HIV Testing Deserts and Vulnerability Among Adolescents and Young Adults in Tampa Bay, Florida.

PURPOSE: Human immunodeficiency virus (HIV) burden among Florida adolescents and young adults (AYA, aged 13-24 years), particularly in Tampa Bay, is among the highest in the nation. We sought to determine the association between zip code-level test site accessibility and AYA HIV burden, compare this association with adult (aged 25-44 years) HIV burden, and identify local AYA HIV testing deserts. We further aimed to identify the association between test site accessibility and population-level markers of social disadvantage. METHODS: We geocoded HIV test sites and determined the percent surface area per zip code within 15-minute walking distance to ≥ 1 test sites (PSA15) in Pinellas and Hillsborough counties. We calculated Pearson's correlation coefficients for the association of PSA15 and HIV burden by age group and, separately, the association of PSA15 and population-level characteristics. RESULTS: Of the 96 zip codes analyzed, 36.5% had a PSA15 for HIV testing of 0%. The association between PSA15 and HIV burden was substantially higher for adults (r = 0.51, p < .001) than for AYA (r = 0.09, p = .38). Overall, we identified four potential AYA testing deserts. We also found that greater PSA15 was correlated with greater %Black/African-American residents (r = 0.32, p = .002), greater %residents living in poverty (r = 0.27, p = .008), and lower child opportunity index scores (r = -0.29, p = .004). DISCUSSION: Walking-accessible HIV test sites in Tampa Bay were limited and geographically distributed largely based on adult HIV burden, population-level markers of social disadvantage, and among areas with higher percentages of Black/African-American residents. Test site distribution was less correlated with AYA HIV burden, leaving this population vulnerable across multiple testing deserts.

S-values for radium-223 and absorbed doses estimates for 223RACL2 using three computational phantoms.

Radium-223 dichloride (223RaCl2), approved by FDA (Food and Drug Administration) in 2013 and in Brazil by ANVISA (Agência Nacional de Vigilância Sanitária) in 2016, offers a new therapeutic option for bone metastases from castration-resistant prostate cancer (CRPC). The advantages of radionuclide therapy for bone metastases include the simultaneous treatment of multiple lesions at the same time. The activity prescription is based on the patient's body weight, disregarding the absorbed dose limit of 2 Gy in the organ at risk: bone marrow. This study focuses on Internal Dosimetry for 223RaCl2 therapy aiming to apply biokinetic models described in the literature to estimate absorbed doses in the organs of interests, especially for the bone marrow. For this purpose, the present paper compares and validates the GATE Monte Carlo simulation with the Radioactive Decay Module (RDM) and calculates a set of S-values for Radium-223 radionuclide using male and female XCAT computational models. Moreover, a comparison of S-values for Radium-223 for three male computational models with different anatomies is also evaluated, Male (standard), Pat1 (lower body weight) and Pat2 (highest body weight). A comprehensive set of S-values was calculated for the Male model, 30 source-regions and 47 target-regions, and for Female model, 30 source-regions and 42 target-regions for Radium-223 and its decay scheme: Radon-219, Polonium-215, Lead-211, Bismuth- 211, Polonium-211 and Thallium-207. The new set of S-values will facilitate absorbed dose calculations for Radium-223 therapy. In addition, Absorbed Dose Evaluation for 223RaCl2 therapy was estimated for three different biodistributions described in the literature within three male computational models. For all biodistributions, the Pat2 phantom has a greatest absorbed dose within the red marrow, when compared with Male and Pat1.

Optimal theranostic SPECT imaging protocol for 223radium dichloride therapy.

223Radium dichloride image-based individual dosimetry requires an optimal acquisition and reconstruction protocol and proper image correction methods for theranostic applications. To assess this problem, radium-223 dichloride SPECT images were acquired from a Jaszczak simulator with a dual-headed gamma camera, LEHR collimator, 128 × 128 matrix, and total time of 32 minutes. A cylindrical PMMA phantom was used to calibrate the measurements performed with Jaszczak. The image quality parameters (noise coefficient, contrast, contrast-to-noise ratio and recovery coefficient) and septal penetration correction were calculated by MATLAB®. The best results for the investigated image quality parameters were obtained with an 89 keV energy window (24% wide) produced together with OSEM/MLEM reconstruction (8 subsets and 4 iterations) applying a Butterworth filter (order 10 and cutoff frequency of 0.48 cycles·cm-1). The successfully performed recovery coefficient parameter evaluation allows uptake correction for future patient dosimetry applications.

