Risk factors for treatment non-completion among patients with syphilis

Background: With recent increases in syphilis, there is growing interest in expanding screening; however, treatment rates have historically been low. Objectives: This study examines demographic and clinical factors that may contribute to non-completion of syphilis treatment. Design: This is a retrospective comparative cohort study of all patients with syphilis from January through November 2018 at an urban, tertiary care hospital. Methods: Demographics and clinical information were extracted from the electronic medical record. Descriptive statistics and odds ratios (ORs) were calculated. Results: Of 171 patients with syphilis, 89 (52.0%) completed treatment. Patients ages 40-49 were least likely to complete treatment (OR 0.14; 95% CI 0.03-0.72, p = 0.02) compared to those ages 18-24. Non-heterosexual patients were significantly more likely to complete treatment (OR 3.60; 95% CI 1.13-11.49, p = 0.03) compared to heterosexual patients. Patients diagnosed in the emergency department completed treatment at the lowest rate. Conclusion: A major gap in syphilis treatment still exists, which must be addressed to achieve optimal impact from syphilis screening programs.</p

BENCH-SCALE TECHNICAL REPORT

This technical report presents findings from bench-scale tests evaluating the ability of electron beam treatment to kill aquatic algae and zooplankton, specifically examining delayed mortality within 48 hours following treatment. This evaluation was the first attempt to assess the effect of electron beam treatment on hatch rates of Daphnia magna ephippia. Researchers from the Lake Superior Research Institute (LSRI) of the University of Wisconsin-Superior (UWS) in Superior, Wisconsin, USA traveled to the Fermi National Accelerator Laboratory, hereafter Fermilab, to conduct the bench-scale evaluation in May 2022. The test apparatus is a stationary copper electron beam accelerator that supplies a radiation dose expected to cause mortality in standard test organisms. Testing conducted in this evaluation was developed based on findings from earlier tests at Fermilab that demonstrated electron beam treatment was effective at causing complete mortality in E. coli at the lowest dose employed (1 kGy) and was effective at causing immediate mortality in D. magna and Eucyclops spp. at doses between 5 and 10 kGy (Polkinghorne et al., 2022). S. capricornutum was more resistant to immediate effects of electron beam treatment in initial tests (Polkinghorne et al., 2022). All experimental exposures were conducted at Fermilab. The irradiation process was conducted by Fermilab staff in the Illinois Accelerator Research Center’s (IARC’s) Accelerator Applications Development and Demonstration (A2D2) machine. Doses ranged from 1 to 50 kGy. Dose effectiveness testing was completed in lab water only, based on initial tests demonstrating minimal differences in treatment effect between high and low challenge water (i.e., low vs. high organic carbon content, suspended solids, and UV-transmittance). In samples examined 48 hours post-treatment, S. capricornutum had >99% mortality and Eucyclops spp. had 90% mortality at the 2 kGy dose. D. magna had 100% mortality at the lowest dose. No D. magna emerged from ephippia treated at any dose with the electron beam

RA2 P4 TECHNICAL REPORT

Understanding the impact of ballast water treatment and neutralization methods on receiving waters is critical to minimizing harmful effects of ballast discharge to the environment, specifically the freshwater of Lake Superior and surrounding Laurentian Great Lakes. While studies have been conducted to evaluate the effect of active substances and disinfection byproducts (DBP) produced by different Ballast Water Management Systems (BWMS) on marine waters, very little has been done to determine what impact these treatment systems could have on a highly utilized Great Lakes port like the Duluth-Superior Harbor, with its seasonally fluctuating organic carbon content and low percent transmittance. Throughout this project, the focus was on a BWMS that utilizes UV radiation combined with filtration as the primary treatment. A series of samples were collected at the Montreal Pier Ballast Treatment System Testing Facility, Superior, WI, during the evaluation of Great Lakes-compatible treatment systems. DBP concentrations and whole effluent toxicity tests were conducted to determine the toxicity of treated discharge water to living aquatic organisms representing three levels of the food web (plants, invertebrates, and vertebrates)

