by the 2018 Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS). The NAIIS linkage to care strategy was further adapted to improve Nigeria's programmatic efforts to achieve the 1st 90 as part of the Nigeria Antiretroviral Therapy (ART) Surge initiative, which also included targeted community testing. In this paper we provide an overview of the NAIIS LTC strategy and describe the impact of this strategy on both the NAIIS and the Surge initiatives.

Methods: The NAIIS collaborated with community-based organizations (CBOs) and deployed mobile health (mHealth) technology with real-time dashboards to manage and optimize community LTC for people living with HIV (PLHIV) diagnosed during the survey. In NAIIS, CBOs' role was to facilitate linkage of identified PLHIV in community to facility of their choice. For the ART Surge, we modified the NAIIS LTC strategy by empowering both CBOs and mobile community teams as responsible for not only active LTC but also for community testing, ART initiation, and retention in care.

Results: Of the 2,739 PLHIV 15 years and above identified in NAIIS, 1,975 (72.1%) were either unaware of their HIV-positive status (N = 1890) or were aware of their HIV-positive status but not receiving treatment (N = 85). Of these, 1,342 (67.9%) were linked to care, of which 952 (70.9%) were initiated on ART. Among 1,890 newly diagnosed PLHIV, 1,278 (67.6%) were linked to care, 33.7% self-linked and 66.3% were linked by CBOs. Among 85 known PLHIV not on treatment, 64 (75.3%) were linked; 32.8% self-linked and 67.2% were linked by a CBO. In the ART Surge, LTC and treatment initiation rates were 98% and 100%, respectively. Three-month retention for monthly treatment initiation cohorts improved from 76% to 90% over 6 months.

Conclusions: Active LTC strategies by local CBOs and mobile community teams improved LTC and ART initiation in the ART Surge initiative. The use of mHealth technology resulted in timely and accurate documentation of results in NAIIS. By deploying mHealth in addition to active LTC, CBOs and mobile community teams could effectively scale up ART with real-time documentation of client-level outcomes.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0257476PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8451986PMC
September 2021

Comparative Metagenomics of the Active Layer and Permafrost from Low-Carbon Soil in the Canadian High Arctic.

Environ Sci Technol 2021 09 2;55(18):12683-12693. Epub 2021 Sep 2.

Center for Environmental Biotechnology, University of Tennessee, Knoxville, Tennessee 37996, United States.

Approximately 87% of the Arctic consists of low-organic carbon mineral soil, but knowledge of microbial activity in low-carbon permafrost (PF) and active layer soils remains limited. This study investigated the taxonomic composition and genetic potential of microbial communities at contrasting depths of the active layer (5, 35, and 65 cm below surface, bls) and PF (80 cm bls). We showed microbial communities in PF to be taxonomically and functionally different from those in the active layer. 16S rRNA gene sequence analysis revealed higher biodiversity in the active layer than in PF, and biodiversity decreased significantly with depth. The reconstructed 91 metagenome-assembled genomes showed that PF was dominated by heterotrophic, fermenting Bacteroidota using nitrite as their main electron acceptor. Prevalent microbes identified in the active layer belonged to bacterial taxa, gaining energy via aerobic respiration. Gene abundance in metagenomes revealed enrichment of genes encoding the plant-derived polysaccharide degradation and metabolism of nitrate and sulfate in PF, whereas genes encoding methane/ammonia oxidation, cold-shock protein, and two-component systems were generally more abundant in the active layer, particularly at 5 cm bls. The results of this study deepen our understanding of the low-carbon Arctic soil microbiome and improve prediction of the impacts of thawing PF.
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http://dx.doi.org/10.1021/acs.est.1c00802DOI Listing
September 2021

Eight Metagenome-Assembled Genomes Provide Evidence for Microbial Adaptation in 20,000- to 1,000,000-Year-Old Siberian Permafrost.

Appl Environ Microbiol 2021 09 10;87(19):e0097221. Epub 2021 Sep 10.

University of Tennessee, Knoxville, Tennessee, USA.

Permafrost microbes may be metabolically active in microscopic layers of liquid brines, even in ancient soil. Metagenomics can help discern whether permafrost microbes show adaptations to this environment. Thirty-three metagenome-assembled genomes (MAGs) were obtained from six depths (3.5 m to 20 m) of freshly cored permafrost from the Siberian Kolyma-Indigirka Lowland region. These soils have been continuously frozen for ∼20,000 to 1,000,000 years. Eight of these MAGs were ≥80% complete with <10% contamination and were taxonomically identified as , , , and within bacteria and within archaea. MAGs from these taxa have been obtained previously from nonpermafrost environments and have been suggested to show adaptations to long-term energy starvation, but they have never been explored in ancient permafrost. The permafrost MAGs had greater proportions in the Clusters of Orthologous Groups (COGs) categories of energy production and conversion and carbohydrate transport and metabolism than did their nonpermafrost counterparts. They also contained genes for trehalose synthesis, thymine metabolism, mevalonate biosynthesis, and cellulose degradation, which were less prevalent in nonpermafrost genomes. Many of these genes are involved in membrane stabilization and osmotic stress responses, consistent with adaptation to the anoxic, high-ionic-strength, cold environments of permafrost brine films. Our results suggest that this ancient permafrost contains DNA of high enough quality to assemble MAGs from microorganisms with adaptations to survive long-term freezing in this extreme environment. Permafrost around the world is thawing rapidly. Many scientists from a variety of disciplines have shown the importance of understanding what will happen to our ecosystem, commerce, and climate when permafrost thaws. The fate of permafrost microorganisms is connected to these predicted rapid environmental changes. Studying ancient permafrost with culture-independent techniques can give a glimpse into how these microorganisms function under these extreme low-temperature and low-energy conditions. This will facilitate understanding how they will change with the environment. This study presents genomic data from this unique environment ∼20,000 to 1,000,000 years of age.
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http://dx.doi.org/10.1128/AEM.00972-21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8432575PMC
September 2021

A comparison of hand function in Colles and scaphoid casts using a modified Jebsen Hand Function Test.

J Hand Surg Eur Vol 2021 Jul 18:17531934211030438. Epub 2021 Jul 18.

Department of Trauma and Orthopaedics, University College London Hospitals, London, UK.

