Awareness of U = U among Sexual and Gender Minorities in Brazil, Mexico, and Peru: Differences According to Self-reported HIV Status.

The slogan Undetectable equals Untransmittable (U = U) communicates that people living with HIV (PLHIV) who are on antiretroviral therapy (ART) will not transmit HIV to their sexual partners. We describe awareness of U = U among sexual and gender minorities (SGM) living in Brazil, Mexico, and Peru by self-reported HIV status (PLHIV, negative, unknown) during 2021 using an online survey. We estimated two models using Poisson regression for each population group: Model A including socio-demographic factors (country, gender, age, race, education, and income), and then Model B including taking ART (for PLHIV) or risk behavior, ever-taking PrEP, and HIV risk perception (for HIV-negative or of unknown HIV status). A total of 21,590 respondents were included (Brazil: 61%, Mexico: 30%, Peru: 9%). Among HIV-negative (74%) and unknown status (12%), 13% ever used PrEP. Among PLHIV (13%), 93% reported current use of ART. Awareness of U = U was 89% in both Brazil and Mexico, which was higher than in Peru 64%. Awareness of U = U was higher among PLHIV (96%) than HIV-negative (88%) and HIV-unknown (70%). In multivariate models, PLHIV with lower education were less aware of U = U, while those taking ART were more aware. Among HIV-negative, non-cisgender, lower income, and those with lower education had lower awareness of U = U, while individuals ever using PrEP had higher awareness. In conclusion, awareness of U = U varied by HIV status, socio-demographic characteristics, and HIV risk behavior. The concept of U = U should be disseminated through educational strategies and include a focus on SGM to combat HIV stigma.

RESUMEN: Indetectable = Intransmisible (I = I) comunica que las personas que viven con VIH (PVVIH) y reciben tratamiento antirretroviral (TAR) no transmitirán el VIH a sus parejas sexuales. En este estudio, describimos la concienciación sobre I = I entre las minorías sexuales y de género (MSG) de Brasil, México y Perú según el estado de VIH autoreportado (PVVIH, negativo, desconocido) durante 2021 utilizando una encuesta en línea. Se estimaron dos modelos mediante regresión de Poisson para cada grupo: Modelo A, que incluyó factores sociodemográficos (país, sexo, edad, raza, educación e ingresos) y Modelo B, que incluyó recibir TAR (para PVVIH) o comportamiento de riesgo, uso de PrEP y percepción de riesgo (para VIH negativo o desconocido). Se incluyó 21,590 encuestados (Brasil: 61%, México: 30%, Perú: 9%). Entre aquellos negativos para VIH (74%) y con estado desconocido (12%), el 13% utilizó alguna vez PrEP. Entre las PVVIH (13%), el 93% reportó recibir actualmente TAR. La concienciación de I = I fue del 89% tanto en Brasil como en México, superior al 64% de Perú. La concienciación de I = I fue mayor entre PVVIH (96%) que entre los VIH-negativos (88%) y los VIH-desconocidos (70%). En los modelos multivariados, las PVVIH con menor educación eran menos conscientes de I = I, mientras que los que tomaban TAR eran más conscientes. Entre los VIH-negativos, las personas no cisgéneros, con menores ingresos y con menor educación eran menos consciente de I = I, mientras que los que tenían experiencia usando PrEP eran más conscientes. En conclusión, la concienciación sobre I = I varió según el estado serológico de VIH, las características sociodemográficas y el comportamiento de riesgo. El concepto de I = I debe difundirse a través de estrategias educativas, incluyendo un enfoque en MSG para combatir el estigma del VIH.

Controls on nitrogen transformation rates on restored floodplains along the Cosumnes River, California.

Levee construction results in the systematic replumbing of river systems and reduces the frequency of floodplain inundation, which impacts nutrient delivery and transformations in floodplains. Floodplain restoration via levee removal affects downstream water quality by restoring soil microbial metabolic pathways such as denitrification, anaerobic ammonium oxidation (anammox), and dissimilatory nitrate reduction to ammonium (DNRA). Although these metabolisms are important for the nitrogen cycle, few studies have quantified the contribution of all three pathways to nitrate retention or loss in restored floodplains. The objectives of this study were to quantify the relevance of denitrification, anammox and DNRA to nitrogen retention, characterize the hydrologic conditions most favorable to each pathway, and estimate the potential for floodplain restoration to improve nitrogen cycling in the Cosumnes River watershed. To address these goals, we simulated flood conditions in soil mesocosms collected from two floodplains where levees were breached in 1997 and 2014 along the Lower Cosumnes River in the San Joaquin Basin of California. River water enriched with K15NO3 tracer was pumped into each mesocosm at a constant rate for a period of 3 months. Samples were collected from the surface water and soil pore water for measurements of NO3-, NO2-, and NH4+ concentrations, and δ15N of dissolved gases (N2 and N2O). To the best of our knowledge, this study reports the highest relative contribution to N2 production due to anammox for freshwater systems (41 to 84%) to date. High anammox rates were associated with heterogeneous grain size distribution across depth and high nitrification rates. We quantify the capacity of restored floodplain soils with distinct textural and chemical characteristics to retain or release nitrogen during large and small floods in a particular water year.

Continuum of care comes full circle. Adding hospice care allows a Denver system to better meet patient needs.

In November 1993 Hospice of Peace, a home hospice program in Denver, was reorganized under a new joint sponsorship of Provenant Health Partners and Catholic Charities and Community Services. Home hospice completes Provenant's continuum of healthcare. Based on the campus of Provenant Senior Life Center, Hospice of Peace employs multidisciplinary professionals who care for patients and their family care givers in their homes. Each hospice team works with a patient's physician and comes from a pool of primary care nurses, certified nurse assistants, social workers, counselors, pastoral care counselors, and specially trained volunteers and bereavement counselors. Respect for human life at all stages is the ethic behind the organizations' hospice efforts. Even at life's end, when aggressive medical treatment is no longer appropriate, healthcare professionals can enhance patients' quality of life and provide bereavement support to their loved ones. Just as Catholic healthcare addresses the spiritual component of healing, so it addresses the spiritual component of dying.

Devices to improve coronary artery bypass grafting (CABG) surgery.

As off-pump coronary artery bypass grafting becomes the method of choice for cardio-thoracic surgeons, it has become apparent that the facilitation of coronary artery anastomosis on a beating heart needs to be addressed by improved instrumentation. We propose an intraluminal anastomosis device used in conjunction with a biologic-glue to eliminate suturing and serve as a scaffold for constructing stable anastomoses. The device will continue to serve as an eluting stent postoperatively. The simple technique of using the device and the adhesive will require 5 minutes or less for anastomosis. Moreover, we introduce a novel parallel port vacuum stabilizer foot equipped with a uniform lateral tension inducing turnbuckle mechanism to be used with off-pump stabilization systems. A proposed in vitro protocol details using saphenous vein segments and coronary arteries to test the patency of multiple end-to-side grafts. A pressure transducer will be attached to the graft to monitor flow characteristics. An in vivo protocol details construction of anastomoses during off-pump coronary artery bypass grafting in pigs using the anastomosis device, the turnbuckle vacuum foot, and the biologic-glue. Anastomosis patency will be evaluated intraoperatively and one month postoperatively. Furthermore, the graft site will be examined via flow measurement, angiography, and histological analysis.