Changes in atherosclerotic cardiovascular disease risk over time among people living with HIV

OBJECTIVE

To describe changes in atherosclerotic cardiovascular disease (ASCVD) risk over time among people living with HIV (PLHIV).

METHODS

We used data from the TREAT Asia HIV Observational Database (TAHOD) and the Australian HIV Observational Database (AHOD). Five-year ASCVD risk was calculated using the D:A:D equation. Individuals were eligible for inclusion if they were aged ≥18 years, had started ART, had no previous history of ASCVD and had complete ASCVD risk factor data available within the first 5 years of ART initiation.

RESULTS

A total of 3368 adults contributed data, 3221 were from TAHOD and 147 were from AHOD. The median age at ART initiation was 36 [IQR 31-43] years for TAHOD participants, and 42 [IQR 35-50] years for AHOD participants. Most TAHOD (70.4%) and AHOD (91.8%) participants were male. Overall, ASCVD risk increased from 0.84% (95% CI 0.81%-0.87%) at ART initiation to 1.34% (95% CI 1.29%-1.39%) after 5 years on ART. After adjusting for traditional and HIV-associated ASCVD risk factors, ASCVD risk increased at a similar rate among sub-populations defined by HIV exposure (heterosexuals, men who have sex with men, people who inject drugs), race/ethnicity (Caucasian and Asian) and nadir CD4 at ART initiation (<200 and ≥200 cells/mm3).

CONCLUSIONS

These findings emphasize the growing burden of ASCVD risk among PLHIV and the need to develop interventions that are effective across a broad range of HIV sub-populations.

Correction: Mabunda et al. Development, Objectives and Operation of Return-of-Service Bursary Schemes as an Investment to Build Health Workforce Capacity in South Africa: A Multi-Methods Study. Healthcare 2023, 11, 2821

In the original publication [...].

Development, Objectives and Operation of Return-of-Service Bursary Schemes as an Investment to Build Health Workforce Capacity in South Africa: A Multi-Methods Study

BACKGROUND

South Africa uses government-funded return-of-service (RoS) schemes to train, recruit and retain skilled health professionals in underserved areas. These educate health professionals locally or internationally in return for a commitment to serve in a specified area for an agreed period. While such schemes are used widely and are funded by substantial public funds, their exact makeup differs across jurisdictions, and little is known about why these differences have emerged or how they influence their effectiveness or impact on the health system. We aimed to fill these gaps through an analysis of the origins, architecture, and evolution of RoS schemes in South Africa.

METHODS

A multimethod research study including a policy review, a literature review, and semi-structured interviews of policymakers was undertaken between October 2020 and August 2022. The included policy documents and literature were analysed using the Walt and Gilson framework and narrative synthesis. Qualitative data were analysed using inductive, thematic analysis in NVIVO 12.

RESULTS

RoS schemes are used as a recruitment and retention strategy and a mechanism to address equity in access to medical education. Whilst there is evidence of RoS schemes existing in 1950, no evidence of beneficiaries was found in databases until 1989. The impact of these schemes is likely being limited by sub-optimal institutional arrangements and poor transparency in their design and implementation.

CONCLUSION

Despite rigorous research methods, the origins of RoS policies in South Africa could not be established due to poor preservation of institutional memory. Opportunities to monitor the value of public investment into RoS programs are being missed and often the underlying objective of the programs has not been well-specified. Policies were found to have been developed and operate in isolation from other health workforce planning activities and thus may not be maximising their impact as a retention and training tool.