This study investigates the impact of Colles versus scaphoid casts on hand function in modern day activities using the Jebsen Hand Function Test with additional modified subtests including texting on a mobile phone, using a computer mouse and typing on a computer keyboard. Twenty healthy volunteers were recruited for the study. Study participants performed worse in a scaphoid cast compared to a Colles cast; most evident in tasks involving fine motor movements such as writing, picking up small objects and stacking checkers (mean time difference 2.3 seconds, 1.5 seconds and 1.2 seconds, respectively) and tasks involving forearm rotation such as card turning and picking up large light objects (mean time difference 1.6 seconds and 1.1 seconds, respectively). This study highlights the importance of careful consideration when assessing the need for thumb immobilization, due to its impact on hand function when performing both traditional and modern-day activities of daily living.
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http://dx.doi.org/10.1177/17531934211030438DOI Listing
July 2021

Initial Referring Physician and Radiologist Experience with Neck Imaging Reporting and Data System.

Laryngoscope 2021 Jul 17. Epub 2021 Jul 17.

Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, North Carolina, U.S.A.

Objectives/hypothesis: Neck Imaging Reporting and Data System (NI-RADS) is a radiology reporting system developed for head and neck cancer surveillance imaging, using standardized terminology, numeric levels of suspicion, and linked management recommendations. Through a multidisciplinary, interdepartmental quality improvement initiative, we implemented NI-RADS for the reporting of head and neck cancer surveillance CT. Our objective is to summarize our initial experience from the standpoints of head and neck cancer providers and radiologists.

Study Design: Quality improvement study.

Methods: Before and 3 months post-implementation, surveys were offered to referring physicians (n = 21 pre-adoption; 22 post-adoption) and radiologists (n = 17 pre- and post-adoption). NI-RADS utilization was assessed over time.

Results: Survey response rates were 62% (13/21) and 73% (16/22) for referring physicians pre- and post-adoption, respectively, and 94% (16/17) for radiologists pre- and post-adoption. Among post-adoption provider respondents, 100% (16/16) strongly agreed or agreed with "I want our radiologists to continue using NI-RADS," "The NI-RADS numerical rating of radiologic suspicion is helpful," and "The language and style of NI-RADS neck CT reports are clear and understandable." Among radiologist respondents, 88% (14/16) strongly agreed or agreed with "NI-RADS improves consistency among our radiologists in the reporting of surveillance neck CTs." Radiologist NI-RADS utilization increased over time (46% month 1; 72% month 3).

Conclusions: Most referring physicians and radiologists preferred NI-RADS. Head and neck cancer providers indicated that NI-RADS reports are clear, understandable, direct, and helpful in guiding clinical management. Radiologists indicated that NI-RADS improves radiologist consistency in the reporting of surveillance neck CT, and radiologists increasingly used NI-RADS over time.

Level Of Evidence: Level 4 Laryngoscope, 2021.
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http://dx.doi.org/10.1002/lary.29765DOI Listing
July 2021

Recycling of Selective Laser Sintering Waste Nylon Powders into Fused Filament Fabrication Parts Reinforced with Mg Particles.

Polymers (Basel) 2021 Jun 22;13(13). Epub 2021 Jun 22.

UniSA Health and Clinical Sciences, University of South Australia, Adelaide, SA 5000, Australia.

This paper presents recycling of selective laser sintering (SLS) waste nylon into printable filaments and parts reinforced with Mg particles. Waste nylon and waste-Mg powder mixture with 2%, 4%, and 8% Mg to nylon were extruded into the filaments. Moisture absorption, differential scanning calorimetry, and melt flow index experiments were conducted to determine the thermal characteristics, while tensile and flexural tests were conducted to evaluate mechanical properties and failure mechanisms. The results were compared with off-the-self (OTS) nylon. Waste powder was found to be extrudable and printable as FFF filament. Waste filament diameter closely matched standard filament size, while exhibiting reduced moisture absorption. High melting and crystallisation temperature for the waste nylon demonstrated a degradation of the plastic during the SLS process. Young's modulus and ultimate tensile strength for the waste filament increased by 1.6-fold compared to that for OTS, while Mg-composite filament surpassed the waste and OTS. Waste and Mg composite dog bone results showed an increase in strength and stiffness, but the ductility deteriorated. Both flexural strength and modulus for the waste nylon increased by 13% and 26%, respectively, over OTS, and the addition of Mg enhanced flexural strength by up to 5-fold at 8% Mg over the waste. Printed surface topography demonstrated that the waste and Mg composite filaments can print the parts with desired geometric shapes and acceptable surface texture. The findings showed that recycling waste SLS powder into FFF prints would be a viable and useful alternative to disposal, given its abundance.
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http://dx.doi.org/10.3390/polym13132046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8272174PMC
June 2021

HIV-1 Recent Infection Testing Algorithm With Antiretroviral Drug Detection to Improve Accuracy of Incidence Estimates.

J Acquir Immune Defic Syndr 2021 Aug;87(Suppl 1):S73-S80

Division of Global HIV and TB, Centers for Disease Control and Prevention, Atlanta, GA.

Background: HIV-1 incidence calculation currently includes recency classification by HIV-1 incidence assay and unsuppressed viral load (VL ≥ 1000 copies/mL) in a recent infection testing algorithm (RITA). However, persons with recent classification not virally suppressed and taking antiretroviral (ARV) medication may be misclassified.

Setting: We used data from 13 African household surveys to describe the impact of an ARV-adjusted RITA on HIV-1 incidence estimates.

Methods: HIV-seropositive samples were tested for recency using the HIV-1 Limiting Antigen (LAg)-Avidity enzyme immunoassay, HIV-1 viral load, ARVs used in each country, and ARV drug resistance. LAg-recent result was defined as normalized optical density values ≤1.5. We compared HIV-1 incidence estimates using 2 RITA: RITA1: LAg-recent + VL ≥ 1000 copies/mL and RITA2: RITA1 + undetectable ARV. We explored RITA2 with self-reported ARV use and with clinical history.

Results: Overall, 357 adult HIV-positive participants were classified as having recent infection with RITA1. RITA2 reclassified 55 (15.4%) persons with detectable ARV as having long-term infection. Those with detectable ARV were significantly more likely to be aware of their HIV-positive status (84% vs. 10%) and had higher levels of drug resistance (74% vs. 26%) than those without detectable ARV. RITA2 incidence was lower than RITA1 incidence (range, 0%-30% decrease), resulting in decreased estimated new infections from 390,000 to 341,000 across the 13 countries. Incidence estimates were similar using detectable or self-reported ARV (R2 > 0.995).

