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Prediction markets are a successful information aggregation structure, however the exact mechanism by which private information is incorporated into the price remains poorly understood. We introduce a novel method based on the “Kyle model” to identify traders who contribute valuable information to the market price. Applied to a large field prediction market dataset, we identify traders whose trades have positive informational price impact. In contrast to others, these traders realize profit (on average) in excess of a theoretical expected informed lower bound. Results are replicated on other field prediction market datasets, providing strong evidence in favor of the Kyle model.

BackgroundTenofovir disoproxil fumarate-containing pre-exposure prophylaxis (PrEP) has been associated with decreases in bone mineral density (BMD), but the bone effects of other non-tenofovir disoproxil fumarate candidate PrEP regimens are not well described.MethodsThe HPTN 069/ACTG A5305 study randomized 406 US cisgender men and transgender women, and 188 cisgender women at risk for HIV infection to one of four double-blinded regimens: (i) maraviroc; (ii) maraviroc + emtricitabine; (iii) maraviroc + tenofovir disoproxil fumarate; or (iv) tenofovir disoproxil fumarate + emtricitabine. BMD was measured in a subset of participants at the lumbar spine (LS) and hip by dual-energy X-ray absorptiometry (DXA) at baseline and 48 weeks. Percentage change in LS and hip BMD was compared between the tenofovir disoproxil fumarate- and non-tenofovir disoproxil fumarate-containing arms by Wilcoxon rank-sum tests and multiple linear regression adjusting for sex, race and baseline BMI.ResultsAt baseline (n = 307), the median age was 33 years, 56% male and 43% black. At the hip, the median percentage change in BMD at 48 weeks was -1.05% in the tenofovir disoproxil fumarate arms and 0.0% in the non-tenofovir disoproxil fumarate arms (between group P = 0.001). No interaction by sex was observed. The median percentage change in LS BMD was not different between arms.ConclusionsTenofovir disoproxil fumarate-containing PrEP was associated with significantly greater bone loss compared with maraviroc ± emtricitabine PrEP at the hip, but not the LS. The BMD changes at the hip were similar in magnitude in men and women.

AimsDeep neural network artificial intelligence (DNN-AI)-based Heart Age estimations have been presented and used to show that the difference between an electrocardiogram (ECG)-estimated Heart Age and chronological age is associated with prognosis. An accurate ECG Heart Age, without DNNs, has been developed using explainable advanced ECG (A-ECG) methods. We aimed to evaluate the prognostic value of the explainable A-ECG Heart Age and compare its performance to a DNN-AI Heart Age.Methods and resultsBoth A-ECG and DNN-AI Heart Age were applied to patients who had undergone clinical cardiovascular magnetic resonance imaging. The association between A-ECG or DNN-AI Heart Age Gap and cardiovascular risk factors was evaluated using logistic regression. The association between Heart Age Gaps and death or heart failure (HF) hospitalization was evaluated using Cox regression adjusted for clinical covariates/comorbidities. Among patients [n = 731, 103 (14.1%) deaths, 52 (7.1%) HF hospitalizations, median (interquartile range) follow-up 5.7 (4.7-6.7) years], A-ECG Heart Age Gap was associated with risk factors and outcomes [unadjusted hazard ratio (HR) (95% confidence interval) (5 year increments): 1.23 (1.13-1.34) and adjusted HR 1.11 (1.01-1.22)]. DNN-AI Heart Age Gap was associated with risk factors and outcomes after adjustments [HR (5 year increments): 1.11 (1.01-1.21)], but not in unadjusted analyses [HR 1.00 (0.93-1.08)], making it less easily applicable in clinical practice.ConclusionA-ECG Heart Age Gap is associated with cardiovascular risk factors and HF hospitalization or death. Explainable A-ECG Heart Age Gap has the potential for improving clinical adoption and prognostic performance compared with existing DNN-AI-type methods. Graphical Abstract

AimsDeep neural network artificial intelligence (DNN-AI)-based Heart Age estimations have been presented and used to show that the difference between an electrocardiogram (ECG)-estimated Heart Age and chronological age is associated with prognosis. An accurate ECG Heart Age, without DNNs, has been developed using explainable advanced ECG (A-ECG) methods. We aimed to evaluate the prognostic value of the explainable A-ECG Heart Age and compare its performance to a DNN-AI Heart Age.Methods and resultsBoth A-ECG and DNN-AI Heart Age were applied to patients who had undergone clinical cardiovascular magnetic resonance imaging. The association between A-ECG or DNN-AI Heart Age Gap and cardiovascular risk factors was evaluated using logistic regression. The association between Heart Age Gaps and death or heart failure (HF) hospitalization was evaluated using Cox regression adjusted for clinical covariates/comorbidities. Among patients [n = 731, 103 (14.1%) deaths, 52 (7.1%) HF hospitalizations, median (interquartile range) follow-up 5.7 (4.7-6.7) years], A-ECG Heart Age Gap was associated with risk factors and outcomes [unadjusted hazard ratio (HR) (95% confidence interval) (5 year increments): 1.23 (1.13-1.34) and adjusted HR 1.11 (1.01-1.22)]. DNN-AI Heart Age Gap was associated with risk factors and outcomes after adjustments [HR (5 year increments): 1.11 (1.01-1.21)], but not in unadjusted analyses [HR 1.00 (0.93-1.08)], making it less easily applicable in clinical practice.ConclusionA-ECG Heart Age Gap is associated with cardiovascular risk factors and HF hospitalization or death. Explainable A-ECG Heart Age Gap has the potential for improving clinical adoption and prognostic performance compared with existing DNN-AI-type methods. Graphical Abstract

AimsDeep neural network artificial intelligence (DNN-AI)-based Heart Age estimations have been presented and used to show that the difference between an electrocardiogram (ECG)-estimated Heart Age and chronological age is associated with prognosis. An accurate ECG Heart Age, without DNNs, has been developed using explainable advanced ECG (A-ECG) methods. We aimed to evaluate the prognostic value of the explainable A-ECG Heart Age and compare its performance to a DNN-AI Heart Age.Methods and resultsBoth A-ECG and DNN-AI Heart Age were applied to patients who had undergone clinical cardiovascular magnetic resonance imaging. The association between A-ECG or DNN-AI Heart Age Gap and cardiovascular risk factors was evaluated using logistic regression. The association between Heart Age Gaps and death or heart failure (HF) hospitalization was evaluated using Cox regression adjusted for clinical covariates/comorbidities. Among patients [n = 731, 103 (14.1%) deaths, 52 (7.1%) HF hospitalizations, median (interquartile range) follow-up 5.7 (4.7-6.7) years], A-ECG Heart Age Gap was associated with risk factors and outcomes [unadjusted hazard ratio (HR) (95% confidence interval) (5 year increments): 1.23 (1.13-1.34) and adjusted HR 1.11 (1.01-1.22)]. DNN-AI Heart Age Gap was associated with risk factors and outcomes after adjustments [HR (5 year increments): 1.11 (1.01-1.21)], but not in unadjusted analyses [HR 1.00 (0.93-1.08)], making it less easily applicable in clinical practice.ConclusionA-ECG Heart Age Gap is associated with cardiovascular risk factors and HF hospitalization or death. Explainable A-ECG Heart Age Gap has the potential for improving clinical adoption and prognostic performance compared with existing DNN-AI-type methods. Graphical Abstract

AimsDeep neural network artificial intelligence (DNN-AI)-based Heart Age estimations have been presented and used to show that the difference between an electrocardiogram (ECG)-estimated Heart Age and chronological age is associated with prognosis. An accurate ECG Heart Age, without DNNs, has been developed using explainable advanced ECG (A-ECG) methods. We aimed to evaluate the prognostic value of the explainable A-ECG Heart Age and compare its performance to a DNN-AI Heart Age.Methods and resultsBoth A-ECG and DNN-AI Heart Age were applied to patients who had undergone clinical cardiovascular magnetic resonance imaging. The association between A-ECG or DNN-AI Heart Age Gap and cardiovascular risk factors was evaluated using logistic regression. The association between Heart Age Gaps and death or heart failure (HF) hospitalization was evaluated using Cox regression adjusted for clinical covariates/comorbidities. Among patients [n = 731, 103 (14.1%) deaths, 52 (7.1%) HF hospitalizations, median (interquartile range) follow-up 5.7 (4.7-6.7) years], A-ECG Heart Age Gap was associated with risk factors and outcomes [unadjusted hazard ratio (HR) (95% confidence interval) (5 year increments): 1.23 (1.13-1.34) and adjusted HR 1.11 (1.01-1.22)]. DNN-AI Heart Age Gap was associated with risk factors and outcomes after adjustments [HR (5 year increments): 1.11 (1.01-1.21)], but not in unadjusted analyses [HR 1.00 (0.93-1.08)], making it less easily applicable in clinical practice.ConclusionA-ECG Heart Age Gap is associated with cardiovascular risk factors and HF hospitalization or death. Explainable A-ECG Heart Age Gap has the potential for improving clinical adoption and prognostic performance compared with existing DNN-AI-type methods. Graphical Abstract

Older persons with HIV (PWH) experience high rates of cognitive impairment and frailty, and accelerated decline in physical function compared with the general population. Metformin use has been associated with beneficial effects on cognitive and physical function among older adults without HIV. The relationship between metformin use on these outcomes in PWH has not been evaluated. AIDS Clinical Trials Group (ACTG) A5322 is an observational cohort study of older PWH with annual assessments for cognition and frailty, including measures of physical function (e.g., gait speed and grip strength). Participants with diabetes who were prescribed antihyperglycemic medications were included in this analysis to evaluate the association between metformin and functional outcomes. Cross-sectional, longitudinal, and time-to-event models were used to evaluate the relationship between metformin exposure with cognitive, physical function, and frailty outcomes. Ninety-eight PWH met inclusion criteria and were included in at least one model. No significant associations between metformin use, frailty, physical, or cognitive function were noted in unadjusted or adjusted cross-sectional, longitudinal, or time-to-event models (p > .1 for all models). This study is the first to examine the association between metformin use on functional outcomes among older PWH. Although it did not ascertain significant associations between metformin use and functional outcomes, our small sample size, restriction to persons with diabetes, and lack of randomization to metformin therapy were limitations. Larger randomized studies are needed to determine whether metformin use has beneficial effects on cognitive or physical function in PWH. Clinical Trial Registration numbers: 02570672, 04221750, 00620191, and 03733132.