The definition and measurement of human capital resources: A content and meta-analytic review

Although human capital resources (HCR) can be important for organizational performance, researchers have defined and measured HCR in various ways. Consequently, it is unclear whether existing measures provide valid inferences about HCR or their relations with other constructs. We conducted this three-study research to address these issues. In Study 1, we reviewed HCR definitions (k = 84) and found that most definitions focus on collective knowledge, skills, and abilities. Recent definitions also tend to include other characteristics (e.g., personality). In Study 2, a content analysis of HCR measures (k = 127) revealed that only 23.6% of the measures focused solely on HCR and they tended to assess only one or two dimensions of the construct (i.e., were deficient). Many measures (46.5%) assessed both HCR and other constructs (i.e., were partially contaminated), and other measures (29.9%) assessed only non-HCR constructs (i.e., were fully contaminated). In Study 3 (k = 94), we found that HCR measures that were less deficient demonstrated stronger criterion-related validity for predicting unit and firm performance. Interestingly, partially contaminated measures were somewhat more predictive than uncontaminated measures (ρ = .35 vs. .25, respectively), mainly because they assessed both HCR and other constructs that are related to performance. Both types of measures demonstrated stronger validity than fully contaminated measures. Overall, findings suggest that extant HCR measures often are deficient and/or contaminated. We discuss implications, as well as offer guidance for measuring HCR in future research. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Technological Convergence: Highlighting the Power of CRISPR Single-Cell Perturbation Toolkit for Functional Interrogation of Enhancers

Higher eukaryotic enhancers, as a major class of regulatory elements, play a crucial role in the regulation of gene expression. Over the last decade, the development of sequencing technologies has flooded researchers with transcriptome-phenotype data alongside emerging candidate regulatory elements. Since most methods can only provide hints about enhancer function, there have been attempts to develop experimental and computational approaches that can bridge the gap in the causal relationship between regulatory regions and phenotypes. The coupling of two state-of-the-art technologies, also referred to as crisprQTL, has emerged as a promising high-throughput toolkit for addressing this question. This review provides an overview of the importance of studying enhancers, the core molecular foundation of crisprQTL, and recent studies utilizing crisprQTL to interrogate enhancer-phenotype correlations. Additionally, we discuss computational methods currently employed for crisprQTL data analysis. We conclude by pointing out common challenges, making recommendations, and looking at future prospects, with the aim of providing researchers with an overview of crisprQTL as an important toolkit for studying enhancers.

Near-Infrared Autofluorescence (NIRAF) in Atherosclerotic Plaque Dissociates from Intraplaque Hemorrhage and Bilirubin

Near-infrared autofluorescence (NIRAF) in unstable atherosclerotic plaque has been suggested as a novel imaging technology for high-risk atherosclerosis. Intraplaque hemorrhage (IPH) and bilirubin, derived from the subsequent degradation of heme, have been proposed as the source of NIRAF, although their roles and the underlying mechanism responsible for NIRAF remain unclear. To test the proposed role of bilirubin as the source of NIRAF in high-risk atherosclerosis, Biliverdin reductase a gene and apolipoprotein E gene double-knockout (Bvra^-/-Apoe^-/-) mice were subjected to the Western diet and tandem stenosis (TS) surgery, as a model of both bilirubin deficiency and plaque instability. Human coronary arteries containing atherosclerotic plaques were obtained from heart transplant recipients. The NIRAF was determined by in vivo fluorescence emission computed tomography, and ex vivo infrared imaging. The cholesterol content was quantified by HPLC with UV detection. In Bvra^+/+Apoe^-/- TS mice, the NIRAF intensity was significantly higher in unstable plaque than in stable plaque, yet the NIRAF in unstable plaque was undistinguishable in Bvra^+/+Apoe^-/- and littermate Bvra^-/-Apoe^-/- TS mice. Moreover, the unstable plaque in TS mice exhibited a lower NIRAF compared with highly cellular plaque that lacked most of the features of unstable plaque. In human coronary arteries, the NIRAF associated with cholesterol-rich, calcified lesions, rather than just cholesterol-rich lesions. The NIRAF in atherosclerotic plaque can be dissociated from IPH and bilirubin, such that the compositional meaning of an elevated NIRAF remains obscure.

