Circular RNA (circRNA) is a novel class of single-stranded RNAs with a closed loop structure. The majority of circRNAs are formed by a back-splicing process in pre-mRNA splicing. Their expression is dynamically regulated and shows spatiotemporal patterns among cell types, tissues and developmental stages. CircRNAs have important biological functions in many physiological processes, and their aberrant expression is implicated in many human diseases. Due to their high stability, circRNAs are becoming promising biomarkers in many human diseases, such as cardiovascular diseases, autoimmune diseases and human cancers. In this review, we focus on the translational potential of using human blood circRNAs as liquid biopsy biomarkers for human diseases. We highlight their abundant expression, essential biological functions and significant correlations to human diseases in various components of peripheral blood, including whole blood, blood cells and extracellular vesicles. In addition, we summarize the current knowledge of blood circRNA biomarkers for disease diagnosis or prognosis.

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The potential of using blood circular RNA as liquid biopsy biomarker for human diseases

Increasing Uninsured Patients’ Compliance with Return Primary Care Visits by Dorothy Carleton MS, Walden University, 2016 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University May 2019 Abstract Patients who are unable to comply with their health care regimen are almost 3 times morePatients who are unable to comply with their health care regimen are almost 3 times more likely to have an adverse health outcome and are more likely to suffer irreversible progression of a chronic disease process. Increasing patient return clinic visits is essential, not only to curtail rapidly rising costs of health care but also to improve patient outcomes. This project focused on an uninsured patient population of a clinic in a rural community in the southeastern United States. The purpose of the project was to conduct a systematic review of the literature and identify the barriers and motivating factors for chronic care return primary care visits among uninsured patients. The theoretical models supporting the project were the health belief model and the chronic care model. A search of scholarly databases resulted in 366 articles meeting the inclusion criteria of peerreviewed English-language literature published since 2014 that focused on outpatient care among uninsured populations. All identified articles were reviewed, and several interventions emerged as options to increase patient return rates: care transition and coordination services, patient education, patient follow up, pharmacy assistance programs, food assistance programs, and integration of computer-based literacy interventions. The clinic administrators determined that the best option for the site would be implementation of an on-site food program. The findings of this project have potential to create social change in clinics for uninsured in the community by addressing food insecurity and providing patients an incentive to return for care every 6 months. Increasing Uninsured Patients’ Compliance with Return Primary Care Visits by Dorothy Carleton MS, Walden University, 2016 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice

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Increasing Uninsured Patients' Compliance with Return Primary Care Visits

Objective:Little is known about long-term viral suppression rates for patients who start antiretroviral therapy (ART) soon after diagnosis. We describe virologic outcomes from the San Francisco-based Ward 86 Rapid ART Program for Individuals with an HIV Diagnosis (RAPID) ART program.Design:Retrospec

RAPID antiretroviral therapy: high virologic suppression rates with immediate antiretroviral therapy initiation in a vulnerable urban clinic population

Perinatal Transmission of Hepatitis C Virus: Defining the Cascade of Care.

Objective Strategies to increase pre-exposure prophylaxis (PrEP) uptake are needed. We hypothesized that same-day PrEP initiation in a sexually transmitted diseases (STD) clinic would be acceptable, feasible, and safe, and that individuals would engage in ongoing PrEP care. Method Individuals aged ≥ 18 years were evaluated for PrEP. Exclusion criteria were HIV, history of renal dysfunction or chronic hepatitis B infection, pregnancy, indications for HIV post-exposure prophylaxis, or positive screen for acute HIV symptoms. One hundred individuals received a free 30-day PrEP starter pack and met with a patient navigator to establish ongoing care. Bivariate analysis and multivariable logistic regression were used to compare individuals who did and did not attend at least 1 PrEP follow-up appointment within 180 days of enrollment. Client satisfaction surveys were given 3 months after enrollment. Results The majority (78%) of participants completed at least 1 PrEP follow-up appointment, and 57% attended at least 2 follow-up appointments. After adjusting for race and ethnicity, age, health insurance status, and annual income, only income was associated with follow-up appointment attendance. Each additional $10,000 increase in income was associated with a 1.7-fold increase in the odds of attending a PrEP follow-up appointment (95% confidence interval, 1.07-2.66, P = .02). The majority (54%) of individuals completed the satisfaction survey and all respondents liked the option of same-day PrEP initiation. Conclusions Our study suggests STD clinic-based, same-day PrEP initiation is acceptable, feasible, safe, and links a high proportion of individuals into ongoing PrEP care. Additional resources may be needed to support low-income individuals' retention in care.