BackgroundPersons with HIV (PWH) have an increased risk of cardiovascular disease (CVD) compared to HIV-seronegative individuals (SN). Inflammation contributes to this risk but the role of lipid mediators, with central roles in inflammation, in HIV infection remain to be established; further aspirin reduces CVD risk in the general population through production of some of these anti-inflammatory lipid mediators, but they have not been studied in PWH.MethodsWe evaluated the relationship between plasma lipid mediators (i.e. 50 lipid mediators including classic eicosanoids and specialized pro-resolving mediators (SPMs)) and HIV status; and the impact of aspirin in PWH on regulating these autacoids. Plasma samples were obtained from 110 PWH receiving antiretroviral therapy (ART) from a randomized trial of aspirin (ACTG-A5331) and 107 matched SN samples (MACS-WIHS Combined Cohort).FindingsPWH had lower levels of arachidonic acid-derived pro-inflammatory prostaglandins (PGs: PGE2 and PGD2) and thromboxanes (Tx: TxB2), and higher levels of select pro-resolving lipid mediators (e.g. RvD4 and MaR2n-3 DPA) compared to SN. At the interval tested, aspirin intervention was observed to reduced PGs and Tx, and while we did not observe an increase in aspirin triggered mediators, we observed the upregulation of other SPM in aspirin treated PWH, namely MaR2n-3 DPA.InterpretationTogether these observations demonstrate that plasma lipid mediators profiles, some with links to systemic inflammation and CVD risk, become altered in PWH. Furthermore, aspirin intervention did not increase levels of aspirin-triggered pro-resolving lipid mediators, consistent with other reports of an impaired aspirin response in PWH.FundingNIH.

AimsDeep neural network artificial intelligence (DNN-AI)-based Heart Age estimations have been presented and used to show that the difference between an electrocardiogram (ECG)-estimated Heart Age and chronological age is associated with prognosis. An accurate ECG Heart Age, without DNNs, has been developed using explainable advanced ECG (A-ECG) methods. We aimed to evaluate the prognostic value of the explainable A-ECG Heart Age and compare its performance to a DNN-AI Heart Age.Methods and resultsBoth A-ECG and DNN-AI Heart Age were applied to patients who had undergone clinical cardiovascular magnetic resonance imaging. The association between A-ECG or DNN-AI Heart Age Gap and cardiovascular risk factors was evaluated using logistic regression. The association between Heart Age Gaps and death or heart failure (HF) hospitalization was evaluated using Cox regression adjusted for clinical covariates/comorbidities. Among patients [n = 731, 103 (14.1%) deaths, 52 (7.1%) HF hospitalizations, median (interquartile range) follow-up 5.7 (4.7-6.7) years], A-ECG Heart Age Gap was associated with risk factors and outcomes [unadjusted hazard ratio (HR) (95% confidence interval) (5 year increments): 1.23 (1.13-1.34) and adjusted HR 1.11 (1.01-1.22)]. DNN-AI Heart Age Gap was associated with risk factors and outcomes after adjustments [HR (5 year increments): 1.11 (1.01-1.21)], but not in unadjusted analyses [HR 1.00 (0.93-1.08)], making it less easily applicable in clinical practice.ConclusionA-ECG Heart Age Gap is associated with cardiovascular risk factors and HF hospitalization or death. Explainable A-ECG Heart Age Gap has the potential for improving clinical adoption and prognostic performance compared with existing DNN-AI-type methods. Graphical Abstract

An initial concept for the plasma diagnostic and control (D&C) system has been developed as part of European studies towards the development of a demonstration tokamak fusion reactor (DEMO). The main objective is to develop a feasible, integrated concept design of the DEMO D&C system that can provide reliable plasma control and high performance (electricity output) over extended periods of operation. While the fusion power is maximized when operating near to the operational limits of the tokamak, the reliability of operation typically improves when choosing parameters significantly distant from these limits. In addition to these conflicting requirements, the D&C development has to cope with strong adverse effects acting on all in vessel components on DEMO (harsh neutron environment, particle fluxes, temperatures, electromagnetic forces, etc.). Moreover, space allocation and plasma access are constrained by the needs for first wall integrity and optimization of tritium breeding. Taking into account these boundary conditions, the main DEMO plasma control issues have been formulated, and a list of diagnostic systems and channels needed for plasma control has been developed, which were selected for their robustness and the required coverage of control issues. For a validation and refinement of this concept, simulation tools are being refined and applied for equilibrium, kinetic and mode control studies.

An initial concept for the plasma diagnostic and control (D&C) system has been developed as part of European studies towards the development of a demonstration tokamak fusion reactor (DEMO). The main objective is to develop a feasible, integrated concept design of the DEMO D&C system that can provide reliable plasma control and high performance (electricity output) over extended periods of operation. While the fusion power is maximized when operating near to the operational limits of the tokamak, the reliability of operation typically improves when choosing parameters significantly distant from these limits. In addition to these conflicting requirements, the D&C development has to cope with strong adverse effects acting on all in vessel components on DEMO (harsh neutron environment, particle fluxes, temperatures, electromagnetic forces, etc.). Moreover, space allocation and plasma access are constrained by the needs for first wall integrity and optimization of tritium breeding. Taking into account these boundary conditions, the main DEMO plasma control issues have been formulated, and a list of diagnostic systems and channels needed for plasma control has been developed, which were selected for their robustness and the required coverage of control issues. For a validation and refinement of this concept, simulation tools are being refined and applied for equilibrium, kinetic and mode control studies.

An initial concept for the plasma diagnostic and control (D&C) system has been developed as part of European studies towards the development of a demonstration tokamak fusion reactor (DEMO). The main objective is to develop a feasible, integrated concept design of the DEMO D&C system that can provide reliable plasma control and high performance (electricity output) over extended periods of operation. While the fusion power is maximized when operating near to the operational limits of the tokamak, the reliability of operation typically improves when choosing parameters significantly distant from these limits. In addition to these conflicting requirements, the D&C development has to cope with strong adverse effects acting on all in vessel components on DEMO (harsh neutron environment, particle fluxes, temperatures, electromagnetic forces, etc.). Moreover, space allocation and plasma access are constrained by the needs for first wall integrity and optimization of tritium breeding. Taking into account these boundary conditions, the main DEMO plasma control issues have been formulated, and a list of diagnostic systems and channels needed for plasma control has been developed, which were selected for their robustness and the required coverage of control issues. For a validation and refinement of this concept, simulation tools are being refined and applied for equilibrium, kinetic and mode control studies.

BackgroundThe adipokines leptin and adiponectin, produced primarily by adipose tissue, have diverse endocrine and immunologic effects, and circulating levels reflect adipocyte lipid content, local inflammation, and tissue composition. We assessed relationships between changes in regional fat depots, leptin and adiponectin levels, and metabolic and inflammatory markers over 96 weeks in the AIDS Clinical Trials Group (ACTG) A5260s metabolic substudy of the A5257 randomized trial of tenofovir disoproxil fumarate/emtricitabine plus atazanavir/ritonavir, darunavir/ritonavir, or raltegravir among treatment-naive persons with human immunodeficiency virus (PWH).MethodsFat depots were measured using dual-energy absorptiometry and abdominal computed tomographic imaging at treatment initiation and 96 weeks later. Serum leptin and adiponectin, homeostatic model assessment of insulin resistance (HOMA-IR), and high-sensitivity C-reactive protein (hsCRP) were measured at the same timepoints. Multivariable regression models assessed relationships between fat depots, adipokines, HOMA-IR, and hsCRP at week 96.ResultsTwo hundred thirty-four participants maintained viral suppression through 96 weeks (90% male, 29% black, median age 36 years). Serum leptin increased over 96 weeks (mean change 22%) while adiponectin did not (mean change 1%), which did not differ by study arm. Greater trunk, limb, and abdominal subcutaneous and visceral fat were associated with higher HOMA-IR and hsCRP at 96 weeks, but serum leptin level was a stronger determinant of these endpoints using a mediation model approach. A similar mediating effect was not observed for adiponectin.ConclusionsHigher circulating leptin is associated with greater HOMA-IR and hsCRP independent of fat depot size, suggesting that greater adipocyte lipid content may contribute to impaired glucose tolerance and systemic inflammation among PWH starting antiretroviral therapy.

ObjectiveThe aim of this study was to assess the association of cardiovascular disease (CVD) risk scores and coronary artery plaque (CAP) progression in HIV-infected participants.MethodsWe studied men with and without HIV-infection enrolled in the Multicenter AIDS Cohort Study (MACS) CVD study. CAP at baseline and follow-up was assessed with cardiac computed tomography angiography (CCTA). We examined the association between baseline risk scores including pooled cohort equation (PCE), Framingham risk score (FRS), and Data collect of Adverse effects of anti-HIV drugs equation (D:A:D) and CAP progression.ResultsWe studied 495 men (211 HIV-uninfected, 284 HIV-infected). The adjusted odds ratio (aOR) of total plaque volume (TPV) and noncalcified plaque volume (NCPV) progression in the highest relative to lowest tertile was 9.4 [95% confidence interval (95% CI) 2.4-12.1, P < 0.001)] and 7.7 (95% CI 3.1-19.1, P < 0.001) times greater, respectively, among HIV-uninfected men in the PCE atherosclerotic cardiovascular disease (ASCVD) high vs. low-risk category. Among HIV-infected men, the association for TPV and NCPV progression for the same PCE risk categories, odds ratio (OR) 2.8 (95% CI 1.4-5.8, P < 0.01) and OR 2.4 (95% CI 1.2-4.8, P < 0.05), respectively (P values for interaction by HIV = 0.02 and 0.08, respectively). Similar results were seen for the FRS risk scores. Among HIV-uninfected men, PCE high risk category identified the highest proportion of men with plaque progression in the highest tertile, although in HIV-infected men, high-risk category by D:A:D identified the greatest percentage of men with plaque progression albeit with lower specificity than FRS and PCE.ConclusionPCE and FRS categories predict CAP progression better in HIV-uninfected than in HIV-infected men. Improved CVD risk scores are needed to identify high-risk HIV-infected men for more aggressive CVD risk prevention strategies.