"It's like a forgotten issue sometimes …": Qualitative study of individuals living and caring for people with chronic breathlessness

INTRODUCTION

This study aims to explore the perspectives of patients and carers with chronic breathlessness on current provision of care, care expectations, and self-management needs to develop relevant health services and resources to improve clinical outcomes.

METHODS

In-depth semistructured interviews were conducted on patients living with chronic breathlessness and carers.

RESULTS

Thirteen patients (cardiac, respiratory, and noncardiorespiratory) and two carers were interviewed (mean age 57 years, 47% female, median duration with breathlessness 5 years). Four main themes were identified: (1) living with breathlessness, (2) diagnosis delays, misdiagnosis, and knowledge gaps, (3) beyond curing disease: symptom relief and improving quality of life, and (4) self-management and limited support for it.

CONCLUSION

Breathlessness has a high personal impact but remains a neglected condition in Australia. Patients suffer from lack of personal, community, and provider awareness, discontinuity of care, and too few clinical and self-management options.

Cells-in-Touch: 3D Printing in Reconstruction and Modelling of Microscopic Biological Geometries for Education and Future Research Applications

Additive manufacturing (3D printing) and computer-aided design (CAD) still have limited uptake in biomedical and bioengineering research and education, despite the significant potential of these technologies. The utility of organ-scale 3D-printed models of living structures is widely appreciated, while the workflows for microscopy data translation into tactile accessible replicas are not well developed yet. Here, we demonstrate an accessible and reproducible CAD-based methodology for generating 3D-printed scalable models of human cells cultured in vitro and imaged using conventional scanning confocal microscopy with fused deposition modeling (FDM) 3D printing. We termed this technology CiTo-3DP (Cells-in-Touch for 3D Printing). As a proof-of-concept, we created dismountable CiTo-3DP models of human epithelial, mesenchymal, and neural cells by using selectively stained nuclei and cytoskeletal components. We also provide educational and research context for the presented cellular models. In the future, the CiTo-3DP approach can be adapted to different imaging and 3D printing modalities and comprehensively present various cell types, subcellular structures, and extracellular matrices. The resulting CAD and 3D printed models could be used for a broad spectrum of education and research applications.

How Were Return-of-Service Schemes Developed and Implemented in Botswana, Eswatini and Lesotho?

Botswana, Eswatini and Lesotho are three Southern African countries that make use of return-of-service (RoS) schemes to increase human resources for health in their countries. These initiatives bind beneficiaries to a pre-defined period of service upon the completion of their studies based on the length of funding support received. We aimed to review the history of these policies to understand the conceptualisation, intent and implementation of these schemes. We used a multi-methods research design which consisted of a literature review, a policy review and semi-structured interviews with policymakers and implementors. All three governments have a combination of grant-loan schemes and full bursaries or scholarships. The policies have all been operating for over 20 years, with Eswatini's pre-service policy being the oldest since it was introduced in 1977, followed by Lesotho's 1978 policy and Botswana's 1995 pre-service policy. These policies have never been reviewed or updated. RoS schemes in these countries were introduced to address critical skills shortages, to improve employability prospects for citizens, to have competent public sector employees by global standards and to aid the career progress of government employees. Ministries of Health are passive role players. However, these schemes can only be efficient if there is clear cooperation and coordination between all stakeholders.

Comparing Cytology Brushes for Optimal Human Nasal Epithelial Cell Collection: Implications for Airway Disease Diagnosis and Research

Primary nasal epithelial cells and culture models are used as important diagnostic, research and drug development tools for several airway diseases. Various instruments have been used for the collection of human nasal epithelial (HNE) cells but no global consensus yet exists regarding the optimal tool. This study compares the efficiency of two cytology brushes (Olympus (2 mm diameter) and Endoscan (8 mm diameter)) in collecting HNE cells. The study involved two phases, with phase one comparing the yield, morphology and cilia beat frequency (CBF) of cells collected from paediatric participants using each of the two brushes. Phase two compared nasal brushing under general anaesthetic and in the awake state, across a wide age range, via the retrospective audit of the use of the Endoscan brush in 145 participants. Results indicated no significant difference in CBF measurements between the two brushes, suggesting that the choice of brush does not compromise diagnostic accuracy. However, the Endoscan brush collected significantly more total and live cells than the Olympus brush, making it a more efficient option. Importantly, the Endoscan brush is more cost-effective, with a notable price difference between the two brushes.

