1
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Turrini G, Chan SS, Klein PW, Cohen SM, Stearns SC, Dempsey A, Hauck H, Cheever LW, Chappel AR. Assessing Health Care Utilization and Spending Among Older Medicare Beneficiaries With and Without HIV. Med Care Res Rev 2024; 81:280-289. [PMID: 37767861 DOI: 10.1177/10775587231198903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2023]
Abstract
Improvements in treatment have made HIV a manageable chronic condition, leading to increased life expectancy and a growing share of people with HIV who are older. Older people with HIV have higher rates of many chronic conditions, yet little is known about differences in health care utilization and spending. This study compared health care utilization and spending for Medicare beneficiaries with and without HIV, accounting for differential mortality. The data included demographic characteristics and claims-based information. Estimated cumulative spending for beneficiaries with HIV aged 67 to 77 years was 26% higher for Medicare Part A and 39% higher for Medicare Part B compared with beneficiaries without HIV; most of these differences would be larger if not for greater mortality risk among people with HIV (and therefore fewer years to receive care). Future research should disentangle underlying causes for this increased need and describe potential responses by policymakers and health care providers.
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Affiliation(s)
- Gina Turrini
- U.S. Department of Health and Human Services, Washington, DC, USA
| | - Stephanie S Chan
- U.S. Department of Health and Human Services, Washington, DC, USA
| | - Pamela W Klein
- U.S. Department of Health and Human Services, Rockville, MD, USA
| | - Stacy M Cohen
- U.S. Department of Health and Human Services, Rockville, MD, USA
| | | | - Antigone Dempsey
- U.S. Department of Health and Human Services, Rockville, MD, USA
| | - Heather Hauck
- U.S. Department of Health and Human Services, Rockville, MD, USA
| | - Laura W Cheever
- U.S. Department of Health and Human Services, Rockville, MD, USA
| | - Andre R Chappel
- U.S. Department of Health and Human Services, Washington, DC, USA
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2
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Keuroghlian AS, Marc L, Goldhammer H, Massaquoi M, Downes A, Stango J, Bryant H, Cahill S, Yen J, Perez AC, Head JM, Mayer KH, Myers J, Rebchook GM, Bourdeau B, Psihopaidas D, Chavis NS, Cohen SM. Correction: A Peer-to-Peer Collaborative Learning Approach for the Implementation of Evidence-Informed Interventions to Improve HIV-Related Health Outcomes. AIDS Behav 2024:10.1007/s10461-024-04296-0. [PMID: 38436808 DOI: 10.1007/s10461-024-04296-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Affiliation(s)
- Alex S Keuroghlian
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA.
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Linda Marc
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Department of Biostatistics, The Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Hilary Goldhammer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Massah Massaquoi
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | | | | | | | - Sean Cahill
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Department of Health Sciences, Bouvé College of Health, Northeastern University, Boston, MA, USA
- Kansas City Free Health Clinic, Kansas City, MO, USA
| | - Jessica Yen
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Antonia C Perez
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Jennifer M Head
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Synergy Scientifics LLC, Port Orford, OR, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Janet Myers
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Gregory M Rebchook
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Beth Bourdeau
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Demetrios Psihopaidas
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, MD, USA
| | - Nicole S Chavis
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, MD, USA
| | - Stacy M Cohen
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, MD, USA
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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3
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Keuroghlian AS, Marc L, Goldhammer H, Massaquoi M, Downes A, Stango J, Bryant H, Cahill S, Yen J, Perez AC, Head JM, Mayer KH, Myers J, Rebchook GM, Bourdeau B, Psihopaidas D, Chavis NS, Cohen SM. A Peer-to-Peer Collaborative Learning Approach for the Implementation of Evidence-Informed Interventions to Improve HIV-Related Health Outcomes. AIDS Behav 2024:10.1007/s10461-023-04260-4. [PMID: 38340221 DOI: 10.1007/s10461-023-04260-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2023] [Indexed: 02/12/2024]
Abstract
The nationwide scale-up of evidence-based and evidence-informed interventions has been widely recognized as a crucial step in ending the HIV epidemic. Although the successful delivery of interventions may involve intensive expert training, technical assistance (TA), and dedicated funding, most organizations attempt to replicate interventions without access to focused expert guidance. Thus, there is a grave need for initiatives that meaningfully address HIV health disparities while addressing these inherent limitations. Here, the Health Resources and Services Administration HIV/AIDS Bureau (HRSA HAB) initiative Using Evidence-Informed Interventions to Improve HIV Health Outcomes among People Living with HIV (E2i) piloted an alternative approach to implementation that de-emphasized expert training to naturalistically simulate the experience of future HIV service organizations with limited access to TA. The E2i approach combined the HAB-adapted Institute for Healthcare Improvement's Breakthrough Series Collaborative Learning Model with HRSA HAB's Implementation Science Framework, to create an innovative multi-tiered system of peer-to-peer learning that was piloted across 11 evidence-informed interventions at 25 Ryan White HIV/AIDS Program sites. Four key types of peer-to-peer learning exchanges (i.e., intervention, site, staff role, and organization specific) took place at biannual peer learning sessions, while quarterly intervention cohort calls and E2i monthly calls with site staff occurred during the action periods between learning sessions. Peer-to-peer learning fostered both experiential learning and community building and allowed site staff to formulate robust site-specific action plans for rapid cycle testing between learning sessions. Strategies that increase the effectiveness of interventions while decreasing TA could provide a blueprint for the rapid uptake and integration of HIV interventions nationwide.
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Affiliation(s)
- Alex S Keuroghlian
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA.
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
| | - Linda Marc
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Department of Biostatistics, The Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Hilary Goldhammer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Massah Massaquoi
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | | | | | | | - Sean Cahill
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, USA
- Kansas City Free Health Clinic, Kansas City, MO, USA
| | - Jessica Yen
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Antonia C Perez
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
| | - Jennifer M Head
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Synergy Scientifics LLC, Port Orford, OR, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Janet Myers
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Gregory M Rebchook
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Beth Bourdeau
- Division of Prevention Science, University of California, San Francisco, San Francisco, CA, USA
| | - Demetrios Psihopaidas
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, MD, USA
| | - Nicole S Chavis
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, MD, USA
| | - Stacy M Cohen
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, MD, USA
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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4
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Yagel S, Cohen SM, Beharier O, Goldman-Wohl D. Cooperation over conflict at the maternal-fetal interface. Ultrasound Obstet Gynecol 2023; 62:911-912. [PMID: 38041630 DOI: 10.1002/uog.27525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 09/26/2023] [Indexed: 12/03/2023]
Abstract
Linked article: This Correspondence comments on Espinoza. Click here to view the article.
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Affiliation(s)
- S Yagel
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S M Cohen
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - O Beharier
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - D Goldman-Wohl
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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5
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Au M, Coombs E, Jones A, Carley F, Talwar-Hebert M, Addison W, Mills RJ, Cohen SM, Klein PW, Cheever L, Gilman B. Coordinating Care for People With HIV Who Have Lower Incomes and Alternative Sources of Health Care Coverage. J Assoc Nurses AIDS Care 2023; 34:280-291. [PMID: 37098817 DOI: 10.1097/jnc.0000000000000408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
ABSTRACT As people with HIV increasingly access affordable health care coverage-enabling them to obtain medical care from private providers-understanding how they use the Ryan White HIV/AIDS Program (RWHAP), and their unmet health care needs, can enhance their overall care. We analyzed RWHAP client-level data and interviewed staff and clients at 29 provider organizations to identify trends in health care coverage and service use for clients who received medical care from private providers. The RWHAP helps cover the cost of premiums and copays for these clients and provides medical and support services that help them stay engaged in care and virally suppressed. The RWHAP plays an important role in HIV care and treatment for clients with health care coverage. The growing number of people who receive a combination of services from RWHAP providers and private providers offers opportunities for greater care coordination through communication and data sharing between these settings.
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Affiliation(s)
- Melanie Au
- Melanie Au, MPP, is Health Researcher, Mathematica, Princeton, New Jersey, USA. Ellie Coombs, MPP, is Managing Associate, Mission Analytics, Inc., San Francisco, California, USA. Andrew Jones, MA, is Research and Informatics Specialist, Mission Analytics, Inc., San Francisco, California, USA. Francis Carley, MPP, is Deputy Director of Strategic Initiatives, Oakland Community Health Network, Troy, Michigan, USA. Maya Talwar-Hebert was Health Associate, Mathematica, Princeton, New Jersey, USA. West Addison is Chief of Statistical Programming, Mission Analytics, Inc., San Francisco, California, USA. Robert Mills, PhD, is Senior Health Statistician, Division of Policy and Data, HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, USA. Stacy Cohen, MPH, is Chief, Evaluation, Analysis, Dissemination Branch, HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, USA. Pamela Klein, PhD, is Senior Health Scientist, HIV/AIDS Bureau, Division of Policy and Data, Health Resources and Services Administration, Rockville, Maryland, USA. Laura Cheever, MD, ScM, is Associate Administrator, HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, USA. Boyd Gilman, PhD, is Principal Researcher, Mathematica, Princeton, New Jersey, USA
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6
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Yagel S, Cohen SM, Goldman-Wohl D, Beharier O. Redefining pre-eclampsia as Type I or II: implementing an integrated model of the maternal-cardiovascular-placental-fetal array. Ultrasound Obstet Gynecol 2023; 61:293-301. [PMID: 36378064 DOI: 10.1002/uog.26121] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 10/04/2022] [Accepted: 10/21/2022] [Indexed: 06/16/2023]
Affiliation(s)
- S Yagel
- Division of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S M Cohen
- Division of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - D Goldman-Wohl
- Division of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - O Beharier
- Division of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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7
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Goldhammer H, Marc LG, Psihopaidas D, Chavis NS, Massaquoi M, Cahill S, Rebchook G, Reisner S, Mayer KA, Cohen SM, Keuroghlian AS. HIV Care Continuum Interventions for Transgender Women: A Topical Review. Public Health Rep 2023; 138:19-30. [PMID: 35060802 PMCID: PMC9730173 DOI: 10.1177/00333549211065517] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Transgender women experience a disproportionate prevalence of HIV and barriers to linkage to care, retention in care, medication adherence, and viral suppression. As part of a national cooperative agreement funded by the Health Resources and Services Administration's HIV/AIDS Bureau, we searched the literature from January 1, 2010, through June 1, 2020, for English-language articles on interventions designed to improve at least 1 HIV care continuum outcome or address 1 barrier to achieving HIV care continuum outcomes among transgender women diagnosed with HIV in the United States. To be included, articles needed to identify transgender women as a priority population for the intervention. We found 22 interventions, of which 15 reported quantitative or qualitative outcomes and 7 reported study protocols. Recent interventions have incorporated a range of strategies that show promise for addressing pervasive structural and individual barriers rooted in societal and cultural stigma and discrimination against transgender people. Cross-cutting themes found among the interventions included meaningful community participation in the design and implementation of the interventions; culturally affirming programs that serve as a gateway to HIV care and combine gender-affirming care and social services with HIV care; interventions to improve behavioral health outcomes; peer-led counseling, education, and navigation; and technology-based interventions to increase access to care management and online social support. Ongoing studies will further elucidate the efficacy and effectiveness of these interventions, with the goal of reducing disparities in the HIV care continuum and bringing us closer to ending the HIV epidemic among transgender women in the United States.