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19) symptoms among people living with HIV (PLWH) are not well described.SettingLongitudinal survey within the MACS/WIHS Combined Cohort Study (MWCCS) of PLWH compared with similar HIV-seronegative (SN) individuals.MethodsTelephone-administered survey of MWCCS participants at 13 clinical research sites across the United States addressing COVID-19 symptoms, SARS-CoV-2 testing, and pandemic impact on social distancing and antiretroviral therapy (ART) use. Primary data collection occurred during May (wave 1), June-July (wave 2), and August-September, 2020 (wave 3).ResultsOne-third of MWCCS participants were tested for SARS-CoV-2 infection; 10% was tested ≥2 times. Similar proportions of PLWH and SN participants were tested, but SARS-CoV-2 positivity was higher among PLWH than among SN individuals (9.4% vs 4.8%, P = 0.003). Odds of SARS-CoV-2 positivity remained higher among PLWH after adjusting for age, sex, race/ethnicity, and study site (adjusted odds ratio = 2.0, 95% confidence interval = 1.2 to 3.2). SARS-CoV-2 positivity was not associated with CD4 cell counts among PLWH. Among SARS-CoV-2 positive participants, 9% had no symptoms, 7% had 1-2 mild symptoms, and 84% had ≥3 symptoms. Most of the (98%) participants reported physical distancing during all survey waves; self-reported ART adherence among PLWH was not adversely affected during the pandemic compared with the previous year (similar adherence in 89% of participants, improved in 9% of participants, and decreased in 2% of participants).ConclusionsDespite similar SARS-CoV-2 testing and physical distancing profiles by HIV serostatus among MWCCS participants, PLWH who reported SARS-CoV-2 testing were more likely to have a positive test result. Additional studies are needed to determine whether and why PLWH are at increased risk of SARS-CoV-2 infection.

ObjectivesPeople with HIV (PWH) are at increased risk for premature cardiovascular disease (CVD). Clonal hematopoiesis is a common age-related condition that may be associated with increased CVD risk. The goal of this study was to determine the prevalence of clonal hematopoiesis and its association with chronic inflammation and CVD in PWH.DesignCross-sectional study utilizing archived specimens and data from 118 men (86 PWH and 32 HIV-uninfected) from the Baltimore-Washington DC center of the Multicenter AIDS Cohort Study (MACS) who had had coronary computed tomography angiography (CTA) and measurement of 34 serologic inflammatory biomarkers.MethodsClonal hematopoiesis was assessed on peripheral blood mononuclear cells utilizing targeted error-corrected next generation sequencing (NGS) focused on 92 genes frequently mutated in hematologic malignancies. Clinical and laboratory data were obtained from the MACS database.ResultsClonal hematopoiesis with a variant allele frequency (VAF) greater than 1% was significantly more common in PWH [20/86 (23.3%)] than in HIV-uninfected men [2/32 (6.3%)] ( P = 0.035). PWH with clonal hematopoiesis (VAF > 1%) were more likely to have coronary artery stenosis of at least 50% than those without clonal hematopoiesis [6/20 (30%) vs. 6/64 (9%); P = 0.021]. Presence of clonal hematopoiesis was not significantly associated with serological inflammatory markers, except for significantly lower serum leptin levels; this was not significant after adjustment for abdominal or thigh subcutaneous fat area.ConclusionClonal hematopoiesis was more common in PWH and among PWH was associated with the extent of coronary artery disease. Larger studies are needed to further examine the biological and clinical consequences of clonal hematopoiesis in PWH.

Background and aimsPeople living with HIV (HIV+) are surviving longer due to effective antiretroviral therapy. Cardiovascular disease is a leading cause of non-AIDS related clinical events. We determined HIV-related factors associated with coronary artery stenosis progression.MethodsWe performed serial coronary CT angiography among HIV+ and HIV-uninfected (HIV-) men in the Multicenter AIDS Cohort Study. The median inter-scan interval was 4.5 years. Stenosis was graded as 0, 1-29, 30-49, 50-69 or ≥70%. Progression was defined as an increase ≥2 categories. Suppressed HIV infection was consistent viral loads <50 copies/mL allowing 1 "blip" <500 copies/mL, otherwise considered viremic. Multivariable Poisson regression analysis assessed adjusted associations between HIV serostatus and viremia with coronary stenosis progression.ResultsThe sample included 310 HIV+ (31% viremic) and 234 HIV- men. The median age was 53 years, 30% Black and 23% current smokers. Viremic men were 2.3 times more likely to develop coronary stenosis progression than HIV- men (adjusted RR 2.30; 95% CI, 1.32-4.00, p = 0.003), with no difference in progression between HIV+ suppressed and HIV- men (RR 1.10; 95% CI, 0.70-1.74, p = 0.67). There was a progressive increase in adjusted relative risk with greater viremia (p = 0.03). Men with >1 viral load >500 copies/ml demonstrated greatest stenosis progression (RR 3.01; 95% CI, 1.53-4.92, p = 0.001 compared with HIV- men). Suppressed HIV+ men with suboptimal antiretroviral adherence had greater stenosis progression (RR 1.91; 95% CI 1.12-3.24, p = 0.02) than HIV + suppressed men with optimal adherence.ConclusionsCoronary artery stenosis progression was associated with suboptimal HIV RNA suppression and antiretroviral therapy adherence. Effective ongoing HIV virologic suppression and antiretroviral therapy adherence may mitigate risk for coronary disease events among people li

An initial concept for the plasma diagnostic and control (D&C) system has been developed as part of European studies towards the development of a demonstration tokamak fusion reactor (DEMO). The main objective is to develop a feasible, integrated concept design of the DEMO D&C system that can provide reliable plasma control and high performance (electricity output) over extended periods of operation. While the fusion power is maximized when operating near to the operational limits of the tokamak, the reliability of operation typically improves when choosing parameters significantly distant from these limits. In addition to these conflicting requirements, the D&C development has to cope with strong adverse effects acting on all in vessel components on DEMO (harsh neutron environment, particle fluxes, temperatures, electromagnetic forces, etc.). Moreover, space allocation and plasma access are constrained by the needs for first wall integrity and optimization of tritium breeding. Taking into account these boundary conditions, the main DEMO plasma control issues have been formulated, and a list of diagnostic systems and channels needed for plasma control has been developed, which were selected for their robustness and the required coverage of control issues. For a validation and refinement of this concept, simulation tools are being refined and applied for equilibrium, kinetic and mode control studies.

An initial concept for the plasma diagnostic and control (D&C) system has been developed as part of European studies towards the development of a demonstration tokamak fusion reactor (DEMO). The main objective is to develop a feasible, integrated concept design of the DEMO D&C system that can provide reliable plasma control and high performance (electricity output) over extended periods of operation. While the fusion power is maximized when operating near to the operational limits of the tokamak, the reliability of operation typically improves when choosing parameters significantly distant from these limits. In addition to these conflicting requirements, the D&C development has to cope with strong adverse effects acting on all in vessel components on DEMO (harsh neutron environment, particle fluxes, temperatures, electromagnetic forces, etc.). Moreover, space allocation and plasma access are constrained by the needs for first wall integrity and optimization of tritium breeding. Taking into account these boundary conditions, the main DEMO plasma control issues have been formulated, and a list of diagnostic systems and channels needed for plasma control has been developed, which were selected for their robustness and the required coverage of control issues. For a validation and refinement of this concept, simulation tools are being refined and applied for equilibrium, kinetic and mode control studies.

This article describes the DEMO cryostat, the vacuum vessel, and the tokamak building as well as the system configurations to integrate the main in-vessel components and auxiliary systems developed during the Pre-Conceptual Design Phase. The vacuum vessel is the primary component for radiation shielding and containment of tritium and other radioactive material. Various systems required to operate the plasma are integrated in its ports. The vessel together with the external magnetic coils is located inside the even larger cryostat that has the primary function to provide a vacuum to enable the operation of the superconducting coils in cryogenic condition. The cryostat is surrounded by a thick concrete structure: the bioshield. It protects the external areas from neutron and gamma radiation emitted from the tokamak. The tokamak building layout is aligned with the VV ports implementing floors and separate rooms, so-called port cells, that can be sealed to provide a secondary confinement when a port is opened during in-vessel maintenance. The ports of the torus-shaped VV have to allow for the replacement of in-vessel components but also incorporate plasma limiters and auxiliary heating and diagnostic systems. The divertor is replaced through horizontal ports at the lower level, the breeding blanket (BB) through upper vertical ports. The pipe work of these in-vessel components is also routed through these ports. To facilitate the vertical replacement of the BB, it is divided into large vertical segments. Their mechanical support during operation relies on vertically clamping them inside the vacuum vessel by a combination of obstructed thermal expansion and radial pre-compression due to the ferromagnetic force acting on the breeding blanket structural material in the toroidal magnetic field.