Sarcopenia, body composition and factors associated with variceal gastrointestinal bleeding and splenectomy in hepatosplenic schistosomiasis mansoni.

BACKGROUND: Sarcopenia is a common complication of cirrhosis and an important predictor of morbimortality. We aimed to determine the prevalence of sarcopenia and its associated factors in hepatosplenic schistosomiasis (HSS) as well as to evaluate whether muscle mass and function are associated with variceal upper gastrointestinal bleeding (VUGIB) and previous splenectomy in subjects without other liver diseases. METHODS: We conducted a cross-sectional study including adults with HSS who underwent clinical, biochemical, anthropometric, muscle strength and physical performance evaluations and were submitted to bioelectrical impedance analysis and abdominal ultrasound. Sarcopenia was diagnosed according to the 2019 European consensus criteria. RESULTS: A total of 66 patients with HSS (62.1% male; mean age 48.8±8.6 y) were included. Overall, six subjects (9.1%) were diagnosed with probable sarcopenia and none had confirmed sarcopenia. Fat-free body mass index (BMI) was independently associated with VUGIB (odds ratio 0.701 [95% confidence interval 0.51 to 0.96]; p=0.025). Compared with patients who did not undergo surgery, individuals who underwent esophagogastric devascularization combined with splenectomy (EGDS) had higher serum lipid levels, fat percentage and frequency of metabolic syndrome, with lower skeletal muscle mass index and hand grip strength. CONCLUSIONS: HSS mansoni seems not to cause sarcopenia. However, a lower fat-free BMI was associated with previous VUGIB and the subgroup of patients who underwent EGDS presented higher lipid levels, fat percentage and frequency of metabolic syndrome and lower muscle mass and function.

Research to law: A qualitative study of Massachusetts' 2018 Care Act expanding emergency department initiation of medication for opioid use disorder.

BACKGROUND: Initiating medication for opioid use disorder (MOUD) during emergency department (ED) visits is an important innovation to engage individuals in addiction treatment. In 2018, Massachusetts passed the CARE Act, becoming the first state to legislate that hospitals with EDs must be able to offer MOUD. We performed a qualitative study to explore factors influencing policy enactment. METHODS: Semi-structured interviews were conducted in 2019 with ten key stakeholders involved in the policymaking process representing state government, hospitals, physician professional societies, and recovery/behavioral health organizations. Data were analyzed in 2020-2021 using a hybrid inductive-deductive approach. RESULTS: The first key theme stakeholders expressed was the importance of research and public health consensus; they described consensus building within existing coalitions regarding the pressing need for action, and supporting expansion of treatment with this evidence-based strategy. Second, stakeholders discussed overcoming financing and feasibility concerns by passing budget-neutral legislation and ensuring flexibility for diverse hospital types. Lastly, stakeholders looked towards implementation, describing the implementation guide development process and ensuring capacity for continuing treatment existed throughout the state. CONCLUSIONS: This study suggests that research supporting the effectiveness of ED MOUD induction drove the passage of this state legislation. Long-term collaboration between diverse stakeholders towards a common goal of increasing access to evidence-based treatment to address the opioid epidemic was also perceived as facilitating the law's passage. Policymakers and advocates in other states may look towards Massachusetts's legislative process as a model for implementing similar legislation as part of their strategies to address the drug overdose crisis.

Liver stiffness is able to differentiate hepatosplenic Schistosomiasis mansoni from liver cirrhosis and spleen stiffness may be a predictor of variceal bleeding in hepatosplenic schistosomiasis.