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Affiliation(s)
| | - Linda G. Marc
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Nicole S. Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | | | - Sean Cahill
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
- Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
| | - Greg Rebchook
- Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Sari Reisner
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kenneth A. Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stacy M. Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | - Alex S. Keuroghlian
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
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8
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Goldhammer H, Marc LG, Chavis NS, Psihopaidas D, Massaquoi M, Cahill S, Bryant H, Bourdeau B, Mayer KH, Cohen SM, Keuroghlian AS. Interventions for Integrating Behavioral Health Services into HIV Clinical Care: A Narrative Review. Open Forum Infect Dis 2022; 9:ofac365. [PMID: 35967264 PMCID: PMC9364372 DOI: 10.1093/ofid/ofac365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
The integration of behavioral health services within human immunodeficiency virus (HIV) care settings holds promise for improving substance use, mental health, and HIV-related health outcomes for people with HIV. As part of an initiative funded by the Health Resources and Services Administration’s HIV/AIDS Bureau, we conducted a narrative review of interventions focused on behavioral health integration (BHI) in HIV care in the United States (US). Our literature search yielded 19 intervention studies published between 2010 and 2021. We categorized the interventions under 6 approaches: collaborative care; screening, brief intervention, and referral to treatment (SBIRT); patient-reported outcomes (PROs); onsite psychological consultation; integration of addiction specialists; and integration of buprenorphine/naloxone (BUP/NX) treatment. All intervention approaches appeared feasible to implement in diverse HIV care settings and most showed improvements in behavioral health outcomes; however, measurement of HIV outcomes was limited. Future research studies of BHI interventions should evaluate HIV outcomes and assess facilitators and barriers to intervention uptake.
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Affiliation(s)
| | - Linda G Marc
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Harvard T.H. Chan School of Public Health , Boston, MA , USA
| | - Nicole S Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration , Rockville, MD , USA
| | | | | | - Sean Cahill
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Boston University School of Public Health , Boston, MA , USA
- Bouve College of Health Sciences, Northeastern University , Boston, MA , USA
| | | | - Beth Bourdeau
- Center for AIDS Prevention Studies, Division of Prevention Science, University of California San Francisco , San Francisco, CA , USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Harvard T.H. Chan School of Public Health , Boston, MA , USA
- Beth Israel Deaconess Medical Center, Harvard Medical School , Boston, MA , USA
| | - Stacy M Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration , Rockville, MD , USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health , Boston, MA , USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School , Boston, MA , USA
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9
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Goldhammer H, Marc LG, Chavis NS, Psihopaidas D, Massaquoi M, Cahill S, Nortrup E, Dawson Rose C, Meyers J, Mayer KH, Cohen SM, Keuroghlian AS. Interventions for addressing trauma among people with HIV: a narrative review. AIDS Care 2021; 34:505-514. [PMID: 34612097 DOI: 10.1080/09540121.2021.1984382] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Traumatic experiences are disproportionately prevalent among people with HIV and adversely affect HIV-related health outcomes. As part of a national cooperative agreement funded by the Health Resources and Services Administration's HIV/AIDS Bureau, we searched the literature for interventions designed to address trauma among people with HIV in the U.S. Our search yielded 22 articles on 14 studies that fell into five intervention categories: expressive writing, prolonged exposure therapy, coping skills, cognitive-behavioral approaches integrated with other methods, and trauma-informed care. Thematic elements among the interventions included adaptating existing interventions for subpopulations with a high burden of trauma and HIV, such as transgender women and racial/ethnic minorities; addressing comorbid substance use disorders; and implementing organization-wide trauma-informed care approaches. Few studies measured the effect of the interventions on HIV-related health outcomes. To address the intersecting epidemics of HIV and trauma, it is critical to continue developing, piloting, and evaluating trauma interventions for people with HIV, with the goal of wide-scale replication of effective interventions in HIV settings.
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Affiliation(s)
| | - Linda G Marc
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Nicole S Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | | | | | - Sean Cahill
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Boston University School of Public Health, Boston, MA, USA.,Bouve College of Health Sciences, Northeastern University, Boston, MA, USA
| | | | - Carol Dawson Rose
- Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Janet Meyers
- Center for AIDS Prevention Studies, University of California, San Francisco, CA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Stacy M Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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10
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Marc LG, Goldhammer H, Mayer KH, Cahill S, Massaquoi M, Nortrup E, Cohen SM, Psihopaidas DA, Carney JT, Keuroghlian AS. Rapid Implementation of Evidence-Informed Interventions to Improve HIV Health Outcomes Among Priority Populations : The E2i Initiative. Public Health Rep 2021; 137:617-624. [PMID: 34185594 DOI: 10.1177/00333549211027849] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Linda G Marc
- 446213 The Fenway Institute, Fenway Health, Boston, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | - Kenneth H Mayer
- 446213 The Fenway Institute, Fenway Health, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,314506 HIV Prevention Research, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Sean Cahill
- 446213 The Fenway Institute, Fenway Health, Boston, MA, USA.,17225 Bouve College of Health Sciences, Northeastern University, Boston, MA, USA.,Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | | | | | - Stacy M Cohen
- Evaluation, Analysis, and Dissemination Branch, Division of Policy and Data, HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | - Demetrios A Psihopaidas
- Evaluation, Analysis, and Dissemination Branch, Division of Policy and Data, HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | - Jhetari T Carney
- Evaluation, Analysis, and Dissemination Branch, Division of Policy and Data, HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, MD, USA
| | - Alex S Keuroghlian
- 446213 The Fenway Institute, Fenway Health, Boston, MA, USA.,Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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11
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Charach R, Cohen SM, Yagel S, Valsky DV. It takes two great vessels to tango: fetal nutcracker phenomenon. Ultrasound Obstet Gynecol 2021; 57:1017-1019. [PMID: 33524214 DOI: 10.1002/uog.23602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 01/22/2021] [Indexed: 06/12/2023]
Affiliation(s)
- R Charach
- Fetal Medicine & Ultrasound Unit, Division of Obstetrics and Gynecology, Mt. Scopus campus, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - S M Cohen
- Division of Obstetrics and Gynecology, Mt. Scopus campus, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - S Yagel
- Division of Obstetrics and Gynecology, Mt. Scopus campus, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - D V Valsky
- Fetal Medicine & Ultrasound Unit, Division of Obstetrics and Gynecology, Mt. Scopus campus, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
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12
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Chavis NS, Klein PW, Cohen SM, Dempsey A, Hauck H, Cheever LW. The Health Resources and Services Administration (HRSA) Ryan White HIV/AIDS Program's Response to the Opioid Epidemic. J Infect Dis 2021; 222:S477-S485. [PMID: 32877537 DOI: 10.1093/infdis/jiaa230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The United States is in the midst of an unprecedented opioid crisis with increasing injection drug use (IDU)-related human immunodeficiency virus (HIV) outbreaks, particularly in rural areas. The Health Resources and Services Administration (HRSA)'s Ryan White HIV/AIDS Program (RWHAP) is well positioned to integrate treatment for IDU-associated HIV infections with treatment for drug use disorders. These activities will be crucial for the "Ending the HIV Epidemic: A Plan for America" (EHE) initiative, in which 7 southern states were identified with rural HIV epidemics. METHODS The RWHAP Services Report data were used to assess the IDU population and substance use services utilization among RWHAP clients in 2017, nationally and in the 7 EHE-identified states. THe HRSA held a 1-day Technical Expert Panel (TEP) to explore how RWHAP can best respond to the growing opioid crisis. RESULTS During the TEP, 8 key themes emerged and 11 best practices were identified to address opioid use disorder (OUD) among people with HIV. In 2017, among RWHAP clients with reported age and transmission category, 6.7% (31 683) had HIV attributed to IDU; among IDU clients, 6.3% (1988) accessed substance use services. CONCLUSIONS The TEP results and RWHAP data were used to develop implementation science projects that focus on addressing OUD and integrating behavioral health in primary care. These activities are critical to ending the HIV epidemic.
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Affiliation(s)
- Nicole S Chavis
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, USA
| | - Pamela W Klein
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, USA
| | - Stacy M Cohen
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, USA
| | - Antigone Dempsey
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Division of Policy and Data, Rockville, Maryland, USA
| | - Heather Hauck
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Office of the Associate Administrator, Rockville, Maryland, USA
| | - Laura W Cheever
- US Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Office of the Associate Administrator, Rockville, Maryland, USA
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Guedalia J, Sompolinsky Y, Novoselsky Persky M, Cohen SM, Kabiri D, Yagel S, Unger R, Lipschuetz M. Prediction of severe adverse neonatal outcomes at the second stage of labour using machine learning: a retrospective cohort study. BJOG 2021; 128:1824-1832. [PMID: 33713380 DOI: 10.1111/1471-0528.16700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 02/19/2021] [Accepted: 03/03/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To create a personalised machine learning model for prediction of severe adverse neonatal outcomes (SANO) during the second stage of labour. DESIGN Retrospective Electronic-Medical-Record (EMR) -based study. POPULATION A cohort of 73 868 singleton, term deliveries that reached the second stage of labour, including 1346 (1.8%) deliveries with SANO. METHODS A gradient boosting model was created, analysing 21 million data points from antepartum features (e.g. gravidity and parity) gathered at admission to the delivery unit, and intrapartum data (e.g. cervical dilatation and effacement) gathered during the first stage of labour. Deliveries were allocated to high-risk and low-risk groups based on the Youden index to maximise sensitivity and specificity. MAIN OUTCOME MEASURES SANO was defined as either umbilical cord pH levels ≤7.1 or 1-minute or 5-minute Apgar score ≤7. RESULTS The model for prediction of SANO yielded an area under the receiver operating curve (AUC) of 0.761 (95% CI 0.748-0.774). A third of the cohort (33.5%, n = 24 721) were allocated to a high-risk group for SANO, which captured up to 72.1% of these cases (odds ratio 5.3, 95% CI 4.7-6.0; high-risk versus low-risk groups). CONCLUSIONS Data acquired throughout the first stage of labour can be used to predict SANO during the second stage of labour using a machine learning model. Stratifying parturients at the beginning of the second stage of labour in a 'time out' session, can direct a personalised approach to management of this challenging aspect of labour, as well as improve allocation of staff and resources. TWEETABLE ABSTRACT Personalised prediction score for severe adverse neonatal outcomes in labour using machine learning model.
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Affiliation(s)
- J Guedalia
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - Y Sompolinsky
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - M Novoselsky Persky
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S M Cohen
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - D Kabiri
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - S Yagel
- Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - R Unger
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel
| | - M Lipschuetz
- The Mina and Everard Goodman Faculty of Life Sciences, Bar-Ilan University, Ramat-Gan, Israel.,Department of Obstetrics and Gynecology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Goyal R, Luca D, Klein PW, Morris E, Mandsager P, Cohen SM, Hu C, Hotchkiss J, Gao J, Jones A, Addison W, O'Brien-Strain M, Cheever LW, Gilman B. Cost-Effectiveness of HRSA's Ryan White HIV/AIDS Program? J Acquir Immune Defic Syndr 2021; 86:174-181. [PMID: 33093330 DOI: 10.1097/qai.0000000000002547] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND With an annual budget of more than $2 billion, the Health Resources and Services Administration's Ryan White HIV/AIDS Program (RWHAP) is the third largest source of public funding for HIV care and treatment in the United States, yet little analysis has been done to quantify the long-term public health and economic impacts of the federal program. METHODS Using an agent-based, stochastic model, we estimated health care costs and outcomes over a 50-year period in the presence of the RWHAP relative to those expected to prevail if the comprehensive and integrated system of medical and support services funded by the RWHAP were not available. We made a conservative assumption that, in the absence of the RWHAP, only uninsured clients would lose access to these medical and support services. RESULTS The model predicts that the proportion of people with HIV who are virally suppressed would be 25.2 percentage points higher in the presence of the RWHAP (82.6 percent versus 57.4 percent without the RWHAP). The number of new HIV infections would be 18 percent (190,197) lower, the number of deaths among people with HIV would be 31 percent (267,886) lower, the number of quality-adjusted life years would be 2.7 percent (5.6 million) higher, and the cumulative health care costs would be 25 percent ($165 billion) higher in the presence of the RWHAP relative to the counterfactual. Based on these results, the RWHAP has an incremental cost-effectiveness ratio of $29,573 per quality-adjusted life year gained compared with the non-RWHAP scenario. Sensitivity analysis indicates that the probability of transmitting HIV via male-to-male sexual contact and the cost of antiretroviral medications have the largest effect on the cost-effectiveness of the program. CONCLUSIONS The RWHAP would be considered very cost-effective when using standard guidelines of less than the per capita gross domestic product of the United States. The results suggest that the RWHAP plays a critical and cost-effective role in the United States' public health response to the HIV epidemic.
