Interprofessional education as a potential foundation for future team-based prevention of alcohol use disorder.

BACKGROUND: Effective screening of alcohol use and prevention of alcohol use disorder (AUD) requires the continuous preparation of educated and confident providers across all health professions who will ideally work in close collaboration in their future practices. As one mechanism for achieving this goal, the development and provision of interprofessional education (IPE) training modules for health care students may cultivate beneficial interactions among future health providers early in their formative education. METHODS: In the present study, we assessed attitudes about alcohol and confidence in screening and AUD prevention in 459 students at our health sciences center. Students represented ten different health professions (audiology, cardiovascular sonography, dental hygiene, dentistry, medicine, nursing, physical therapy, public health, respiratory therapy, and speech language pathology programs). For purposes of this exercise, students were divided into small, professionally diverse teams. Responses to ten survey questions (Likert scale) were collected via a web-based platform. These assessments were collected before and after a case-based exercise that provided information to students on the risks of excessive alcohol use as well as the effective screening and team-based management of individuals susceptible to AUD. RESULTS: Wilcoxon signed-rank analyses revealed that the exercise led to significant decreases in stigma toward individuals engaging in at-risk alcohol use. We also discovered significant increases in self-reported knowledge and confidence in personal qualifications needed to initiate brief interventions to reduce alcohol use. Focused analyses of students from individual health programs uncovered unique improvements according to question theme and health profession. CONCLUSION: Our findings demonstrate the utility and effectiveness of single, focused IPE-based exercises to impact personal attitudes and confidence in young health professions learners. While additional longitudinal cohort follow-up studies are needed, these results may translate into more effective and collaborative AUD treatment in future clinical settings.

Difelikefalin, a peripherally restricted KOR (kappa opioid receptor) agonist, produces diuresis through a central KOR pathway.

Difelikefalin is a peripherally restricted kappa opioid receptor (KOR) agonist that was recently approved by the FDA to treat pruritis in dialysis patients. Here, we investigated the cardiovascular and renal responses to difelikefalin, and using the KOR antagonist norbinaltorphimine (norBNI), examined whether any difelikefalin-induced changes in the renal excretion of water and/or electrolytes were mediated through a central or peripheral KOR pathway. The effects of norBNI pretreatment on nalfurafine, a KOR agonist that crosses the blood-brain barrier, were also examined. We hypothesized that difelikefalin would alter urine output differently than nalfurafine, given that KOR agonists produce diuresis via activating central KORs to inhibit vasopressin release. Following catheterization, conscious Sprague-Dawley rats were infused i.v. with isotonic saline and pretreated with norBNI centrally via an intracerebroventricular (ICV) cannula or peripherally via an intravenous catheter. After stabilization, difelikefalin or nalfurafine was administered i.v. and urine output, heart rate and mean arterial pressure (MAP) were recorded for 90 min. Difelikefalin produced a significant increase in urine output, and significant decrease in urinary sodium and potassium excretion, urine osmolality, and MAP. ICV norBNI pretreatment markedly attenuated the increase in urine output caused by difelikefalin and nalfurafine but did not inhibit the electrolyte effects. However, IV norBNI pretreatment prevented all responses to difelikefalin and nalfurafine. Together, these findings demonstrate that difelikefalin and nalfurafine utilize central KOR pathways to elicit diuresis and a decrease in MAP but enhance renal tubular electrolyte reabsorption through a peripheral KOR pathway, providing important insight into two clinically useful KOR agonists.

Alcohol Use Is Associated With Intestinal Dysbiosis and Dysfunctional CD8+ T-Cell Phenotypes in Persons With Human Immunodeficiency Virus.