Conclusions: Including ARV in RITA2 improved the accuracy of HIV-1 incidence estimates by removing participants with likely long-term HIV infection.
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http://dx.doi.org/10.1097/QAI.0000000000002707DOI Listing
August 2021

Successful Use of Near Point-of-Care Early Infant Diagnosis in NAMPHIA to Improve Turnaround Times in a National Household Survey.

J Acquir Immune Defic Syndr 2021 Aug;87(Suppl 1):S67-S72

ICAP at Columbia University, New York, NY; and.

Background: In the population-based HIV impact assessment surveys, early infant diagnosis (EID) was provided to infants <18 months without a prior diagnosis. For the Namibia population-based HIV impact assessment (NAMPHIA), the GeneXpert platform was assessed for the feasibility of near POC EID testing compared with the standard Roche COBAS AmpliPrep/COBAS TaqMan (CAP/CTM) platform. Quality assurance measures and turnaround time were compared to improve EID results reporting.

Methods: NAMPHIA participants were screened for HIV exposure using Determine HIV-1/2 rapid test; samples reactive on Determine received EID testing on the GeneXpert instrument and Xpert HIV-1 Qual assay using whole blood. Results were confirmed at the Namibia Institute of Pathology using dried blood spots on the Roche CAP/CTM platform per national guidelines.

Results: Of the 762 screened infants, 61 (8.0%) were Determine-reactive and considered HIV-exposed. Of the 61 exposed infants, 2 were found to be HIV-infected whereas 59 were negative on both GeneXpert and Roche platforms, achieving 100% concordance. Average turnaround time was 3.4 days for the Xpert HIV-1 Qual assay, and average time from collection to testing was 1.0 days for GeneXpert compared with 10.7 days for Roche. No samples failed using GeneXpert whereas 1 sample failed using Roche and was repeated.

Conclusion: Quality POC EID testing is feasible in a national survey through extensive training and external quality assurance measures. The use of decentralized POC EID for national testing would provide rapid diagnosis and improve TATs which may prevent loss to follow-up, ensure linkage to care, and improve clinical outcomes for infants.
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http://dx.doi.org/10.1097/QAI.0000000000002706DOI Listing
August 2021

Antigonococcal Activity of (+)-Medicarpin.

ACS Omega 2021 Jun 28;6(23):15274-15278. Epub 2021 May 28.

Department of Chemistry and Biochemistry, North Carolina Central University, 1801 Fayetteville Street, Durham, North Carolina 27707, United States.

Antibiotics are the primary drugs for combating infections, but with evolving antibiotic resistance of this bacterium, new druggable molecules are needed to stem the tide of this impending public health crisis. Propolis has long been recognized for its antimicrobial properties, being composed of secondary metabolites with antibacterial potential. We herein describe the evaluation of a Jamaican multifloral propolis for antibacterial activity against The bioassay-guided evaluation of the ethyl acetate extract yielded (+)-medicarpin (), whose final structure was elucidated based on spectral analysis and comparison with the known metabolites. Compound () selectively inhibited with a minimum inhibitory concentration value of 0.25 mg/mL, showing an additive effect against when combined with vancomycin.
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http://dx.doi.org/10.1021/acsomega.1c01590DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8210425PMC
June 2021

Effectiveness of point-of-use and pitcher filters at removing lead phosphate nanoparticles from drinking water.

Water Res 2021 Aug 25;201:117285. Epub 2021 May 25.

US Environmental Protection Agency, Office of Research and Development, Drinking Water Management Branch, Center for Environmental Solutions & Emergency Response, Water Infrastructure Division, 26 W. Martin Luther King Dr., Cincinnati, Ohio 45268. Electronic address:

Orthophosphate (PO) addition is a common corrosion control treatment used to lower lead (Pb) concentrations at the consumer's tap by forming relatively insoluble Pb-phosphate (Pb-PO) minerals. However, some Pb-PO particles that can form in drinking water are mobile nanoparticles (i.e., 0.001-0.1 µm) that have the potential to reach the tap. Point-of-use (POU) or pitcher filters are often used to manage risks during distribution system upsets, when corrosion control treatment is not optimized, or following Pb service line replacements. To abide by industry convention, POU and pitcher filters must be NSF/ANSI-certified for Pb reduction (NSF/ANSI-53) using a test water containing dissolved Pb and large Pb particles. Certification for particulates reduction (NSF/ANSI-42) is done using a test water that contains particles, but not leaded particles. To address the lack of testing for Pb nanoparticles, this study challenged six certified commercially available faucet-mounted POU (3) and pitcher (3) filters with aqueous suspensions of Pb-PO nanoparticle. For the water quality investigated, the Pb particles formed ranged between 0.016 and 0.098 µm, based on scanning electron microscopy, transmission electron microscopy, and dynamic light scattering analysis. These particles represented 98.5% of total Pb in suspension. The total Pb removals were between 44.6 and 65.1% for the POU filters, and between 10.9 and 92.9% for the pitcher filters. The electron microscopy results confirm that Pb-PO nanoparticles passed through the filters. The findings can inform future efforts to re-examine the test waters used in the certification challenge tests.
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http://dx.doi.org/10.1016/j.watres.2021.117285DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8380470PMC
August 2021

Selective inhibition of the K efflux sensitive NLRP3 pathway by Cl channel modulation.

Chem Sci 2020 Oct 12;11(43):11720-11728. Epub 2020 Oct 12.

Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, University of Manchester Stopford Building, Oxford Road Manchester M13 9PT UK

The NLRP3 inflammasome regulates production of the pro-inflammatory cytokines interleukin-1β (IL-1β) and IL-18, and contributes to inflammation exacerbating disease. Fenamate non-steroidal anti-inflammatory drugs (NSAIDs) were recently described as NLRP3 inflammasome inhibitors chloride channel inhibition. Fenamate NSAIDs inhibit cyclooxygenase (COX) enzymes, limiting their potential as therapeutics for NLRP3-associated diseases due to established side effects. The aim here was to develop properties of the fenamates that inhibit NLRP3, and at the same time to reduce COX inhibition. We synthesised a library of analogues, with feedback from COX docking potential, and IL-1β release inhibitory activity. Through iterative screening and rational chemical design, we established a collection of chloride channel inhibiting active lead molecules with potent activity at the canonical NLRP3 inflammasome and no activity at COX enzymes, but only in response to stimuli that activated NLRP3 by a K efflux-dependent mechanism. This study identifies a model for the isolation and removal of unwanted off-target effects, with the enhancement of desired activity, and establishes a new chemical motif for the further development of NLRP3 inflammasome inhibitors.
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http://dx.doi.org/10.1039/d0sc03828hDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8162947PMC
October 2020

Component Parts of Bacteriophage Virions Accurately Defined by a Machine-Learning Approach Built on Evolutionary Features.

mSystems 2021 Jun 27;6(3):e0024221. Epub 2021 May 27.