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Affiliation(s)
| | | | - Pamela W Klein
- HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services; and
| | | | - Paul Mandsager
- HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services; and
| | - Stacy M Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services; and
| | | | | | | | | | | | | | - Laura W Cheever
- HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services; and
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Goyal R, Hu C, Klein PW, Hotchkiss J, Morris E, Mandsager P, Cohen SM, Luca D, Gao J, Jones A, Addison W, O'Brien-Strain M, Cheever LW, Gilman B. Development of a Mathematical Model to Estimate the Cost-Effectiveness of HRSA's Ryan White HIV/AIDS Program. J Acquir Immune Defic Syndr 2021; 86:164-173. [PMID: 33109934 DOI: 10.1097/qai.0000000000002546] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND The Health Resources and Services Administration's Ryan White HIV/AIDS Program provides services to more than half of all people diagnosed with HIV in the United States. We present and validate a mathematical model that can be used to estimate the long-term public health and cost impact of the federal program. METHODS We developed a stochastic, agent-based model that reflects the current HIV epidemic in the United States. The model simulates everyone's progression along the HIV care continuum, using 2 network-based mechanisms for HIV transmission: injection drug use and sexual contact. To test the validity of the model, we calculated HIV incidence, mortality, life expectancy, and lifetime care costs and compared the results with external benchmarks. RESULTS The estimated HIV incidence rate for men who have sex with men (502 per 100,000 person years), mortality rate of all people diagnosed with HIV (1663 per 100,000 person years), average life expectancy for individuals with low CD4 counts not on antiretroviral therapy (1.52-3.78 years), and lifetime costs ($362,385) all met our validity criterion of within 15% of external benchmarks. CONCLUSIONS The model represents a complex HIV care delivery system rather than a single intervention, which required developing solutions to several challenges, such as calculating need for and receipt of multiple services and estimating their impact on care retention and viral suppression. Our strategies to address these methodological challenges produced a valid model for assessing the cost-effectiveness of the Ryan White HIV/AIDS Program.
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Affiliation(s)
| | | | - Pamela W Klein
- HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services; and
| | | | | | - Paul Mandsager
- HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services; and
| | - Stacy M Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services; and
| | | | | | | | | | | | - Laura W Cheever
- HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services; and
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Bourdeau B, Shade S, Koester K, Rebchook G, Dawson-Rose C, Guzé M, Psihopaidas D, Cohen SM, Myers J. Implementation Science Protocol: evaluating evidence-informed interventions to improve care for people with HIV seen in Ryan White HIV/AIDS program settings. AIDS Care 2021; 33:1551-1559. [PMID: 33427484 DOI: 10.1080/09540121.2020.1861585] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In 2017, the Health Resources and Services Administration's HIV/AIDS Bureau funded an Evaluation Center (EC) and a Coordinating Center for Technical Assistance (CCTA) to oversee the rapid implementation of 11 evidence-informed interventions at 26 HIV care and treatment providers across the U.S. This initiative aims to address persistent gaps in HIV-related health outcomes emerging from social determinants of health that negatively impact access to and retention in care. The EC adapted the Conceptual Model of Implementation Research to develop a Hybrid Type III, multi-site mixed-methods evaluation, described in this paper. The results of the evaluation will describe strategies associated with uptake, implementation outcomes, as well as HIV-related health outcomes for clients engaged in the evidence-informed interventions. This approach will allow us to understand in detail the processes that sites undergo to implement these important intervention strategies for high priority populations.
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Affiliation(s)
- Beth Bourdeau
- Division of Prevention Science, University of California San Francisco, San Francisco, CA, USA
| | - Starley Shade
- Division of Prevention Science, University of California San Francisco, San Francisco, CA, USA
| | - Kim Koester
- Division of Prevention Science, University of California San Francisco, San Francisco, CA, USA
| | - Greg Rebchook
- Division of Prevention Science, University of California San Francisco, San Francisco, CA, USA
| | - Carol Dawson-Rose
- Division of Prevention Science, University of California San Francisco, San Francisco, CA, USA
| | - Mary Guzé
- Division of Prevention Science, University of California San Francisco, San Francisco, CA, USA
| | - Demetrios Psihopaidas
- HIV AIDS Bureau, Human Resources and Services Administration, San Francisco, CA, USA
| | - Stacy M Cohen
- HIV AIDS Bureau, Human Resources and Services Administration, San Francisco, CA, USA
| | - Janet Myers
- Division of Prevention Science, University of California San Francisco, San Francisco, CA, USA
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Psihopaidas D, Cohen SM, West T, Avery L, Dempsey A, Brown K, Heath C, Cajina A, Phillips H, Young S, Stubbs-Smith A, Cheever LW. Implementation science and the Health Resources and Services Administration's Ryan White HIV/AIDS Program's work towards ending the HIV epidemic in the United States. PLoS Med 2020; 17:e1003128. [PMID: 33156852 PMCID: PMC7647058 DOI: 10.1371/journal.pmed.1003128] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Demetrios Psihopaidas and co-authors discuss the implementation science framework of an HIV/AIDS program in the United States.
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Affiliation(s)
- Demetrios Psihopaidas
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Stacy M. Cohen
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Tanchica West
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Latham Avery
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Antigone Dempsey
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Kim Brown
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Corliss Heath
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Adan Cajina
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Harold Phillips
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Steve Young
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - April Stubbs-Smith
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Laura W. Cheever
- United States Department of Health and Human Services, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
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Klein PW, Psihopaidas D, Xavier J, Cohen SM. HIV-related outcome disparities between transgender women living with HIV and cisgender people living with HIV served by the Health Resources and Services Administration's Ryan White HIV/AIDS Program: A retrospective study. PLoS Med 2020; 17:e1003125. [PMID: 32463815 PMCID: PMC7255591 DOI: 10.1371/journal.pmed.1003125] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 04/21/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND In the United States, approximately one-fifth of transgender women are living with HIV-nearly one-half of Black/African American (Black) transgender women are living with HIV. Limited data are available on HIV-related clinical indicators among transgender women. This is because of a lack of robust transgender data collection and research, especially within demographic subgroups. The objective of this study was to examine retention in care and viral suppression among transgender women accessing the Health Resources and Services Administration's (HRSA) Ryan White HIV/AIDS Program (RWHAP)-supported HIV care, compared with cisgender women and cisgender men. METHODS AND FINDINGS We assessed the association between gender (cisgender or transgender) and (1) retention in care and (2) viral suppression using 2016 client-level RWHAP Services Report data. Multivariable modified Poisson regression models adjusting for confounding by age, race, health care coverage, housing, and poverty level, overall and stratified by race/ethnicity, were used to calculate adjusted prevalence ratios (aPRs) and 95% confidence intervals (CIs). In 2016, the RWHAP served 6,534 transgender women (79.8% retained in care, 79.0% virally suppressed), 143,173 cisgender women (83.7% retained in care, 84.0% virally suppressed), and 382,591 cisgender men (81.0% retained in care, 85.9% virally suppressed). Black transgender women were less likely to be retained in care than Black cisgender women (aPR: 0.95, 95% CI: 0.92-0.97, p < 0.001). Black transgender women were also less likely to reach viral suppression than Black cisgender women (aPR: 0.55, 95%I CI: 0.41-0.73, p < 0.001) and Black cisgender men (aPR: 0.55, 95% CI: 0.42-0.73, p < 0.001). A limitation of the study is that RWHAP data are collected for administrative, not research, purposes, and clinical outcome measures, including retention and viral suppression, are only reported to the RWHAP for the approximately 60% of RWHAP clients engaged in RWHAP-supported outpatient medical care. CONCLUSIONS In this study, we observed disparities in HIV clinical outcomes among Black transgender women. These results fill an important gap in national HIV data about transgender people with HIV. Reducing barriers to HIV medical care for transgender women is critical to decrease disparities among this population.
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Affiliation(s)
- Pamela W. Klein
- Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
- * E-mail:
| | - Demetrios Psihopaidas
- Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Jessica Xavier
- Independent Consultant, Silver Spring, Maryland, United States of America
| | - Stacy M. Cohen
- Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
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Chan SS, Chappel AR, Maddox KEJ, Hoover KW, Huang YLA, Zhu W, Cohen SM, Klein PW, De Lew N. Pre-exposure prophylaxis for preventing acquisition of HIV: A cross-sectional study of patients, prescribers, uptake, and spending in the United States, 2015-2016. PLoS Med 2020; 17:e1003072. [PMID: 32275654 PMCID: PMC7147726 DOI: 10.1371/journal.pmed.1003072] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 03/12/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND In 2015, there were approximately 40,000 new HIV diagnoses in the United States. Pre-exposure prophylaxis (PrEP) is an effective strategy that reduces the risk of HIV acquisition; however, uptake among those who can benefit from it has lagged. In this study, we 1) compared the characteristics of patients who were prescribed PrEP with individuals newly diagnosed with HIV infection, 2) identified the specialties of practitioners prescribing PrEP, 3) identified metropolitan statistical areas (MSAs) within the US where there is relatively low uptake of PrEP, and 4) reported median amounts paid by patients and third-party payors for PrEP. METHODS AND FINDINGS We analyzed prescription drug claims for individuals prescribed PrEP in the Integrated Dataverse (IDV) from Symphony Health for the period of September 2015 to August 2016 to describe PrEP patients, prescribers, relative uptake, and payment methods in the US. Data were available for 75,839 individuals prescribed PrEP, and findings were extrapolated to approximately 101,000 individuals, which is less than 10% of the 1.1 million adults for whom PrEP was indicated. Compared to individuals with newly diagnosed HIV infection, PrEP patients were more likely to be non-Hispanic white (45% versus 26.2%), older (25% versus 19% at ages 35-44), male (94% versus 81%), and not reside in the South (30% versus 52% reside in the South).Using a ratio of the number of PrEP patients within an MSA to the number of newly diagnosed individuals with HIV infection, we found MSAs with relatively low uptake of PrEP were concentrated in the South. Of the approximately 24,000 providers who prescribed PrEP, two-thirds reported primary care as their specialty. Compared to the types of payment methods that people living with diagnosed HIV (PLWH) used to pay for their antiretroviral treatment in 2015 to 2016 reported in the Centers for Disease Control and Prevention (CDC) HIV Surveillance Special Report, PrEP patients were more likely to have used commercial health insurance (80% versus 35%) and less likely to have used public healthcare coverage or a publicly sponsored assistance program to pay for PrEP (12% versus 45% for Medicaid). Third-party payors covered 95% of the costs of PrEP. Overall, we estimated the median annual per patient out-of-pocket spending on PrEP was approximately US$72. Limitations of this study include missing information on prescription claims of patients not included in the database, and for those included, some patients were missing information on patient diagnosis, race/ethnicity, educational attainment, and income (34%-36%). CONCLUSIONS Our findings indicate that in 2015-2016, many individuals in the US who could benefit from being on PrEP were not receiving this HIV prevention medication, and those prescribed PrEP had a significantly different distribution of characteristics from the broader population that is at risk for acquiring HIV. PrEP patients were more likely to pay for PrEP using commercial or private insurance, whereas PLWH were more likely to pay for their antiretroviral treatment using publicly sponsored programs. Addressing the affordability of PrEP and otherwise promoting its use among those with indications for PrEP represents an important opportunity to help end the HIV epidemic.