BACKGROUND: Ultrasonography is limited for differentiating portal hypertension due to liver cirrhosis from that secondary to hepatosplenic schistosomiasis (HSS). We aimed to investigate the role of transient elastography (TE) in differentiating HSS mansoni from cirrhosis and the factors associated with liver and spleen stiffness (LS and SS) in HSS. METHOD: A cross-sectional study was conducted including patients with HSS mansoni (n=29) and liver cirrhosis due to non-alcoholic steatohepatitis (n=23). All patients underwent TE and those with HSS were assessed by the Niamey protocol. RESULTS: HSS subjects presented lower median LS (9.6 vs 21.3 Kpa, p<0.001) and liver controlled attenuation parameter (229 vs 274 dB/m, p=0.010) than cirrhosis subjects, in addition to higher SS (73.5 vs 42.2 Kpa, p=0.002). The area under the receiver operating characteristic curve for detecting cirrhosis by LS was 0.947 (95% CI 0.89 to 1.00, p<0.001), with an optimal cut-off of 11.75 Kpa. In HSS subjects, higher SS was associated with the presence of the following: diabetes mellitus (p=0.036), metabolic syndrome (p=0.043), esophageal varices (p=0.001), portal vein thrombosis (p=0.047) and previous variceal bleeding (p=0.011). In HSS patients without portal vein thrombosis, variceal bleeding was associated with higher SS (p=0.018). Niamey categories were not associated with LS (p=0.676) or SS (p=0.504). CONCLUSION: TE can play a role in differentiating HSS from cirrhosis, especially by LS. SS may be further investigated for predicting complications in HSS.

Coccidioidomycosis Knowledge and Behaviors of California Hispanic Farm Workers.

(1) Describe knowledge, attitudes, beliefs, and behaviors related to coccidioidomycosis (Valley fever, VF) reported by farm workers in a highly endemic area to design and evaluate prevention messages and (2) identify health information sources preferred by farm workers to disseminate VF prevention messages. There were 119 primarily Mexican-born residents of two migrant farm labor housing centers in Kern County, who completed an interviewer-administered survey on VF knowledge, attitudes, beliefs, and behaviors in 2017. The 73% of participants aware of VF demonstrated a knowledge score of 53%. Over 90% erroneously believed VF was associated with pesticide exposure; approximately two-thirds believed that wearing a bandana mask was protective. Over half of respondents believed that VF was contagious, could be contracted from contaminated food or water, and caused gastrointestinal symptoms. Of those aware of VF, 75% expressed concern about becoming infected because of where they lived and working outdoors. Working outdoors in dusty conditions was the most commonly reported risk-associated work practice. Among 67 participants reporting use of respiratory protection, 94% indicated they wear a bandana; most male participants did not wear face coverings in dusty conditions. The most frequent protective work practice was wetting soil. Preferred sources of health information included television; family, friend, or co-worker; healthcare provider; and radio. Farm workers reported multiple risk factors for VF. Results identified several areas of poor knowledge, risk behavior, and preferred channels of prevention messages. Important protective behaviors are not under the control of farm workers; engagement with employers is essential.

Noninvasive predictors of esophageal varices in patients with hepatosplenic schistosomiasis mansoni.

BACKGROUND: No previous study have evaluated transient elastography for predicting esophageal varices in hepatosplenic schistosomiasis. AIM: To investigate noninvasive methods of predicting esophageal varices in patients with hepatosplenic schistosomiasis mansoni. METHODS: Cross-sectional multicentric study included 51 patients with hepatosplenic schistosomiasis. Patients underwent ultrasonography-dopplerfluxometry, upper endoscopy, complete blood cell count and transient elastography (Fibroscan®) for liver and spleen stiffness measurement (LSM and SSM). Noninvasive scores previously established for cirrhotic population were studied: platelet count to spleen diameter ratio (PSR), LSM-spleen diameter to platelet ratio score (LSPS) and varices risk score (VRS). We proposed a version of LSPS and VRS by replacing LSM with SSM and named them SSPS and modified-VRS, respectively. RESULTS: Esophageal varices were detected in 42 (82.4%) subjects. Individuals with varices presented higher SSM (73.5 vs 36.3 Kpa, p = 0.001), splenic vein diameter (10.8 vs 8.0 mm, p = 0.017), SSPS (18.7 vs 6.7, p = 0.003) and modified-VRS (4.0 vs 1.4, p = 0.013), besides lower PSR (332 vs 542, p = 0.038), than those without varices. SSPS was independently associated with varices presence (OR=1.19, 95%CI 1.03-1.37, p = 0.020) after multivariate analysis. In a model excluding noninvasive scores, SSM was independently associated with varices diagnosis (OR=1.09, 95%CI 1.03-1.16, p = 0.004). AUROC was 0.856 (95%CI 0.752-0.961, p = 0.001) for SSM and 0.816 (95%CI 0.699-0.932, p = 0.003) for SSPS (p = 0.551). CONCLUSIONS: Spleen-related variables were predictors of esophageal varices: SSM, splenic vein diameter, SSPS, modified-VRS and PSR. Multivariate models indicated that SSM and SSPS are useful tools for predicting varices in non-cirrhotic portal hypertension by hepatosplenic schistosomiasis and may be used in clinical practice.

