Estimating HIV incidence and detection rates from surveillance data

BACKGROUND: Markov models that incorporate HIV test information can increase precision in estimates of new infections and permit the estimation of detection rates. The purpose of this study was to assess the functioning of a Markov model for estimating new HIV infections and HIV detection rates in Louisiana using surveillance data. METHODS: We expanded a discrete-time Markov model by accounting for the change in AIDS case definition made by the Centers for Disease Control and Prevention in 1993. The model was applied to quarterly HIV/AIDS surveillance data reported in Louisiana from 1981 to 1996 for various exposure and demographic subgroups. When modeling subgroups defined by exposure categories, we adjusted for the high proportion of missing exposure information among recent cases. We ascertained sensitivity to changes in various model assumptions. RESULTS: The model was able to produce results consistent with other sources of information in the state. Estimates of new infections indicated a transition of the HIV epidemic in Louisiana from (1) predominantly white men and men who have sex with men to (2) women, blacks, and high-risk heterosexuals. The model estimated that 61% of all HIV/AIDS cases were detected and reported by 1996, yet half of all HIV/non-AIDS cases were yet to be detected. Sensitivity analyses demonstrated that the model was robust to several uncertainties. CONCLUSIONS: In general, the methodology provided a useful and flexible alternative for estimating infection and detection trends using data from a U.S. surveillance program. Its use for estimating current infection will need further exploration to address assumptions related to newer treatments.     

Contrast‐enhanced whole‐heart coronary MRI with bolus infusion of gadobenate dimeglumine at 1.5 T

We sought to investigate the T₁ kinetics of blood and myocardium after three infusion schemes of gadobenate dimeglumine (Gd‐BOPTA) and subsequently compared contrast‐enhanced whole‐heart coronary MRI after a bolus Gd‐BOPTA infusion with nonenhanced coronary MRI at 1.5 T. Blood and myocardium T₁ was measured in seven healthy adults, after each underwent three Gd‐BOPTA infusion schemes (bolus: 0.2 mmol/kg at 2 mL/sec, hybrid: 0.1 mmol/kg at 2 mL/sec followed by 0.1 mmol/kg at 0.1 mL/sec, and slow: 0.2 mmol/kg at 0.3 mL/sec). Fourteen additional subjects underwent contrast‐enhanced coronary MRI with an inversion‐recovery steady‐state free precession sequence after bolus Gd‐BOPTA infusion. Images were compared with nonenhanced T₂‐prepared steady‐state free precision whole‐heart coronary MRI in signal‐to‐noise ratio, contrast‐to‐noise ratio, depicted vessel length, vessel sharpness, and subjective image quality. Bolus and slow infusion schemes resulted in similar T₁ during coronary MRI, whereas the hybrid infusion method yielded higher T₁ values. A bolus infusion of Gd‐BOPTA significantly improved signal‐to‐noise ratio, contrast‐to‐noise ratio, depicted coronary artery length, and subjective image quality, when all segments were collectively compared but not when compared segment by segment. In conclusion, whole‐heart steady‐state free precision coronary MRI at 1.5 T can benefit from a bolus infusion of 0.2 mmol/kg Gd‐BOPTA. Magn Reson Med, 2011. © 2010 Wiley‐Liss, Inc.     

Noncontrast SSFP pulmonary vein magnetic resonance angiography: impact of off-resonance and flow

Purpose

To investigate pulmonary vein (PV) off‐resonance and blood flow as causes of signal void artifacts in noncontrast steady‐state‐free‐precession (SSFP) PV magnetic resonance angiography (MRA).

Materials and Methods

PV blood off‐resonance was measured on 11 healthy adult subjects and 10 atrial fibrillation (AF) patients. Noncontrast PV MRA was performed using a 3D slab‐selective SSFP sequence at 1.5T on seven healthy subjects with signal profile shifts of 0–125 Hz. The time‐resolved blood flow velocity of the PVs was measured on five healthy subjects. The impact of flow was studied on six healthy subjects, on whom SSFP PV MRA was acquired twice with the electrocardiogram (ECG) trigger delay corresponding to low and high flow, respectively.

Results

The PV off‐resonances were 97 ± 27 Hz, 65 ± 20 Hz, 74 ± 25 Hz, and 52 ± 17 Hz for right inferior, left inferior, right superior, and left superior PVs, respectively, on healthy subjects, and 74 ± 20 Hz, 38 ± 9 Hz, 51 ± 20 Hz, and 28 ± 11 Hz on AF patients (P<0.01 for all). The off‐resonance caused severe signal voids in the PVs. Signal acquired during mid‐diastole with high PV flow caused additional signal voids in the left atrium, which was reduced by setting the ECG trigger delay to late‐diastole.