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Affiliation(s)
- Stephanie S. Chan
- US Department of Health and Human Services (HHS), Office of the Assistant Secretary for Planning and Evaluation, Office of Health Policy, Washington, DC, United States of America
- * E-mail:
| | - Andre R. Chappel
- US Department of Health and Human Services (HHS), Office of the Assistant Secretary for Planning and Evaluation, Office of Health Policy, Washington, DC, United States of America
| | - Karen E. Joynt Maddox
- Washington University School of Medicine in St. Louis, St. Louis, Missouri, United States of America
| | - Karen W. Hoover
- HHS, Centers for Disease Control and Prevention, Division of HV/AIDS Prevention, Epidemiology Branch, Atlanta, Georgia, United States of America
| | - Ya-lin A. Huang
- HHS, Centers for Disease Control and Prevention, Division of HV/AIDS Prevention, Epidemiology Branch, Atlanta, Georgia, United States of America
| | - Weiming Zhu
- HHS, Centers for Disease Control and Prevention, Division of HV/AIDS Prevention, Epidemiology Branch, Atlanta, Georgia, United States of America
| | - Stacy M. Cohen
- HHS, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Pamela W. Klein
- HHS, Health Resources and Services Administration, HIV/AIDS Bureau, Rockville, Maryland, United States of America
| | - Nancy De Lew
- US Department of Health and Human Services (HHS), Office of the Assistant Secretary for Planning and Evaluation, Office of Health Policy, Washington, DC, United States of America
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Klein PW, Geiger T, Chavis NS, Cohen SM, Ofori AB, Umali KT, Hauck H. The Health Resources and Services Administration's Ryan White HIV/AIDS Program in rural areas of the United States: Geographic distribution, provider characteristics, and clinical outcomes. PLoS One 2020; 15:e0230121. [PMID: 32203556 PMCID: PMC7089565 DOI: 10.1371/journal.pone.0230121] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 02/21/2020] [Indexed: 11/21/2022] Open
Abstract
Background People living with HIV (PLWH) residing in rural areas experience substantial barriers to HIV care, which may contribute to poor HIV health outcomes, including retention in HIV care and viral suppression. The Health Resources and Services Administration’s Ryan White HIV/AIDS Program (HRSA RWHAP) is an important source of HIV medical care and support services in rural areas. The purpose of this analysis was to (1) assess the reach of the RWHAP in rural areas of the United States, (2) compare the characteristics and funded services of RWHAP provider organizations in rural and non-rural areas, and (3) compare the characteristics and clinical outcomes of RWHAP clients accessing medical care and support services in rural and non-rural areas. Methods and findings Data for this analysis were abstracted from the 2017 RWHAP Services Report (RSR), the primary source of annual, client-level RWHAP data. Organizations funded to deliver RWHAP any service (“RWHAP providers”) were categorized as rural or non-rural according to the HRSA FORHP’s definition of modified Rural-Urban Commuting Area (RUCA) codes. RWHAP clients were categorized based on their patterns of RWHAP service use as “visited only rural providers,” “visited only non-rural providers,” or “visited rural and non-rural providers.” In 2017, among the 2,113 providers funded by the RWHAP, 6.2% (n = 132) were located in HRSA-designated rural areas. Rural providers were funded to deliver a greater number of service categories per site than non-rural providers (44.7% funded for ≥5 services vs. 34.1% funded for ≥5 services, respectively). Providers in rural areas served fewer clients than providers in non-rural areas; 47.3% of RWHAP providers in rural areas served 1–99 clients, while 29.6% of non-rural providers served 1–99 clients. Retention in care and viral suppression outcomes did not differ on the basis of whether a client accessed services from rural or non-rural providers. Conclusions RWHAP providers are a crucial component of HIV care delivery in the rural United States despite evidence of significant barriers to engagement in care for rural PLWH, RWHAP clients who visited rural providers were just as likely to be retained in care and reach viral suppression as their counterparts who visited non-rural providers. The RWHAP, especially in partnership with Rural Health Clinics and federally funded Health Centers, has the infrastructure and expertise necessary to address the HIV epidemic in rural America.
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Affiliation(s)
- Pamela W. Klein
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
- * E-mail:
| | - Tanya Geiger
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Nicole S. Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Stacy M. Cohen
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Alexa B. Ofori
- Federal Office of Rural Health Policy, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Kathryn T. Umali
- Federal Office of Rural Health Policy, Health Resources and Services Administration, Rockville, Maryland, United States of America
| | - Heather Hauck
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, United States of America
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Yagel S, Cohen SM, Valsky DV. Simplifying imaging of the abdominal fetal precordial venous system. Ultrasound Obstet Gynecol 2019; 53:571-575. [PMID: 29573303 DOI: 10.1002/uog.19053] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 03/10/2018] [Accepted: 03/16/2018] [Indexed: 06/08/2023]
Affiliation(s)
- S Yagel
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Mt Scopus, Jerusalem, Israel
| | - S M Cohen
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Mt Scopus, Jerusalem, Israel
| | - D V Valsky
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Center, Mt Scopus, Jerusalem, Israel
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de Souza NP, Cardoso AF, Gomide L, Lima T, Miot HA, Martino-Andrade AJ, Arnold LL, Pennington KL, Cohen SM, de Camargo J, Nascimento E Pontes MG. Experimental cryptorchidism enhances testicular susceptibility to dibutyl phthalate or acrylamide in Sprague-Dawley rats. Hum Exp Toxicol 2019; 38:899-913. [PMID: 30995857 DOI: 10.1177/0960327119845040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Cryptorchidism (CPT), the most common male congenital abnormality, is variably associated with other male reproductive tract problems. We evaluated if cryptorchid rats develop enhanced testicular susceptibility to dibutyl phthalate (DBP) or acrylamide (AA) after extended exposure. Three studies with rats were performed: (1) in utero and postnatal exposure to DBP or AA; (2) establishment of CPT and orchiopexy; and (3) in utero and postnatal exposures to DBP or AA associated with CPT/orchiopexy. Seminiferous tubules were histologically scored according to the severity of lesions: (1) Rats exposed to DBP (score 1.5) or AA (score 1.1) presented mostly preserved spermatogenesis. Some seminiferous tubules showed vacuolated germinative epithelium, germ cell apoptosis, and a Sertoli cell-only (SCO) pattern. (2) CPT (score 3.3) resulted in decreased absolute testes weights, degenerated and SCO tubules, and spermatogenesis arrest that were reversed by orchiopexy (score 1.1). (3) Exposure to DBP or AA with CPT/orchiopexy led to atrophic testes, spermatogenesis arrest, germ cell exfoliation/multinucleation, and SCO tubules (both chemicals score 2.5). Exposure to chemicals such as DBP or AA prevented the recovery of cryptorchid testes by orchiopexy. The possible role of environmental contaminants should be considered when looking for factors that modulate human testicular disorders associated with CPT.
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Affiliation(s)
- N P de Souza
- 1 Department of Pathology, Center for Evaluation of the Impact of the Environmental on Human Health (TOXICAM), Botucatu Medical School, Botucatu Campus, Sao Paulo State University (UNESP), São Paulo, Brazil
| | - Ap Ferragut Cardoso
- 1 Department of Pathology, Center for Evaluation of the Impact of the Environmental on Human Health (TOXICAM), Botucatu Medical School, Botucatu Campus, Sao Paulo State University (UNESP), São Paulo, Brazil
| | - Lmm Gomide
- 1 Department of Pathology, Center for Evaluation of the Impact of the Environmental on Human Health (TOXICAM), Botucatu Medical School, Botucatu Campus, Sao Paulo State University (UNESP), São Paulo, Brazil
| | - Trr Lima
- 1 Department of Pathology, Center for Evaluation of the Impact of the Environmental on Human Health (TOXICAM), Botucatu Medical School, Botucatu Campus, Sao Paulo State University (UNESP), São Paulo, Brazil
| | - H A Miot
- 1 Department of Pathology, Center for Evaluation of the Impact of the Environmental on Human Health (TOXICAM), Botucatu Medical School, Botucatu Campus, Sao Paulo State University (UNESP), São Paulo, Brazil
| | - A J Martino-Andrade
- 2 Department of Physiology, Polytechnic Centre, Federal University of Paraná, Curitiba, Brazil
| | - L L Arnold
- 3 Department of Pathology and Microbiology and the Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - K L Pennington
- 3 Department of Pathology and Microbiology and the Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA
| | - S M Cohen
- 3 Department of Pathology and Microbiology and the Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE, USA.,4 Havlik-Wall Professor of Oncology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jlv de Camargo
- 1 Department of Pathology, Center for Evaluation of the Impact of the Environmental on Human Health (TOXICAM), Botucatu Medical School, Botucatu Campus, Sao Paulo State University (UNESP), São Paulo, Brazil
| | - M G Nascimento E Pontes
- 1 Department of Pathology, Center for Evaluation of the Impact of the Environmental on Human Health (TOXICAM), Botucatu Medical School, Botucatu Campus, Sao Paulo State University (UNESP), São Paulo, Brazil
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Semino R, Moreton JC, Ramsahye NA, Cohen SM, Maurin G. Understanding the origins of metal-organic framework/polymer compatibility. Chem Sci 2018; 9:315-324. [PMID: 29629100 PMCID: PMC5868319 DOI: 10.1039/c7sc04152g] [Citation(s) in RCA: 95] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Accepted: 10/26/2017] [Indexed: 12/23/2022] Open
Abstract
The microscopic interfacial structures for a series of metal-organic framework/polymer composites consisting of the Zr-based UiO-66 coupled with different polymers are systematically explored by applying a computational methodology that integrates density functional theory calculations and force field-based molecular dynamics simulations. These predictions are correlated with experimental findings to unravel the structure-compatibility relationship of the MOF/polymer pairs. The relative contributions of the intermolecular MOF/polymer interactions and the flexibility/rigidity of the polymer with respect to the microscopic structure of the interface are rationalized, and their impact on the compatibility of the two components in the resulting composite is discussed. The most compatible pairs among those investigated involve more flexible polymers, i.e. polyvinylidene fluoride (PVDF) and polyethylene glycol (PEG). These polymers exhibit an enhanced contact surface, due to a better adaptation of their configuration to the MOF surface. In these cases, the irregularities at the MOF surface are filled by the polymer, and even some penetration of the terminal groups of the polymer into the pores of the MOF can be observed. As a result, the affinity between the MOF and the polymer is very high; however, the pores of the MOF may be sterically blocked due to the strong MOF/polymer interactions, as evidenced by UiO-66/PEG composites. In contrast, composites involving polymers that exhibit higher rigidity, such as the polymer of intrinsic microporosity-1 (PIM-1) or polystyrene (PS), present interfacial microvoids that contribute to a decrease in the contact surface between the two components, thus reducing the MOF/polymer affinity.
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Affiliation(s)
- R Semino
- Institut Charles Gerhardt Montpellier UMR 5253 CNRS , Université de Montpellier , Place E. Bataillon , 34095 Montpellier Cedex 05 , France .
| | - J C Moreton
- Department of Chemistry and Biochemistry , University of California , La Jolla , San Diego , California 92093-0358 , USA .
| | - N A Ramsahye
- Institut Charles Gerhardt Montpellier UMR 5253 CNRS , Université de Montpellier , Place E. Bataillon , 34095 Montpellier Cedex 05 , France .
- Institut Charles Gerhardt Montpellier , UMR 5253 CNRS, UM, ENSCM , 8 rue de l'Ecole Normale , 34296 Montpellier Cedex 05 , France
| | - S M Cohen
- Department of Chemistry and Biochemistry , University of California , La Jolla , San Diego , California 92093-0358 , USA .
| | - G Maurin
- Institut Charles Gerhardt Montpellier UMR 5253 CNRS , Université de Montpellier , Place E. Bataillon , 34095 Montpellier Cedex 05 , France .
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Troester MA, Sun X, Allott EH, Kit CK, Thorne L, Mathews M, Cohen SM, Geradts J, Kirk E, Li Y, Hu Z, Robinson W, Hoadley KA, Reeder-Hayes K, Earp S, Olshan AF, Carey LA, Perou CM. Abstract PD8-01: Race and age differences in PAM50 biomarker status in the Carolina breast cancer study. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-pd8-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: African American breast cancer patients have lower relative frequency of hormone receptor (HR)-positive/HER2-negative disease and higher subtype-specific mortality. However, few population-based studies have RNA-based subtyping data, and racial differences in the biology of HR-positive/HER2-negative tumors are not well understood.