BACKGROUND: Inflammation persists among persons with human immunodeficiency virus (PWH) despite effective antiretroviral therapy and may contribute to T-cell dysfunction. Alcohol use is prevalent among PWH and promotes intestinal leak, dysbiosis, and a proinflammatory milieu. Whether alcohol use is associated with T-cell late differentiation remains to be investigated. METHODS: Data and samples from PWH (N = 359 of 365) enrolled in the New Orleans Alcohol Use in HIV Study were used. Alcohol use was assessed by self-report (Alcohol Use Disorders Identification Test; lifetime alcohol exposure; 30-day Alcohol Timeline Followback) and phosphatidylethanol (PEth) quantitation. In a subset of participants, fecal bacterial content was assessed by ribosomal 16S marker gene deep sequencing and quantitative polymerase chain reaction. Intestinal leak was assessed by fecal-to-plasma α-1-antitrypsin (A1AT) enzyme-linked immunosorbent assay ratio. Peripheral T-cell populations were quantified by flow cytometry. RESULTS: Alcohol Use Disorder Identification Test scores were positively associated with activated-senescent, exhausted, and terminal effector memory CD45RA+CD8+ but not CD4+ T cells (cells/µL) after confounder adjustment (P < .050). Phosphatidylethanol was positively associated with A1AT (P < .050). The PEth and activated-senescent CD8+ were associated with bacterial ß-diversity (P < .050) and positively associated with the relative abundance of coabundant Prevotellaceae members (q < .100). CONCLUSIONS: Alcohol use among PWH is associated with CD8+ T-cell late differentiation, intestinal leak, and dysbiosis. Alcohol-associated dysbiosis is implicated in CD8+ T-cell senescence.

Improving stereotypes: The impact of interprofessional education in pre-health students.

Research within interprofessional education (IPE) indicates health professional students hold stereotypes of other health professions at all stages within their academic journey. IPE can minimize negative stereotypes and influence a student's willingness and readiness to collaborate with others. This article explores undergraduate pre-health student stereotypes of various health professionals at the beginning and end of a six-week summer academic enrichment program, which included IPE. Convenience sampling was used to request participation in a survey, which included the Student Stereotypes Ratings Questionnaire (SSRQ). The SSRQ asks students to rate their perception of health professions on multiple traits. One hundred pre-health students across three institutions completed the SSRQ. The mean scores across all professions and all traits increased post-survey. Lowest pre-mean scores were for nursing (the ability to work independently and the ability to lead a team) and registered dietitian (the ability to lead a team). The highest pre-mean score was for the physician profession for academic ability. Results from this study indicate varying levels of stereotypes have already developed in pre-health students. After the six-week program, pre-health students' perceptions of health professions were positively affected. Data from this study indicates there are benefits to exposing pre-health students to IPE.

Assessing dental student perceptions after engaging in a longitudinal interprofessional education curriculum: A preliminary study.

PURPOSE/OBJECTIVES: Baseline IPE perceptions for dental students were gathered prior to the implementation of a 2-year formalised IPE curriculum at a US institution. The goal was to establish a baseline of student perceptions and, in the future, continue to track student IPE perception data with IPE engagement as one measure of outcomes. The purpose of this paper is to analyse two dental student cohort perceptions of IPE after engaging in a 2-year longitudinal curriculum. METHODS: First- and second-year students were required to participate in a 2-year IPE curriculum. As a requirement of the curriculum, students were asked to complete a validated IPE assessment, the Student Perceptions of Interprofessional Clinical Education-Revised instrument, version 2 (SPICE-R2). Students completed the SPICE-R2 survey, using a retrospective pretest/post-test design, after engaging in the 2-year curriculum. RESULTS: Sixty-four students in cohort 2017 and 70 students in cohort 2018 completed the entire SPICE-R2. Statistically significant positive changes (p < .05) were found in both dental student cohorts after engagement in the 2-year longitudinal IPE curriculum. CONCLUSION(S): A longitudinal IPE curriculum has the potential to impact student IPE perceptions. Additional longitudinal multi-institutional research is needed to determine best practices in delivery and learning.

Longitudinal interprofessional education in a graduate physiology course.

