18FDG PET-CT imaging detects arterial inflammation and early atherosclerosis in HIV-infected adults with cardiovascular disease risk factors

BACKGROUND: Persistent vascular inflammation has been implicated as an important cause for a higher prevalence of cardiovascular disease (CVD) in HIV-infected adults. In several populations at high risk for CVD, vascular (18)Fluorodeoxyglucose ((18)FDG) uptake quantified using 3D-positron emission-computed tomography (PET-CT) has been used as a molecular level biomarker for the presence of metabolically active proinflammatory macrophages in rupture-prone early atherosclerotic plaques. We hypothesized that (18)FDG PET-CT imaging would detect arterial inflammation and early atherosclerosis in HIV-infected adults with modest CVD risk. METHODS: We studied 9 HIV-infected participants with fully suppressed HIV viremia on antiretroviral therapy (8 men, median age 52 yrs, median BMI 29 kg/m(2), median CD4 count 655 cells/μL, 33% current smokers) and 5 HIV-negative participants (4 men, median age 44 yrs, median BMI 25 kg/m(2), no current smokers). Mean Framingham Risk Scores were higher for HIV-infected persons (9% vs. 2%, p < 0.01). (18)FDG (370 MBq) was administered intravenously. 3D-PET-CT images were obtained 3.5 hrs later. (18)FDG uptake into both carotid arteries and the aorta was compared between the two groups. RESULTS: Right and left carotid (18)FDG uptake was greater (P < 0.03) in the HIV group (1.77 ±0.26, 1.33 ±0.09 target to background ratio (TBR)) than the control group (1.05 ± 0.10, 1.03 ± 0.05 TBR). (18)FDG uptake in the aorta was greater in HIV (1.50 ±0.16 TBR) vs control group (1.24 ± 0.05 TBR), but did not reach statistical significance (P = 0.18). CONCLUSIONS: Carotid artery (18)FDG PET-CT imaging detected differences in vascular inflammation and early atherosclerosis between HIV-infected adults with CVD risk factors and healthy HIV-seronegative controls. These findings confirm the utility of this molecular level imaging approach for detecting and quantifying glucose uptake into inflammatory macrophages present in metabolically active, rupture-prone atherosclerotic plaques in HIV infected adults; a population with increased CVD risk

Using the General Social Survey - National Death Index cohort to study the relationship between neighbourhood fear and mortality in the USA

Objectives Fear of crime is associated with adverse mental health outcomes and reduced social interaction independent of crime. Because mental health and social interactions are associated with poor physical health, fear of crime may also be associated with death. The main objective is to determine whether neighbourhood fear is associated with time to death. Setting and participants Data from the 1978–2008 General Social Survey were linked to mortality data using the National Death Index (GSS-NDI) (n=20 297). Methods GSS-NDI data were analysed to assess the relationship between fear of crime at baseline and time to death among adults after removing violent deaths. Fear was measured by asking respondents if they were afraid to walk alone at night within a mile of their home. Crude and adjusted HRs were calculated using survival analysis to calculate time to death. Analyses were stratified by sex. Results Among those who responded that they were fearful of walking in their neighbourhood at night, there was a 6% increased risk of death during follow-up in the adjusted model though this was not significant (HR=1.06, 95% CI 0.99 to 1.13). In the fully adjusted models examining risk of mortality stratified by sex, findings were significant among men but not women. Among men, in the adjusted model, there was an 8% increased risk of death during follow-up among those who experienced fear at baseline in comparison with those who did not experience fear (HR=1.08, 95% CI 1.02 to 1.14). Conclusions Research has recently begun examining fear as a public health issue. With an identified relationship with mortality among men, this is a potential public health problem that must be examined more fully

Voter Suppression Undermines Public Health for All

In the US, policies have actively suppressed the voices of Black, Indigenous, and people of color (BIPOC) while amplifying their oppressors’ voices. In spite of multiple constitutional amendments to guarantee access to the right to vote for those who initially were deprived of this right, attacks on this civil liberty have persisted. While some states have expanded access to voting rights in the past year, many others have made voting more difficult and some states have had a mixed approach of making voting easier in some ways and harder in others. This continued interest in creating systems in which it is harder for people to vote has had indelible effects on population health and has widened health inequities. This essay explores the overlap in restricting access to voting and Medicaid expansion, decisions that disproportionately disadvantage BIPOC while also negatively affecting White residents by hindering expanded access to healthcare. This type of zero-sum decision making, as Heather McGhee articulates in her book, The Sum of Us, exacerbates poorer health outcomes, undermines public health, and widens health inequities