Infection & Immunity Program, Biomedicine Discovery Institute, Monash University, Clayton, Australia.

Antimicrobial resistance (AMR) continues to evolve as a major threat to human health, and new strategies are required for the treatment of AMR infections. Bacteriophages (phages) that kill bacterial pathogens are being identified for use in phage therapies, with the intention to apply these bactericidal viruses directly into the infection sites in bespoke phage cocktails. Despite the great unsampled phage diversity for this purpose, an issue hampering the roll out of phage therapy is the poor quality annotation of many of the phage genomes, particularly for those from infrequently sampled environmental sources. We developed a computational tool called STEP to use the "evolutionary features" that can be recognized in genome sequences of diverse phages. These features, when integrated into an ensemble framework, achieved a stable and robust prediction performance when benchmarked against other prediction tools using phages from diverse sources. Validation of the prediction accuracy of STEP was conducted with high-resolution mass spectrometry analysis of two novel phages, isolated from a watercourse in the Southern Hemisphere. STEP provides a robust computational approach to distinguish specific and universal features in phages to improve the quality of phage cocktails and is available for use at http://step3.erc.monash.edu/. In response to the global problem of antimicrobial resistance, there are moves to use bacteriophages (phages) as therapeutic agents. Selecting which phages will be effective therapeutics relies on interpreting features contributing to shelf-life and applicability to diagnosed infections. However, the protein components of the phage virions that dictate these properties vary so much in sequence that best estimates suggest failure to recognize up to 90% of them. We have utilized this diversity in evolutionary features as an advantage, to apply machine learning for prediction accuracy for diverse components in phage virions. We benchmark this new tool showing the accurate recognition and evaluation of phage component parts using genome sequence data of phages from undersampled environments, where the richest diversity of phage still lies.
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http://dx.doi.org/10.1128/mSystems.00242-21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8269216PMC
June 2021

Inpatient Use and Outcomes at Children's Hospitals During the Early COVID-19 Pandemic.

Pediatrics 2021 06 23;147(6). Epub 2021 Mar 23.

Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio; and.

Background And Objectives: The coronavirus disease 2019 (COVID-19) pandemic has led to changes in health care use, including decreased emergency department visits for children. In this study, we sought to describe the impact of the COVID-19 pandemic on inpatient use within children's hospitals.

Methods: We performed a retrospective study using the Pediatric Health Information System. We compared inpatient use and clinical outcomes for children 0 to 18 years of age during the COVID-19 period (March 15 to August 29, 2020) to the same time frame in the previous 3 years (pre-COVID-19 period). Adjusted generalized linear mixed models were used to examine the association of the pandemic period with inpatient use. We assessed trends overall and for a subgroup of 15 medical All Patient Refined Diagnosis Related Groups (APR-DRGs).

Results: We identified 424 856 hospitalizations (mean: 141 619 hospitalizations per year) in the pre-COVID-19 period and 91 532 in the COVID-19 period. Compared with the median number of hospitalizations in the pre-COVID-19 period, we observed declines in hospitalizations overall (35.1%), and by APR-DRG (range: 8.5%-81.3%) with asthma (81.3%), bronchiolitis (80.1%), and pneumonia (71.4%) experiencing the greatest declines. Overall readmission rates were lower during the COVID-19 period; however, other outcomes, including length of stay, cost, ICU use, and mortality remained similar to the pre-COVID-19 period with some variability by APR-DRGs.

Conclusions: US children's hospitals observed substantial reductions in inpatient admissions with largely unchanged hospital-level outcomes during the COVID-19 pandemic. Although the impact on use varied by condition, the most notable declines were related to inpatient admissions for respiratory conditions, including asthma, bronchiolitis, and pneumonia.
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http://dx.doi.org/10.1542/peds.2020-044735DOI Listing
June 2021

High avidity drives the interaction between the streptococcal C1 phage endolysin, PlyC, with the cell surface carbohydrates of Group A Streptococcus.

Mol Microbiol 2021 08 3;116(2):397-415. Epub 2021 Apr 3.

Biomedicine Discovery Institute, Department of Microbiology, Monash University, Melbourne, VIC, Australia.

Endolysin enzymes from bacteriophage cause bacterial lysis by degrading the peptidoglycan cell wall. The streptococcal C1 phage endolysin PlyC, is the most potent endolysin described to date and can rapidly lyse group A, C, and E streptococci. PlyC is known to bind the Group A streptococcal cell wall, but the specific molecular target or the binding site within PlyC remain uncharacterized. Here we report for the first time, that the polyrhamnose backbone of the Group A streptococcal cell wall is the binding target of PlyC. We have also characterized the putative rhamnose binding groove of PlyC and found four key residues that were critical to either the folding or the cell wall binding action of PlyC. Based on our results, we suggest that the interaction between PlyC and the cell wall may not be a high-affinity interaction as previously proposed, but rather a high avidity one, allowing for PlyC's remarkable lytic activity. Resistance to our current antibiotics is reaching crisis levels and there is an urgent need to develop the antibacterial agents with new modes of action. A detailed understanding of this potent endolysin may facilitate future developments of PlyC as a tool against the rise of antibiotic resistance.
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http://dx.doi.org/10.1111/mmi.14719DOI Listing
August 2021

Assessing Health Care Utilization and Compliance in Kawasaki Disease.

J Pediatr 2021 Jul 20;234:181-186.e1. Epub 2021 Mar 20.

Medical University of South Carolina, Charleston, SC.

Objective: To characterize health care utilization and costs associated with care after diagnosis of Kawasaki disease including adherence to guidelines for echocardiograms.

Study Design: We analyzed children hospitalized for Kawasaki disease using 2015-2017 national Truven MarketScan commercial claims data. The mean 90-day prehospitalization utilization and costs were quantified and compared with the 90 days posthospitalization via Wilcoxon 2-sample test. Adherence to echocardiogram guidelines was examined using multivariable logistic regression to identify factors associated with adherence.

