pinecone/core-2020-05-10-deduplication huggingface dataset:
Contribution of body mass index to postoperative outcome in minority patients

OBJECTIVE:  The purpose of this investigation was to examine the association of body mass index (BMI) category with short‐term outcomes in minority surgical patients—a relationship that previously has not been well characterized.    METHODS:  Data from the National Surgical Quality Improvement Program were used to calculate the BMI of minority patients undergoing surgery from 2005 to 2008. Patients were stratified into 5 BMI classes. Stepwise logistic regression was used to calculate odds ratios for mortality after controlling for known clinically relevant covariates.    MAIN OUTCOME MEASURES:  Morbidity and mortality at 30 days, across all 5 BMI classes.    RESULTS:  Among 119,619 minority patients studied, 50% were African American, 36% Hispanic, 10% Asian and Pacific Islanders, and 4% American Indian and Alaskan natives. Seventy percent were overweight or obese. Women were more likely to be obese or severely obese. The overall mortality rate was 1.5%, and this varied significantly by BMI class. Distribution of 30‐day mortality demonstrated a progressive decrease, with the highest risk of death in the underweight class, and the lowest risk of death in the severely obese class. This relationship was maintained, even in patients with at least 1 major postoperative complication.    CONCLUSION:  The prevalence of being overweight or obese was high in this nationally representative cohort of minority surgical patients. Although BMI class is a significant predictor of 30‐day mortality, the effect appeared paradoxical. The poorest outcomes were in the underweight and normal BMI patients. Severely obese patients had the lowest risk of mortality, even after experiencing a major postoperative complication. Journal of Hospital Medicine 2012; © 2011 Society of Hospital Medicine
Factors associated with HIV testing among young men who have sex with men in Myanmar : a cross-sectional study

Introduction: In Myanmar, men who have sex with men (MSM) experience high risk of HIV infection. However, access to HIV testing and prevention services remains a challenge among this marginalized population. The objective of this study was to estimate population prevalence and correlates of prior HIV testing among young MSM (YMSM) and informs the development of HIV testing and intervention programmes that respond to the specific needs of this population. 
Methods: Five hundred and eighty-five YMSM aged 18 to 24 years were recruited using respondent-driven sampling (RDS) in a cross-sectional survey conducted in six townships of Myanmar. RDS-adjusted population estimates were calculated to estimate prevalence of HIV testing; RDS-weighted logistic regression was used to examine correlates of HIV testing in the past 6 months and in a lifetime. 
Results: There were 12 participants who reported receiving a HIV-positive test; of those, five were tested in the past 6 months. The RDS-weighted prevalence estimates of lifetime (any prior) HIV testing was 60.6% (95% CI: 53.3% to 66.4%) and of recent (<= 6 months) HIV testing was 50.1% (95% CI: 44.1% to 55.5%). In multivariable analysis, sexual identity was associated with lifetime but not recent HIV testing. Lifetime and recent HIV testing were associated with having three or more male sexual partners in the past 12 months (adjusted ORs (aORs) = 2.28, 95% CIs: 1.21 to 4.32 and 2.69, 95% CI: 1.59 to 4.56), having good HIV-related knowledge (aORs = 1.96, 95% CIs: 1.11 to 3.44 and 1.77, 95% CI: 1.08 to 2.89), reporting high HIV testing self-efficacy (aORs = 13.5, 95% CIs: 6.0 to 30.1 and 9.81, 95% CI: 4.27 to 22.6) and having access to and use of non-HIV health-related services in the past 12 months (aORs = 13.2, 95% CIs: 6.85 to 25.6 and 7.15, 95% CI: 4.08 to 12.5) respectively. 
Conclusions: HIV testing coverage among YMSM aged 18 to 24 years old in Myanmar is still suboptimal. Integrated HIV testing and prevention services in existing health service provision systems with tailored HIV information and education programmes targeting YMSM to improve HIV-related knowledge and self-efficacy may help to promote regular HIV testing behaviour and contribute to sustainable control of the HIV epidemic among this marginalized population in Myanmar
Predictors of timely linkage-to-ART within universal test and treat in the HPTN 071 (PopART) trial in Zambia and South Africa: findings from a nested case-control study