Background We aimed to investigate whether there are differences in cardiac structure and systolic and diastolic function evaluated by 2-dimensional echocardiography among men living with versus without HIV in the era of combination antiretroviral therapy. Methods and Results We performed a cross-sectional analysis of 1195 men from MACS (Multicenter AIDS Cohort Study) who completed a transthoracic echocardiogram examination between 2017 and 2019. Associations between HIV serostatus and echocardiographic indices were assessed by multivariable regression analyses, adjusting for demographics and cardiovascular risk factors. Among men who are HIV+, associations between HIV disease severity markers and echocardiographic parameters were also investigated. Average age was 57.1±11.9 years; 29% of the participants were Black, and 55% were HIV+. Most men who were HIV+ (77%) were virally suppressed; 92% received combination antiretroviral therapy. Prevalent left ventricular (LV) systolic dysfunction (ejection fraction <50%) was low and HIV serostatus was not associated with left ventricular ejection fraction. Multivariable adjustment models showed that men who were HIV+ versus those who were HIV- had greater LV mass index and larger left atrial diameter and right ventricular (RV) end-diastolic area; lower RV function; and higher prevalence of diastolic dysfunction. Higher current CD4+ T cell count ≥400 cell/mm3 versus <400 was associated with smaller LV diastolic volume and RV area. Virally suppressed men who were HIV+ versus those who were HIV- had higher indexed LV mass and left atrial areas and greater diastolic dysfunction. Conclusions HIV seropositivity was independently associated with greater LV mass index, left atrial and RV sizes, lower RV function and diastolic abnormalities, but not left ventricular ejection fraction, which may herald a future predisposition to heart failure with preserved ejection fraction among men living with HIV.

BackgroundSafe and effective long-acting injectable agents for preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) infection are needed to increase the options for preventing HIV infection.MethodsWe conducted a randomized, double-blind, double-dummy, noninferiority trial to compare long-acting injectable cabotegravir (CAB-LA, an integrase strand-transfer inhibitor [INSTI]) at a dose of 600 mg, given intramuscularly every 8 weeks, with daily oral tenofovir disoproxil fumarate-emtricitabine (TDF-FTC) for the prevention of HIV infection in at-risk cisgender men who have sex with men (MSM) and in at-risk transgender women who have sex with men. Participants were randomly assigned (1:1) to receive one of the two regimens and were followed for 153 weeks. HIV testing and safety evaluations were performed. The primary end point was incident HIV infection.ResultsThe intention-to-treat population included 4566 participants who underwent randomization; 570 (12.5%) identified as transgender women, and the median age was 26 years (interquartile range, 22 to 32). The trial was stopped early for efficacy on review of the results of the first preplanned interim end-point analysis. Among 1698 participants from the United States, 845 (49.8%) identified as Black. Incident HIV infection occurred in 52 participants: 13 in the cabotegravir group (incidence, 0.41 per 100 person-years) and 39 in the TDF-FTC group (incidence, 1.22 per 100 person-years) (hazard ratio, 0.34; 95% confidence interval, 0.18 to 0.62). The effect was consistent across prespecified subgroups. Injection-site reactions were reported in 81.4% of the participants in the cabotegravir group and in 31.3% of those in the TDF-FTC group. In the participants in whom HIV infection was diagnosed after exposure to CAB-LA, INSTI resistance and delays in the detection of HIV infection were noted. No safety concerns were identified.ConclusionsCAB-LA was superior to daily oral TDF-FTC in preventing HIV infection am

The number of people with HIV (PWH) aged 50 years or older continues to steadily increase. The convergence of age- and HIV-related complications in these individuals presents a challenge for both patients and clinicians alike. New findings continue to emerge, as numerous researchers evaluate the combined impact of these two factors on quality of life, physiological systems, and mental health in PWH. Since its first occurrence in 2009, the International Workshop on HIV and Aging has served as a multidisciplinary meeting to share basic biomedical data, clinical trial results, treatment strategies, and epidemiological recommendations, toward better understanding and outcomes among like-minded scientific professionals. In this article, we share a selection of key findings presented in plenary talks at the 11th Annual International Workshop on HIV and Aging, held virtually from September 30, 2020 to October 2, 2020. We will also address the future directions of HIV and aging research, to further assess how the aging process intersects with chronic HIV.

BackgroundSafe and effective long-acting injectable agents for preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) infection are needed to increase the options for preventing HIV infection.MethodsWe conducted a randomized, double-blind, double-dummy, noninferiority trial to compare long-acting injectable cabotegravir (CAB-LA, an integrase strand-transfer inhibitor [INSTI]) at a dose of 600 mg, given intramuscularly every 8 weeks, with daily oral tenofovir disoproxil fumarate-emtricitabine (TDF-FTC) for the prevention of HIV infection in at-risk cisgender men who have sex with men (MSM) and in at-risk transgender women who have sex with men. Participants were randomly assigned (1:1) to receive one of the two regimens and were followed for 153 weeks. HIV testing and safety evaluations were performed. The primary end point was incident HIV infection.ResultsThe intention-to-treat population included 4566 participants who underwent randomization; 570 (12.5%) identified as transgender women, and the median age was 26 years (interquartile range, 22 to 32). The trial was stopped early for efficacy on review of the results of the first preplanned interim end-point analysis. Among 1698 participants from the United States, 845 (49.8%) identified as Black. Incident HIV infection occurred in 52 participants: 13 in the cabotegravir group (incidence, 0.41 per 100 person-years) and 39 in the TDF-FTC group (incidence, 1.22 per 100 person-years) (hazard ratio, 0.34; 95% confidence interval, 0.18 to 0.62). The effect was consistent across prespecified subgroups. Injection-site reactions were reported in 81.4% of the participants in the cabotegravir group and in 31.3% of those in the TDF-FTC group. In the participants in whom HIV infection was diagnosed after exposure to CAB-LA, INSTI resistance and delays in the detection of HIV infection were noted. No safety concerns were identified.ConclusionsCAB-LA was superior to daily oral TDF-FTC in preventing HIV infection am

Chronic inflammation, including among people with HIV (PWH), elevates immune cell expression of lymphocyte activation gene 3 (LAG3); however, low plasma LAG3 predicts cardiovascular disease (CVD) events in the general population. The associations among LAG3 plasma levels, subclinical atherosclerosis, inflammation, and HIV infection have not been well described. We measured plasma LAG3 in 704 men with and without HIV from the multicenter AIDS cohort study, who underwent coronary computed tomography angiography. HIV serostatus was not independently associated with LAG3 after adjustment for sociodemographic and CVD risk factors. Current smoking status and African American race were associated with lower LAG3, and age and sTNFαRI concentration were associated with greater LAG3. LAG3 was not associated with coronary artery stenosis. Thus, no difference was found in plasma LAG3 concentration by HIV serostatus, and no association between LAG3 and subclinical coronary atherosclerosis in men with and without HIV was observed.

BackgroundDespite advances in antiretroviral therapy (ART), people living with human immunodeficiency virus (HIV) continue to be at increased risk of cardiometabolic complications compared to HIV-uninfected individuals. Advanced glycation end products (AGEs) are implicated in the development and progression of cardiometabolic complications in the general population. Their role in HIV remains unclear.MethodsACTG A5260s is a prospective open-label randomized trial in which ART-naive people living with HIV were randomized to tenofovir disoproxil fumarate /emtricitabine plus atazanavir/ritonavir, darunavir/ritonavir, or raltegravir over 96 weeks. Changes in circulating AGEs with ART initiation were assessed, and linear regression was used to examine the associations between serum AGEs with carotid intima-media thickness (cIMT), visceral and subcutaneous adipose tissue, total fat, lean mass, body mass index, insulin resistance, leptin, and adiponectin.ResultsOverall, 214 participants were included. Ninety percent were male, 48% were White, the median age was 36 years, median HIV-1 RNA was 4.58 log10 copies/mL, and median CD4 count was 338 cells/µL. Most AGEs remained relatively unchanged following 96 weeks of ART initiation, except for methylglyoxal-derived hydroimidazolone 1 (MG-H1), which increased following 96 weeks of ART (mean fold change, 1.15 [95% confidence interval, 1.02-1.30]). No differences were detected across ART regimens. Increases in AGE levels over time were associated with worsening body fat composition measures, insulin resistance, and cIMT, even after adjusting for clinically relevant factors.ConclusionsAGE levels did not decrease following ART initiation. Most AGE levels remained stable, except for MG-H1, which increased. In people with HIV on ART, the accumulation of circulating AGEs over time appears to be independently associated with worsening cardiometabolic biomarkers.Summary: Antiretroviral therapy (ART) does not appear to be effective in redu

BackgroundDespite advances in antiretroviral therapy (ART), people living with human immunodeficiency virus (HIV) continue to be at increased risk of cardiometabolic complications compared to HIV-uninfected individuals. Advanced glycation end products (AGEs) are implicated in the development and progression of cardiometabolic complications in the general population. Their role in HIV remains unclear.MethodsACTG A5260s is a prospective open-label randomized trial in which ART-naive people living with HIV were randomized to tenofovir disoproxil fumarate /emtricitabine plus atazanavir/ritonavir, darunavir/ritonavir, or raltegravir over 96 weeks. Changes in circulating AGEs with ART initiation were assessed, and linear regression was used to examine the associations between serum AGEs with carotid intima-media thickness (cIMT), visceral and subcutaneous adipose tissue, total fat, lean mass, body mass index, insulin resistance, leptin, and adiponectin.ResultsOverall, 214 participants were included. Ninety percent were male, 48% were White, the median age was 36 years, median HIV-1 RNA was 4.58 log10 copies/mL, and median CD4 count was 338 cells/µL. Most AGEs remained relatively unchanged following 96 weeks of ART initiation, except for methylglyoxal-derived hydroimidazolone 1 (MG-H1), which increased following 96 weeks of ART (mean fold change, 1.15 [95% confidence interval, 1.02-1.30]). No differences were detected across ART regimens. Increases in AGE levels over time were associated with worsening body fat composition measures, insulin resistance, and cIMT, even after adjusting for clinically relevant factors.ConclusionsAGE levels did not decrease following ART initiation. Most AGE levels remained stable, except for MG-H1, which increased. In people with HIV on ART, the accumulation of circulating AGEs over time appears to be independently associated with worsening cardiometabolic biomarkers.Summary: Antiretroviral therapy (ART) does not appear to be effective in redu