Results: The mean total payments 90 days prior to hospitalization ($2090; n = 360) were significantly lower than those after discharge ($3778), though out of pocket costs were higher ($400 vs $270) (P < .0001). There was an increase in office visits, medical procedures, and echocardiograms after discharge. A majority of health care utilization before hospitalization occurred in the 7 days immediately prior to the date of admission; 51% obtained an echocardiogram within the first 2 weeks, and 14% were completely adherent with recommendations. Children with greater utilization prior to admission were more likely to adhere to American Heart Association guidelines for follow-up echocardiograms (OR 1.03, 95% CI 1.01-1.06).

Conclusions: Outpatient health care expenditure nearly doubles after Kawasaki disease hospital discharge when compared with prehospitalization, suggesting the financial ramifications of this diagnosis persist beyond costs incurred during hospitalization. A significant portion of patients do not receive guideline recommended follow-up echocardiograms. This issue should be explored in more detail given the morbidity and mortality associated with this diagnosis.
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http://dx.doi.org/10.1016/j.jpeds.2021.03.022DOI Listing
July 2021

The removal of ammonia, arsenic, iron and manganese by biological treatment from a small Iowa drinking water system.

Environ Sci (Camb) 2020 Nov;6(11):3142-3156

U.S. Environmental Protection Agency, Office of Research and Development, Center for Environmental Solutions and Emergency Response, Water Infrastructure Division, Cincinnati, Ohio 45268, USA.

Although not regulated in United States drinking water, ammonia has the potential to increase chlorine consumption and cause nitrification problems in the distribution system. Many groundwaters with elevated ammonia are also contaminated with other inorganic analytes such as arsenic, iron, and manganese, all of which have primary or secondary maximum contaminant levels (MCLs). The objective of this work was to demonstrate the effectiveness of an innovative biological treatment process to simultaneously remove ammonia (2.9 mg N per L), arsenic (23 μg L), iron (2.9 mg L) and manganese (80 μg L) from a groundwater source in Iowa. The biological treatment system consisted of an "aeration contactor" followed by a conventional granular media filter. Orthophosphate was also added, as a biological nutrient, at 0.3 mg PO per L. Ammonia, manganese, and iron were consistently reduced through the pilot system by 98 to 99%. Complete oxidation of ammonia to nitrate was observed (., no nitrite was released) and arsenic was consistently removed to below the 10 μg L MCL. Ammonia was oxidized by ammonia and nitrite oxidizing bacteria and arsenic by bacteria which converted As(III) in the source water to more readily removable As(V). Iron was presumably oxidized by oxygen during aeration although some biologically assisted oxidation could not be ruled out. As(V) bound iron particles were removed in the filter resulting in effective arsenic (and iron) reduction. A surprising treatment benefit was the effective manganese reduction, the mechanism of which was not so clear, but was attributed to biologically assisted oxidation of Mn(II). While some system acclimation time was necessary to achieve desired ammonia and manganese reductions, acceptable arsenic and iron reductions were observed shortly after start-up.
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http://dx.doi.org/10.1039/d0ew00361aDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7898138PMC
November 2020

Population Viral Load, Viremia, and Recent HIV-1 Infections: Findings From Population-Based HIV Impact Assessments (PHIAs) in Zimbabwe, Malawi, and Zambia.

J Acquir Immune Defic Syndr 2021 08;87(Suppl 1):S81-S88

ICAP at Columbia University, New York, NY.

Background: HIV population viral load (PVL) can reflect antiretroviral therapy program effectiveness and transmission potential in a community. Using nationally representative data from household surveys conducted in Zimbabwe, Malawi, and Zambia in 2015-16, we examined the association between various VL measures and the probability of at least one recent HIV-1 infection in the community.

Methods: We used limiting-antigen avidity enzyme immunoassay, viral load suppression (VLS) (HIV RNA <1000 copies/mL), and antiretrovirals in the blood to identify recent HIV-1 cases.

Results: Among 1510 enumeration areas (EAs) across the 3 surveys, 52,036 adults aged 15-59 years resided in 1363 (90.3%) EAs with at least one HIV-positive adult consenting to interview and blood draw and whose VL was tested. Mean HIV prevalence across these EAs was 13.1% [95% confidence intervals (CI) 12.7 to 13.5]. Mean VLS prevalence across these EAs was 58.7% (95% CI: 57.3 to 60.0). In multivariable analysis, PVL was associated with a recent HIV-1 case in that EA (adjusted odds ratio: 1.4, 95% CI: 1.2 to 1.6, P = 0.001). VLS prevalence was inversely correlated with recent infections (adjusted odds ratio: 0.3, 95% CI: 0.1 to 0.6, P = 0.004). The 90-90-90 indicators, namely, the prevalence of HIV diagnosis, antiretroviral therapy coverage, and VLS at the EA level, were inversely correlated with HIV recency at the EA level.

Conclusions: We found a strong association between PVL and VLS prevalence and recent HIV-1 infection at the EA level across 3 southern African countries with generalized HIV epidemics. These results suggest that population-based measures of VLS in communities may serve as a proxy for epidemic control.
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http://dx.doi.org/10.1097/QAI.0000000000002637DOI Listing
August 2021

The Impact of Physician Productivity Models on Access to Subspecialty Care: A White Paper From the Society for the Study of Male Reproduction and the Society for Male Reproduction and Urology.

Urology 2021 Jul 20;153:28-34. Epub 2021 Jan 20.

Department of Urology, University of California San Francisco, San Francisco, CA.

Male infertility is a common disease. Male infertility is also a core competency of urology training and clinical practice. In this white paper from the Society for the Study of Male Reproduction and the Society for Male Reproduction and Urology, we identify and define different physician productivity plans. We then describe the advantages and disadvantages of various physician productivity measurement systems for male infertility practices. We close with recommendations for measuring productivity that we hope urologists and administrators can use when creating productivity plans for male infertility practices.
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http://dx.doi.org/10.1016/j.urology.2021.01.016DOI Listing
July 2021

Practice and Dissemination of Motivational Interviewing: A Psychology Internship Curriculum.

Train Educ Prof Psychol 2020 Feb;14(1):34-41

Department of Psychiatry and Human Behavior, University of Mississippi Medical Center.