Introduction HPTN 071 (PopART) is a three-arm community randomized trial in Zambia and South Africa evaluating the impact of a combination HIV prevention package, including universal test and treat (UTT), on HIV incidence. This nested study examined factors associated with timely linkage-to-care and ART initiation (TLA) (i.e. within six-months of referral) in the context of UTT within the intervention communities of the HPTN 071 (PopART) trial. Methods Of the 7572 individuals identified as persons living with HIV (PLWH) (and not on antiretroviral treatment (ART)) during the first year of the PopART intervention provided by Community HIV-care Providers (CHiPs) through door-to-door household visits, individuals who achieved TLA (controls) and those who did not (cases), stratified by gender and community, were randomly selected to be re-contacted for interview. Standardized questionnaires were administered to explore factors potentially associated with TLA, including demographic and behavioural characteristics, and participants’ opinions on HIV and related services. Odds ratios comparing cases and controls were estimated using a multi-variable logistic regression. Results Data from 705 participants (333 cases/372 controls) were analysed. There were negligible differences between cases and controls by demographic characteristics including age, marital or socio-economic position. Prior familiarity with the CHiPs encouraged TLA (aOR of being a case: 0.58, 95% CI: 0.39 to 0.86, p = 0.006). Participants who found clinics overcrowded (aOR: 1.51, 95% CI: 1.08 to 2.12, p = 0.006) or opening hours inconvenient (aOR: 1.63, 95% CI: 1.06 to 2.51, p = 0.02) were less likely to achieve TLA, as were those expressing stronger feelings of shame about having HIV (ptrend = 0.007). Expressing “not feeling ready” (aOR: 2.75, 95% CI: 1.89 to 4.01, p < 0.001) and preferring to wait until they felt sick (aOR: 2.00, 95% CI: 1.27 to 3.14, p = 0.02) were similarly indicative of being a case. Worrying about being seen in the clinic or about how staff treated patients was not associated with TLA. While the association was not strong, we found that the greater the number of self-reported lifetime sexual partners the more likely participants were to achieve TLA (ptrend = 0.06). There was some evidence that participants with HIV-positive partners on ART were less likely to be cases (aOR: 0.75, 95% CI: 0.53 to 1.06, p = 0.07). Discussion The lack of socio-demographic differences between cases and controls is encouraging for a “universal” intervention that seeks to ensure high coverage across whole communities. Making clinics more “patient-friendly” could enhance treatment uptake further. The finding that those with higher risk behaviour are more actively engaging with UTT holds promise for treatment-as-prevention
The effectiveness and cost-effectiveness of community-based support for adolescents receiving antiretroviral treatment: an operational research study in South Africa

INTRODUCTION: Adolescents and youth receiving antiretroviral treatment (ART) in sub-Saharan Africa have high attrition and
inadequate ART outcomes, and evaluations of interventions improving ART outcomes amongst adolescents are very limited.
Sustainable Development Goal (SDG) target 3c is to substantially increase the health workforce in developing countries. We
measured the effectiveness and cost-effectiveness of community-based support (CBS) provided by lay health workers for adolescents
and youth receiving ART in South Africa.
METHODS: A retrospective cohort study including adolescents and youth who initiated ART at 47 facilities. Previously unemployed
CBS-workers provided home-based ART-related education, psychosocial support, symptom screening for opportunistic
infections and support to access government grants. Outcomes were compared between participants who received CBS plus
standard clinic-based care versus participants who received standard care only. Cumulative incidences of all-cause mortality
and loss to follow-up (LTFU), adherence measured using medication possession ratios (MPRs), CD4 count slope, and virological
suppression were analysed using multivariable Cox, competing-risks regression, generalized estimating equations and mixedeffects
models over five years of ART. An expenditure approach was used to determine the incremental cost of CBS to usual
care from a provider perspective. Incremental cost-effectiveness ratios were calculated as annual cost per patient-loss
(through death or LTFU) averted.
RESULTS: Amongst 6706 participants included, 2100 (31.3%) received CBS. Participants who received CBS had reduced mortality,
adjusted hazard ratio (aHR) = 0.52 (95% CI: 0.37 to 0.73; p < 0.0001). Cumulative LTFU was 40% lower amongst participants
receiving CBS (29.9%) compared to participants without CBS (38.9%), aHR = 0.60 (95% CI: 0.51 to 0.71);
p < 0.0001). The effectiveness of CBS in reducing attrition ranged from 42.2% after one year to 35.9% after five years. Virological
suppression was similar after three years, but after five years 18.8% CBS participants versus 37.2% non-CBS participants
failed to achieve viral suppression, adjusted odds ratio = 0.24 (95% CI: 0.06 to 1.03). There were no significant
differences in MPR or CD4 slope. The cost of CBS was US$49.5/patient/year. The incremental cost per patient-loss averted
was US$600 and US$776 after one and two years, respectively.
CONCLUSIONS: CBS for adolescents and youth receiving ART was associated with substantially reduced patient attrition, and is
a low-cost intervention with reasonable cost-effectiveness that can aid progress towards several health, economic and equality-
related SDG targets
Hep-CORE: a cross-sectional study of the viral hepatitis policy
                environment reported by patient groups in 25 European countries
                in 2016 and 2017