Conclusion

PV off‐resonance and flow causes signal void artifacts in noncontrast 3D slab‐selective SSFP PV MRA. J. Magn. Reson. Imaging 2010;32:1255–1261. © 2010 Wiley‐Liss, Inc.     

Whole heart magnetization‐prepared steady‐state free precession coronary vein MRI

Purpose

To compare two coronary vein imaging techniques using whole‐heart balanced steady‐state free precession (SSFP) and a targeted double‐oblique spoiled gradient‐echo (GRE) sequences in combination with magnetization transfer (MT) preparation sequence for tissue contrast improvement.

Materials and Methods

Nine healthy subjects were imaged with the proposed technique. The results are compared with optimized targeted MT prepared GRE acquisitions. Both quantitative and qualitative analyses were performed to evaluate each imaging method.

Results

Whole‐heart images were successfully acquired with no visible image artifact in the vicinity of the coronary veins. The anatomical features and visual grading of both techniques were comparable. However, the targeted small slab acquisition of the left ventricular lateral wall was superior to whole‐heart acquisition for visualization of relevant information for cardiac resynchronization therapy (CRT) lead implantation.

Conclusion

We demonstrated the feasibility of whole‐heart coronary vein MRI using a 3D MT‐SSFP imaging sequence. A targeted acquisition along the lateral left ventricular wall is preferred for visualization of branches commonly used in CRT lead implantation. J. Magn. Reson. Imaging 2009;29:1293–1299. © 2009 Wiley‐Liss, Inc.     

Inaccuracies associated with the automated measurement of mean cell hemoglobin concentration in dehydrated cells

Because of discrepancies between electronically and manually measured values of mean cell hemoglobin concentration (MCHC) encountered in studies of pathologic red cells, we studied the effect of cell water content on MCHC measurements by both methods. A series of red cell samples with varying water contents (54%-164% normal) were prepared from normal cells using the antibiotic nystatin. MCHC was then measured, using the microhematocrit centrifuge and three different electronic cell counters in common laboratory use. For MCHC values above 36 g/dl as measured by the spun hematocrit method, all three electronic counters under estimmated the MCHC, with increasing error as the true MCHC increased. For MCHC values below 30 g/dl, the values from two conductivity based instruments agreed with those from the spun hematocrit method, whereas one instrument based on light scattering overestimated the MCHC. These results indicate that inaccuracies in the measured mean cell volume (MCV) of dehydrated or otherwise undeformable cells may lead to spurious values for MCHC when electronic cell counters are used.     

Retail health clinics drive innovation into primary care practices

A myriad of patient dissatisfaction issues stemming from antiquated approaches to primary care access are resulting in the establishment of retail health clinics (RHCs) throughout the country. RHCs are usually located within retail stores or stand-alone pharmacies and are staffed by nurse practitioners (NPs). They offer treatment for colds, coughs, skin rashes, and ear infections along with offering preventive care and physicals. As disruptive innovations, or innovations that offer services to ignored markets, these clinics are siphoning patient care visits away from primary care physicians because of their attention to quick access, affordable prices, and consumer-friendly approaches. In response, family and internal medicine physicians must follow three strategies to secure their patient population as well as attract new patients: build relationships with RHCs through referral networks and NP supervisory agreements, transform the provision of patient access through the development of physician-owned RHCs, and support the concept of the advanced medical home.     

Incidence and predictors of reinfection with Trichomonas vaginalis in HIV-infected women

BACKGROUND AND OBJECTIVES: The presence of sexually transmitted infections (STIs) may facilitate transmission of HIV to uninfected partners. GOAL: To describe the incidence of reinfection with Trichomonas vaginalis in HIV-infected women and to assess predictors of reinfection. STUDY DESIGN: A retrospective cohort study using data abstracted from medical records of HIV-infected women with at least one diagnosis of trichomoniasis. RESULTS: Approximately one third (36%) of the study population was reinfected with T vaginalis during the follow-up period, with an incidence of 16.4 reinfections per 100 person years. Significant predictors of reinfection included history of another STI (hazard ratio, 1.52; 95% CI, 1.08-2.14) and becoming pregnant during the follow-up period (hazard ratio, 0.59; 95% CI, 0.39-0.87). CONCLUSIONS: There is a high rate of reinfection with T vaginalis in HIV-infected women. Further research that includes information on sexual partners should be conducted to better describe the reinfection patterns of trichomoniasis.     

Parasite genomics: current status and future prospects

The past year has brought great progress in the genome-sequencing efforts on a large number of protozoan and metazoan parasites. Whereas many of these projects are in their initial stages, at least one (for Plasmodium falciparum) is nearing completion. The information released to date has been most revealing with respect to immune evasion mechanisms.