Youtubers e juventude: uma análise dos vídeos mais populares e suas implicações na saúde mental / Youtubers and youth: an analysis of the most popular videos and their consequences for the mental health / Youtubers y jóvenes: un análisis de los videos más populares y sus consecuencias para la salud mental

Estudo de caráter exploratório que tem como objetivo analisar as temáticas abordadas em vídeos produzidos por youtubers brasileiros. Foram levantados os 10 principais canais para o público jovem na plataforma de vídeos YouTube, de 19 de março de 2019 até 08 de abril de 2019, criados e apresentados pelos chamados youtubers. Após seleção e análise foram obtidas as seguintes categorias: cultura tecnológica, relações familiares e sexualidade. Os vídeos possuem expressivo número de visualizações e abordam temáticas de interesse do público jovem, porém revelam carência de fundamentos teórico-científicos sobre as implicações que têm em sua saúde mental. Conclui-se que é preciso inserir os pais e os jovens em discussões de educação digital, de modo a conscientizá-los dos possíveis riscos provocados por alguns conteúdos e a dialogarem a respeito do uso consciente e saudável da tecnologia.

Exploratory study aiming to analyse themes ­ addressed in videos produced by Brazilian Youtubers ­ focusing on mental health. The ten most-viewed channels aimed at teen audience on the video platform YouTube from March 19, 2019 to April 8, 2019 created and presented by the so-called Youtubers were searched out. After selecting and analysing, the following categories were obtained: technological culture, family relationships and sexuality. These videos have a significant number of users and deal with topics of interest to the young audience, nevertheless they have no scientific basis concerning the possible consequences of their contents for the mental health of their public. It was concluded that it is necessary parents and young people become involved with discussions on digital education, in order to have aware of the possible risks produced by some contents and to dialogue about the conscious and healthy use of technology.

Este artículo presenta un estudio exploratório con el objetivo de analizar los temas tratados en vídeos producidos por youtubers brasileños. Fueron rastreados los 10 principales canales dirigidos a la audiencia adolescente en la plataforma YouTube, desde 19 de marzo de 2019 hasta 8 de abril de 2019, creados y presentados por los llamados youtubers. Después de la selección y del análisis, se obtuvieron las categorías siguientes: cultura tecnológica, relaciones familiares y sexualidad. Los vídeos tienen un número significativo de visualizaciones y se ocupan de temas de interés del público joven, pero no tienen fundamentos científicos acerca de las implicaciones de su contenido para ese público. Ha sido concluido que es necesario que los padres y los jóvenes se reúnan en discusiones sobre educación digital, a fin de generar consciencia acerca de los posibles riesgos originados de algunos contenidos y diálogo sobre el uso consciente y saludable de la tecnologia.

Portal vein thrombosis in patients with hepatosplenic schistosomiasis who underwent oesophagogastric devascularization combined with splenectomy.

BACKGROUND: Portal vein thrombosis (PVT) has been described in nearly 50% of patients who underwent oesophagogastric devascularization combined with splenectomy (EGDS), but no previous study has compared its occurrence in surgical and non-surgical groups. This study aimed to investigate PVT in hepatosplenic schistosomiasis (HSS) and its association with EGDS and upper variceal bleeding (UVB). METHODS: Retrospectively, 104 HSS individuals were enrolled. Following EGDS, the occurrence of PVT, mesenteric vein thrombosis (MVT), hospital admissions and UVB were recorded. RESULTS: EGDS was performed in 27 (26%) patients. PVT and MVT were detected in 30 (33%) and 8 (9.8%) patients, respectively. Patients who underwent EGDS were at greater risk of PVT (63% vs 19.7%; odds ratio [OR] 6.12 [95% confidence interval {CI} 2.3 to 16.1], p<0.001) when compared with a non-surgical approach. There was no significant difference in UVB occurrence and ß-blocker usage. PVT was associated with more hospital admissions (p=0.030) and higher alkaline phosphatase levels (p=0.008). UVB occurrence in patients with and without thrombosis was similar. In multivariate analysis, after adjustment, PVT was associated with the surgical approach (OR 4.56 [95% CI 1.55 to 13.38], p=0.006) and age at HSS diagnosis (OR 0.94 [95% CI 0.90 to 0.99], p=0.021). CONCLUSIONS: EGDS was not associated with a decreased frequency of UVB when compared with the non-surgical approach but was an independent risk factor for PVT.