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Same-Day HIV Pre-Exposure Prophylaxis (PrEP) Initiation During Drop-in Sexually Transmitted Diseases Clinic Appointments Is a Highly Acceptable, Feasible, and Safe Model that Engages Individuals at Risk for HIV into PrEP Care.

Acute human immunodeficiency virus infection.

While HIV incidence declines nationally, the Southern United States remains disproportionally affected. New Orleans ranks third in the United States for the rate of new HIV infections. Previous studies in San Francisco, Haiti, and South Africa have shown that immediate initiation of antiretroviral therapy (ART) leads to earlier virologic suppression, increased retention in care, and decreased mortality. Further, the publication of three influential studies showed no linked transmission events in patients when ART results in viral suppression. Scientific advances demonstrate that effective treatment with ART prevents sexual HIV transmission. The Centers for Disease Control and Prevention has endorsed the concept of U = U (undetectable = untransmittable.) The Federally Qualified Health Center (FQHC), CrescentCare, partnered with the New Orleans Office of Health Policy, to start all newly diagnosed patients on ART within 72 h of diagnosis. The CrescentCare Start Initiative (CCSI) enhances navigation, expedites clinic intake, and initiates immediate ART. CCSI started on December 1, 2016, and in October 2017 underwent an analysis comparing the first 8 months to a matched cohort. A Standard Operating Procedure (SOP) was disseminated agency wide, including training sessions for all providers. CCSI optimized provider availability and the navigator scheduled patients into any available slot. The intervention leveraged existing CrecentCare-run HIV testing sites, its sexually transmitted diseases (STD) clinic, and informed the clinic’s referral network. A navigator was available 24 h per day to coordinate linkage of new diagnoses. The intake process for CCSI was streamlined for a focused HIV visit with a treating provider. Initial visit was 30 min. The first dose of ART was directly observed. Providers were encouraged to use tenofovir alafenanide/entricitabine (TAF/FTC) + dolutegravir as the initial regimen. It was chosen for the regimen’s effectiveness, tolerability, and empiric coverage of hepatitis B, and approved use in patients with a creatinine clearance greater than or equal to 30 mL/min. After the visit, baseline HIV labs were drawn, and patients saw case management, behavioral health, and eligibility specialists when indicated. A medical checklist was developed to standardize workflow. All primary-care providers committed to seeing patients for the initial visit. Referral was then made to an HIV specialist for on-going management. Labs were reviewed within 48 h. An HIV specialist regularly reviewed patient encounters. Follow-up appointments were made within 4 weeks and were longer in duration. The patient navigator assisted with all appointments through the second provider visit. The provider or patient could decline therapy through shared decision making. In October, CCSI was compared to a cohort from the previous year. The comparator group tested positive at CrescentCare community testing sites and used the same navigator to minimize confounders. The 29 patients in the cohort saw an HIV specialist for their initial visit and were started on an integrase-based initial regimen (Table 1). Viral suppression was defined as an HIV RNA less than 200 copies/mm. Time to suppression was defined as days from diagnosis to viral suppression. All patient information and data points were complete through October 6, 2017. For patients who transferred care, the last viral load was used for analysis. Continuous characteristics were compared using Wilcoxon’s rank-sum test, given that normality could not be assumed. HIV viral load was log-transformed before analysis. Pearson’s v test was used to compare categorical variables (Fisher’s exact test when sample size assumptions were not met). Time to suppression (median and 95% confidence interval) was estimated using the Kaplan-Meier product-limit method; the logrank test was used to assess differences in time to suppression between the two groups of patients. Analyses were conducted using SAS software v. 9.4 (SAS Institute, Inc., Cary, NC). Seventy-seven patients with a new diagnosis of HIV were referred to CCSI from December 5, 2016, to August 6, 2017. 92% (71/77) were linked, saw a treating provider, and started ART within 72 h of diagnosis. Four of the six patients not linked within 72 h were linked to care within 30 days of diagnosis. 69% (49/71) were seen within 24 h of diagnosis, and the remainder (31%, 22/71) within 72 h. Tenofovir