Background We aimed to investigate whether there are differences in cardiac structure and systolic and diastolic function evaluated by 2-dimensional echocardiography among men living with versus without HIV in the era of combination antiretroviral therapy. Methods and Results We performed a cross-sectional analysis of 1195 men from MACS (Multicenter AIDS Cohort Study) who completed a transthoracic echocardiogram examination between 2017 and 2019. Associations between HIV serostatus and echocardiographic indices were assessed by multivariable regression analyses, adjusting for demographics and cardiovascular risk factors. Among men who are HIV+, associations between HIV disease severity markers and echocardiographic parameters were also investigated. Average age was 57.1±11.9 years; 29% of the participants were Black, and 55% were HIV+. Most men who were HIV+ (77%) were virally suppressed; 92% received combination antiretroviral therapy. Prevalent left ventricular (LV) systolic dysfunction (ejection fraction <50%) was low and HIV serostatus was not associated with left ventricular ejection fraction. Multivariable adjustment models showed that men who were HIV+ versus those who were HIV- had greater LV mass index and larger left atrial diameter and right ventricular (RV) end-diastolic area; lower RV function; and higher prevalence of diastolic dysfunction. Higher current CD4+ T cell count ≥400 cell/mm3 versus <400 was associated with smaller LV diastolic volume and RV area. Virally suppressed men who were HIV+ versus those who were HIV- had higher indexed LV mass and left atrial areas and greater diastolic dysfunction. Conclusions HIV seropositivity was independently associated with greater LV mass index, left atrial and RV sizes, lower RV function and diastolic abnormalities, but not left ventricular ejection fraction, which may herald a future predisposition to heart failure with preserved ejection fraction among men living with HIV.

The number of people with HIV (PWH) aged 50 years or older continues to steadily increase. The convergence of age- and HIV-related complications in these individuals presents a challenge for both patients and clinicians alike. New findings continue to emerge, as numerous researchers evaluate the combined impact of these two factors on quality of life, physiological systems, and mental health in PWH. Since its first occurrence in 2009, the International Workshop on HIV and Aging has served as a multidisciplinary meeting to share basic biomedical data, clinical trial results, treatment strategies, and epidemiological recommendations, toward better understanding and outcomes among like-minded scientific professionals. In this article, we share a selection of key findings presented in plenary talks at the 11th Annual International Workshop on HIV and Aging, held virtually from September 30, 2020 to October 2, 2020. We will also address the future directions of HIV and aging research, to further assess how the aging process intersects with chronic HIV.

BackgroundSafe and effective long-acting injectable agents for preexposure prophylaxis (PrEP) for human immunodeficiency virus (HIV) infection are needed to increase the options for preventing HIV infection.MethodsWe conducted a randomized, double-blind, double-dummy, noninferiority trial to compare long-acting injectable cabotegravir (CAB-LA, an integrase strand-transfer inhibitor [INSTI]) at a dose of 600 mg, given intramuscularly every 8 weeks, with daily oral tenofovir disoproxil fumarate-emtricitabine (TDF-FTC) for the prevention of HIV infection in at-risk cisgender men who have sex with men (MSM) and in at-risk transgender women who have sex with men. Participants were randomly assigned (1:1) to receive one of the two regimens and were followed for 153 weeks. HIV testing and safety evaluations were performed. The primary end point was incident HIV infection.ResultsThe intention-to-treat population included 4566 participants who underwent randomization; 570 (12.5%) identified as transgender women, and the median age was 26 years (interquartile range, 22 to 32). The trial was stopped early for efficacy on review of the results of the first preplanned interim end-point analysis. Among 1698 participants from the United States, 845 (49.8%) identified as Black. Incident HIV infection occurred in 52 participants: 13 in the cabotegravir group (incidence, 0.41 per 100 person-years) and 39 in the TDF-FTC group (incidence, 1.22 per 100 person-years) (hazard ratio, 0.34; 95% confidence interval, 0.18 to 0.62). The effect was consistent across prespecified subgroups. Injection-site reactions were reported in 81.4% of the participants in the cabotegravir group and in 31.3% of those in the TDF-FTC group. In the participants in whom HIV infection was diagnosed after exposure to CAB-LA, INSTI resistance and delays in the detection of HIV infection were noted. No safety concerns were identified.ConclusionsCAB-LA was superior to daily oral TDF-FTC in preventing HIV infection am

IntroductionAge and vitamin D levels may affect symptom burden in chronic obstructive pulmonary disease (COPD). We used the Subpopulations and Intermediate Outcome Measures in COPD Study (SPIROMICS) to determine independent associations between vitamin D levels and COPD symptoms in different age strata.MethodsSerum 25-hydroxy (OH)-vitamin D levels were modeled continuously and categorically (<20 ng/ml versus ≥20 ng/ml). Stratifying by age group (middle-age: 40-64 years old and older: >65 years old), multivariable modeling was performed to identify relationships between 25-OH-vitamin D levels and the COPD Assessment Test (CAT), the modified Medical Research Council score (mMRC), the St George's Respiratory Questionnaire (SGRQ) total and subdomain scores, the Veterans' Specific Activity Questionnaire, and the 6-minute walk test distance.ResultsInIn the middle-aged group, each 5 ng/ml higher 25-OH-vitamin D level was independently associated with more favorable CAT score (-0.35 [-0.67 to -0.03], P=0.03), total SGRQ (-0.91 [-1.65 to -0.17]; P=0.02), and the SGRQ subdomains (Symptoms:-1.07 [-1.96 to -0.18], P=0.02; Impact: -0.77 [-1.53 to -0.003], P=0.049; Activity: -1.07 [-1.96 to -0.18], P=0.02). These associations persisted after the addition of comorbidity score, reported vitamin D supplementation, outdoor time, or season of blood draw to models. No associations were observed between 25-OH-vitamin D levels and symptom scores in the older age group.DiscussionWhen controlled for clinically relevant covariates, higher 25-OH-vitamin D levels are associated with more favorable respiratory-specific symptoms and quality-of-life assessments in middle-age but not older COPD individuals. Study of the role of vitamin D supplementation in the symptom burden of younger COPD patients is needed.

BackgroundNeurocognitive impairment (NCI) and frailty are more prevalent among persons with HIV (PWH) compared to those without HIV. Frailty and NCI often overlap with one another. Whether frailty precedes declines in neurocognitive function among PWH or vice versa has not been well-established.SettingAIDS Clinical Trials Group (ACTG) A5322 is an observational cohort study of older PWH. Participants undergo annual assessments for NCI and frailty.MethodsACTG A5322 participants who developed NCI as indexed by tests of impaired executive functioning and processing speed during the first 3 years were compared to persons who maintained normal cognitive function; those who demonstrated resolution of NCI were compared to those who had persistent NCI. Participants were similarly compared by frailty trajectory. We fit multinomial logistic regression models to assess associations between baseline covariates (including NCI) and frailty, and associations between baseline covariates (including frailty) and NCI.Results929 participants were included with a median age of 51 years (IQR 46-56). At study entry, 16% had NCI and 6% were frail. Over 3 years, 6% of participants developed NCI; 5% developed frailty. NCI was associated with development of frailty (odds ratio [OR]=2.06; 95% confidence interval [CI]=0.94, 4.48; p=0.07). Further adjustment for confounding strengthened this association (OR=2.79; 95% CI=1.21, 6.43; p=0.02). Baseline frailty however was not associated with NCI development.ConclusionsNCI was associated with increased risk of frailty, but frailty was not associated with development of NCI. These findings suggest that the presence of NCI in PWH should prompt monitoring for the development of frailty and interventions to prevent frailty in this population.

BackgroundWe have previously shown that the initiation of antiretroviral therapy (ART) is associated with a decrease in skeletal muscle density (greater fat accumulation), suggesting that gains in lean body mass seen in many ART studies may reflect gains in low quality, fatty muscle. Here, we explore whether skeletal muscle density and area are associated with markers of inflammation and immune activation.MethodsART-naïve people with HIV were randomized to raltegravir or ritonavir-boosted atazanavir or darunavir, each with tenofovir disoproxil fumarate/emtricitabine. Abdominal computed tomography scans from baseline and week 96 were reanalyzed for psoas density and area and correlations explored with inflammation [interleukin-6 (IL-6) and high-sensitivity C-reactive protein] and immune activation [soluble CD14 (sCD14), soluble CD163 (sCD163), and %CD38+HLADR+ on CD4+ or CD8+ T cells].ResultsTwo hundred twenty-two participants had available inflammation/immune activation markers and paired computed tomography scans. At baseline, lower psoas density (greater fat) correlated with higher IL-6 (r = -0.26, P < 0.001) and sCD163 (r -0.15, P = 0.03) and lower lean psoas area correlated with higher IL-6, high-sensitivity C-reactive protein, sCD14, sCD163, and %CD38+HLADR+ on CD4+ T cells (r = -0.30-0.13; all P ≤ 0.05). From baseline to week 96, greater percent decrease in total psoas density (more fat) correlated with greater increase in IL-6 (r = -0.14; P = 0.04); greater % decrease in lean psoas area correlated greater increases in IL-6, sCD14, sCD163, and %CD38+HLADR+ on CD8+ T cells (r = -0.15 to -0.18; all P < 0.04).ConclusionsGreater fat infiltration within the psoas muscle (lower density) and greater loss in lean psoas muscle area were associated with higher inflammation and immune activation, which may portend important effects on muscle function and cardiometabolic risk.