Methods: Using data and biospecimens from the Carolina Breast Cancer Study (CBCS) Phase 3 (2008-2013), we classified approximately 1,000 invasive breast cancers according to PAM50 subtype and two risk of recurrence scores (ROR-P and ROR-PT). Relative frequency of Luminal A, Luminal B, Her2-enriched, and Basal-like subtypes and ROR scores (low/medium/high) were compared by race (blacks vs. whites) and age (≤50 years vs. >50 years), overall and among HR-positive/HER2-negative cases.
Results: Black women of all ages had significantly higher relative frequency of Basal-like breast cancer (36 and 31% in blacks vs. 18 and 15% in whites; younger and older, respectively) and lower frequency of Luminal A breast cancer (26 and 34% in blacks vs. 43 and 52% in whites; younger and older, respectively). Frequency of Luminal B and HER2-enriched breast cancer did not vary by race or age. Among clinically HR-positive, HER2-negative cases, Luminal A subtype comprised only half of the cases among black women, and was significantly less common than among white women (51% vs 60% in whites, p<0.05). Black women with HR-positive/HER2-negative disease also had significantly higher ROR scores (ROR-P medium or high 82% vs. 66% in whites, p=0.01; ROR-PT medium or high 85% vs. 69% in whites, p<0.01).
Conclusions: Multi-gene assays highlight disparities in frequency of aggressive, poorer prognosis tumor subtypes and implicate differences in tumor biology as an important contributor to mortality disparities among HR-positive/HER2-negative patients.
Citation Format: Troester MA, Sun X, Allott EH, Kit C-K, Thorne L, Mathews M, Cohen SM, Geradts J, Kirk E, Li Y, Hu Z, Robinson W, Hoadley KA, Reeder-Hayes K, Earp S, Olshan AF, Carey LA, Perou CM. Race and age differences in PAM50 biomarker status in the Carolina breast cancer study [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr PD8-01.
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Affiliation(s)
- MA Troester
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - X Sun
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - EH Allott
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - C-K Kit
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - L Thorne
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - M Mathews
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - SM Cohen
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - J Geradts
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - E Kirk
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - Y Li
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - Z Hu
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - W Robinson
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - KA Hoadley
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - K Reeder-Hayes
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - S Earp
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - AF Olshan
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - LA Carey
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
| | - CM Perou
- University of North Carolina at Chapel Hill; Dana Farber Cancer Institute
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Valsky DV, Lipschuetz M, Cohen SM, Daum H, Messing B, Yagel I, Yagel S. Persistence of levator ani sonographic defect detected by three-dimensional transperineal sonography in primiparous women. Ultrasound Obstet Gynecol 2015; 46:724-729. [PMID: 25760927 DOI: 10.1002/uog.14840] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/02/2015] [Accepted: 03/04/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Correlation of the sonographic appearance of levator ani muscle (LAM) injury soon after delivery with that at long-term follow-up has not been described fully. We aimed to compare results of three-dimensional (3D) transperineal sonographic (TPS) evaluation of the LAM from the period immediately postpartum with long-term follow-up, to determine whether sonographic findings persist over time. METHODS Primiparous women (n = 210) who had been examined by 3D-TPS in a previous study to determine LAM trauma 24-72 hours after delivery were invited to participate in a follow-up examination 3-21 months postpartum. We included in this study only women who were not pregnant when approached and who had not given birth in the interim. LAM trauma was diagnosed with 3D-TPS when we observed discontinuity and distortion of the most anteromedial part of the pubovisceral muscle in the coronal C-plane or rendered image. Initial and follow-up 3D-TPS results were compared using Cohen's kappa test for inter-rater agreement. RESULTS Among the 87 women included in this study we found strong correlation between earlier and later sonographic appearance of LAM: 17/21 women with a sonographic finding of LAM injury in the period immediately postpartum were positive in the follow-up examination, and only 2/66 women negative for LAM damage at the first examination were found to have sonographic evidence of LAM defect at follow-up (Cohen's kappa, 0.805 (95% CI, 0.656-0.954), P < 0.001). CONCLUSIONS Our findings suggest that 3D-TPS of the LAM is a reliable examination. A sonographic finding of LAM defect identified in the period immediately postpartum persists months or years after delivery; therefore, this test may be performed following delivery, or may be delayed without impacting the result. It is likely that this sonographic defect represents real anatomical disruption and is not an imaging artifact.
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Affiliation(s)
- D V Valsky
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - M Lipschuetz
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - S M Cohen
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - H Daum
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - B Messing
- Department of Obstetrics and Gynecology, Mayanei HaYeshua Medical Center, Bnei Brak, Israel
| | - I Yagel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
| | - S Yagel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
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D'Hoore A, Albert MR, Cohen SM, Herbst F, Matter I, Van Der Speeten K, Dominguez J, Rutten H, Muldoon JP, Bardakcioglu O, Senagore AJ, Ruppert R, Mills S, Stamos MJ, Påhlman L, Choman E, Wexner SD. COMPRES: a prospective postmarketing evaluation of the compression anastomosis ring CAR 27(™) /ColonRing(™). Colorectal Dis 2015; 17:522-9. [PMID: 25537083 DOI: 10.1111/codi.12884] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 11/11/2014] [Indexed: 02/08/2023]
Abstract
AIM Preclinical studies have suggested that nitinol-based compression anastomosis might be a viable solution to anastomotic leak following low anterior resection. A prospective multicentre open label study was therefore designed to evaluate the performance of the ColonRing(™) in (low) colorectal anastomosis. METHOD The primary outcome measure was anastomotic leakage. Patients were recruited at 13 different colorectal surgical units in Europe, the United States and Israel. Institutional review board approval was obtained. RESULTS Between 21 March 2010 and 3 August 2011, 266 patients completed the study protocol. The overall anastomotic leakage rate was 5.3% for all anastomoses, including a rate of 3.1% for low anastomoses. Septic anastomotic complications occurred in 8.3% of all anastomoses and 8.2% of low anastomoses. CONCLUSION Nitinol compression anastomosis is safe, effective and easy to use and may offer an advantage for low colorectal anastomosis. A prospective randomized trial comparing ColonRing(™) with conventional stapling is needed.
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Affiliation(s)
- A D'Hoore
- Department of Abdominal Surgery, University Hospital Gasthuisberg Leuven, Leuven, Belgium
| | - M R Albert
- Center for Colon and Rectal Surgery, Altamonte Springs and Florida Hospital, Orlando, Florida, USA
| | - S M Cohen
- Southern Regional Medical Center, Spivey Station Surgery Center, Emory Healthcare, Atlanta, Georgia, USA
| | - F Herbst
- Abteilung für Chirurgie, Barmherzige Brueder, Krankenhaus Wien, Vienna, Austria
| | - I Matter
- Bnai Zion Medical Center, Haifa, Israel
| | | | - J Dominguez
- Department of Colorectal Surgery, Ferrell-Duncan Clinic, Springfield, Missouri, USA
| | - H Rutten
- Catharina Ziekenhuis, Eindhoven, Netherlands
| | - J P Muldoon
- Section of Colon and Rectal Surgery, NorthShore University Healthsystem and University of Chicago, Pritzker School of Medicine, Chicago, Illinois, USA
| | - O Bardakcioglu
- Department of Surgery, University of Nevada School of Medicine, Las Vegas, Nevada, USA
| | - A J Senagore
- Department of General Surgery, CMU College of Medicine, Saginaw, Missouri, USA
| | - R Ruppert
- Klinikum Neuperlach, Department of Coloproctology, Munich, Germany
| | - S Mills
- Department of Surgery, Division of Colon and Rectal Surgery, University of California, Irvine, Orange, California, USA
| | - M J Stamos
- Department of Surgery, University of California, Irvine, Orange, California, USA
| | - L Påhlman
- Deparment of Surgical Science, Uppsala University, Uppsala, Sweden
| | | | - S D Wexner
- Digestive Disease Center, Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida, USA
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27
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Yagel S, Cohen SM, Valsky DV, Shen O, Lipschuetz M, Messing B. Systematic examination of the fetal abdominal precordial veins: a cohort study. Ultrasound Obstet Gynecol 2015; 45:578-583. [PMID: 24919785 DOI: 10.1002/uog.13444] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 05/21/2014] [Accepted: 06/05/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Examination of the fetal venous system is a necessary part of complete fetal organ scanning to confirm landmark anatomy, such as the ductus venosus and course of the umbilical veins, and, whenever cardiovascular anomalies are identified, to exclude associated anomalous development of the fetal veins. We aimed to develop a protocol for systematic examination of the fetal venous system during midtrimester targeted organ scanning. METHODS We included low-risk women with a singleton fetus presenting between January 2011 and June 2013 to our center for routine midtrimester (20-24 weeks) targeted organ scanning. Imaging of the venous system was added to the booked scan and comprised two-dimensional color Doppler scanning of the fetal abdomen in three discrete planes, two transverse and one longitudinal. The more caudal plane was obtained in a ventral or lateral transverse abdominal plane to image the umbilical vein, left portal vein, portal sinus, anterior right portal vein, posterior right portal vein, main portal vein and splenic vein and artery. Moving cephalad, a ventral or lateral transverse plane was obtained to image the right, middle and left hepatic veins and inferior vena cava (IVC). Finally, a longitudinal anteroposterior plane showed the umbilical vein, ductus venosus, IVC and left hepatic vein. In some cases the pulsed Doppler waveform of a given target vessel was also examined. Three-dimensional/4D ultrasound was applied as necessary, when anomalous cases were encountered. RESULTS We examined 1810 women. Their body mass index ranged from 19 to 40 (mean, 24.7). In 38 (2.1%) women, the target anatomy was not visualized satisfactorily owing to maternal body habitus. A T-shaped configuration of the portal system vessels was observed in 63% of cases, an X-shaped configuration in 25% and an H-shaped configuration in 12%. During the study period, 24 congenital anomalies of the precordial venous system were diagnosed: nine cases of persistent right umbilical vein, seven of agenesis of the ductus venosus, five of anomalous portal venous drainage and three of interrupted IVC with azygos continuation. CONCLUSIONS Examination of the fetal venous system is feasible with the application of three abdominal planes. While a venous system scan is not practicable as part of a screening-level examination, mastery of the normal anatomy is an essential part of the professional knowledge base, in order to provide ready and complete scanning of the system in cases of suspected anomalies or disordered cardiac function.
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Affiliation(s)
- S Yagel
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
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28
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Affiliation(s)
- S M Cohen
- Department of Pathology and Microbiology, University of Nebraska Medical Center, Omaha
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29
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Cahill JF, Fei H, Cohen SM, Prather KA. Characterization of core-shell MOF particles by depth profiling experiments using on-line single particle mass spectrometry. Analyst 2015; 140:1510-5. [PMID: 25587577 DOI: 10.1039/c4an01913j] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Materials with core-shell structures have distinct properties that lend themselves to a variety of potential applications. Characterization of small particle core-shell materials presents a unique analytical challenge. Herein, single particles of solid-state materials with core-shell structures were measured using on-line aerosol time-of-flight mass spectrometry (ATOFMS). Laser 'depth profiling' experiments verified the core-shell nature of two known core-shell particle configurations (<2 μm diameter) that possessed inverted, complimentary core-shell compositions (ZrO2@SiO2 versus SiO2@ZrO2). The average peak area ratios of Si and Zr ions were calculated to definitively show their core-shell composition. These ratio curves acted as a calibrant for an uncharacterized sample – a metal-organic framework (MOF) material surround by silica (UiO-66(Zr)@SiO2; UiO = University of Oslo). ATOFMS depth profiling was used to show that these particles did indeed exhibit a core-shell architecture. The results presented here show that ATOFMS can provide unique insights into core-shell solid-state materials with particle diameters between 0.2-3 μm.