The primary purpose of conducting two interprofessional education (IPE) experiences during a multidisciplinary physiology graduate-level course was to provide basic science, physical therapy, and physician assistant graduate students opportunities to work as a team in the diagnosis, treatment, and collaborative care when presented with a patient case focused on acute kidney injury (first case) and female athlete triad (second case). The secondary purpose was to apply basic physiology principles to patient case presentations of pathophysiology. The overall purpose was to assess the longitudinal effects and the value of IPE integrated within a basic science course. The following Interprofessional Education Collaborative subcompetencies were targeted: roles/responsibilities (RR1, RR4). Students were given a pre- and postsurvey to assess their IPE perceptions and knowledge of professional roles. There were statistically significant increases from the presurvey renal IPE experience to the presurvey endocrine IPE experience for two perception questions regarding the ability to explain the roles and responsibilities of a physical therapist (PT) and physician assistant using a Likert scale. In addition, student knowledge of the role of a PT increased significantly when comparing the renal IPE presurvey to the endocrine IPE presurvey results to open-ended questions. Students' perceptions of their knowledge as well as their ability to express, in writing, their newly learned knowledge of the role of a PT was sustained over time. Incorporating multiple IPE experiences into multidisciplinary health science courses represents an appropriate venue to have students learn and apply interprofessional competencies.

Supporting health system transformation through an interprofessional education experience focused on population health.

The purpose of the study was to determine the impact of an interprofessional education (IPE) experience on first year students across all schools of a health sciences center on the topic of pediatric immunizations. The authors conducted a pre-/post-test at Louisiana State University Health Sciences Center-New Orleans with 731 first year students from 25 academic programs encompassing all six schools (Allied Health, Dentistry, Graduate Studies, Medicine, Nursing and Public Health). In the four questions related to the Interprofessional Education Collaborative (IPEC) sub-competencies and the three questions related to professional role regarding immunizations, there was a statistically significant difference in the pre-/post-test survey results (P < 0.0001). Student learning related to the collaboration needed to make a larger impact on patient outcomes was demonstrated through assessment of an open-ended question. IPE experiences can improve first-year students' perceptions of IPEC sub-competencies regarding the importance of population health and teamwork. By utilizing a population health focus with IPE activities, novice learners are equipped to learn and apply collaborative practice skills along with recognizing the importance of promoting overall health and well-being instead of just health care.

Supporting Health System Transformation: The development of an integrated interprofessional curriculum inclusive of public health students.

Under pressures to support health system transformation, many health professional accreditation organizations have incorporated standards requiring interprofessional education. However, the inclusion of population health topics and public health or health administration students into IPE experiences is limited. With the belief that understanding and cooperation among the health professions will be important to support health system transformation, The Louisiana State University Health Sciences Center-New Orleans has created several IPE experiences focused on population health, programs that are examined in this article along with insights that could prove useful for other programs seeking to build IPE into their regular curricula.

SNP interaction pattern identifier (SIPI): an intensive search for SNP-SNP interaction patterns.

Motivation: Testing SNP-SNP interactions is considered as a key for overcoming bottlenecks of genetic association studies. However, related statistical methods for testing SNP-SNP interactions are underdeveloped. Results: We propose the SNP Interaction Pattern Identifier (SIPI), which tests 45 biologically meaningful interaction patterns for a binary outcome. SIPI takes non-hierarchical models, inheritance modes and mode coding direction into consideration. The simulation results show that SIPI has higher power than MDR (Multifactor Dimensionality Reduction), AA_Full, Geno_Full (full interaction model with additive or genotypic mode) and SNPassoc in detecting interactions. Applying SIPI to the prostate cancer PRACTICAL consortium data with approximately 21 000 patients, the four SNP pairs in EGFR-EGFR , EGFR-MMP16 and EGFR-CSF1 were found to be associated with prostate cancer aggressiveness with the exact or similar pattern in the discovery and validation sets. A similar match for external validation of SNP-SNP interaction studies is suggested. We demonstrated that SIPI not only searches for more meaningful interaction patterns but can also overcome the unstable nature of interaction patterns. Availability and Implementation: The SIPI software is freely available at http://publichealth.lsuhsc.edu/LinSoftware/ . Contact: hlin1@lsuhsc.edu. Supplementary information: Supplementary data are available at Bioinformatics online.