Risk for Coccidioidomycosis among Hispanic Farm Workers, California, USA, 2018.

To determine occupational risk factors for coccidioidomycosis among adult Hispanic outdoor agricultural workers in California, USA, we conducted a case-control study of workers seen at the Kern County medical facility and referred to the public health laboratory for coccidioidomycosis serologic testing. Participants completed an interviewer-administered health and work questionnaire. Among 203 participants (110 case-patients with positive and 93 controls with negative serologic results), approximately half were women, and more than three quarters were born in Mexico. Associated with coccidioidomycosis were self-reported dust exposure and work with root and bulb vegetable crops. A protective factor was leaf removal, an activity associated with grape cultivation. We conclude that subjective dust exposure and work with root and bulb vegetable crops are associated with increased risk for coccidioidomycosis among Hispanic farm workers. The agricultural industry should evaluate and promote dust-reduction measures, including wetting soil and freshly harvested products.

Changes in gene expression in European eels (Anguilla anguilla) induced by infection with swim bladder nematodes (Anguillicola crassus).

The European eel, Anguilla anguilla, is considered an endangered species that is under pressure for many reasons. Among others, the introduced parasite Anguillicola crassus is thought to play an important role in the decline of eel populations. These nematodes have been shown to negatively affect many fitness-related traits in eels, e.g., growth, osmoregulation, and stress tolerance. Nevertheless, there has been little work on the way in which the host-parasite interaction influences the molecular regulation of these key physiological processes. We experimentally analyzed the effect of this nematode on the expression of genes involved in the physiology of European eels during their continental life. Included are genes that are implicated in the eel's somatic growth (insulin-like growth factor 1 and thyroid hormone receptor beta), osmoregulation (Na+/K+-ATPase beta1 and aquaporin 3), and hematopoiesis (hemoglobin alpha-chain). Our results showed the absence of an effect on genes involved in fish growth; the parasite may, however, have an effect on osmoregulation and hematopoiesis. We also noted a differential impact of male and female parasites on the expression of some genes, perhaps owing to the sexual dimorphism in body size of the parasite.

Dynamic expression of immune response genes in the sea bass, Dicentrarchus labrax, experimentally infected with the monogenean Diplectanum aequans.

The sea bass, Dicentrarchus labrax, is one of the most extensively farmed marine fishes in the Mediterranean. Under the high-density condition common in aquaculture, the monogenean gill parasite Diplectanum aequans can cause significant economic losses. This study used real-time quantitative PCR to investigate the dynamic expression of immune response genes in sea bass infected with Diplectanum aequans. The target genes, interleukin-1 (IL-1beta, transforming growth factor (TGF-beta and T-cell receptor (TCR-beta), were studied in the gills and spleen of the sea bass from the first day of infection until thirty days post- infection. Our results showed that there was an increase in IL-1beta gene expression in the spleen and gills and in TGF-beta gene expression in the gills of infected fish. These results show that parasitic infection induced a local inflammatory reaction and that reaction was restricted to the site of infection. Finally, the absence of relationship between TCR-beta expression and the parasitic infection suggests that the adaptive immune system is not involved in the response against this parasite.

Genetically modified organisms in the United States: implementation, concerns, and public perception.

We examine the state of biotechnology with respect to genetically modified (GM) organisms in agriculture. Our focus is on the USA, where there has been significant progress and implementation but where, to date, the matter has drawn little attention. GM organisms are the result of lateral gene transfers, the transfer of genes from one species to another, or sometimes, from one kingdom to another. The introduction of foreign genes makes some people very uncomfortable, and a small group of activists have grave concerns about the technology. Attempts by activists to build concern in the general public have garnered little attention; however, the producers of GM organisms have responded to their concerns and established extensive testing programs to be applied to each candidate organism that is produced. In the meantime, GM varieties of corn, cotton, soybean and rapeseed have been put into agricultural production and are now extensively planted. These crops, and the other, newer GM crops, have produced no problems and have pioneered a silent agricultural revolution in the USA.