An Assessment of Sea Scallop Abundance and Distribution in Georges Bank Closed Area I and II and Surrounds: Final Report

For the sea scallop, Placopecten magellanicus, the concepts of space and time have emerged as the basis of an effective management tool. The strategy of closing or limiting activities in certain areas for specific lengths of time has gained support as a method to conserve and enhance the scallop resource. In the last decade, rotational area management has provided a mechanism to protect juvenile scallops from fishing mortality by closing areas based upon scallop abundance and observed age distribution. Approximately half of the sea scallop industry’s current annual landings are attributed to from areas under this rotational harvest strategy. While this represents a management success, it also highlights the extent to which landings are dependent on the effective implementation of this strategy. The continued prosperity of scallop spatial management is dependent on both periodic and large incoming year classes, as well as a mechanism to delineate the scale of a recruitment event and subsequently monitor the growth and abundance of these scallops over time. Current and accurate information related to the abundance and distribution of adult and juvenile scallops is essential for managers to respond to changes in resource subunits

Variability in hospital treatment costs: A time-driven activity-based costing approach for early-stage invasive breast cancer patients

Objectives: Using a standardised diagnostic and generic treatment path for breast cancer, and the molecular subtype perspective, we aim to measure the impact of several patient and disease characteristics on the overall treatment cost for patients. Additionally, we aim to generate insights into the drivers of cost variability within one medical domain. Design: setting and participants. We conducted a retrospective study at a breast clinic in Belgium. We used 14 anonymous patient files for conducting our analysis. Results: Significant cost variations within each molecular subtype and across molecular subtypes were found. For the luminal A classification, the cost differential amounts to roughly 166%, with the greatest treatment cost amounting to US$29 780 relative to US$11 208 for a patient requiring fewer medical activities. The major driver for these cost variations relates to disease characteristics. For the luminal B classification, a cost difference of roughly 242% exists due to both disease-related and patient-related factors. The average treatment cost for triple negative patients amounted to US$26 923, this is considered to be a more aggressive type of cancer. The overall cost for HER2-enriched is driven by the inclusion of Herceptin, thus this subtype is impacted by disease characteristics. Cost variability across molecular classifications is impacted by the severity of the disease, thus disease-related factors are the major drivers of cost. Conclusions: Given the cost challenge in healthcare, the need for greater cost transparency has become imperative. Through our analysis, we generate initial insights into the drivers of cost variability for breast cancer. We found evidence that disease characteristics such as severity and more aggressive cancer forms such as HER2-enriched and triple negative have a significant impact on treatment cost across the different subtypes. Similarly, patient factors such as age and presence of gene mutation contribute to differences in treatment cost variability within molecular subtypes.Co--funded by an unconditional grant provided by Xperthis in Belgium, but no conflict of interest to be reported

Pan-Cancer Analysis of lncRNA Regulation Supports Their Targeting of Cancer Genes in Each Tumor Context

Long noncoding RNAs (lncRNAs) are commonly dys-regulated in tumors, but only a handful are known toplay pathophysiological roles in cancer. We inferredlncRNAs that dysregulate cancer pathways, onco-genes, and tumor suppressors (cancer genes) bymodeling their effects on the activity of transcriptionfactors, RNA-binding proteins, and microRNAs in5,185 TCGA tumors and 1,019 ENCODE assays.Our predictions included hundreds of candidateonco- and tumor-suppressor lncRNAs (cancerlncRNAs) whose somatic alterations account for thedysregulation of dozens of cancer genes and path-ways in each of 14 tumor contexts. To demonstrateproof of concept, we showed that perturbations tar-geting OIP5-AS1 (an inferred tumor suppressor) andTUG1 and WT1-AS (inferred onco-lncRNAs) dysre-gulated cancer genes and altered proliferation ofbreast and gynecologic cancer cells. Our analysis in-dicates that, although most lncRNAs are dysregu-lated in a tumor-specific manner, some, includingOIP5-AS1, TUG1, NEAT1, MEG3, and TSIX, synergis-tically dysregulate cancer pathways in multiple tumorcontexts