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  • 1
    Online Resource
    Online Resource
    Antiretroviral Therapy Anchor-based Trends in Body Mass Index Following Treatment Initiation Among Military Personnel with HIV
    Oxford University Press (OUP) ; 2021
    In:  Military Medicine Vol. 186, No. 3-4 ( 2021-02-26), p. 279-285
    Details
    In: Military Medicine, Oxford University Press (OUP), Vol. 186, No. 3-4 ( 2021-02-26), p. 279-285
    Abstract: Weight gain and obesity in people living with HIV have been associated with increased risk for non-AIDS-related comorbidities, and integrase strand transfer inhibitor (INSTI)-based regimens may lead to comparatively more weight gain than other regimens. We evaluated body mass index (BMI) following antiretroviral therapy (ART) initiation among participants in the U.S. Military HIV Natural History Study (NHS). Materials and Methods NHS participants with available baseline weight and height data initiating ART from 2006 to 2017 were considered for analysis. Antiretroviral therapy was categorized by anchor class to include INSTIs, non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs). Linear growth-curve modeling was used to predict BMI changes from ART initiation through 2 years of follow-up in participants stratified by baseline BMI ( & lt;25 vs ≥25 kg/m2) at ART start and anchor drug class. These models were adjusted for demographic- and HIV-related characteristics. Results Of 961 NHS participants started on initial ART between 2006 and 2017, 491 men who had available baseline BMI data and were virally suppressed ( & lt;200 c/mL) at 1 and 2 years of follow-up were included. Overall, the predicted BMI increased at each time point over 2 years regardless of baseline BMI. There was a trend toward less weight gain for non-INSTI regimens regardless of demographic- or HIV-related factors (−0.65 kg/m2/yr, P = .070). In participants with BMI  & lt;25, all regimens were associated with BMI gains except in those with high viral load (≥100,000 copies/mL) started on PI regimens (−1.91 kg/m2/yr, P = .000; n = 13). For those participants with BMI ≥25, only INSTI- and PI-based regimens were significantly associated with increased BMI (INSTI 0.54 kg/m2/y, P = .000; PI 0.39 kg/m2/yr, P = .006). Non-nucleoside reverse transcriptase inhibitors were not associated with weight gain regardless of race- or HIV-related characteristics. African Americans with BMI ≥25 were more likely to gain weight as compared to Whites (0.99 kg/m2/yr, P = .016). Specific anchor drug-based predictions revealed that only INSTI use among African Americans was significantly associated with BMI gains (1.85 kg/m2/yr, P = .007); NNRTI- and PI-related weight change was not significant as compared to Whites. Conclusions In our cohort of young military members with HIV infection, those with BMI  & lt;25 experienced BMI gains across all ART classes. Among those with BMI ≥25, African Americans on INSTI regimens had the greatest BMI gains. Further studies are needed to determine whether NNRTI regimens should be considered in certain individuals at risk for INSTI-associated weight gain.
    Type of Medium: Online Resource
    ISSN: 0026-4075 , 1930-613X
    URL: Article
    DOI: 10.1093/milmed/usaa416
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2130577-8
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  • 2
    Online Resource
    Online Resource
    Efficacy of interferon beta-1a plus remdesivir compared with remdesivir alone in hospitalised adults with COVID-19: a double-blind, randomised, placebo-controlled, phase 3 trial
    Elsevier BV ; 2021
    In:  The Lancet Respiratory Medicine Vol. 9, No. 12 ( 2021-12), p. 1365-1376
    Details
    In: The Lancet Respiratory Medicine, Elsevier BV, Vol. 9, No. 12 ( 2021-12), p. 1365-1376
    Type of Medium: Online Resource
    ISSN: 2213-2600
    URL: Article
    DOI: 10.1016/S2213-2600(21)00384-2
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2021
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  • 3
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    Online Resource
    1878. Demographic and Clinical Characteristics of COVID-19 Reinfection
    Oxford University Press (OUP) ; 2022
    In:  Open Forum Infectious Diseases Vol. 9, No. Supplement_2 ( 2022-12-15)