Leishmania RNA virus-1 is similarly detected among metastatic and non-metastatic phenotypes in a prospective cohort of American Tegumentary Leishmaniasis

American Tegumentary Leishmaniasis (ATL) is an endemic and neglected disease of South America. Here, mucosal leishmaniasis (ML) disproportionately affects up to 20% of subjects with current or previous localised cutaneous leishmaniasis (LCL). Preclinical and clinical reports have implicated the Leishmania RNA virus-1 (LRV1) as a possible determinant of progression to ML and other severe manifestations such as extensive cutaneous and mucosal disease and treatment failure and relapse. However, these associations were not consistently found in other observational studies and are exclusively based on cross-sectional designs. In the present study, 56 subjects with confirmed ATL were assessed and followed out for 24-months post-treatment. Lesion biopsy specimens were processed for molecular detection and quantification of Leishmania parasites, species identification, and LRV1 detection. Among individuals presenting LRV1 positive lesions, 40% harboured metastatic phenotypes; comparatively 58.1% of patients with LRV1 negative lesions harboured metastatic phenotypes (p = 0.299). We found treatment failure (p = 0.575) and frequency of severe metastatic phenotypes (p = 0.667) to be similarly independent of the LRV1. Parasite loads did not differ according to the LRV1 status (p = 0.330), nor did Leishmanin skin induration size (p = 0.907) or histopathologic patterns (p = 0.780). This study did not find clinical, parasitological, or immunological evidence supporting the hypothesis that LRV1 is a significant determinant of the pathobiology of ATL.

The Leishmania RNA virus-1 (LRV1) has been implicated as a possible modulator agent in the pathogenesis of leishmaniasis. In-vivo and in-vitro studies have depicted specific mechanisms of how LRV1 could lead to metastasis. Clinical studies and epidemiological evidence have both supported and rejected the hypothesis that LRV1 is a relevant determinant of progression, treatment failure and clinical severity of American Tegumentary Leishmaniasis (ATL). This lack of consistency between preclinical and clinical reports requires further longitudinal studies to clarify the role of LRV1 in ATL. Due to the complex nature of ATL, as other frequent human diseases, these studies should tackle multiple determinants of pathogenicity, including LRV1 status, parasite features, immune status, and prevalent comorbidities affecting individuals in endemic settings. Also, critical methodological aspects allowing for the reliable identification and quantification of LRV1 should be guaranteed.

Intensive glucose-lowering and the risk of vascular events and premature death in patients with decreased kidney function: The ADVANCE trial

To assess the effects of intensive glucose control on the risk of major clinical outcomes according to estimated glomerular filtration rate (eGFR) levels in people with type 2 diabetes. Of 11 140 ADVANCE trial participants, 11 096 with baseline eGFR measurements were included, and classified into three eGFR groups: ≥90 mL/min/1.73 m² ; 60 to 89 mL/min/1.73 m² ; and < 60 mL/min/1.73 m² . Relative risk reduction of randomized intensive glucose control with regard to the composite outcome of major macro- and microvascular events, all-cause death and cardiovascular death did not significantly vary by eGFR level (P for heterogeneity ≥0.49). The risk of severe hypoglycaemia increased with intensive glucose control; however, this risk did not vary across eGFR groups (P for heterogeneity = 0.83). The risk-benefit profile of intensive glucose control in patients with type 2 diabetes and impaired kidney function appears similar to that observed in those with preserved kidney function.