BackgroundStudies suggest lower risk of breast cancer in women with HIV versus without HIV. These estimates may be biased by lower life expectancy and younger age distribution of women with HIV. Our analysis evaluated this bias and characterized secular trends in breast cancer among women with HIV initiating antiretroviral therapy. We hypothesized breast cancer risk would increase over time as mortality decreased.SettingWomen with HIV prescribed antiretroviral therapy in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) from 1997 through 2016.MethodsWe estimated breast cancer hazard (cause-specific hazard ratios) and cumulative incidence accounting for competing risks (subdistribution hazard ratios) to assess changes in breast cancer risk over time. This was assessed overall (1997-2016) and within/across calendar periods. Analyses were adjusted for race/ethnicity and inverse probability weighted for cohort. Cumulative incidence was graphically assessed by calendar period and race/ethnicity.ResultsWe observed 11,587 women during 1997-2016, contributing 63 incident breast cancer diagnoses and 1,353 deaths [73,445 person-years (median follow-up = 4.5 years)]. Breast cancer cumulative incidence was 3.2% for 1997-2016. We observed no secular trends in breast cancer hazard or cumulative incidence. There were annual declines in the hazard and cumulative incidence of death (cause-specific hazard ratios and subdistribution hazard ratios: 0.89, 95% confidence interval: 0.87 to 0.91) which remained within and across calendar periods.ConclusionsThese findings contradict the hypothesis of increasing breast cancer risk with declining mortality over time among women with HIV, suggesting limited impact of changing mortality on breast cancer risk. Additional inquiry is merited as survival improves among women with HIV.

BackgroundThe total QT interval comprises both ventricular depolarization and repolarization currents. Understanding how HIV serostatus and other risk factors influence specific QT interval subcomponents could improve our mechanistic understanding of arrhythmias.MethodsTwelve-lead electrocardiograms (ECGs) were acquired in 774 HIV-infected (HIV+) and 652 HIV-uninfected (HIV-) men from the Multicenter AIDS Cohort Study. Individual QT subcomponent intervals were analyzed: R-onset to R-peak, R-peak to R-end, JT segment, T-onset to T-peak, and T-peak to T-end. Using multivariable linear regressions, we investigated associations between HIV serostatus and covariates, including serum concentrations of inflammatory biomarkers such as interleukin-6 (IL-6), and each QT subcomponent.ResultsAfter adjustment for demographics and risk factors, HIV+ versus HIV- men differed only in repolarization phase durations with longer T-onset to T-peak by 2.3 ms (95% CI 0-4.5, p < .05) and T-peak to T-end by 1.6 ms (95% CI 0.3-2.9, p < .05). Adjusting for inflammation attenuated the strength and significance of the relationship between HIV serostatus and repolarization. The highest tertile of IL-6 was associated with a 7.3 ms (95% CI 3.2-11.5, p < .01) longer T-onset to T-peak. Age, race, body mass index, alcohol use, and left ventricular hypertrophy were each associated with up to 2.2-12.5 ms longer T-wave subcomponents.ConclusionsHIV seropositivity, in combination with additional risk factors including increased systemic inflammation, is associated with longer T-wave subcomponents. These findings could suggest mechanisms by which the ventricular repolarization phase is lengthened and thereby contribute to increased arrhythmic risk in men living with HIV.

DEPARTMENT OF THE ARMY U.S. ARMY CORPS OF ENGINEERS 441 G STREET NW WASHINGTON, D.C. 20314-1000 14 MAY 2020 Dr. Mary Barber Chair, Environmental Advisory Board RTI International 2839 Chesterfield Pl., NW Washington, DC 20008 Dear Dr. Barber, On behalf of the U.S. Army Corps of Engineers (USACE), I wish to thank the Environmental Advisory Board (EAB) for its letter on 21 September 2018 with recommendations and rationale for USACE to revise, approve, publish and disseminate the draft technical guide: A Systems Approach to Ecosystem Adaptive Management, CP2A 11-x (December 2011), by the U.S. Army Engineer Research and Development Center's (ERDC) Environmental Lab. The EAB's review and analysis of technical tools for USACE's implementation of monitoring and adaptive management for aquatic ecosystem restoration and mitigation projects was timely and helpful. The draft technical guide, ERDC/EL SR-19-9, was significantly revised and subsequently finalized in consideration of the edits and recommendations provided by the EAB. The final technical guide was published in November 2019 and is available at the following website https://hdl.handle.net/11681/34855. The EAB's unique perspective and expertise helped produce a final guide that will be instrumental to the USACE to better respond to particular and unique needs of restoration and mitigation projects across the country, realize better long-term success of projects, while meeting the intent and requirements found in statutes. I look forward to the EAB continuing with a second phase of this task, which will provide me recommendations on how the USACE could operationalize monitoring and adaptive management more consistently and integrate it more effectively into planning and policy. As demonstrated by your report, the value the EAB provides to USACE through your independent perspective is significant and your support to USAGE is of upmost importance to us. Sincerely, Todd T. Semonite Lieutenant General, U.S. Army Commanding

DEPARTMENT OF THE ARMY CHIEF OF ENGINEERS 2600 ARMY PENTAGON WASHINGTON, D.C. 20310-2600 DAEN JUN 0 9 2020 SUBJECT: Rahway River Basin, New Jersey Coastal Storm Risk Management THE SECRETARY OF THE ARMY 1. I submit for transmission to Congress my report on coastal storm risk management for the Rahway River Basin, New Jersey. It is accompanied by the report of the District Commander. This report is an interim response to a March 24, 1998 resolution of the U.S. House of Representatives Committee on Transportation and Infrastructure which requested that the Secretary "review the report of the Chief of Engineers on the Rahway River, New Jersey, published as House Document 67, 89th Congress, and other pertinent reports to determine whether any modifications of the recommendations contained therein are advisable at the present time, in the interest of water resources development, including flood control, environmental restoration and protection and other related purposes." This is also an interim response to Public Law 113-2, the Disaster Relief Appropriations Act of 2013, which provided "[f]or an additional amount for "Investigations" for necessary expenses related to the consequences of Hurricane Sandy, $50,000,000, to remain available until expended to expedite at full Federal expense studies of flood and storm damage reduction: Provided, That using $29,500,000 of the funds provided herein, the Secretary of the Army shall expedite and complete ongoing flood and storm damage reduction studies in areas that were impacted by Hurricane Sandy in the North Atlantic Division of the United States Army Corps of Engineers". Preconstruction Engineering and Design activities for the Rahway River Basin, New Jersey, Coastal Storm Risk Management project will continue under the project authority cited above. 2. The reporting officers recommend authorizing a plan to reduce the risk of damages from flooding in the lower Rahway River Basin. The plan is the National Economic Development

DEPARTMENT OF THE ARMY CHIEF OF ENGINEERS 2600 ARMY PENTAGON WASHINGTON, DC 20310-2600 DAEN SUBJECT: Westminster, East Garden Grove, California Flood Risk Management THE SECRETARY OF THE ARMY 1. I submit, for transmission to Congress, my report on flood risk management in the Westminster watershed in Orange County, California to reduce the occurrence of flood flows overtopping existing drainage channel systems during storm events. It is accompanied by the report of the District Commander. The report is an interim response to the resolution adopted by the House of Representatives Committee on Public Works on May 8, 1964 which requested that the U.S. Army Corps of Engineers (USACE) review "the reports on (a) San Gabriel River and Tributaries, published as House Document No. 838, 76th Congress, 3d Session; (b) Santa Ana River and Tributaries, published as House Document No. 135, 81 st Congress, 1st Session; and (c) the project authorized by the Flood Control Act of 1936 for the protection of the metropolitan area in Orange County, with a view to determining the advisability of modification of the authorized projects in the interest of flood control and related purposes." Funds from the Bipartisan Budget Act of 2018, Public Law 115-123, were used to complete the study. Preconstruction, engineering, and design activities, if funded, will continue under the study authority cited above. 2. The reporting officers recommend authorizing a Locally Preferred Plan to reduce flood risks to the communities located within the Westminster watershed in Orange County, California. The principal features of the plan include: a. Modification of approximately 25 miles of existing drainage channels to increase storage capacity and improve conveyance efficiency. This Locally Preferred Plan is designed to contain the one-percent annual exceedance probability (AEP) storm event. For the C02/C04 channel system, the plan includes conversion of approximately 11 ,600 linear feet of trapezoidal cha

DEPARTMENT OF THE ARMY CHIEF OF ENGINEERS 2600 ARMY PENTAGON WASHINGTON, D.C. 20310-2600 23 r 2D26 SUBJECT: Houston Ship Channel Expansion Channel Improvement Project, Harris, Chambers, and Galveston Counties, Texas, Final Integrated Feasibility Report — Environmental Impact Statement THE SECRETARY OF THE ARMY 1. 1 submit for transmission to Congress my report on navigation improvements for the Houston Ship Channel (HSC) Expansion Channel Improvement Project (ECIP), Harris, Chambers, and Galveston Counties, Texas. It is accompanied by the Final Integrated Feasibility Report - Environmental Impact Statement (FIFR-EIS) of the Galveston District Commander. This report is an interim response to the study authority, Section 216 of the Flood Control Act (FCA) of 1970 (Public Law [P.L.] 91-61 1), as amended. Section 216 of the 1970 FCA authorizes the Secretary of the Army to review the operation of projects constructed by the U.S. Army Corps of Engineers (USACE) when found advisable due to significantly changed physical, economic, or environmental conditions. Preconstruction engineering and design activities, if funded, would be continued under this same authority. 2. The reporting officers recommend a plan that will contribute to the economic efficiency of commercial navigation. The National Economic Development (NED) Plan includes widening 11 miles of the lower bay channel from 530 feet to 700 feet (Bolivar Roads to Redfish Reef). Additionally, Bayport Ship Channel (BSC) and Barbours Cut Channels (BCC) would be widened up to 455 feet, with a flare expansion at BSC, and a combined flare and turning basin at 8CC. HSC main channel segments from Boggy Bayou to the main turning basin would be deepened to depths ranging from 46.5 feet to 41.5 feet and improvements would be made to existing turning basins. Lastly, non-federal improvements for which the Government has already assumed maintenance would be added to the federal project. Based on Fiscal Year 2020 price levels, a 2.7