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Affiliation(s)
- J F Cahill
- Organic and Biological Mass Spectrometry Group, Chemical Sciences Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831-6131, USA
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30
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Lipschuetz M, Valsky DV, Shick-Naveh L, Daum H, Messing B, Yagel I, Yagel S, Cohen SM. Sonographic finding of postpartum levator ani muscle injury correlates with pelvic floor clinical examination. Ultrasound Obstet Gynecol 2014; 44:700-703. [PMID: 24510840 DOI: 10.1002/uog.13325] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 12/19/2013] [Accepted: 01/28/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVES Correlation of the sonographic finding of levator ani muscle (LAM) injuries with clinical examination in primiparous women following vaginal delivery has not been fully described. We aimed to examine the correlation of three-dimensional transperineal ultrasound (3D-TPS) finding of LAM defects with results of clinical examination of the pelvic floor, at intermediate follow-up. METHODS Subjects were primiparae 3-21 months following vaginal delivery, who had not become pregnant or delivered in the interim. On 3D-TPS, LAM trauma was diagnosed when discontinuity and distortion were visible in the most anteromedial part of the pubovisceral muscle in the coronal C-plane or rendered image. Clinical examination was performed by a physiotherapist who was blinded to the ultrasound results, and included palpation of the medial and lateral parts of the LAM mass, evaluation of tissue quality and whether there was any palpable gap. Muscle strength was evaluated using the modified Oxford scale. RESULTS Eighty-seven women were included, 19 (21.8%) of whom were found to have a sonographic LAM injury. Oxford score palpation parameter of asymmetric muscle mass or texture was significantly correlated with the finding of a LAM defect: of 68 women with normal 3D-TPS, 22 (32.4%) were found to have asymmetry of muscle mass or tissue quality on clinical examination vs 12 (63.2%) of 19 women with sonographic evidence of LAM injury (P = 0.016). Muscle strength and endurance parameters did not significantly correlate with the 3D-TPS findings. CONCLUSION Our findings suggest that persistent 3D-TPS LAM injury after primary vaginal delivery has clinical expression in changes in mass and texture of the LAM, as assessed by palpation.
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Affiliation(s)
- M Lipschuetz
- Division of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
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Abstract
The burden of HIV disease in the United States is monitored by using a comprehensive surveillance system. Data from this system are used at the federal, state, and local levels to plan, implement, and evaluate public health policies and programs. Implementation of HIV reporting has differed by area, and for the first time in early 2013, estimated data on diagnosed HIV infection were available from all 50 states, the District of Columbia, and six U.S. dependent areas. The newly available data for the entire U.S. as well as several other key changes to the surveillance system support the need to provide an updated summary of the status of the National HIV Surveillance System.
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Affiliation(s)
- Stacy M Cohen
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Kristen Mahle Gray
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - M Cheryl Bañez Ocfemia
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - Anna Satcher Johnson
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
| | - H Irene Hall
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of HIV/AIDS Prevention, Atlanta, GA
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32
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Messing B, Gilboa Y, Lipschuetz M, Valsky DV, Cohen SM, Yagel S. Fetal tricuspid annular plane systolic excursion (f-TAPSE): evaluation of fetal right heart systolic function with conventional M-mode ultrasound and spatiotemporal image correlation (STIC) M-mode. Ultrasound Obstet Gynecol 2013; 42:182-188. [PMID: 23288668 DOI: 10.1002/uog.12375] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 10/17/2012] [Accepted: 10/29/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES Fetal tricuspid annular plane systolic excursion (f-TAPSE) is a modified method to measure the vertical movement of the tricuspid valve annulus by M-mode ultrasound, in order to assess the fetal right heart. Evaluation of right heart function is well-recognized in pediatric and adult cardiology, but has not been studied widely in the fetus. We aimed to study f-TAPSE in the second half of gestation in normal fetuses, to establish reference ranges for this measure, to evaluate the usefulness of spatiotemporal image correlation (STIC) M-mode in obtaining it, and to compare conventional M-mode and STIC M-mode-based measures of f-TAPSE. METHODS We recruited gravidae presenting to our centers from 20 to 38 weeks for targeted organ scans, fetal echocardiography or third-trimester fetal surveillance, with structurally normal singleton fetuses and verified gestational age (GA). Because of the small number of subjects at the lower limit, fetuses at 20 and those at 21 weeks were combined into a single group ('21 weeks'). During the booked scan, in addition to standard biometry, M-mode was applied to the tricuspid annulus, parallel to the ventricular septum, and the amplitude of the resulting wave was measured. To allow comparison with STIC M-mode, a STIC volume was acquired and saved. In post-processing, the volume was rotated to show an apical four-chamber view, and f-TAPSE was investigated in a similar fashion to that used for conventional M-mode. Two to three measures of TAPSE were taken and the results averaged. In thirty women, measurements were performed by two observers and inter- and intraobserver variation were calculated. RESULTS We examined 341 fetuses at GA 20-39 weeks. Conventional M-mode f-TAPSE values ranged from a mean of 3.6 (± 1.1) mm at 21 weeks to a mean of 8.6 (± 1.5) mm at 39 weeks. In 45 cases we were unable to perform conventional M-mode ultrasound because of fetal lie; in eight cases STIC volumes were found in post-processing to be unsuitable for analysis. STIC f-TAPSE values ranged from a mean of 4.2 (± 1.4) mm at 21 weeks to a mean of 8.3 (± 1.5) mm at 39 weeks. Scatterplots of f-TAPSE measures obtained with conventional M-mode and with STIC M-mode were created vs GA and estimated fetal weight (EFW). For both modalities, f-TAPSE increased linearly with GA and with EFW. Good correlation was found between the two methods (Pearson's R(2) = 0.904). No significant difference was found in mean or variance of the distributions or slopes of the regression equations. Inter- and intraobserver variation (intraclass correlation coefficient) in conventional M-mode and STIC M-mode f-TAPSE measures were 0.94 and 0.97, respectively. CONCLUSION F-TAPSE in normal fetuses increases over the course of gestation and correlates to EFW. F-TAPSE measurement is easy to perform and available on all ultrasound machines; STIC f-TAPSE is possible on machines with STIC capability and produces similar measures with a greater success rate. We suggest the addition of f-TAPSE measurement to fetal right cardiac function evaluation.
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Affiliation(s)
- B Messing
- Department of Obstetrics and Gynecology, Mayanei HaYeshua Medical Center, Bnei Brak, Israel.
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Liberty G, Boldes R, Shen O, Shaul C, Cohen SM, Yagel S. The fetal larynx and pharynx: structure and development on two- and three-dimensional ultrasound. Ultrasound Obstet Gynecol 2013; 42:140-148. [PMID: 23239522 DOI: 10.1002/uog.12358] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To present a systematic approach for evaluating the fetal pharynx and larynx based on two- and three-dimensional ultrasound (2D-US and 3D-US) modalities, describing the sonographic appearance and function of the fetal upper respiratory tract and measuring the anatomical components of the pharynx and larynx. METHODS Gravidae presenting from the late first trimester to mid-gestation for routine booked examinations with structurally normal singleton fetuses of confirmed gestational age were enrolled. Transabdominal 2D-US was performed for anatomical and functional evaluation of the pharynx and larynx. Color Doppler was used to show fluid motion in the target area. 3D-US (Voluson® E6 with RAB-4-8-D transducer) scans of the fetal neck were acquired during fetal quiescence and in the absence of movements of the pharynx and larynx. Multiplanar reconstruction (MPR) in post-processing allowed adjustment of the volume to obtain the coronal plane. After a learning period to understand the sonographic anatomy of the target area, we measured the pharynx width and height, the upper, middle and lower larynx width and the larynx height. Render mode was applied for spatial evaluation of the target area. We developed a new methodological approach for structured evaluation of the fetal pharynx and larynx based on five spatial planes: posterior and anterior coronal planes and high, mid and low axial planes. RESULTS We examined 582 fetuses during the second trimester of pregnancy; target anatomy was imaged successfully in 218 patients at 11-24 gestational weeks. Acquisition added approximately 1 min to examination time. Rates of successful visualization and measurements increased significantly as pregnancy progressed, being 23% (46/194) at 11-13 weeks, 29% (69/240) at 14-16 weeks, 35% (18/51) at 17-19 weeks and 88% (85/97) at 20-24 weeks (P < 0.01). Pharynx components identified were: the sphenoid bone, pterygoid processes, constrictor muscles, piriform recesses and uvula. Larynx components identified were: the epiglottis, aryepiglottic folds, corniculate cartilages, arytenoid cartilages, cricoid cartilage, thyroid cartilage and vocal cords. MPR showed the biconcave shape of the uvula, which may explain the 'equals sign' observed on 2D-US. We observed the bilateral mode of movements of the constrictor muscles, aryepiglottic folds and vocal cords, and the bidirectional fluid jet flows through the larynx. Scatterplots of measured structures vs gestational age were created. Pharynx width ranged from 0.11 to 0.93 (mean ± SD, 0.48 ± 0.17) cm; pharynx height ranged from 0.23 to 2.01 (mean ± SD, 0.94 ± 0.34) cm; upper larynx width ranged from 0.04 to 0.37 (mean ± SD, 0.15 ± 0.07) cm; middle larynx width ranged from 0.08 to 0.77 (mean ± SD, 0.34 ± 0.16) cm; lower larynx width ranged from 0.05 to 0.64 (mean ± SD, 0.24 ± 0.11) cm; and larynx height ranged from 0.20 to 1.83 (mean ± SD, 0.71 ± 0.31) cm. All measurements were positively correlated with gestational age. CONCLUSIONS The fetal larynx and pharynx can be evaluated thoroughly using 2D- and 3D-US modalities. Knowledge of normal anatomy, function and biometry may prove useful in the evaluation of anatomical or functional pathology involving the fetal upper respiratory tract. Recognition of anatomical anomalies may enhance fetal intervention such as balloon placement in cases of diaphragmatic hernia.
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Affiliation(s)
- G Liberty
- Department of Obstetrics and Gynecology, Barzilai Medical Center, Ashkelon, Israel.
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Hall HI, Frazier EL, Rhodes P, Holtgrave DR, Furlow-Parmley C, Tang T, Gray KM, Cohen SM, Mermin J, Skarbinski J. Differences in human immunodeficiency virus care and treatment among subpopulations in the United States. JAMA Intern Med 2013; 173:1337-44. [PMID: 23780395 DOI: 10.1001/jamainternmed.2013.6841] [Citation(s) in RCA: 279] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Early diagnosis of human immunodeficiency virus (HIV) infection, prompt linkage to and sustained care, and antiretroviral therapy are associated with reduced individual morbidity, mortality, and transmission of the virus. However, levels of these indicators may differ among population groups with HIV. Disparities in care and treatment may contribute to the higher incidence rates among groups with higher prevalence of HIV. OBJECTIVE To examine differences between groups of persons living with HIV by sex, age, race/ethnicity, and transmission category at essential steps in the continuum of care. DESIGN AND SETTING We obtained data from the National HIV Surveillance System of the Centers for Disease Control and Prevention to determine the number of persons living with HIV who are aware and unaware of their infection using back-calculation models. We calculated the percentage of persons linked to care within 3 months of diagnosis on the basis of CD4 level and viral load test results. We estimated the percentages of persons retained in care, prescribed antiretroviral therapy, and with viral suppression using data from the Medical Monitoring Project, a surveillance system of persons receiving HIV care in select areas representative of all such persons in the United States. PARTICIPANTS All HIV-infected persons in the United States. MAIN OUTCOMES AND MEASURES Percentage of persons living with HIV who are aware of their infection, linked to care, retained in care, receiving antiretroviral therapy, and achieving viral suppression. RESULTS Of the estimated 1,148,200 persons living with HIV in 2009 in the United States, 81.9% had been diagnosed, 65.8% were linked to care, 36.7% were retained in care, 32.7% were prescribed antiretroviral therapy, and 25.3% had a suppressed viral load (≤200 copies/mL). Overall, 857 276 persons with HIV had not achieved viral suppression, including 74.8% of male, 79.0% of black, 73.9% of Hispanic/Latino, and 70.3% of white persons. The percentage of blacks in each step of the continuum was lower than that for whites, but these differences were not statistically significant. Among persons with HIV who were 13 to 24 years of age, only 40.5% had received a diagnosis and 30.6% were linked to care. Persons aged 25 to 34, 35 to 44, and 45 to 54 years were all significantly less likely to achieve viral suppression than were persons aged 55 to 64 years. CONCLUSIONS AND RELEVANCE Significant age disparities exist at each step of the continuum of care. Additional efforts are needed to ensure that all persons with HIV receive a diagnosis and optimal care to reduce morbidity, mortality, disparities in care and treatment, and ultimately HIV transmission. Ensuring that people stay in care and receive treatment will increase the proportion of HIV-infected individuals who achieve and maintain a suppressed viral load.