The potential of interprofessional education to translate physiology curricula effectively into future team-based healthcare.

Incorporating active interprofessional education (IPE) opportunities into the classroom setting is a potentially effective mechanism to enhance student learning both in the basic sciences and for future interprofessional collaboration. We integrated an IPE exercise into a graduate-level human physiology course at our health sciences center that enrolled physician assistant (PA), physical therapy (PT), and graduate studies students. Our activity adopted and targeted the four Interprofessional Education Collaborative (IPEC) competency domains of values/ethics (VE), roles/responsibilities, interprofessional communication, and teams and teamwork (TT). Effectiveness of the training exercise was determined via pre- and postsurveys, which assessed student self-perceptions of IPEC competency domains, as well as student reflections and evaluations of the exercise itself. We noted a significant improvement in each of the targeted IPEC subcompetencies among all of the students, and within both PT and PA groups when analyzed separately. Moreover, a positive correlation was found between the number of previous IPE experiences and presurvey IPEC VE and TT subcompetency ratings. Our discoveries provide an example of broad acquisition of IPE learning within the context of a physiology curriculum. Perhaps more importantly, our findings indicate that a history of IPE training sets the stage for future IPE learning, reflecting a potential for IPE to transform basic physiological principles into team-based practice and improvement in patient outcomes.

Risk Factors for Severe Complications of Operative Mandibular Fractures.

PURPOSE: The purpose of the present study was to identify the risk factors for major complications developing during the operative treatment of mandibular fractures. PATIENTS AND METHODS: We conducted a retrospective medical record review of patients who had undergone open reduction, internal fixation of mandibular fractures from August 1, 2012 to December 31, 2014 at a large, urban teaching hospital and level 1 trauma center. The outcome variable of interest was major complications, defined as the occurrence of any one of the following events: hospital readmission, return to the operating room, and a prolonged, unexpected postoperative stay. Multiple demographic, social, medical, injury-related, and treatment-related variables were recorded during the medical record review. The relationships between these variables and our outcome variable were analyzed using univariate and multivariable logistic regression analyses. RESULTS: A total of 317 patients met the inclusion criteria. The hospital readmission rate was 7.2%, the reoperation rate was 9.5%, and the rate of unplanned, prolonged admission was 0.6%, for a total major complication rate of 11.4%. Eight variables reached statistical significance in their association with the occurrence of major complications. These were the presence of medical comorbidities, a diagnosis of depression, a diagnosis of a psychiatric disorder, incarceration, interpersonal violence as a mechanism of injury, the presence of a left angle fracture, the removal of a tooth in the line of fracture, and patient noncompliance. On multivariable analysis, patient noncompliance, depression, the presence of a left angle fracture, and the removal of a tooth in the line of fracture continued to have statistically significant associations with the occurrence of major complications. CONCLUSIONS: The identification of risk factors for the development of complications in mandibular trauma is a primary concern for surgeons in the modern healthcare system. The present study identified a number of variables significantly associated with an increased risk of the occurrence of major complications, and special consideration should be given to patients with these risk factors.

Effectiveness of interprofessional education in renal physiology curricula for health sciences graduate students.

The primary purpose of conducting an interprofessional education (IPE) experience during the renal physiology block of a graduate-level course was to provide basic science, physical therapy, and physician assistant graduate students with an opportunity to work as a team in the diagnosis, treatment, and collaborative care of a patient with acute kidney injury. The secondary purpose was to enhance the understanding of basic renal physiology principles with a patient case presentation of renal pathophysiology. The overall purpose was to assess the value of IPE integration within a basic science course by examining student perceptions and program evaluation. Graduate-level students operated in interprofessional teams while working through an acute kidney injury patient case. The following Interprofessional Education Collaborative subcompetencies were targeted: Roles/Responsibilities (RR) Behavioral Expectations (RR1, RR4) and Interprofessional Communication (CC) Behavioral Expectations (CC4). Clinical and IPE stimulus questions were discussed both within and between teams with assistance provided by faculty facilitators. Students were given a pre- and postsurvey to determine their knowledge of IPE. There were statistically significant increases from pre- to postsurvey scores for all six IPE questions for all students. Physical therapy and physician assistant students had a statistically significant increase in pre- to postsurvey scores, indicating a more favorable perception of their interprofessional competence for RR1, RR4, and CC4. No changes were noted in pre- to postsurvey scores for basic science graduate students. Incorporating planned IPE experiences into multidisciplinary health science courses represents an appropriate venue to have students learn and apply interprofessional competencies.