DEPARTMENT OF THE ARMY CHIEF OF ENGINEERS 2600 ARMY PENTAGON WASHINGTON, D.C. 20310-2600 DAEN SUBJECT: New Jersey Beneficial Use of Dredged Material for the Delaware River, New Jersey THE SECRETARY OF THE ARMY 1. I submit for transmission to Congress my report on beneficially using dredged materials from two federal navigation projects -Delaware River between Philadelphia, Pennsylvania and Trenton, New Jersey, and Delaware River Philadelphia, Pennsylvania to the Sea-to provide coastal storm risk management along the Delaware Estuary shoreline. It is accompanied by the report of the District Commander. These reports are an interim response to a resolution by the Committee on Environment and Public Works of the United States Senate ("Resolution"), adopted 26 October 2005, and the Disaster Relief Appropriations Act, 2013, Public Law (P.L.) 113-2. The Resolution requested a revie'Y of "the report ofthe Chief of Engineers on the Delaware River between Philadelphia, Pennsylvania and Trenton, New Jersey, and Philadelphia to the Sea, published as House Document 358, Eighty Third Congress, Second Session (1954), and other pertinent reports, with a view to determining whether any modifications of the recommendations contained therein are advisable in the interest of beneficial use ofdredged material resulting from the aforementioned project, including transfer and transport facilities for the drying, rehandling, and transferring ofdredged material, as it relates to comprehensive watershed and regional sediment management, ecosystem restoration, navigation, stream restoration, water quality, restoration of coal and other mined areas, cover material for sanitary landfills and other allied purposes." Pursuant to the Resolution, USACE undertook a reconnaissance study to look at the beneficial use of dredged material for a variety ofpurposes, including ecosystem restoration, flood risk management and navigation. In 2012, the "Delaware River New Jersey, Delaware and Pennsylvania Dr

DEPARTMENT OF THE ARMY CHIEF OF ENGINEERS 2600 ARMY PENTAGON WASHINGTON, D.C. 20310-2600 MAY 2 6 2020 DAEN SUBJECT: Hudson-Raritan Estuary Ecosystem Restoration, New York and New Jersey THE SECRETARY OF THE ARMY 1. I submit for transmission to Congress my report on the Hudson-Raritan Estuary Ecosystem Restoration, New York and New Jersey. It is accompanied by the report of the District Commander. This report is an interim response to multiple resolutions by the United States House of Representatives Committee on Public Works and Transportation on August 1, 1990; September 28, 1994; March 24, 1998; and April 15, 1999. The authorizations requested that the Secretary of the Army review existing reports with a view to determining the feasibility of environmental restoration and protection relating to water resources and sediment quality within the New York and New Jersey Port District, including but not ·limited to creation, enhancement, and restoration of aquatic, wetland, and adjacent upland habitats. Pre-construction Engineering and Design and additional studies, if funded, will continue under the April 15, 1999 authority cited above. 2. The Hudson-Raritan Estuary (HRE) is designated as an estuary of national significance under the Environmental Protection Agency's National Estuary Program. The HRE is located within one of the most urbanized regions in the United States. Over 13 million people live within 25 miles of the Statue of Liberty, the approximate center of the estuary, including the highly urbanized cities of New York, and Jersey City, Newark, and Elizabeth, New Jersey. Two locations within HRE (Bronx and Harlem River Watersheds New York, and Lower Passaic River/Newark, New Jersey) are included within the Urban Waters Federal Partnership and are part of the National Estuarine Research Reserve System in partnership with the National Oceanic and Atmospheric Administration and the State of New York. There are currently 27 federally threatened or endangered spec

DEPARTMENT OF THE ARMY U.S. ARMY CORPS OF ENGINEERS 441 G STREET, NW WASHINGTON, DC 20314-1000 DAEN MAY 2 9 2020 SUBJECT: Port of Nome Modifications, Nome, Alaska THE SECRETARY OF THE ARMY 1. I submit for transmission to Congress my report on navigation improvements for the Port of Nome, Nome, Alaska. It is accompanied by the report of the District and Division Commanders. These reports were prepared in partial response to Section 204 of the Flood Control Act of 1948, which provided that "[t]he Secretary of the Army is hereby authorized and directed to cause preliminary examinations and surveys for flood controls and allied purposes to be made under the direction of the Chief of Engineers, in drainage areas of the United States and Territorial possessions, which include the following named localities: Harbors and Rivers in Alaska, with a view to determining the advisability of improvements in the interest of navigation, flood control, hydroelectric power, and related water uses." These reports are also prepared utilizing authority provided by Section 2006 of the Water Resources Development Act (WRDA) of 2007, as amended, Remote and Subsistence Harbors, which provides that in conducting a study of harbor and navigation improvements the Secretary may recommend a project without demonstrating that the improvements are justified solely by National Economic Development (NED) benefits, if the Secretary determines that the improvements meet certain criteria. Preconstruction Engineering and Design (PED) activities, if funded, would be continued under the authority cited. Additional authority under Section 1202(c)(3) of WRDA 2016 was utilized that allows for the consideration of national security benefits to communities located within the region served by a remote and subsistence harbor when evaluating navigation improvements for the harbor. 2. The Port of Nome is a regional port located on the Seward Peninsula and adjacent to the Norton Sound, which is centrally located alo

DEPARTMENT OF THE ARMY CHIEF OF ENGINEERS 2600 ARMY PENTAGON WASHINGTON, D.C. 20310-2600 AUG 13 2020 DAEN MEMORANDUM FOR THE SECRETARY OF THE ARMY SUBJECT: St. George Harbor Improvement, St. George, Alaska 1. I submit for transmission to Congress my report on navigation improvements for St. George, Alaska. It is accompanied by the report of the District Commander. These reports were prepared in response to Section 4010 of the Water Resources Development Act (WRDA) of 2007, Public Law 110-114, which authorizes a study to determine the feasibility of providing navigation improvements at St. George, Alaska. These reports are also prepared utilizing authority provided by Section 2006 of WRDA 2007, as amended, Remote and Subsistence Harbors, which provides that in conducting a study of harbor and navigation improvements the Secretary may recommend a project without demonstrating that the improvements are justified solely by National Economic Development (NED) benefits, if the Secretary determines that the improvements meet certain criteria. Preconstruction Engineering and Design (PED) activities, if funded , would be continued under the authority cited. 2. The City of St. George is on the northeast shore of St. George Island, the southern­most of five islands in the Pribilofs located in the Bering Sea. It lies 49 miles south of St. Paul Island, 750 air miles southwest of Anchorage, and 250 miles northwest of Unalaska. The 2017 population of St. George is 72. St. George is accessible only by water and air. St. George is also the name of the federally-recognized tribe on St. George. Subsistence activities are vital to this Alaska community and to many long term non-Native residents. The current conditions in the harbor are such that navigation to, from, and within the harbor are unsafe due to the wave climate in the entrance channel, seiche conditions within the inner basin, and degradation and overtopping of the existing breakwaters. These unsafe conditions limit the use

DEPARTMENT OF THE ARMY CHIEF OF ENGINEERS 2600 ARMY PENTAGON WASHINGTON, D.C. 20310-2600 DAEN MAY O.7 2020 SUBJECT: Westchester County Streams, Byram River Basin, Fairfield County, Connecticut and Westchester County, New York, Flood Risk Management Feasibility Study THE SECRETARY OF THE ARMY 1. I submit, for transmission to Congress, my report on the study of flood risk management along the Byram River Basin in Fairfield County, Connecticut and Westchester County, New York. It is accompanied by the report ofthe District and Division Commanders. This report is a response to an authorization by the House of Representatives, Committee on Transportation and Infrastructure, Resolution, Docket Number 2779 (May 2007). The authorization requested that the "Secretary of the Army review the report of the Chief of Engineers on the Streams in Westchester County, New York, and the Mamaroneck and Sheldrake Rivers Basin and Byram River Basin, New York and Connecticut published as House Document 98-112, and other pertinent reports on the Hutchinson, Mamaroneck and Sheldrake Rivers to determine whether modifications to the recommendations contained therein are advisable at the present time in the interest of water resources development, including flood damage reduction, storm damage reduction, environmental restoration, navigation, watershed management, water supply, and other allied purposes." Preconstruction, engineering, and design activities, if funded, will continue under this same authority. 2. The reporting officers recommended authorizing a plan to reduce the risk of damages from fluvial flooding to the Town of Greenwich, Connecticut and the Village of Port Chester, New York. The recommended plan is supported by the non-federal sponsor for construction, the Town ofGreenwich, Connecticut. The principal features ofthe plan include removing and replacing the two bridges that carry U.S. Route 1 over the Byram River in the Village of Port Chester, New York. Both ofthese bridges a