INTRODUCTION: The first World Health Organization (WHO) global
                health sector strategy on hepatitis B and C viruses (HBV and
                HCV) has called for the elimination of viral hepatitis as a
                major public health threat by 2030. This study assesses policies
                and programmes in support of elimination efforts as reported by
                patient groups in Europe. METHODS: In 2016 and 2017, hepatitis
                patient groups in 25 European countries participated in a
                cross-sectional survey about their countries' policy responses
                to HBV and HCV. The English-language survey addressed overall
                national response; public awareness/engagement; disease
                monitoring; prevention; testing/diagnosis; clinical assessment;
                and treatment. We performed a descriptive analysis of data and
                compared 2016 and 2017 findings. RESULTS: In 2017, 72% and 52%
                of the 25 European study countries were reported to not have
                national HBV and HCV strategies respectively. The number of
                respondents indicating that their governments collaborated with
                civil society on viral hepatitis control increased from 13 in
                2016 to 18 in 2017. In both 2016 and 2017, patient groups
                reported that 9 countries (36%) have disease registers for HBV
                and 11 (44%) have disease registers for HCV. The number of
                countries reported to have needle and syringe exchange
                programmes available in all parts of the country dropped from 10
                (40%) in 2016 to 8 in 2017 (32%). In both 2016 and 2017, patient
                groups in 5 countries (20%) reported that HCV treatment is
                available in non-hospital settings. From 2016 to 2017, the
                reported number of countries with no restrictions on access to
                direct-acting antivirals for HCV increased from 3 (12%) to 7
                (28%), and 5 fewer countries were reported to refuse treatment
                to people who are currently injecting drugs. CONCLUSIONS: The
                patient-led Hep-CORE study offers a unique perspective on the
                readiness of study countries to undertake comprehensive viral
                hepatitis elimination efforts. Viral hepatitis monitoring should
                be expanded to address policy issues more comprehensively and to
                incorporate civil society perspectives, as is the case with
                global HIV monitoring. Policy components should also be
                explicitly added to the WHO framework for monitoring
                country-level progress against viral hepatitis
Gender differences in the use of cardiovascular interventions in HIV-positive persons; the D:A:D Study