Sufficient training in substance use issues has been identified as a common gap in professional psychology graduate training. Satisfactory training in evidence-based practices has also been identified as a common gap for providers who care for individuals with substance use problems. The "practice and dissemination" curriculum we developed seeks to address both of these gaps during the predoctoral internship training year by first training psychology interns to competently deliver motivational interviewing (MI) to individuals with substance use problems and then train community providers and volunteers to do so. From 2012-2013, a total of 55 community providers and volunteers from a homeless shelter, a substance use treatment facility, and a community mental health facility received training in MI through this curriculum by attending continuing education events delivered by 17 psychology interns. Evaluation of the dissemination portion of the curriculum as part of an exempt educational research project revealed that community providers were able to achieve significant increases in MI knowledge, readiness to implement MI, and MI skill as assessed with a video analogue measure by the end of the workshop. They also reported satisfaction with the workshop. These evaluation findings provide preliminary support for the curriculum as a novel and efficacious way to disseminate MI to community providers. Research is necessary to determine long-term outcomes of such training and to identify strategies to overcome potential barriers such as the substantial faculty effort necessary to implement the intensive curriculum.
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http://dx.doi.org/10.1037/tep0000280DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731985PMC
February 2020

A Cost Comparison of Infliximab Versus Intravenous Immunoglobulin for Refractory Kawasaki Disease Treatment.

Hosp Pediatr 2021 01 8;11(1):88-93. Epub 2020 Dec 8.

Department of Pediatrics and.

Background And Objectives: In 10% to 20% of cases, Kawasaki disease is refractory to intravenous immunoglobulin (IVIg), an expensive medication under a national shortage. Data suggest that infliximab is a viable alternative to a second dose of IVIg, with similar efficacy and safety. We compared the cost of a second IVIg dose to that of infliximab in the treatment of refractory Kawasaki disease (rKD).

Methods: A decision analysis model was used to compare rKD treatments: a second dose of IVIg at 2 g/kg versus infliximab at 10 mg/kg. Infliximab monitoring times were 24, 36, and 48 hours. Direct hospital costs beginning at rKD diagnosis were estimated by using 2016-2017 Truven MarketScan data. Redbook was used for drug costs. Calculations were applied to 3 hypothetical cohorts of 100 patients aged 2 (12.5 kg), 4 (16 kg), and 8 years (25.5 kg). Indirect costs included parental missed workdays.

Results: The total direct cost for children receiving IVIg was $1 677 801, $1 791 652, and $2 100 675 for the 2-, 4-, and 8-year-old cohorts. The direct cost of infliximab with 24 hours of monitoring was $853 042, $899 096, and $1 024 101, respectively. A 20% bidirectional sensitivity analysis revealed stability of our model, with overall cost savings with use of infliximab. With monitoring 48 hours after infliximab treatment, 20% changes in length of stay (LOS) tipped the balance for the 2- and 4-year-old cohorts. Overall, IVIg and infliximab LOS had the most influence on our model.

Conclusions: Infliximab has potential to yield shorter LOS and significant cost savings in the treatment of rKD. Infliximab treatment, followed by 24 hours of monitoring, nearly halved hospital costs, regardless of age.
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http://dx.doi.org/10.1542/hpeds.2020-0188DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7769204PMC
January 2021

Prevalence of nonsuppressed viral load and associated factors among HIV-positive adults receiving antiretroviral therapy in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe (2015 to 2017): results from population-based nationally representative surveys.

J Int AIDS Soc 2020 11;23(11):e25631

ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY, USA.

Introduction: The global target for 2020 is that ≥90% of people living with HIV (PLHIV) receiving antiretroviral therapy (ART) will achieve viral load suppression (VLS). We examined VLS and its determinants among adults receiving ART for at least four months.

Methods: We analysed data from the population-based HIV impact assessment (PHIA) surveys in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe (2015 to 2017). PHIA surveys are nationally representative, cross-sectional household surveys. Data collection included structured interviews, home-based HIV testing and laboratory testing. Blood samples from PLHIV were analysed for HIV RNA, CD4 counts and recent exposure to antiretroviral drugs (ARVs). We calculated representative estimates for the prevalence of VLS (viral load <1000 copies/mL), nonsuppressed viral load (NVL; viral load ≥1000 copies/mL), virologic failure (VF; ARVs present and viral load ≥1000 copies/mL), interrupted ART (ARVs absent and viral load ≥1000 copies/mL) and rates of switching to second-line ART (protease inhibitors present) among PLHIV aged 15 to 59 years who participated in the PHIA surveys in Eswatini, Lesotho, Malawi, Zambia and Zimbabwe, initiated ART at least four months before the survey and were receiving ART at the time of the survey (according to self-report or ARV testing). We calculated odds ratios and incidence rate ratios for factors associated with NVL, VF, interrupted ART, and switching to second-line ART.

Results: We included 9200 adults receiving ART of whom 88.8% had VLS and 11.2% had NVL including 8.2% who experienced VF and 3.0% who interrupted ART. Younger age, male sex, less education, suboptimal adherence, receiving nevirapine, HIV non-disclosure, never having married and residing in Zimbabwe, Lesotho or Zambia were associated with higher odds of NVL. Among people with NVL, marriage, female sex, shorter ART duration, higher CD4 count and alcohol use were associated with lower odds for VF and higher odds for interrupted ART. Many people with VF (44.8%) had CD4 counts <200 cells/µL, but few (0.31% per year) switched to second-line ART.

Conclusions: Countries are approaching global VLS targets for adults. Treatment support, in particular for younger adults, and people with higher CD4 counts, and switching of people to protease inhibitor- or integrase inhibitor-based regimens may further reduce NVL prevalence.
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http://dx.doi.org/10.1002/jia2.25631DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7680921PMC
November 2020

Insights into community of photosynthetic microorganisms from permafrost.

FEMS Microbiol Ecol 2020 11;96(12)

Soil Cryology Laboratory, Institute of Physicochemical and Biological Problems in Soil Science, Institutskaya Street, Bldg. 2, Pushchino, Russia.