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Linkage and Antiretroviral Therapy Within 72 Hours at a Federally Qualified Health Center in New Orleans

Disclosure of HIV Status to Social Networks Is Strongly Associated with Increased Retention Among an Urban Cohort in New Orleans

Patients who are retained in HIV care have a higher likelihood of viral suppression and increased survival. Lab markers have been used as surrogate markers for clinical visits to estimate retention, but the accuracy of these markers at predicting retention in care has not been validated. A retrospective cohort study was conducted using patients newly diagnosed with HIV in the Emergency Department of Interim Louisiana Public Hospital (ILPH). Retention in care was defined as two clinical visits to an HIV provider separated by at least three months within a one-year period as per the Health Resources and Services Administration (HRSA) definition. Retention by lab markers was defined as two documented labs, either a CD4 count or an HIV viral load, separated by at least three months within the same one-year period. Ninety-nine patients were newly diagnosed with HIV; 36 patients (36%) were retained at 1 year using the HRSA definition and 40 patients (40%) using lab markers. The sensitivity and specificity of using lab markers among the newly diagnosed were 100% and 93.7%, respectively. The positive predictive value (PPV) and negative predictive value (NPV) were 90% and 100%, respectively. Among the 99 patients, 56 were linked to the HIV clinic associated with our hospital, of which 63% (36) were retained at year 1 using the HRSA definition and 70% (39) using lab markers. The sensitivity and specificity of using lab markers among linked patients were 100% and 85%, respectively. The PPV and NPV were 92% and 100%, respectively. Lab markers slightly overestimate currently accepted definitions of retention. While lab markers may be the easiest way to estimate retention at the population level, further study should be done before lab markers are accepted as the gold standard surrogate measure for retention.

Laboratory markers slightly overestimate retention in HIV care among newly diagnosed individuals.

Background: Human immunodeficiency virus (HIV) seropositivity may be associated with higher risk of local recurrence and poor survival in multiple malignancies. However, long-term disease control in HIV-positive patients with head and neck cancer (HNC) is not well described. The purpose of this study is to review the disease-related outcomes of HIV+ patients who underwent radiotherapy (RT) or chemoradiotherapy (CRT) at our institution. Methods: We retrospectively reviewed 24 HIV-positive patients who underwent radiotherapy (RT) for HNC between 2004 and 2013. Patient characteristics, treatment details and outcomes were collected. Overall survival (OS) and local recurrence-free survival (LRFS) was investigated. Kaplan-Meier estimated survival was calculated. Results: Median follow-up was 21 months. All patients were treated with curative intent. Eighty-three percent had stage III-IV. Primary sites of disease included oropharynx (n=12), larynx (n=6), oral cavity (n=2), unknown primary (n=2), nasal cavity (n=1), and paranasal sinuses (n=1). Four patients (17%) had definitive RT alone and 9 definitive CRT (38%; 8 cisplatin and 1 cetuximab). Eleven (46%) were treated in the adjuvant setting after surgical resection; 6 with RT alone and 5 with concurrent cisplatin. Eight patients had acute Grade 3 toxicity with no acute Grade 4 or 5 toxicities. Fifteen patients (63%) were alive and disease-free. 2 and 5-year OS was 67% and 59%. LRFS at 2-years was 82%. Median OS was 83 months. Conclusions: In this cohort, HIV-positive patients treated aggressively with curative intent had excellent overall survival and local control following RT or CRT for HNC. Treatment was relatively well-tolerated compared to historical controls. This group of patients should be managed aggressively with intent to cure.

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Jason Halperin

Papers

Acute human immunodeficiency virus infection.

Linkage and Antiretroviral Therapy Within 72 Hours at a Federally Qualified Health Center in New Orleans

Disclosure of HIV Status to Social Networks Is Strongly Associated with Increased Retention Among an Urban Cohort in New Orleans

Laboratory markers slightly overestimate retention in HIV care among newly diagnosed individuals.

Toxicity and Disease-Related Outcomes after Radiotherapy for Head and Neck Cancer in Human Immunodeficiency Virus-Positive Patients