INTRODUCTION  There is paucity of data related to potential gender differences in the use of interventions to prevent and treat cardiovascular disease (CVD) among HIV-positive individuals. We investigated whether such differences exist in the observational D:A:D cohort study.  METHODS  Participants were followed from study enrolment until the earliest of death, six months after last visit or February 1, 2015. Initiation of CVD interventions [lipid-lowering drugs (LLDs), angiotensin-converting enzyme inhibitors (ACEIs), anti-hypertensives, invasive cardiovascular procedures (ICPs) were investigated and Poisson regression models calculated whether rates were lower among women than men, adjusting for potential confounders.  RESULTS  Women (n = 12,955) were generally at lower CVD risk than men (n = 36,094). Overall, initiation rates of CVD interventions were lower in women than men; LLDs: incidence rate 1.28 [1.21, 1.35] vs. 2.40 [2.34, 2.46]; ACEIs: 0.88 [0.82, 0.93] vs. 1.43 [1.39, 1.48]; anti-hypertensives: 1.40 [1.33, 1.47] vs. 1.72 [1.68, 1.77] and ICPs: 0.08 [0.06, 0.10] vs. 0.30 [0.28, 0.32], and this was also true for most CVD interventions when exclusively considering periods of follow-up for which individuals were at high CVD risk. In fully adjusted models, women were less likely to receive CVD interventions than men (LLDs: relative rate 0.83 [0.78, 0.88]; ACEIs: 0.93 [0.86, 1.01]; ICPs: 0.54 [0.43, 0.68]), except for the receipt of anti-hypertensives (1.17 [1.10, 1.25]).  CONCLUSION  The use of most CVD interventions was lower among women than men. Interventions are needed to ensure that all HIV-positive persons, particularly women, are appropriately monitored for CVD and, if required, receive appropriate CVD interventions
The impact of population dynamics on the population HIV care cascade: results from the ANRS 12249 Treatment as Prevention\ud
trial in rural KwaZulu-Natal (South Africa)

Introduction\ud
The universal test and treat strategy (UTT) was developed to maximize the proportion of all HIV‐positive individuals on antiretroviral treatment (ART) and virally suppressed, assuming that it will lead to a reduction in HIV incidence at the population level. The evolution over time of the cross‐sectional HIV care cascade is determined by individual longitudinal trajectories through the HIV care continuum and underlying population dynamics. The purpose of this paper is to quantify the contribution of each component of population change (in‐ and out‐migration, HIV seroconversion, ageing into the cohort and definitive exit such as death) on the HIV care cascade in the context of the ANRS 12249 Treatment as Prevention (TasP) cluster‐randomized trial, investigating UTT in rural KwaZulu‐Natal, South Africa, between 2012 and 2016.\ud
\ud
Methods\ud
HIV test results and information on clinic visits, ART prescriptions, viral load and CD4 count, migration and deaths were used to calculate residency status, HIV status and HIV care status for each individual on a daily basis. Position within the HIV care continuum was considered as a score ranging from 0 (undiagnosed) to 4 (virally suppressed). We compared the cascade score of each individual joining or leaving the population of resident adults living with HIV with the average score of their cluster at the time of entry or exit. Then, we computed the contribution of each entry or exit on the average cascade score and their annualized total contribution, by component of change.\ud
\ud
Results\ud
While the average cascade score increased over time in all clusters, that increase was constrained by population dynamics. Permanent exits and ageing into the people living with HIV cohort had a marginal effect. Both in‐migrants and out‐migrants were less likely to be retained at each step of the HIV care continuum. However, their overall impact on the cross‐sectional cascade was limited as the effect of in‐ and out‐migration balanced each other. The contribution of HIV seroconversions was negative in all clusters.\ud
\ud
Conclusions\ud
In a context of high HIV incidence, the continuous flow of newly infected individuals slows down the efforts to increase ART coverage and population viral suppression, ultimately attenuating any population‐level impact on HIV incidence.\ud
\ud
Clinical Trial Number\ud
NCT01509508 (clinicalTrials.gov)/DOH‐27‐0512‐3974 (South African National Clinical Trials Register)
“In the United States, we say, ‘No breastfeeding,’ but that is no longer realistic” : provider perspectives towards infant feeding among women living with HIV in the United States.