This work integrates cultivation studies of Siberian permafrost and analyses of metagenomes from different locations in the Arctic with the aim of obtaining insights into the community of photosynthetic microorganisms in perennially frozen deposits. Cyanobacteria and microalgae have been described in Arctic aquatic and surface soil environments, but their diversity and ability to withstand harsh conditions within the permafrost are still largely unknown. Community structure of photosynthetic organisms in permafrost sediments was explored using Arctic metagenomes available through the MG-RAST. Sequences affiliated with cyanobacteria represented from 0.25 to 3.03% of total sequences, followed by sequences affiliated with Streptophyta (algae and vascular plants) 0.01-0.45% and Chlorophyta (green algae) 0.01-0.1%. Enrichment and cultivation approaches revealed that cyanobacteria and green algae survive in permafrost and they could be revived during prolonged incubation at low light intensity. Among photosynthetic microorganisms isolated from permafrost, the filamentous Oscillatoria-like cyanobacteria and unicellular green algae of the genus Chlorella were dominant. Our findings suggest that permafrost cyanobacteria and green algae are expected to be effective members of the re-assembled community after permafrost thawing and soil collapse.
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http://dx.doi.org/10.1093/femsec/fiaa229DOI Listing
November 2020

Lead Particle Size Fractionation and Identification in Newark, New Jersey's Drinking Water.

Environ Sci Technol 2020 11 22;54(21):13672-13679. Epub 2020 Oct 22.

Office of Research and Development, Center for Environmental Solutions & Emergency Response, Water Infrastructure Division, U.S. Environmental Protect Agency, 26W. Martin Luther King Dr., Cincinnati, Ohio 45268, United States.

Following a pH reduction in their drinking water over a span of more than 20 years, the City of Newark, New Jersey, has struggled with elevated lead (Pb) release from Pb service lines and domestic plumbing in the zone fed by the Pequannock Water Treatment Plant. In response, Newark initiated orthophosphate addition and provided faucet-mounted point-of-use (POU) filters and pitcher filters certified for Pb and particulate reduction under NSF/ANSI Standards 53 and 42 to residential homes in that zone. Water chemistry analysis and size fractionation sampling were performed at four of these houses. Analysis of the particulate material retained by the fractionation filters revealed that Pb was dominantly present in the water as fine Pb(II) orthophosphate particles. A considerable amount of the particulates occurred as a nanoscale fraction that sometimes passed through the POU faucet or pitcher filtration units. Scanning electron microscopy, transmission electron microscopy, and energy-dispersive spectroscopy analyses showed that the nanoparticles (<100 nm) and their aggregates were composed of Pb, phosphorus, and chlorine, which are consistent with pyromorphite, Pb(PO)Cl. Electron diffraction and X-ray analyses supported the presence of hydroxypyromorphite and chloropyromorphite nanoparticles and the size range estimates from the imaging. This research confirmed that nonadherent Pb(II)-orthophosphate nanoparticles were an important form of Pb in drinking water in the Pequannock water quality zone of Newark.
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http://dx.doi.org/10.1021/acs.est.0c03797DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7702024PMC
November 2020

Observational study to define reference ranges for the 3% oxygen desaturation index during sleep in healthy children under 12 years using oximetry motion-resistant technology.

Arch Dis Child 2021 06 20;106(6):583-586. Epub 2020 Oct 20.

Department of Respiratory Paediatrics, Southampton Children's Hospital, Southampton, UK

Objective: To define reference ranges for the 3% oxygen desaturation index (DI3) in healthy children under 12 years old during sleep.

Design: Observational.

Setting: Home.

Subjects: Healthy children aged 6 months to 12 years of age.

Intervention: Nocturnal pulse oximetry at home. Parents documented sleep times. Visi-Download software (Stowood Scientific) analysed data with artefact and wake periods removed.

Main Outcome Measures: The following oximetry parameters used in the assessment of sleep-disordered breathing conditions were measured: 3% (DI3) and 4% (DI4) oxygen desaturation indices-the number of times per hour where the oxygen saturation falls by at least 3% or 4% from baseline, mean saturations (SAT50), minimum saturations (SATmin), delta index 12 s (DI12s), and percentage time with saturations below 92% and 90%.

Results: Seventy-nine children underwent nocturnal home pulse oximetry, from which there were 66 studies suitable for analysis. The median values for DI3 and DI4 were 2.58 (95% CI 1.96 to 3.10) and 0.92 (95% CI 0.73 to 1.15), respectively. The 95th and 97.5th centiles for DI3 were 6.43 and 7.06, respectively, which inform our cut-off value for normality. The mean values for SAT50 and SATmin were 97.57% (95% CI 97.38% to 97.76%) and 91.09% (95% CI 90.32% to 91.86%), respectively.

Conclusion: In children aged 6 months to 12 years, we define normality of the 3% oxygen desaturation index as <7 using standalone, motion-resistant pulse oximeters with short averaging times.
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http://dx.doi.org/10.1136/archdischild-2020-320066DOI Listing
June 2021

Comparative host-coronavirus protein interaction networks reveal pan-viral disease mechanisms.

Science 2020 12 15;370(6521). Epub 2020 Oct 15.

Quantitative Biosciences Institute (QBI) COVID-19 Research Group (QCRG), San Francisco, CA 94158, USA.

The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a grave threat to public health and the global economy. SARS-CoV-2 is closely related to the more lethal but less transmissible coronaviruses SARS-CoV-1 and Middle East respiratory syndrome coronavirus (MERS-CoV). Here, we have carried out comparative viral-human protein-protein interaction and viral protein localization analyses for all three viruses. Subsequent functional genetic screening identified host factors that functionally impinge on coronavirus proliferation, including Tom70, a mitochondrial chaperone protein that interacts with both SARS-CoV-1 and SARS-CoV-2 ORF9b, an interaction we structurally characterized using cryo-electron microscopy. Combining genetically validated host factors with both COVID-19 patient genetic data and medical billing records identified molecular mechanisms and potential drug treatments that merit further molecular and clinical study.
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http://dx.doi.org/10.1126/science.abe9403DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808408PMC
December 2020

Lessons from a system-wide response to a measles outbreak, Canterbury, February-April 2019.

N Z Med J 2020 09 25;133(1522):71-83. Epub 2020 Sep 25.

Health Protection Officer, Community and Public Health, Canterbury District Health Board, Christchurch.

