Health Information Exchange: A Novel Re-linkage Intervention in an Urban Health System

Background

Public health information exchanges (HIEs) link real-time surveillance and clinical data and can help to re-engage out-of-care people with HIV (PWH).

Methods

We conducted a retrospective cohort study of out-of-care PWH who generated an HIE alert in the Grady Health System (GHS) Emergency Department (ED) between January 2017 and February 2018. Alerts were generated for PWH who registered in the GHS ED without Georgia Department of Public Health (GDPH) CD4 or HIV-1 RNA in the prior 14 months. The alert triggered a social work (SW)–led re-linkage effort. Multivariate logistic regression analyses used HIE-informed SW re-linkage efforts as the independent variable, and linkage to care and 3- and 6-month viral suppression (HIV-1 RNA < 200 c/mL) as primary outcomes. Patients admitted to the hospital were excluded from primary analysis.

Results

One hundred forty-seven out-of-care patients generated an alert. Ninety-eight were included in the primary analysis (mean age [SD], 41 ± 12 years; 70% male; 93% African American), and 20 received the HIE-informed SW intervention. Sixty percent of patients receiving the intervention linked to care in 6 months, compared with 35% who did not. Patients receiving the intervention were more likely to link to care (adjusted risk ratio [aRR], 1.63; 95% confidence interval [CI], 0.99–2.68) and no more likely to achieve viral suppression (aRR, 1.49; 95% CI, 0.50–4.46) than those who did not receive the intervention.

Conclusions

An HIE-informed, SW-led intervention systematically identified out-of-care PWH and may increase linkage to care for this important population. HIEs create an opportunity to intervene with linkage and retention strategies.

Invited review: Influence of climatic conditions on the development, performance, and health of calves

The objective of this review is to provide the reader with an overview of thermoregulatory mechanisms and the influence of climatic conditions in different housing systems on the development, performance, and health of calves. Thermic stress is observed in association with extreme temperatures and large temperature variations, but other variables such as relative humidity and wind speed can also contribute to thermic stress. Thermoregulation in calves is similar to that in adult cattle, but especially dystocial calves are more prone to heat loss. Heat or cold stress results in direct economic losses because of increased calf mortality and morbidity, as well as indirect costs caused by reduced weight gain, performance, and long-term survival. The climatic conditions in a variety of housing systems, associated health problems, and strategies to mitigate thermic stress are discussed in this review. The goal of housing is to alleviate the effect of climate on calves and provide a microclimate. Adequate ventilation with fresh air is essential to reduce respiratory disease. Common practices such as raising calves in individual outdoor enclosures have been challenged lately. Recent research seeks to evaluate the suitability of group housing under practical, economic, and animal welfare considerations. Limited results for reducing thermic stress can be achieved by simple measures such as shades or shelter, but additional heat or cold stress relieving strategies can be required depending on the housing system.

Short communication: evaluation of an automated in-house hematology analyzer for bovine blood