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Affiliation(s)
- H Irene Hall
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Godfrey ME, Messing B, Cohen SM, Valsky DV, Yagel S. Functional assessment of the fetal heart: a review. Ultrasound Obstet Gynecol 2012; 39:131-144. [PMID: 21611999 DOI: 10.1002/uog.9064] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/12/2011] [Indexed: 05/30/2023]
Abstract
The purpose of this review is to evaluate the current modalities available for the assessment of fetal cardiac function. The unique anatomy and physiology of the fetal circulation are described, with reference to the difference between in-utero and ex-utero life. M-mode, early/atrial ratio, myocardial performance index, three-dimensional and four-dimensional ultrasound, tissue Doppler including strain and strain rate, speckle tracking, magnetic resonance imaging and venous flow assessment are described. The modalities are analyzed from the perspective of the clinician and certain questions are posed. Does the modality assess systolic function, diastolic function or both? Is it applicable to both ventricles? Does it require extensive post-processing or additional hardware, or does it make use of technology already available to the average practitioner? The reproducibility and reliability of the techniques are evaluated, with reference to their utility in clinical decision-making. Finally, directions for future research are proposed.
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Affiliation(s)
- M E Godfrey
- Department of Pediatric Cardiology, Schneider Children's Medical Center Israel, Petach Tikva, Israel
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Valsky DV, Cohen SM, Lipschuetz M, Hochner-Celnikier D, Yagel S. Three-dimensional transperineal ultrasound findings associated with anal incontinence after intrapartum sphincter tears in primiparous women. Ultrasound Obstet Gynecol 2012; 39:83-90. [PMID: 21845740 DOI: 10.1002/uog.10072] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Three-dimensional transperineal sonography (3D-TPS) performed in women following third- or fourth-degree intrapartum tears repaired with the overlapping technique demonstrates characteristic signs. The aim of this study was to investigate the correlation of these signs with clinical complaints of incontinence. METHODS This was a prospective observational study. Sixty primiparous women underwent 3D-TPS 3-42 (mean, 10.6) months after surgical repair of third- or fourth-degree postpartum sphincter tears with the overlapping technique and were evaluated for clinical degree of incontinence using the St Mark's Incontinence Score (SMIS) questionnaire. The following signs were assessed on 3D-TPS: interruption of the internal anal sphincter or external anal sphincter, 'half moon' sign, changes in the mucosal folds and thickening of the external anal sphincter in the area of sphincter repair. As a comparison group, 27 primiparous women after normal vaginal delivery, without clinically recognized anal sphincter tears, were evaluated similarly, 3-37 (mean, 9.9) months postpartum. RESULTS Abnormal sonographic signs were apparent in 35 (58.3%) of 60 women in the study group, and 39 (65%) of 60 had some clinical complaints of incontinence 3-42 months after delivery, most of a mild degree. Higher SMIS results were found in women of the study group than in those of the comparison group (mean (SD) 2.80 (0.481) vs. 1.15 (0.365); P = 0.018). The rates of incontinence were similar between the women in the study group with normal ultrasound findings and the women in the comparison group (9/25 vs. 10/27; relative risk (RR) = 0.97, 95% CI, 0.47-1.97). CONCLUSIONS Sonographic signs of anal sphincter tear and repair had disappeared at follow-up examination in almost half of the patients, and therefore this examination should be deferred from the early postpartum period. A substantial proportion of women report some complaint of incontinence after sphincter repair, most of a slight degree. Such complaints are associated with abnormal 3D-TPS findings at follow up, while in women with a normal 3D-TPS scan the rate of incontinence complaints is similar to that in women after normal delivery.
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Affiliation(s)
- D V Valsky
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Mount Scopus, Jerusalem, Israel.
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Gafton AR, Cohen SM, Eastwood JD, Dang MK, Hoang JK. Recurrent laryngopyocele: CT-guided hookwire localization for re-excision surgery. AJNR Am J Neuroradiol 2011; 34:E39-42. [PMID: 22173772 DOI: 10.3174/ajnr.a2810] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Laryngopyocele recurrence after initial surgical resection is a very rare occurrence. We present a case of recurrent laryngopyocele in which CT fluoroscopy-guided hookwire placement was used to facilitate resection. In this article, we illustrate the imaging findings of laryngopyocele, review the approach to management, and describe the CT fluoroscopy-guided hookwire placement procedure.
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Affiliation(s)
- A R Gafton
- Department of Radiology, Duke University Hospital, Box 3808, Erwin Rd, Durham NC, 27710, USA
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Messing B, Cohen SM, Valsky DV, Shen O, Rosenak D, Lipschuetz M, Yagel S. Fetal heart ventricular mass obtained by STIC acquisition combined with inversion mode and VOCAL. Ultrasound Obstet Gynecol 2011; 38:191-197. [PMID: 21370304 DOI: 10.1002/uog.8980] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Estimation of fetal heart ventricular mass is important for fetal cardiac evaluation in cases of structural or functional cardiac disorders or extracardiac factors. It may be used with other cardiac parameters to ascertain the severity and prognosis of such disorders, or the nature and timing of intervention. We applied a novel technique combining spatiotemporal image correlation (STIC) with three-dimensional inversion mode and Virtual Organ Computer-aided AnaLysis (VOCAL™) for fetal cardiac mass assessment in healthy fetuses in the second and third trimesters. METHODS STIC acquisition was performed during fetal quiescence with the abdomen uppermost, at an angle of 30-50°, without color Doppler mapping. Myocardial volume measurements were performed in postprocessing using VOCAL mode, set to 15°. Beginning with the heart in four-chamber view at end diastole, a trace was drawn manually including the myocardium and interventricular septum. Inversion mode colors the intraventricular (anechoic, fluid-filled) voxels; this intraventricular volume was subtracted automatically from the total. Mass was determined by multiplying the result by the estimated fetal myocardial density (1.050 g/cm(3) ). The process was repeated for right and left ventricles. RESULTS Data from 106 fetuses at 21-38 weeks' gestation were obtained and scatterplots of fetal cardiac ventricular mass distribution were created. Several cases of fetuses with disordered cardiac ventricle (supraventricular tachycardia, hypoplastic left heart syndrome, dilated cardiomyopathy, twin-to-twin transfusion syndrome, Ebstein anomaly, non-immune hydrops fetalis, septate right atrium and diaphragmatic hernia) were examined. Ventricular mass parameters were markedly affected as compared with normal cases of similar gestational age. CONCLUSIONS STIC acquisition combined with inversion mode and VOCAL is a feasible method of cardiac ventricular mass quantification. This methodology may have added value in fetal cardiac evaluation in cases of anatomic malformation or cardiac dysfunction, or in cases of maternal diabetes.
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Affiliation(s)
- B Messing
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
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Yagel S, Cohen SM, Rosenak D, Messing B, Lipschuetz M, Shen O, Valsky DV. Added value of three-/four-dimensional ultrasound in offline analysis and diagnosis of congenital heart disease. Ultrasound Obstet Gynecol 2011; 37:432-437. [PMID: 21031348 DOI: 10.1002/uog.8867] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/19/2010] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Many published studies have shown that application of three-dimensional (3D) and real-time 3D (4D) ultrasound modalities can improve certain aspects of fetal echocardiography, but have left open the question of whether these modalities improved the accuracy of prenatal detection of anatomical fetal cardiovascular malformations. We aimed to determine whether 3D/4D ultrasound improved diagnostic ability in cases of congenital heart disease (CHD). METHODS Women who attended for early- or midtrimester targeted organ scans had complete fetal echocardiography according to our five-planes protocol, as well as examination of the ductus venosus and longitudinal aortic arch planes, performed with 2D ultrasound combined with 2D color Doppler, spatiotemporal image correlation (STIC), STIC with color Doppler, and STIC with B-flow. Ultrasound data of cases of CHD were stored in a dedicated archive. Stored cases were anonymized and the list order was randomized. Stored 2D ultrasound cineloops and 4D ultrasound volumes were reviewed separately according to a standardized table of 23 specified structures on five required planes of visualization: the upper abdomen, four-chamber view, five-chamber view, pulmonary artery bifurcation view, and three vessels and trachea plane. Separate diagnoses were recorded and finally compared. Diagnoses were confirmed by pathological examination or neonatal echocardiography. RESULTS During the study period, 13 101 examinations were performed; 181 diagnoses of CHD were made. In 12 of these, 3D/4D ultrasound added to the accuracy of our diagnosis: one right aortic arch with anomalous branching; one transposition of the great arteries with pulmonary atresia diagnosed with tomographic ultrasound imaging (TUI); one segmental interrupted aortic arch diagnosed with TUI; one right ventricle aneurysm diagnosed with B-flow; two agenesis of ductus venosus to the coronary sinus diagnosed by multiplanar reconstruction (MPR) and B-flow; two total anomalous pulmonary venous connection diagnosed with MPR; and four ventricular septal defect (VSD) diagnosed with the aid of virtual planes. There were 12 missed diagnoses and no false-positive results. CONCLUSIONS 3D/4D ultrasound modalities may have advantages in some aspects of fetal cardiovascular evaluation, however, overall 3D/4D ultrasound modalities had added value in only about 6% of cases of fetal anatomical cardiovascular anomalies.
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Affiliation(s)
- S Yagel
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel.
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Shen O, Valsky DV, Messing B, Cohen SM, Lipschuetz M, Yagel S. Shunt diameter in agenesis of the ductus venosus with extrahepatic portosystemic shunt impacts on prognosis. Ultrasound Obstet Gynecol 2011; 37:184-190. [PMID: 20521238 DOI: 10.1002/uog.7702] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/20/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Agenesis of the ductus venosus (ADV) is a rare condition in which there are two variants of umbilical vein drainage: intrahepatic shunt or extrahepatic (portosystemic) shunt. It has been posited that the extrahepatic variant carries a poorer prognosis. However, in the absence of associated anomalies there is still a wide variation in outcome. We evaluated the portal system in cases of ADV and aimed to identify parameters that might predict outcome. METHODS We conducted a retrospective study of cases of ADV with extrahepatic shunt that had been examined in two centers, and collected new cases prospectively. The route of the shunt was depicted using two-dimensional (2D) and three-dimensional (3D) ultrasound imaging. In an attempt to characterize portal system and shunt developmental variations and their possible impact on outcome, the diameter of the shunt was compared with the diameter of the umbilical vein and the entire portal vasculature was assessed. Poor outcome was defined as persistent morbidity or fetal or neonatal death. RESULTS Twenty-two cases of ADV were identified: nine retrospectively and 13 prospectively. Aberrant shunts from the umbilical vein were identified to the right atrium, coronary sinus, inferior vena cava (IVC) and iliac vein. In seven of 22 cases (32%) a wide connection was observed. In six of these seven cases (86%) the outcome was poor, including four with severe associated anomalies and two with hepatic dysfunction. In five of these cases, cardiomegaly with tricuspid regurgitation was observed, as well as underdevelopment of the portal system. In only five of 15 cases with a narrow shunt (33%) was the outcome poor, and in all five cases the poor outcome was related to associated anomalies. CONCLUSION In cases of ADV with extrahepatic shunt, portal system development is impacted by the diameter of the shunt. If the shunt is narrow, the portal system will have developed normally. A wide shunt is associated with underdevelopment or absence of the portal system. In cases of ADV with extrahepatic shunt, prognosis is determined by the severity of associated anomalies, the diameter of the shunt and development of the portal system.
