Our findings suggest an increased risk of CVD from recent abacavir exposure. The risk remained elevated after adjusting for potential confounders. Further investigations are needed to understand CVD risk from cumulative exposure.

In this study we wish to augment our understanding of the effect of environment on corneal growth and morphology. To understand how corneal development of chicks raised in constant light differs from that of 'normal' eyes exposed to cyclic periods of light and dark, white Leghorn chicks were raised under either constant light (approximately 700 lux at cage top) or in 12 h light/12 h dark conditions for up to 12 weeks after hatching. To determine whether corneal expansion is uniform, some birds from each group received corneal tattoos for periodic photographic assessment. By 16 days of age, constant light corneas weighed less than light/dark regimen corneas [7.39 ± 0.35 mg (SE) vs. 8.47 mg ± 0.26 mg SE wet weight, P ≤ 0.05], and corresponding differences were seen in corneal dry weights. Spatial expansion of the corneal surface was uniform in both groups, but the rate of expansion was slower in constant light chicks [0.0327 ± 0.009 (SE) vs. 0.144 ± 0.018 (SE) mm 2 day -1 for normal chicks, P ≤ 0.001]. At 1 day of age, there were 422 ± 12.5 (SE) stromal cells 0.01 mm -2 in the central cornea and 393 ± 21.5(SE) stromal cells 0.01 mm -2 peripherally. Although this difference is not statistically significant, the cell densities in the central cornea were always larger than those of the peripheral cornea in all eight measurements over a 10.5-week period, and this difference is significant ( P ≤ 0.008, binomial test). Light/dark regimen birds show no such consistent difference in cell densities between central and peripheral corneas. Thus, the density distribution of corneal stromal cells of chicks grown in constant light differs from that of normal chicks. Taken together, all these observations suggest that diurnal cycles of light and darkness are necessary for normal corneal growth.

Introduction Although individual antiretroviral drugs have been shown to be associated with elevated cardiovascular disease (CVD) risk, data are limited on the role of antiretroviral drug combinations. Therefore, we sought to investigate CVD risk associated with antiretroviral drug combinations. Methods Using an administrative health-plan dataset, risk of acute myocardial infarction (AMI) associated with current exposure to antiretroviral drug combinations was assessed among persons living with HIV receiving antiretroviral therapy (ART) across the U.S. from October 2009 through December 2014. To account for confounding-by-indication and for factors simultaneously acting as causal mediators and confounders, we applied inverse probability of treatment weighted marginal structural models to longitudinal data of patients. Results Over 114,417 person-years (n = 73,071 persons) of ART exposure, 602 cases of AMI occurred at an event rate of 5.26 (95% CI: 4.86, 5.70)/1000 person-years. Of the 14 antiretroviral drug combinations studied, persons taking abacavir-lamivudine-darunavir had the highest incidence rate (IR: 11/1000; 95% CI: 7.4–16.0) of AMI. Risk (HR; 95% CI) of AMI was elevated for current exposure to abacavir-lamivudine-darunavir (1.91; 1.27–2.88), abacavir-lamivudine-atazanavir (1.58; 1.08–2.31), and tenofovir-emtricitabine-raltegravir (1.35; 1.07–1.71). Tenofovir-emtricitabine-efavirenz was associated with reduced risk (0.65; 0.54–0.78). Abacavir-lamivudine-darunavir was associated with increased risk of AMI beyond that expected of abacavir alone, likely attributable to darunavir co-administration. We did not find an elevated risk of AMI when abacavir-lamivudine was combined with efavirenz or raltegravir. Conclusion The antiretroviral drug combinations abacavir-lamivudine-darunavir, abacavir-lamivudine-atazanavir and tenofovir-emtricitabine-raltegravir were found to be associated with elevated risk of AMI, while tenofovir-emtricitabine-efavirenz was associated with a lower risk. The AMI risk associated with abacavir-lamivudine-darunavir was greater than what was previously described for abacavir, which could suggest an added risk from darunavir. The results should be confirmed in additional studies.

and Mental Hygiene when individuals ages 18-30 are hospitalized for first-episode psychosis (FEP). This study examined the implementation of NYC START, a program that meets patients hospitalized with FEP to offer a voluntary, 3-month critical time intervention provided by social workers and peer specialists to connect individuals to appropriate community mental health services after discharge.Methods: Service logs completed by program staff were summarized to determine the mean number of contacts received per client per week, types of services provided by social workers and peer specialists, survival analyses of time to discharge from NYC START, and connection rates with community mental health services.• This study examined the implementation of NYC START, a program that meets patients hospitalized with FEP to offer them a voluntary, 3-month critical time intervention.• Of the 285 clients who accepted NYC START services in 2016, 87% attended an initial mental health appointment after hospital discharge and 78% completed at least 3 months of the program.• The program has been well received by clients, as evidenced by high enrollment rates, with the vast majority of enrollees continuing mental health services before discharge from NYC START.

Because of its noted success, the NYC Epi Scholars program may serve as a "best-practice" model for expansion in other urban health departments.

the patient to offer services to improve linkage to care and transition back into the community.To identify missed opportunities to intervene with young adults with FEP before the first hospitalization, we manually reviewed hospital discharge summaries from 145 NYC START enrollees discharged between January 1 and July 31, 2016. We noted time from behavior change to hospitalization (TBCH), measured from the time when the patient or others reported first noticing behavior suggestive of early psychosis (e.g., withdrawing or talking to self ) to time of admission as a proxy for duration of untreated psychosis (DUP). Because the World Health Organization recommends limiting DUP to less than 90 days (2), we divided the sample into TBCH #90 days versus .90 days. We reviewed 30 discharge summaries to identify common areas of potential missed opportunities, then coded these opportunities as present or absent in the remaining summaries.Of 145 discharge summaries examined, 38 were removed from analysis, 31 (82%) of which indicated psychiatric hospitalization prior to that precipitating NYC START referral, six (16%) indicated lengthy prior outpatient treatment for psychosis, and one (2%) indicated substanceinduced psychosis. Of 107 remaining, there were no statistically significant differences in gender, age, race, or insurance between those with TBCH #90 days (N555) and those with TBCH .90 days (N552). After adjusted logistic regression analysis, we found that discharged patients with declines in educational performance or discontinued education had greater odds of TBCH .90 days compared with those who stayed in school or had completed a degree (odds ratio [OR]5 4.33, 95% confidence interval [CI]51.72-10.87). Those with family or friends noticing behavior changes had greater odds of TBCH .90 days compared with those who did not (OR54.01, 95% CI51.31-12.34). [A table in the online supplement indicates demographic and additional information.]Findings suggest that family and friends often identify behavior changes that constitute the prodromal phase of psychosis. Also, expectedly, FEP may cause major