A Bayesian sequential design with binary outcome.

Several researchers have proposed solutions to control type I error rate in sequential designs. The use of Bayesian sequential design becomes more common; however, these designs are subject to inflation of the type I error rate. We propose a Bayesian sequential design for binary outcome using an alpha-spending function to control the overall type I error rate. Algorithms are presented for calculating critical values and power for the proposed designs. We also propose a new stopping rule for futility. Sensitivity analysis is implemented for assessing the effects of varying the parameters of the prior distribution and maximum total sample size on critical values. Alpha-spending functions are compared using power and actual sample size through simulations. Further simulations show that, when total sample size is fixed, the proposed design has greater power than the traditional Bayesian sequential design, which sets equal stopping bounds at all interim analyses. We also find that the proposed design with the new stopping for futility rule results in greater power and can stop earlier with a smaller actual sample size, compared with the traditional stopping rule for futility when all other conditions are held constant. Finally, we apply the proposed method to a real data set and compare the results with traditional designs.

Chronic binge alcohol administration impairs glucose-insulin dynamics and decreases adiponectin in asymptomatic simian immunodeficiency virus-infected macaques.

Alcohol use disorders (AUDs) frequently exist among persons living with HIV/AIDS. Chronic alcohol consumption, HIV infection, and antiretroviral therapy (ART) are independently associated with impairments in glucose-insulin dynamics. Previous studies from our laboratory have shown that chronic binge alcohol (CBA) administration decreases body mass index, attenuates weight gain, and accentuates skeletal muscle wasting at end-stage disease in non-ART-treated simian immunodeficiency virus (SIV)-infected male rhesus macaques. The aim of this study was to investigate whether CBA and ART alone or in combination alter body composition or glucose-insulin dynamics in SIV-infected male rhesus macaques during the asymptomatic phase of SIV infection. Daily CBA or sucrose (SUC) administration was initiated 3 mo before intrarectal SIV inoculation and continued until the study end point at 11 mo post-SIV infection. ART or placebo was initiated 2.5 mo after SIV infection and continued until study end point. Four treatment groups (SUC/SIV ± ART and CBA/SIV ± ART) were studied. CBA/SIV macaques had significantly decreased circulating adiponectin and resistin levels relative to SUC/SIV macaques and reduced disposition index and acute insulin response to glucose, insulin, and C-peptide release during frequently sampled intravenous glucose tolerance test, irrespective of ART status. No statistically significant differences were observed in homeostatic model assessment-insulin resistance values, body weight, total body fat, abdominal fat, or total lean mass or bone health among the four groups. These findings demonstrate CBA-mediated impairments in glucose-insulin dynamics and adipokine profile in asymptomatic SIV-infected macaques, irrespective of ART.

Student perceptions about interprofessional education after an elective course.

A growing body of evidence indicates interprofessional collaborative practice improves patient care. With this in mind, Louisiana State University Health Sciences Center formally committed to expanding interprofessional education (IPE) initiatives. Thirty-eight self-selected students enrolled in an IPE elective course during the fall of 2012. Students completed the Readiness for Interprofessional Learning Scale (RIPLS) pre- and post-course and also completed a post-course survey. Results indicated a significant change in the roles and responsibilities scale of the RIPLS. Analysis of the data from the post-course survey demonstrated students were able to identify key terms of an IPE definition, as related to their learning experience. In addition, themes of communication, learning/increased knowledge, and collaboration/contribution of other health care professionals were noted across all questions in the post-course survey. Based on the results of this study, an elective course is a promising educational opportunity to increase awareness and knowledge of IPE within academic medical centers.