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Affiliation(s)
- O Shen
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Jerusalem, Israel
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Valsky DV, Esh-Broder E, Cohen SM, Lipschuetz M, Yagel S. Added value of the gray-scale whirlpool sign in the diagnosis of adnexal torsion. Ultrasound Obstet Gynecol 2010; 36:630-634. [PMID: 20586041 DOI: 10.1002/uog.7732] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE Adnexal torsion is a common gynecologic emergency affecting females of all ages. Expedient diagnosis and treatment are important, particularly in young fertile patients to preserve ovarian viability. Classical parameters for the clinical and sonographic diagnosis of adnexal torsion have very high false-positive rates, approaching 50%. The sonographic 'whirlpool' sign has been shown to be effective for visualizing the torsed part in the prenatal diagnosis of malrotation of the midgut with volvulus, as well as scrotal and ovarian torsion. We aimed to evaluate the efficacy of the whirlpool sign in the diagnosis of torsion, as compared to a protocol based on 'classic' sonographic signs of torsion alone. METHODS This was a retrospective chart review. Files of all patients who underwent laparoscopy for suspected torsion at our center between January 2006 and May 2009 were extracted and reviewed. Ultrasound reports were retrieved from our computerized database. Patients were assigned to the study group if the whirlpool sign had been investigated during pre-procedural evaluation or to the control group if only the standard protocol had been applied. RESULTS Eighty women were referred for laparoscopy for suspected adnexal torsion during the study period. In 22 women the ultrasound investigation had included the whirlpool sign (study group) while 58 had been examined by the standard protocol (control group). Twenty women in the study group had a positive whirlpool sign on ultrasound, 18 of whom (90.0%) had confirmed torsion on laparoscopy. In the control group 32 of 58 (55.2%) women had confirmed torsion on laparoscopy. CONCLUSION The addition of the sonographic whirlpool sign to the preoperative sonographic evaluation of patients with suspected torsion appears to improve the rate of true-positive diagnoses as confirmed by laparoscopy. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.
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Affiliation(s)
- D V Valsky
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Mt Scopus, Jerusalem, Israel.
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Yagel S, Kivilevitch Z, Cohen SM, Valsky DV, Messing B, Shen O, Achiron R. The fetal venous system, Part II: ultrasound evaluation of the fetus with congenital venous system malformation or developing circulatory compromise. Ultrasound Obstet Gynecol 2010; 36:93-111. [PMID: 20205158 DOI: 10.1002/uog.7622] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The human fetal venous system is well-recognized as a target for investigation in cases of circulatory compromise, and a broad spectrum of malformations affecting this system has been described. In Part I of this review, we described the normal embryology, anatomy and physiology of this system, essential to the understanding of structural anomalies and the sequential changes encountered in intrauterine growth restriction and other developmental disorders. In Part II we review the etiology and sonographic appearance of malformations of the human fetal venous system, discuss the pathophysiology of the system and describe venous Doppler investigation in the fetus with circulatory compromise.
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Affiliation(s)
- S Yagel
- Obstetrics and Gynecology Ultrasound Center, Hadassah-Hebrew University Medical Centers, Mt Scopus, Jerusalem, Israel.
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Yagel S, Kivilevitch Z, Cohen SM, Valsky DV, Messing B, Shen O, Achiron R. The fetal venous system, part I: normal embryology, anatomy, hemodynamics, ultrasound evaluation and Doppler investigation. Ultrasound Obstet Gynecol 2010; 35:741-50. [PMID: 20205155 DOI: 10.1002/uog.7618] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Since its introduction in the mid-1980s sonographic evaluation of the human fetal venous system has advanced dramatically. The venous system is well-recognized as a target for investigation in cases of circulatory compromise, and a broad spectrum of malformations affecting this system has been described. Appreciation of the normal embryology, anatomy and physiology of this system is essential to an understanding of structural anomalies and the sequential changes encountered in intrauterine growth restriction or other developmental disorders. We review the normal embryology, anatomy, and hemodynamics of the human fetal venous system, and provide an overview of Doppler investigation, as well as three- and four-dimensional ultrasound modalities and their application to this system.
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Affiliation(s)
- S Yagel
- Obstetrics and Gynecology Ultrasound Center, Hadassah-Hebrew University Medical Centers, Mt Scopus, Jerusalem, Israel.
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Abstract
Although the incidence of (myelodysplastic syndrome (MDS)) is higher among heart and lung transplant recipients than the general population, the same has not been shown in liver transplant (OLT) patients. We present the second known case of MDS after OLT. Case reports of MDS in OLT were identified using PubMed. Patient data were gathered from the patient and the medical record. A 54-year-old Caucasian man underwent OLT in 2003 and again in 2004 for hepatitis C-related cirrhosis. In 2007, the patient developed weakness, malaise, and shortness of breath. Laboratory studies revealed pancytopenia. Bone marrow biopsy showed MDS, with refractory anemia and excess blasts-1. The patient underwent chemotherapy and reduction in immunosuppression without a clinical response. Our experience suggested that MDS, although rare, should be considered in the differential diagnosis of pancytopenia after OLT. Once diagnosed, immunosuppression reduction, chemotherapy, and even stem cell transplantation may be the appropriate treatment in selected candidates.
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Affiliation(s)
- R Potru
- Rush University Medical Center, Chicago, IL, USA.
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Valsky DV, Cohen SM, Hamani Y, Lipschuetz M, Yagel S, Esh-Broder E. Whirlpool sign in the diagnosis of adnexal torsion with atypical clinical presentation. Ultrasound Obstet Gynecol 2009; 34:239-242. [PMID: 19644943 DOI: 10.1002/uog.7310] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Affiliation(s)
- D V Valsky
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Mt. Scopus, Jerusalem, Israel.
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Abstract
BACKGROUND Alcoholic hepatitis is a severe, cholestatic liver disease occurring in patients with alcohol abuse. Mortality is substantial; however, therapies may improve clinical outcomes. AIM To provide an updated review of the epidemiology, diagnosis, staging and treatment of alcoholic hepatitis. METHODS A MEDLINE literature search was performed to identify pertinent articles. Relevant clinical abstracts were also reviewed. RESULTS Severe alcoholic hepatitis occurs in a small fraction of patients who abuse alcohol. The 28-day mortality ranges from 30% to 50% in most series. Diagnosis is generally based on clinical features, with a limited role for liver biopsy. Beneficial treatment options include alcohol abstinence and nutritional therapy. Despite variable results in clinical trials, corticosteroids and pentoxifylline appear to provide moderate survival benefit. Anti-tumour necrosis factor agents and antioxidants have not proven beneficial, and should be limited to clinical trials. Liver transplant is not a frequent option given the active or recent alcohol use. CONCLUSIONS Severe alcoholic hepatitis is a clinically-diagnosed condition associated with significant mortality. Alcohol abstinence and nutritional therapy have been associated with improved clinical parameters and should be considered in all patients. Corticosteroid therapy and pentoxifylline therapy appear to show moderate survival benefit and should be considered as first-line therapeutic agents.
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Affiliation(s)
- S M Cohen
- Section of Hepatology, Rush University Medical Center, Chicago, IL 60612, USA.
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Messing B, Cohen SM, Valsky DV, Rosenak D, Hochner-Celnikier D, Savchev S, Yagel S. Fetal cardiac ventricle volumetry in the second half of gestation assessed by 4D ultrasound using STIC combined with inversion mode. Ultrasound Obstet Gynecol 2007; 30:142-51. [PMID: 17566143 DOI: 10.1002/uog.4036] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE Quantification of fetal heart ventricle volume can aid in the evaluation of functional and anatomical aspects of congenital heart disease. The aim of this study was to establish nomograms for ventricular volume using three-dimensional (3D) inversion mode ultrasonography with the spatio-temporal image correlation (STIC) modality and to calculate ejection fraction and stroke volume. METHODS The fetal heart was scanned using the STIC modality, during fetal quiescence with abdomen uppermost, at an angle of 30-50 degrees , without color Doppler flow mapping. In post-processing, starting with the classic four-chamber view plane in the A-frame, the reference point was moved to the center of the ventricle. The operator used the edit volume followed by Virtual Organ Computer-aided AnaLysis (VOCAL) mode options; in manual trace the VOCAL settings were set to 15 degrees . The trace was drawn and included the myocardium; inversion mode thresholding provided the volume of the intraventricular (anechoic) voxels within the region of interest. The total volume and the intraventricular volume were displayed. The process was repeated for right (R) and left (L) ventricles at end diastole (EDV) and end systole (ESV). The stroke volume (SV = EDV - ESV) and ejection fraction (EF = SV/EDV) were calculated from these measurements. Intraclass correlation was used to evaluate intra- and interobserver agreement. RESULTS One hundred fetuses ranging from 20 + 5 to 40 + 0 gestational weeks were included in the study. In addition, six fetuses diagnosed during the study period with a cardiac anomaly were examined and their ventricular volumes compared with those of the main study group. LEDV ranged from a mean of 0.53 cm(3) at midgestation to a mean of 3.96 cm(3) at term. LESV ranged from a mean of 0.17 cm(3) at midgestation to 1.56 cm(3) at term. REDV ranged from a mean of 0.68 cm(3) at midgestation to a mean of 5.44 cm(3) at term. RESV ranged from a mean of 0.26 cm(3) at midgestation to 2.29 cm(3) at term. Total stroke volume ranged from a mean of 0.78 cm(3) at midgestation to a mean of 5.5 cm(3) at term. The mean right : left ventricle ratio was 1.4, and left ejection fraction ranged from 42.5 to 86% in these fetuses. Nomograms were created for RESV, LESV, REDV, LEDV and total stroke volumes vs. estimated fetal weight and gestational age. Intra- and interobserver agreement reached 96%. CONCLUSIONS 3D inversion mode sonography combined with STIC represents a simple and reproducible method for estimating fetal cardiac ventricle volume. This innovative methodology may add to overall evaluation of cardiac volume and function, and improve our understanding of normal and abnormal cardiac structure, as well as the severity and prognosis of cardiac lesions.
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Affiliation(s)
- B Messing
- Department of Obstetrics and Gynecology, Hadassah-Hebrew University Medical Centers, Mt. Scopus, Jerusalem, Israel
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Adams TB, McGowen MM, Williams MC, Cohen SM, Feron VJ, Goodman JI, Marnett LJ, Munro IC, Portoghese PS, Smith RL, Waddell WJ. The FEMA GRAS assessment of aromatic substituted secondary alcohols, ketones, and related esters used as flavor ingredients. Food Chem Toxicol 2007; 45:171-201. [PMID: 17046133 DOI: 10.1016/j.fct.2006.07.029] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2006] [Revised: 07/12/2006] [Accepted: 07/20/2006] [Indexed: 11/17/2022]
Abstract
This publication is the 11th in a series of safety evaluations performed by the Expert Panel of the Flavor and Extract Manufacturers Association (FEMA). In 1993, the Panel initiated a comprehensive program to re-evaluate the safety of more than 1700 GRAS flavoring substances under conditions of intended use. The list of GRAS substances has now grown to more than 2100 substances. Elements that are fundamental to the safety evaluation of flavor ingredients include exposure, structural analogy, metabolism, pharmacokinetics and toxicology. Flavor ingredients are evaluated individually and in the context of the available scientific information on the group of structurally related substances. In this monograph, a detailed interpretation is presented on the renal carcinogenic potential of the aromatic secondary alcohol alpha-methylbenzyl alcohol, aromatic ketone benzophenone, and corresponding alcohol benzhydrol. The relevance of these effects to the flavor use of these substances is also discussed. The group of aromatic substituted secondary alcohols, ketones, and related esters was reaffirmed as GRAS (GRASr) based, in part, on their rapid absorption, metabolic detoxication, and excretion in humans and other animals; their low level of flavor use; the wide margins of safety between the conservative estimates of intake and the no-observed-adverse effect levels determined from subchronic and chronic studies and the lack of significant genotoxic and mutagenic potential.
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Affiliation(s)
- T B Adams
- Flavor and Extract Manufacturers Association, 1620 I Street, NW, Suite 925, Washington, DC 20006, USA.
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