The objective of this study was to evaluate the suitability of the V-Sight hematology analyzer (A. Menarini Pharma GmbH, Vienna, Austria) for bovine blood by a comparison with a reference device (Advia 2120i, Siemens AG, Erlangen, Germany). In total, 97 blood samples were obtained from 75 dairy cows. Analyzed parameters included counts of white blood cells (WBC), lymphocytes, monocytes, granulocytes, red blood cells (RBC), and platelets (PLT), as well as hemoglobin concentration (HGB), hematocrit (HCT), mean corpuscular volume, mean corpuscular hemoglobin (MCH), MCH concentration (MCHC), mean platelet volume (MPV), and plateletcrit (PCT). Based on Passing-Bablok regression, the V-Sight provided accurate and precise results for MCH and MCHC only. The PCT results were comparable to the reference method, but precision was inconclusive. Significant proportional differences were detected for monocytes, granulocytes, HCT, and PLT. For all other analytes, significant proportional and systemic differences were observed. The WBC and lymphocyte results from the V-Sight were characterized by poor accuracy, poor precision, and a high number of false positive outliers. Bland-Altman analysis indicated negative biases for all WBC parameters, the erythrocyte indices, and PLT. Positive biases were observed for RBC, HGB, HCT, MPV, and PCT. Correlation coefficients of >0.9 between the V-Sight and the reference method were found only for RBC, HGB, HCT, and MPV. Intraassay precision of the V-Sight analyzer was acceptable (coefficient of variation <5%) for granulocytes, the erythrocyte indices, and MPV. It was unacceptable (coefficient of variation ≥5%) for WBC, lymphocytes, monocytes, as well as RBC, and inconclusive for HGB, HCT, PLT, and PCT. Sensitivity was high for all RBC counts and indices as well as PLT, but low for monocytes, granulocytes, and MPV. Specificity was high for monocytes and granulocytes, but low for RBC, HCT, MCH, and MCHC. With accurate and precise results for only 2 out of 13 parameters, the V-Sight cannot be recommended for analysis of bovine blood.

Correlation of intratumoral microvessel density and p53 protein overexpression in human colorectal adenocarcinoma

A malignant cell population needs the development of microvessels in order to grow and metastasize. Recently, a role for the p53 gene in the regulation of this angiogenic process has been suggested. Wild-type p53 is involved in the secretion of Trombospondin-1 (TSP-1), an angiogenesis inhibitor. Mutations of the p53 gene cause a downregulation of TSP-1 mRNA in cell lines. Mutant p53 also upregulates the expression of vascular endothelial cell growth factor, a potent angiogenic factor. Together with the reported association of p53 protein overexpression and microvessel density (MVD) in head-and-neck squamous-cell carcinoma, these in vitro findings led us to investigate whether this association would also apply in colorectal adenocarcinomas. Structural changes of the p53 gene are the most frequent observed mutations in colorectal carcinoma and are suspected to be involved in the carcinogenesis at a relatively early stage. Parallel tissue sections from primary colorectal adenocarcinomas were immunostained for CD31, an endothelial cell marker, and with DO7, recognizing both mutant and wild-type p53 protein overexpression. The presence of p53 protein overexpression was found to be significantly associated with high MVD in the vascular hot spots. Our results are in accordance with the in vitro studies on the involvement of p53 in angiogenesis. Mutant p53 might stimulate tumor angiogenesis both indirectly, by augmenting the tumor cell proliferation, and directly, by upregulating angiogenic factors and downregulating angiogenic inhibitors.

Behavior of radionuclides in sanitary landfills

his study was undertaken to evaluate the possibility of disposing low-level radioactive waste in sanitary landfills with leachate containment to prevent environmental releases. To meet this objective, two simulated landfills, each 200 l. in volume and containing 55 kg of municipal refuse, were operated in the laboratory with simulated rainfall additions for a 9-month period to observe the extent to which radio-cobalt, -cesium, -strontium and tritium were leached into the liquid phase. One of the units was operated with leachate recycle, the other as a single pass control. Liquid samples were analyzed weekly for 3H, 58Co, 85Sr and 134Cs tracers. Weekly analyses were also performed for approximately 30 parameters to define the degree of stabilization of the waste. Major parameters included BOD, COD, pH and concentrations of specific organics, metals and gases. Concentrations of stable cobalt, strontium and cesium were also measured periodically. Soluble radioactivity levels in both systems were reduced by factors of 50 for 58Co, 5 for 85Sr and 7 for 134Cs, taking radioactive decay and dilution into account. Some radionuclide removal from the liquid phase was associated with major chemical changes in the landfills that occurred within 80 days for the control system and within 130 days for the recycle unit. Observed acid, sulfide, and CO2 concentrations suggested mechanisms for removing some of the radionuclides from leachate. Detection of 3H in the off-gas indicated that less than 1% of tritiated waste became airborne. The waste in the leachate recycle unit was more completely stabilized than in the control unit.