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 9, No. Supplement_2 ( 2022-12-15)
    Abstract: COVID-19 reinfection is generally defined as having 2 positive SARS-CoV-2 tests greater than 90 days apart. The clinical implications and impact of COVID-19 reinfection are not completely understood. We evaluated clinical and demographic characteristics of patients with COVID-19 reinfection. Methods All SARS-CoV-2 polymerase chain reaction (PCR) tests performed at Joint Base San Antonio (JBSA), from March 27, 2020 through January 19, 2022 were analyzed. COVID-19 reinfection was defined as having 2 positive PCR tests & gt;90 days apart. Available data for comorbidities, travel, COVID-19 vaccination status, SARS-CoV-2 genotype, symptoms, hospitalization, and treatments were compared for first and second infections. Results A total of 310,704 SARS-CoV-2 PCR tests performed of which 25,543 (8.2%) were positive at JBSA during the study period. Patients with COVID-19 reinfection (n=532; 4.2%) were identified and 266 (50%) charts reviewed. The mean age was 36.5 (±15) years and approximately half were males and active duty members (Table 1). The median time from first to second infection was 326 days (IQR 160-385). Patients were predominantly unvaccinated (91.4%) at initial infection, however unvaccinated status was less common (40.2%) at second infection (40.2%; P & lt; 0.0001). A significantly higher proportion of patients were symptomatic at first infection (88.3%) compared to second infection (51.5%; P & lt; 0.001). Pneumonia diagnosis was significantly higher (4.9% vs. 0.4%; P=0.0011) whereas hospitalization was similar (2.6% vs. 2.3%; P=0.0788) for first compared to second infection. Among hospitalized patients, critical illness was common for first infection (57.1%) but none of the patients were critically ill with their second infection. A third episode of infection was rarely observed (1.5%). Of 80 genotype samples available, 14 (30%) were paired samples. Among all paired samples different genotypes were responsible for reinfection (Table 2). Conclusion Patients with COVID-19 reinfections were less likely to be symptomatic, had lower severity of illness, and typically had a different SARS-CoV-2 genotype at second infection. Reinfection occurred despite COVID-19 vaccination in many patients, which highlights the need to develop novel strategies for vaccination. Disclosures All Authors: No reported disclosures.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofac492.1505
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2757767-3
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  • 4
    Online Resource
    Online Resource
    Gene expression profiling: opening the black box of plant ecosystem responses to global change
    Wiley ; 2009
    In:  Global Change Biology Vol. 15, No. 5 ( 2009-05), p. 1201-1213
    Details
    In: Global Change Biology, Wiley, Vol. 15, No. 5 ( 2009-05), p. 1201-1213
    Type of Medium: Online Resource
    ISSN: 1354-1013 , 1365-2486
    URL: Issue
    URL: Article
    DOI: 10.1111/gcb.2009.15.issue-5
    DOI: 10.1111/j.1365-2486.2008.01818.x
    Language: English
    Publisher: Wiley
    Publication Date: 2009
    detail.hit.zdb_id: 2020313-5
    SSG: 12
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  • 5
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    2063. Implementation of a Rapid HIV Screening Program in the Emergency Department
    Oxford University Press (OUP) ; 2022
    In:  Open Forum Infectious Diseases Vol. 9, No. Supplement_2 ( 2022-12-15)
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 9, No. Supplement_2 ( 2022-12-15)
    Abstract: Guidelines recommend that human immunodeficiency virus (HIV) screening be performed for all patients evaluated for sexually transmitted infections (STIs). The current practice for STI evaluation in the Brooke Army Medical Center (BAMC) emergency department (ED) is to defer HIV testing to Primary Care Managers (PCMs), however PCM follow-up and HIV screening may not occur. This project evaluated HIV screening practices before and after implementation of rapid HIV testing in the ED. Methods The pre-intervention period (Aug – Oct 2021) included usual practice in the BAMC ED followed by the post-intervention period (Dec 2021 – Feb 2022) after implementation of rapid