Despite New Zealand's "measles elimination" status, the risk of measles outbreaks persists, due to ongoing measles importation and sub-optimal vaccination coverage, including specific sub-populations with higher proportions of susceptible people. From February to April 2019, Canterbury experienced a measles outbreak with 38 local cases and an unidentified index case. The outbreak strain was linked to a large outbreak in the Philippines. The whole-of-health-system response included active case and contact follow-up by public health and hospital staff, and a prioritised vaccination campaign in primary care. Important features of a measles outbreak response in an "elimination" context include cross-system liaison, co-ordination of communications, careful prioritisation of use of available resources, and support for households affected by isolation and/or quarantine requests. Closer analysis of the effectiveness of outbreak control measures would help prioritise use of scarce public health and health care resources during outbreaks. Future measles outbreaks could be prevented by a systematic primary care-based MMR catch-up campaign.
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September 2020

Synthesis and characterization of stable lead (II) orthophosphate nanoparticle suspensions.

J Environ Sci Health A Tox Hazard Subst Environ Eng 2020 22;55(13):1504-1512. Epub 2020 Sep 22.

Office of Research and Development, Drinking Water Management Branch, Center for Environmental Solutions & Emergency Response, Water Infrastructure Division, U.S. Environmental Protection Agency, Cincinnati, Ohio, USA.

There is great interest in producing nanoparticles for various applications. The objective of this work was to develop a procedure for reproducibly creating stable lead (Pb) phosphate nanoparticle aqueous suspensions. A stable 5 mg/L Pb-phosphate nanoparticle "stock" suspension was synthesized via chemical precipitation of Pb and orthophosphate in water at pH 7.5 with 4.4 mg soluble PO/L and 7 mg C/L dissolved inorganic carbon. The stock suspension was subsequently diluted to produce stable 0.10 mg/L Pb "challenge" water suspensions without compromising the nanoparticle size, structure, mineralogy and solubility. Specifically, the hexagonal hydroxypyromorphite nanoparticles had an average diameter of 38 nm based on transmission electron microscopy analysis and an associated Pb solubility of 0.001 mg/L. The properties of the stock suspensions were not impacted by further dilutions, and the challenge water suspensions remained stable for 24 hours. In the context of drinking water, a protocol to produce such a stable Pb nanoparticle challenge water suspension would be very useful in evaluating Pb bioavailability, identifying Pb remediation strategies, and testing filter effectiveness to remove Pb from water.
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http://dx.doi.org/10.1080/10934529.2020.1810498DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8064302PMC
January 2021

Overcoming Barriers to HIV Care: Findings from a Peer-Delivered, Community-Based, Linkage Case Management Program (CommLink), Eswatini, 2015-2018.

AIDS Behav 2021 May;25(5):1518-1531

U.S. Centers for Disease Control and Prevention, Mbabane, Eswatini.

To help persons living with HIV (PLHIV) in Eswatini initiate antiretroviral therapy (ART), the CommLink case-management program provided a comprehensive package of linkage services delivered by HIV-positive, peer counselors. Of 1250 PLHIV participants aged ≥ 15 years diagnosed in community settings, 75% reported one or more barriers to care (e.g., fearing stigmatization). Peer counselors helped resolve 1405 (65%) of 2166 identified barriers. During Test and Treat (October 2016-September 2018), the percentage of participants who initiated ART and returned for ≥ 1 antiretroviral refills was 92% overall (759/824); 99% (155/156) among participants without any identified barriers; 96% (544/564) among participants whose counselors helped resolve all or all but one barrier; and 58% (59/102) among participants who had ≥ 2 unresolved barriers to care. The success of CommLink is attributed, at least in part, to peer counselors who helped their clients avoid or at least temporarily resolve many well-known barriers to HIV care.
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http://dx.doi.org/10.1007/s10461-020-02991-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7876149PMC
May 2021

Hearing conservation measures of effectiveness across the Department of Defense.

MSMR 2020 Jul;27(7):2-6

This article summarizes the findings from the first report of the new, standard Measures of Effectiveness developed by the Department of Defense (DoD) Hearing Conservation Program Working Group in 2018. When examining periodic hearing test results of DoD personnel, the overall risk of potential hearing injury/illness was stable from 2012 through 2018. The National Guard and Reserve components showed a higher potential risk of hearing loss, possibly related to lower compliance on follow-up tests when a shift in hearing occurred. Finally, the overall percentage of DoD personnel (who received periodic hearing tests) with hearing impairment decreased over the years presented.
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July 2020

Prevalence and correlates of active syphilis and HIV co-Infection among sexually active persons aged 15-59 years in Zambia: Results from the Zambia Population-based HIV Impact Assessment (ZAMPHIA) 2016.

PLoS One 2020 24;15(7):e0236501. Epub 2020 Jul 24.

Ministry of Health Zambia, Ndeke House, Lusaka, Zambia.

Objectives: The main objectives of the study are to estimate HIV prevalence, active syphilis prevalence, and correlates of co-infection with HIV in Zambia, among recently sexually active individuals aged 15 to 59 years old.

Methods: We used data from the 2016 Zambia Population-based HIV Impact Assessment (ZAMPHIA), a national household survey that included biomarker testing for HIV and syphilis. Chembio DPP® Syphilis Screen and Confirm Assay was used to distinguish between active and older syphilis infections. This is the first time Chembio DPP® has been used in a national survey. Log-binominal modelling was utilized to understand the risk of acquiring HIV/active syphilis co-infection using select socio-demographic and sexual behavior variables. Multivariable analysis compared those with co-infection and those with no infection. All reported results account for the complex survey design and are weighted.

Results: A total of 19,114 individuals aged 15-59 years responded to the individual interview and had a valid syphilis and/or HIV test. The prevalence for those sexually active in the 12 months preceding ZAMPHIA 2016 was 3.5% and 13% for active syphilis and HIV, respectively. The prevalence of HIV/active syphilis co-infection was 1.5%. Factors associated with higher prevalence of co-infection versus no infection among females included, but were not limited to, those living in urban areas (adjusted prevalence ratio (aPR) = 3.0, 95% CI = 1.8, 4.8), those had sexual intercourse before age 15 years (aPR = 1.8, 95% CI = 1.1, 2.9), and those who had two or more sexual partners in the 12 months preceding the survey (aPR = 2.7, 95% CI = 1.6, 4.7).

Conclusion: These findings show high prevalence for both mono-infection with HIV and syphilis, as well as co-infection with HIV/active syphilis in Zambia. There is a need for better screening and partner services, particularly among those engaging in high-risk sexual behaviors (e.g., engaging in transactional sex).
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0236501PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7380641PMC
September 2020
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