Current oral hygiene and recreational behavioral trends in HIV disease.

OBJECTIVE: HIV disease is evolving with more HIV+ persons experiencing a high quality of life with well-controlled viremia. We recently enrolled a large cohort of HIV+ and clinically relevant HIV- persons for oral microbiome analyses that included a questionnaire related to oral hygiene and recreational behaviors. Here, the questionnaire responses were analyzed for behavioral trends within the cohort, together with trends over time by comparison to a previous geographically centered HIV+ cohort. METHODS: Data were collected by questionnaire at baseline visits as cross-sectional assessments. Multivariable analyses were conducted for associations of HIV status as well as age, race, and sex, on oral hygiene/recreational behaviors. RESULTS: HIV+ subjects had reduced brushing frequency, but increased incidence of past cleanings and frequency of dry mouth, compared to the HIV- subjects. Within the entire cohort, positive associations were identified between age and several oral hygiene practices, and between age, race, and sex for several recreational behaviors. In comparison to the historical cohort, the contemporary HIV+ cohort participated in fewer high-risk behaviors, but with similar trends for smoking and oral hygiene practices. CONCLUSION: HIV status had little association with oral hygiene and recreational behaviors despite several differences in age, race, and sex. Behavioral trends over time support a higher quality of life in people currently living with HIV.

Horizontal augmentation of thin maxillary ridge with bovine particulate xenograft is stable during 500 days of follow-up: preliminary results of 12 consecutive patients.

PURPOSE: The purpose of our evaluation was to determine the stability of the horizontal augmentation of the anterior maxilla using particulate bovine xenograft under a membrane. The hypothesis to be tested was that bovine particulate graft material is effective for augmenting the narrow ridge of the anterior maxilla and can maintain its augmentation dimension within 1 mm over time. MATERIALS AND METHODS: A consecutive series of 12 patients who received a bovine particulate graft were evaluated in a retrospective manner. Using a standardized method, their cone beam scans were measured for width at 3 vertical locations preoperatively (T0), immediately after the augmentation (T1), 3 to 6 months after augmentation and before implant placement (T2), immediately after implant placement (T3), and at the longest postoperative point (T4). One examiner, who was not involved in the surgical procedures, measured all the radiographs. The intraexaminer error approximated 0.2 mm in all areas of measurements. A linear mixed effects model was used to determine the stability of the augmentation over time. RESULTS: The most coronal aspect of the crest had the least width augmentation. The midway region and apical region had the greatest width changes (P < .001). Within the sample size, there were no statistically significant differences in width changes over time after augmentation was performed. CONCLUSIONS: Within the limitations of this sample, horizontal ridge augmentation using bovine particulate material under a membrane was stable over time in the anterior maxilla.

Development of a Common Clinical Assessment Tool for Evaluation in Nurse Anesthesia Education.

There is a lack of standardization among evaluations completed by clinical educators of student registered nurse anesthetists (SRNAs) during their clinical education as reported by nurse anesthesia program administrators and students. To address this issue, the Council on Accreditation of Nurse Anesthesia Educational Programs (COA) Board created the Common Clinical Assessment Tool (CCAT) Special Interest Group to develop a standardized clinical evaluation instrument. The goal was to improve the consistency of clinical evaluation across nurse anesthesia programs while assisting program administrators to make programmatic changes to ensure compliance with COA standards. In May 2016, the CCAT Special Interest Group began to create an evaluation instrument that was competency based and reflective of the COA's Practice Doctorate Standards. After a review of literature, input from the communities of interest, results from the American Association of Nurse Anesthetists professional practice survey, and analysis of the National Certification Examination for Nurse Anesthetists content outline and information from other sources, a draft CCAT was completed. A Delphi study was conducted, and expert opinions from program administrators, academic and clinical faculty, and students were collected to ascertain consensus on competencies, competency descriptors, and progression indicators.