DEPARTMENT OF THE ARMY OFFICE OF THE CHIEF OF ENGINEERS WASHINGTON, D.C. 20314-1000 DAEN MAY 0 7 2020 SUBJECT: New Haven Harbor Navigation Improvement Project, Conne~ticut THE SECRETARY OF THE ARMY 1. I submit for transmission to Congress my report on the review of deep draft navigation works for the New Haven Harbor Navigation Project in the vicinity of New Haven, Connecticut. It is accompanied by the report of the New England District Commander and the North Atlantic Division Commander. These reports are an interim response to a resolution by the United States Senate Committee on the Environment and Public Works dated 31 July 2007, which requested a review of "the report ofthe Chief of Engineers on New Haven Harbor, Connecticut, published as House Document 51 7, 79th Congress, 2nd Session, and other pertinent reports, to determine whether modifications to the recommendations contained therein are advisable in the interest of navigation, sediment control, environmental restoration and preservation, and other related purposes at New Haven Harbor, Connecticut." Preconstruction, engineering, and design activities, if funded, will continue under the authority cited above. 2. The reporting officers recommend authorizing a plan to modify the New Haven Harbor Navigation Project in the vicinity of New Haven, Connecticut. The recommended plan is the National Economic Development (NED) Plan. The recommended plan includes deepening the main ship channel, maneuvering area, and turning basin to -40 feet Mean Lower Low Water (MLL W) and extending the entrance channel to allow for the deepening; widening the turning basin to the north 200 feet; widening the inner channel to 500 feet; widening the entrance channel to 600 feet; and widening the channel bend near the East Breakwater to 800 feet. Dredged material from the project will be placed at several open water sites within the harbor and Long Island Sound. These open water disposal sites include Morris Cove borrow pit, an oyste

DEPARTMENT OF THE ARMY CHIEF OF ENGINEERS 2600 ARMY PENTAGON WASHINGTON, D.C. 20310-2600 AUG 2 5 2020 DAEN SUBJECT: Raritan Bay and Sandy Hook Bay, Highlands, New Jersey, Coastal Storm Risk Management THE SECRETARY OF THE ARMY 1. I submit for transmission to Congress my report on the study of coastal storm risk management for the Borough of Highlands, Monmouth County, New Jersey. It is accompanied by the report of the New York District Commander. This report was prepared in response to a resolution by the Committee on Transportation and Infrastructure of the U.S. House of Representatives, adopted August 1, 1990. This is also an interim response to Public Law 113-2 (29 Jan 13), the Disaster Relief Appropriations Act of 2013 (the Act), which provided "[f]or an additional amount for "Investigations" for necessary expenses related to the consequences of Hurricane Sandy, $50,000,000, to remain available until expended to expedite at full Federal expense studies of flood and storm damage reduction: Provided, That using $29,500,000 of the funds provided herein, the Secretary of the Army shall expedite and complete ongoing flood and storm damage reduction studies in areas that were impacted by Hurricane Sandy in the North Atlantic Division of the United States Army Corps of Engineers." Preconstruction engineering and design activities will continue under the study authority cited above. 2. The reporting officers recommended authorizing the National Economic Development Plan to reduce the risk of damages from flooding to the portions of northeastern New Jersey, within the New York City metropolitan area. The principal features of the plan include: a. I-Type and T-Type floodwalls to an elevation +14 feet North American Vertical Datum of 1988 (NAVD88) with a total length of 10,737 linear feet along the Sandy Hook Bay shoreline. b. For interior drainage purposes a detention pond, one pump station, and pressurized pipes. 3. The New Jersey State Department of Environmental Protec

DEPARTMENT OF THE ARMY U.S. ARMY CORPS OF ENGINEERS 441 G STREET, NW WASHINGTON, DC 20314-1000 DAEN JUL O 9 2028 SUBJECT: Fire Island Inlet to Montauk Point, New York Reformulation THE SECRETARY OF THE ARMY 1. I submit, for transmission to Congress, my report on the reformulation study of coastal storm risk management for communities located between Fire Island Inlet and Montauk Point along the Atlantic Coast of Suffolk County, Long Island, New York. It is accompanied by the report of the District Commander. Construction of the project was authorized by Section 101 of the River and Harbor Act of 1960, with modifications to the project authorized by the Disaster Relief Appropriations Act of 2013 (P.L. 113-2). P.L. 113-2 provided funding to "reduce future flood risk in ways that will support the long-term sustainability of the coastal ecosystem and communities and reduce the economic costs and risks associated with large-scale flood and storm events in areas along the Atlantic Coast within the boundaries of the North Atlantic Division of the Corps that were affected by Hurricane Sandy" and provided further "[t]hat efforts using these funds shall incorporate current science and engineering standards in constructing previously authorized Corps projects designed to reduce flood and storm damage risks and modifying existing Corps projects that do not meet these standards, with such modifications as the Secretary determines are necessary to incorporate these standards or to meet the goal of providing sustainable reduction to flooding and storm damage risks." This report describes the previously authorized Fire Island to Montauk Point project with modifications as authorized by P.L. 113-2 to incorporate current science and engineering standards or to meet the goal of providing sustainable reduction to flooding and storm damage risks. The U.S. Army Corps of Engineers (USAGE) intends to undertake initial construction of the modified project using funds provided in P.L. 113-2.

DEPARTMENT OF THE ARMY CHIEF OF ENGINEERS 2600 ARMY PENTAGON WASHINGTON, D.C. 20310-2600 DAEN SUBJECT: Delaware Beneficial Use of Dredged Material for the Delaware River, Delaware THE SECRETARY OF THE ARMY 1. I submit for transmission to Congress my report on beneficially using dredged materials from two federal navigation projects -Delaware River between Philadelphia, Pennsylvania and Trenton, New Jersey, and Delaware River Philadelphia, Pennsylvania to the Sea-to provide coastal storm risk management along the Delaware Estuary shoreline. It is accompanied by the report of the District Commander. These reports are an interim response to a resolution by the Committee on Environment and Public Works ofthe United States Senate ("Resolution"), adopted 26 October 2005 and the Disaster Relief Appropriations Act, 2013, Public Law (P.L.) 113-2. The resolution requested a review ofthe report of the Chief of E_ngineers on the Delaware River between Philadelphia, Pennsylvania and Trenton, New Jersey, and Philadelphia to the Sea, published as House Document 358, Eighty Third Congress, Second Session (1954), and other pertinent reports, with a view to determining "whether any modifications ofthe recommendations contained therein are advisable in the interest ofbeneficial use ofdredged material resulting from the aforementioned project, including transfer and transport facilities for the drying, rehandling, and transferring of dredged material, as it relates to comprehensive watershed and regional sediment management, ecosystem restoration, navigation, stream restoration, water quality, restoration of coal and other mined areas, cover material for sanitary landfills and other allied purposes." Pursuant to the Resolution, the U.S. Army Corps of Engineers (USA CE) undertook a reconnaissance study to look at the beneficial use ofdredged material for a variety ofpurposes, including ecosystem restoration, flood risk management and navigation. In 2012, the "Delaware River New Jersey

DEPARTMENT OF THE ARMY CHIEF OF ENGINEERS 2600 ARMY PENTAGON WASH|NGTON, DC 20310-2600 DAEN /3 lrlw'loz0 SUBJECT: Middle Rio Grande Flood Protection, Bernalillo to Belen, New Mexico at Albuquerque, New Mexico THE SECRETARY OF THE ARMY 1. I submit for transmission to Congress my report on flood damage reduction along the Rio Grande in the vicinity of Albuquerque, New Mexico. It is accompanied by the report of the Albuquerque District Engineer and South Pacific Division Engineer. The Middle Rio Grande Flood Protection Bernalillo to Belen, New Mexico project was originally authorized by Section 401 of the Water Resources Development Act (WRDA) of 1986, Public Law 99-662. As of the date of this report, only the Corrales Unit, completed in 1997,has been constructed. Preconstruction engineering and design activities of the units described in this report, if funded, would be continued under the authority provided above. 2. The reporting officers recommend authorizing a plan to reduce flood damages by constructing the Mountain View, Isleta West, Belen East and Belen West Units in the vicinity of Albuquerque, New Mexico. The recommended plan for reducing flood damages includes construction of approximately 48 miles of engineered levee. The project includes the creation of approximately 266 acres of riparian habitat in the floodway to reduce the overall impact on endangered species to an acceptable level. This feature would be monitored for up to five years to ensure its performance. The recommended plan is the national economic development plan. All features are located in New Mexico. 3. The Middle Rio Grande Conservancy District (MRGCD) is the non-federal cost-sharing sponsor for all features. Based on October 2019 price levels, the estimated total first cost of the plan is 5293,136,000. In accordance with the cost sharing provisions of Section 103 of WRDA 1986, as amended (33 U.S.C. 2213), the federal share of the first costs of the flood damage reductions features would b

DEPARTMENT OF THE ARMY CHIEF OF ENGINEERS 2600 ARMY PENTAGON WASHINGTON, D.C. 20310-2600 JUL O 9 2020 DAEN SUBJECT: South Fork of the South Branch of the Chicago River, Bubbly Creek, Illinois Ecosystem Restoration THE SECRETARY OF THE ARMY 1. I submit for transmission to Congress my report on ecosystem restoration for the South Fork of the South Branch of the Chicago River, commonly referred to as "Bubbly Creek." It is accompanied by the report of the District Commander. This report is in response to the study resolution adopted by the Committee on Environment and Public Works, United States Senate, July 20, 2005. The resolution requested a review of "the report of the Chief of Engineers on the Illinois River, and other pertinent reports, to determine whether any modifications to the South Fork of the South Branch of the Chicago River (commonly known as Bubbly Creek) for ecosystem restoration is advisable at this time." Preconstruction engineering and design activities, if funded, would be conducted under the authority provided by this resolution. 2. The reporting officers recommend authorization of the National Ecosystem Restoration (NER) Plan which includes the following sustainable and effective measures for restoring the ecosystem: substrate restoration by placing a sand layer and stone armor layer over 30.7 acres within Bubbly Creek; riparian plantings, including the removal of invasive species and planting of native riparian species over 9.3 acres; emergent plantings, including amendment of the substrate with organic material and planting of native emergent species over 1.0 acres; submergent plantings, including amendment of the substrate with organic material and planting native submergent species over 3.3 acres; and woody debris, including the anchoring of trees, rootwads, trunks and large branches in 10 locations within Bubbly Creek. All features are located in the City of Chicago. The NER Plan was developed in coordina Ion and consultation with federal, st