Introduction:\ud
Currently, the United States (U.S.) recommends that infants born to women living with HIV (WLHIV) be fed formula, whereas many low‐resource settings follow the World Health Organization's recommendation to exclusively breastfeed with ongoing antiretroviral therapy. Evidence on infant feeding among WLHIV in high‐resource countries suggest that these contrasting recommendations create challenges for providers and patients. Our study used multiple methods to understand providers’ infant feeding perspectives on caring for their pregnant and post‐partum WLHIV in the U.S.\ud
\ud
Methods:\ud
We sent a survey (n = 93) to providers across the U.S. who have cared for WLHIV. A subset of survey participants opted into a follow‐up qualitative interview (n = 21). These methods allowed us to capture a broad understanding of provider attitudes via the survey and more nuanced qualitative interviews. The study was completed prior to an updated breastfeeding section of the U.S. Perinatal Guidelines.\ud
\ud
Results:\ud
The majority of providers (66.7%) discussed infant feeding intent with their patients using open‐ended questions. Many also discussed alternative feeding methods (37.6%) and disclosure avoidance strategies (34.4%). Over 75% (95% confidence interval (CI): 65.1 to 84.2) of participants reported that a WLHIV asked if she could breastfeed her child, and 29% (95% CI 20 to 40.3) reported caring for a patient who breastfed despite recommendations against breastfeeding. Providers reported that their patients’ primary concern was stigma associated with not breastfeeding (58%), while providers were primarily concerned about medication adherence during breastfeeding (70%). Through qualitative analysis, four overarching categories emerged that reflect providers’ sentiments, including (1) U.S. guidelines inadequately addressing WLHIV's desire to breastfeed; (2) negotiating patient autonomy amidst complex feeding situations; (3) harm reduction approaches to supporting WLHIV in breastfeeding; and (4) providers anticipating multilayered patient stigmatization.\ud
\ud
Conclusions:\ud
The majority of provider respondents cared for a WLHIV who desired to breastfeed, and a third had WLHIV who breastfed despite recommendations against it. Providers found that the status of U.S. guidelines and their incongruity with WHO guidelines left them without adequate resources to support WLHIV's infant feeding decisions. Our findings provide important insight to inform professional associations’ discussions about public health policy as they consider future directions for infant feeding guidelines among WLHIV
Maintaining yeast viability in continuous primary beer fermentation

Continuous fermentation is a long known and vastly studied process. The use of immobilized cell technology (ICT) is exploited in a significant number of studies owing to the associated high volumetric productivity, time savings and low capital demand. This work was aimed at solving one of the most relevant obstacles to implementing ICT on a large scale in beer fermentations, namely the control of biomass and the maintenance of cell viability in a gas-lift bioreactor. For this purpose, foam fractionation by skimming was proposed as a tool for control of continuous biomass concentration. The consequences of foaming on lignocellulosic yeast carrier losses were assessed and discussed. A steady consumption of sugars from wort, as well as consistent ethanol production, were achieved. The viability of the suspended cells in the reactor was compared with that of the cell population in the foam using flow cytometry. Results suggest that foam might be used as a promising tool to skim non-viable biomass out of the gas-lift reactor, thus ensuring the maintenance of a cell culture with optimum viability. Copyright © 2014 The Institute of Brewing & DistillingEduardo Pires gratefully acknowledges the Fundacao para a Ciencia e a Tecnologia (FCT, Portugal) for PhD fellowship support (SFRH/BD/61777/2009) and Cristina Ribeiro from the Centre of Molecular and Environmental Biology/Department of Biology for technical support. This work was also supported by FEDER through POFC - COMPETE and by national funds from FCT through the project PEst-C/BIA/UI4050/2011. The materials supplied by UNICER Bebidas, S.A. (S. Mamede de Infesta, Portugal) are gratefully acknowledged. The financial contributions of the EU FP7 project EcoBioCAP - Ecoefficient Biodegradable Composite Advanced Packaging, grant agreement no. 265669 as well as of the Grant Agency of the Czech Republic (project GACR P503/12/1424) are also gratefully acknowledged
Production of indigenous alcoholic beverages in a rural village of Cameroon

In this study, the indigenous alcoholic beverages in a rural village of Cameroon were investigated. The technique for producing alcoholic beverages in the village was observed, and the concentrations of ethanol, glucose and lactic acid and the pH values during the course of production were measured using portable devices at the field site. Eight different kinds of alcoholic beverage (palm wine, palm spirits, raffia wine, cassava spirits, maize turbid beer, maize spirits, plantain wine and plantain spirits) were produced and consumed in the village. Of these beverages, palm wine, made from palm sap, was the most important alcoholic beverage in a villager's daily life. In addition, starch-based alcoholic beverages were distilled rather than drunk directly. As germinated maize, which has a relatively low amylase activity, was used as an amylase source in production, starch-based alcoholic beverages might need to be distilled to enhance the ethanol concentration. During the course of production, the pH was reduced using local techniques, which proved to be effective in preventing bacterial contamination