testing with the Determine™ HIV-1/2 Ag/Ab Combo test. ED providers were educated to include HIV rapid testing for patients with STI complaints. Patients with Neisseria gonorrhea/Chlamydia trachomatis (GC/CT) tests ordered in the ED pre-intervention (n=303) and post-intervention (n=268) were selected for chart review and demographic, clinical, and laboratory data were used to assess HIV screening practices. Results A similar proportion of patients in the pre-intervention period presented with an STI chief complaint (13.5% vs. 17.2%), tested positive for GC/CT (13.5% vs. 10.8%), and received empiric treatment for GC/CT (38.3% vs. 34.3%) compared to the post-intervention period (Table 1). HIV screening in the ED significantly increased both overall (4.3% vs. 19.8%; P & lt; 0.001) and in the subgroup treated empirically for GC/CT (9.7% vs. 30.4%; P & lt; 0.001, Table 2). Among patients treated empirically for GC/CT who did not receive HIV screening in the ED, PCM follow-up was low in both the pre- and post-intervention periods (20.7% and 34%, respectively; P & lt; 0.001) and HIV screening was not commonly performed by PCMs during those visits (6.2% vs. 8.4%, respectively; P=0.350). Conclusion STIs are considered biologic markers of HIV risk, including acquisition and forward transmission. Implementation of a rapid screening protocol in the ED resulted in a nearly 5-fold increase in HIV screening, however HIV screening by PCMs remained low. Although rapid HIV testing can be a useful tool, continued education and training of ED providers and PCMs is also needed to improve uptake of HIV screening. Disclosures All Authors: No reported disclosures.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofac492.1685
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
    detail.hit.zdb_id: 2757767-3
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  • 6
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    Comparison of A(H3N2) Neutralizing Antibody Responses Elicited by 2018–2019 Season Quadrivalent Influenza Vaccines Derived from Eggs, Cells, and Recombinant Hemagglutinin
    Oxford University Press (OUP) ; 2021
    In:  Clinical Infectious Diseases Vol. 73, No. 11 ( 2021-12-06), p. e4312-e4320
    Details
    In: Clinical Infectious Diseases, Oxford University Press (OUP), Vol. 73, No. 11 ( 2021-12-06), p. e4312-e4320
    Abstract: Low vaccine effectiveness against A(H3N2) influenza in seasons with little antigenic drift has been attributed to substitutions in hemagglutinin (HA) acquired during vaccine virus propagation in eggs. Clinical trials comparing recombinant HA vaccine (rHA) and cell-derived inactivated influenza vaccine (IIV) to egg-derived IIVs provide opportunities to assess how egg-adaptive substitutions influence HA immunogenicity. Methods Neutralization titers in pre- and postimmunization sera from 133 adults immunized with 1 of 3 types of influenza vaccines in a randomized, open-label trial during the 2018–2019 influenza season were measured against egg- and cell-derived A/Singapore/INFIMH-16-0019/2016-like and circulating A(H3N2) influenza viruses using HA pseudoviruses. Results All vaccines elicited neutralizing antibodies to all H3 vaccine antigens, but the rHA vaccine elicited the highest titers and seroconversion rates against all strains tested. Egg- and cell-derived IIVs elicited responses similar to each other. Preimmunization titers against H3 HA pseudoviruses containing egg-adaptive substitutions T160K and L194P were high, but lower against H3 HA pseudoviruses without those substitutions. All vaccines boosted neutralization titers against HA pseudoviruses with egg-adaptive substitutions, but poorly neutralized wild-type 2019–2020 A/Kansas/14/2017 (H3N2) HA pseudoviruses. Conclusion Egg- and cell-derived 2018–2019 season influenza vaccines elicited similar neutralization titers and response rates, indicating that the cell-derived vaccine did not improve immunogenicity against the A(H3N2) viruses. The higher responses after rHA vaccination may be due to its higher HA content. All vaccines boosted titers to HA with egg-adaptive substitutions, suggesting boosting from past antigens or better exposure of HA epitopes. Studies comparing immunogenicity and effectiveness of different influenza vaccines across many seasons are needed.