Hyperbaric oxygen therapy for mild traumatic brain injury persistent postconcussion syndrome: a randomized controlled trial.

Persistent postconcussion syndrome (PPCS) after mild traumatic brain injury (mTBI) is a significant public health and military problem for which there is limited treatment evidence. The aim of this study was to determine whether forty 150 kPa hyperbaric oxygen therapies (HBOTs) can improve symptoms and cognitive function in subjects with the PPCS of mTBI, using a randomized controlled crossover design with 2-month follow-up. Sixty-three civilian and military subjects with mTBI/PPCS were randomized to either 40 HBOTs at 150 kPa/60 minutes, once daily, 5 days per week in 8 weeks or an equivalent no-treatment control period. The Control Group was then crossed over to HBOT. Subjects underwent symptom, neuropsychological, and psychological testing, before and after treatment or control with retesting 2 months after the 40th HBOT. Fifty subjects completed the protocol with primary outcome testing. HBOT subjects experienced significant improvements in Neurobehavioral Symptom Inventory, Memory Index, Automated Neuropsychological Assessment Metrics, Hamilton Depression Scale, Hamilton Anxiety Scale, Post-Traumatic Stress Disorder Checklist, Pittsburgh Sleep Quality Index, and Quality Of Life after Brain Injury compared to the Control Group. After crossing over to HBOT the Control Group experienced near-identical significant improvements. Further improvements were experienced by both groups during the 2-month follow-up period. These data indicate that 40 HBOTs at 150 kPa/60 minutes demonstrated statistically significant improvements in postconcussion and Post-Traumatic Stress Disorder symptoms, memory, cognitive functions, depression, anxiety, sleep, and quality of life in civilian and military subjects with mTBI/PPCS compared to controls. Improvements persisted at least 2 months after the 40th HBOT. The study was registered on ClinicalTrials.gov (NCT02089594) on March 18, 2014 and with the U.S. Food and Drug Administration under Investigational New Drug #113823. The Institutional Review Boards of the United States Army Medical Research and Materiel Command Office of Research Protections Human Research Protection Office and the Louisiana State University School of Medicine (approval No. 7381) approved the study on May 13, 2014 and December 20, 2013, respectively.

Lifetime alcohol use among persons living with HIV is associated with frailty.

BACKGROUND: The average lifespan of persons living with HIV (PLWH) on antiretroviral therapy approximates the general population. However, PLWH are susceptible to early aging and frailty. Behaviors such as alcohol consumption may contribute to frailty among PLWH. OBJECTIVE: To determine the relationships between recent and lifetime alcohol use and frailty among PLWH. DESIGN: Cross-sectional, prospective cohort study of in-care PLWH (n = 365) participating in the New Orleans Alcohol Use in HIV Study. METHODS: Recent alcohol exposure was measured by the 30-day alcohol timeline follow-back (TLFB) assessment and by whole-blood-spot phosphatidylethanol (PEth) quantitation. Lifetime alcohol exposure (LAE) was estimated by a modified lifetime drinking history instrument. Frailty was assessed by a 58-item deficit index (DI58) and the phenotypic frailty index (PFI). The Veterans Aging Cohort Study Risk Index 2.0 was calculated. RESULTS: Using generalized linear regression, LAE was positively associated with the DI58 (95% CI 0.001--0.006) and PFI severity (95% CI 0.004--0.023) after adjustment for age and other factors. Conversely, recent alcohol exposure was negatively associated with the DI58 [TLFB 95% CI: (-0.126 to -0.034), PEth: (-0.163 to -0.058)] and PFI severity [TLFB 95% CI (-0.404 to -0.015), PEth (-0.406 to 0.034)]. The VACS was not associated with alcohol use. Median per-decade alcohol exposure peaked in the second decade and tapered with aging thereafter. Increasing LAE and decreasing TLFB were co-associated with a specific subset of health deficits. CONCLUSION: Lifetime alcohol use is positively associated with frailty among PLWH. Specific health deficits may discourage alcohol consumption in some PLWH.