TESTS EXPOLORING THE EFFECTIVENESS OF ELECTRON BEAM TREATMENT FOR BALLAST WATER MANAGEMENT

This technical report presents findings from bench-scale tests evaluating the ability of electron beam treatment to inactivate aquatic organisms. This evaluation was the first attempt to assess the electron beam treatment as a potential treatment method for ballast water in the Laurentian Great Lakes. Researchers from the Lake Superior Research Institute (LSRI) of the University of Wisconsin-Superior (UWS) in Superior, Wisconsin, USA traveled to the Fermi National Accelerator Laboratory, hereafter Fermilab, to conduct the bench-scale evaluation in January 2022. The test apparatus is a stationary copper particle accelerator that supplies a radiation dose expected to cause mortality in standard test organisms. It has been previously demonstrated that electron beam treatment can cause direct damage by creating either single- or double-strand breaks in the DNA molecule beyond cell repair (Shehata, M.M.K. et al., 2011) or recovery (Lei, J. et al., 2020). All experimental exposures were conducted at Fermilab. The irradiation process was conducted by Fermilab staff in the Illinois Accelerator Research Center’s (IARC’s) Accelerator Applications Development and Demonstration (A2D2) machine. Doses ranged from 1 to 50 kGy. Dose effectiveness testing was completed in two water types using bacteria, algae, and zooplankton—Escherichia coli, Selenastrum capricornutum, Eucyclops spp., and Daphnia magna, respectively. The treatment caused complete mortality for E. coli in both water types at even the lowest dose employed. Eucyclops spp. and Daphnia magna also experienced complete mortality in both water types between 5 and 10 kGy. Selenastrum capricornutum was the most resistant to treatment effect in both water types, but did experience mortality at the highest doses. Algae examined a week after exposure for delayed mortality experienced high mortality rates at all doses

TEST EXPLORING THE EFFECTIVENESS OF THE ULTRASONICATOR INVASIVE SPECIES WATER TREATMNET FOR BALLAST WATER MANAGEMNET

This technical report presents findings from bench-scale evaluation of the ultrasonicator invasive species water treatment developed by UPIR LLC to inactivate aquatic organisms. This evaluation was the first attempt to assess this technology as a potential flow through or recirculating ballast water treatment method for use on ships within the Laurentian Great Lakes. The evaluation began in January 2022 and ended in February 2022. All analyses occurred at the Lake Superior Research Institute at the University of Wisconsin-Superior in Superior, Wisconsin, USA. According to the developer, the UPIR ultrasonicator invasive species water treatment system produces a unique cavitation and agitation environment within the treated water to destroy unwanted organisms. Biological effectiveness testing was completed with the bacteria, Escherichia coli and Enterococcus faecium, and algae, Selenastrum capricornutum, in dechlorinated laboratory water. The system was found to be ineffective in the treatment of bacteria and algae when the organisms were exposed to a single pass through the system at a flow rate of 6 gpm. However, when exposed to multiple passes through the system, the delayed mortality of bacteria increased, and effectiveness with algae remained low. Water quality parameters were minimally impacted by the ultrasonicator invasive species water treatment

LB-6. Increased Diagnoses of Acute HIV Infection through Routine ED Screening and Rapid Linkage to Care and initiation of HAART During the COVID-19 Pandemic

Abstract Background The COVID-19 pandemic has negatively impacted routine HIV screening in healthcare settings. This has serious implications, especially for patients with acute HIV infection (AHI) presenting with symptoms suggesting COVID-19 infection. This is a high priority population for rapid linkage to care (LTC) and initiation of HAART. Methods We reviewed data from our eXpanded HIV Testing and LTC (X-TLC) Program, a collaboration effort between 13 healthcare centers on the South and West Sides of Chicago. Since 2016, most sites had 4th or 5th generation HIV Ag/Ab testing available. Results Most sites experienced reductions in HIV screens during the COVID-19 pandemic. Advanced planning by our ED incorporated blood draws for HIV screens as part of COVID-19 evaluations. UCM performed 19,111 HIV screens (11,133 in the ED) between 1/1/20 and 8/17/20, along with 100,635 COVID PCRs (14,754 in ED) between 3/17/20 and 8/17/20. Nine patients were diagnosed with AHI after the first case of COVID-19 in Chicago (1/24/20), and 7 were diagnosed after the first case of community transmission in Cook County (3/8/20). All cases of AHI were diagnosed in the ED. The rate of AHI was significantly higher in 2020 versus the prior 4 years (14.4 vs 6.8 per year, p &amp;lt; 0.05). AHI patients comprised 25.7 % (9/35) of all new diagnoses, the highest percent ever. There were 7 men (6 identified as MSM) and 2 cis-gender women, median age of 25 years (21 to 28 years). The median viral load was 6 million (115,000 to &amp;gt; 6 million) copies/mL. Eight of 9 patients presented with an illness indistinguishable from COVID-19, including 1co-infected patient. All were LTC and started on HAART from time of PCR result within a median of 1 day (0–38), but 3 days (range 1–41) from sample collection as a result of delayed reflex PCR confirmatory testing due to high demands on lab personnel and scarcity of reagents due to COVID-19 PCR volumes (since resolved). HIV Screening and COVID-19 Testing in the ED During COVID-19 Conclusion Continued HIV screening in our ED during the COVID-19 pandemic identified an increased number of patients with AHI. These individuals may be more likely to present for care due to fear of COVID-19 infection. We achieved rapid LTC and initiation of HAART without any incremental increases in resources. All HIV screening programs should incorporate blood-based HIV screening into their COVID-19 testing programs. Disclosures Moira McNulty, MD, MS, Gilead Sciences (Grant/Research Support) </jats:sec