    Type of Medium: Online Resource
    ISSN: 1058-4838 , 1537-6591
    URL: Article
    DOI: 10.1093/cid/ciaa1352
    RVK:
    XA 10000
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2002229-3
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  • 7
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    Online Resource
    Outcomes of Coronavirus Disease 2019 Drive-Through Screening at an Academic Military Medical Center
    Oxford University Press (OUP) ; 2020
    In:  Open Forum Infectious Diseases Vol. 7, No. 8 ( 2020-08-01)
    Details
    In: Open Forum Infectious Diseases, Oxford University Press (OUP), Vol. 7, No. 8 ( 2020-08-01)
    Abstract: Drive-through coronavirus disease 2019 screening can evaluate large numbers of patients while reducing healthcare exposures and personal protective equipment use. We describe the characteristics of screened individuals as well as drive-through process and outcome measures. Optimal drive-through screening involves rapid turnaround of test results and linkage to follow-up care.
    Type of Medium: Online Resource
    ISSN: 2328-8957
    URL: Article
    DOI: 10.1093/ofid/ofaa306
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2020
    detail.hit.zdb_id: 2757767-3
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  • 8
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    Online Resource
    Greater antioxidant and respiratory metabolism in field‐grown soybean exposed to elevated O 3 under both ambient and elevated CO 2
    Wiley ; 2012
    In:  Plant, Cell & Environment Vol. 35, No. 1 ( 2012-01), p. 169-184
    Details
    In: Plant, Cell & Environment, Wiley, Vol. 35, No. 1 ( 2012-01), p. 169-184
    Abstract: This study investigated the molecular, biochemical and physiological changes in soybean exposed to elevated [O 3 ] in a background of ambient [CO 2 ] and elevated [CO 2 ] in the field. Principle components analysis was used to separate variability in [O 3 ] from variability in other environmental conditions (temperature, light and relative humidity). The key results show that energetically expensive increases in antioxidant metabolism and tetrapyrrole synthesis at elevated [O 3 ] were supported by greater respiratory metabolism.
    Type of Medium: Online Resource
    ISSN: 0140-7791 , 1365-3040
    URL: Issue
    URL: Article
    DOI: 10.1111/pce.2012.35.issue-1
    DOI: 10.1111/j.1365-3040.2011.02427.x
    RVK:
    WA 15000
    Language: English
    Publisher: Wiley
    Publication Date: 2012
    detail.hit.zdb_id: 391893-2
    detail.hit.zdb_id: 2020843-1
    SSG: 12
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  • 9
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    Online Resource
    Critical Care Education and Skills Validation Course for Internal Medicine Physicians in the Military
    Oxford University Press (OUP) ; 2023
    In:  Military Medicine Vol. 188, No. 7-8 ( 2023-07-22), p. e1356-e1361
    Details
    In: Military Medicine, Oxford University Press (OUP), Vol. 188, No. 7-8 ( 2023-07-22), p. e1356-e1361
    Abstract: Military internist and internal medicine (IM) subspecialist physicians must be prepared to function in both traditional inpatient and outpatient settings, as well as manage critically ill patients within a deployed austere environment. As many critical care procedures are not performed on a routine basis in general IM practice, many active duty IM physicians experience skills degradation and lack confidence in performing these procedures. In order to address this perceived deficiency, the U.S. Army and Air Force Internal Medicine Education and Skills Validation Course was developed to provide essential training in critical care procedures for active duty military IM physicians and subspecialists. Materials and Methods Staff internist and subspecialist physicians at multiple military treatment facilities participated in a 2-day simulation-based training course in critical care procedures included in the Army Individual Critical Task Lists and the Air Force Comprehensive Medical Readiness Program. Educational content included high-yield didactic lectures, multi-disciplinary Advanced Cardiac Life Support/Advanced Trauma Life Support high-fidelity simulation scenarios, and competency training/validation in various bedside procedures, including central venous and arterial line placement, trauma-focused ultrasound exam, airway management and endotracheal intubation, chest tube thoracotomy, and mechanical ventilation, among others. Results A total of 87 staff IM physicians participated in the course with an average of 2–4 years of experience following completion of graduate medical education. Upon course completion, all participants successfully achieved rigorous, checklist-based, standardized validation in all the required procedures. Survey data indicated a significant improvement in overall skills confidence, with 100% of participants indicating improvement in their ability to function independently as deployed medical officers. Conclusions Broad implementation of this program at military hospitals would improve pre-deployment critical care procedural readiness in military IM physicians.
    Type of Medium: Online Resource
    ISSN: 0026-4075 , 1930-613X
    URL: Article
    DOI: 10.1093/milmed/usab210
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2130577-8
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