Implementation of a Collaborative HIV and Hepatitis C Screening Program in Appalachian Urgent Care Settings

Introduction: With the current hepatitis C (HCV) epidemic in the Appalachian region and the risk of human immunodeficiency virus (HIV) co-infection, there is a need for increased secondary prevention efforts. The purpose of this study was to implement routine HIV and HCV screenings in the urgent care setting through the use of an electronic medical record (EMR) to increase a provider’s likelihood of testing eligible patients. Methods: From June 2017 through May 2018, EMR-based HIV and HCV screenings were implemented in three emergency department-affiliated urgent care settings: a local urgent care walk-in clinic; a university-based student health services center; and an urgent care setting located within a multi-specialty clinic. EMR best practice alerts (BPA) were developed based on Centers for Disease Control and Prevention (CDC) guidelines and populated on registered patients who qualified to receive HIV and/or HCV testing. Patients were excluded from the study if they chose to opt out from testing or the provider deemed it clinically inappropriate. Upon notification of a positive HIV and/or HCV test result through the EMR, patient navigators (PNs) were responsible for linking patients to their first medical appointment. Results: From June 2017 through May 2018, 48,531 patients presented to the three urgent care clinics. Out of 27,230 eligible patients, 1,972 patients (7.2%) agreed to be screened for HIV; for HCV, out of 6,509 eligible patients, 1,895 (29.1%) agreed to be screened. Thirty-one patients (1.6%) screened antibody-positive for HCV, with three being ribonucleic acid confirmed positives. No patients in either setting were confirmed positive for HIV; however, two initially screened HIV- positive. PNs were able to link 17 HCV antibody-positive patients (55%) to their first appointment, with the remainder having a scheduled future appointment. Conclusion: Introducing an EMR-based screening program is an effective method to identify and screen eligible patients for HIV and HCV in Appalachian urgent care settings where universal screenings are not routinely implemented. [West J Emerg Med. 2018;19(6)1057–1064.

Long-Wavelength Instability in Surface-Tension-Driven Benard Convection

Laboratory studies reveal a deformational instability that leads to a drained region (dry spot) in an initially flat liquid layer (with a free upper surface) heated uniformly from below. This long-wavelength instability supplants hexagonal convection cells as the primary instability in viscous liquid layers that are sufficiently thin or are in microgravity. The instability occurs at a temperature gradient 34% smaller than predicted by linear stability theory. Numerical simulations show a drained region qualitatively similar to that seen in the experiment.Comment: 4 pages. The RevTeX file has a macro allowing various styles. The appropriate style is "mypprint" which is the defaul

Retrospective Review of the Patient Cases at a Major Trauma Center in Nairobi, Kenya and Implications for Emergency Care Development

Introduction Low- and middle-income countries (LMICs) are continuing to experience a “triple burden” of disease - traumatic injury, non-communicable diseases (NCDs), and communicable disease with maternal and neonatal conditions (CD&Ms). The epidemiology of this triad is not well characterised and poses significant challenges to resource allocations, administration, and education of emergency care providers. The data collected in this study provide a comprehensive description of the emergency centre at Kenya\u27s largest public tertiary care hospital. Methods This study is a retrospective chart review conducted at Kenyatta National Hospital of all patient encounters over a four-month period. Data were collected from financial and emergency centre triage records along with admission and mortality logbooks. Chief complaints and discharge diagnoses collected by specially trained research assistants were manually converted to standardised diagnoses using International Classification of Disease 10 (ICD-10) codes. ICD-10 codes were categorised into groups based on the ICD-10 classification system for presentation. Results A total of 23,941 patients presented to the emergency centre during the study period for an estimated annual census of 71,823. The majority of patients were aged 18-64 years (58%) with 50% of patients being male and only 3% of unknown sex. The majority of patients (61%) were treated in the emergency centre, observed, and discharged home. Admission was the next most common disposition (33%) followed by death (6%). Head injury was the overall most common diagnosis (11%) associated with admission. Conclusions Trends toward NCDs and traumatic diseases have been described by this study and merit further investigation in both the urban and rural setting. Specifically, the significance of head injury on healthcare cost, utilisation, and patient death and disability points to the growing need of additional resources at Kenyatta National Hospital for acute care. It further demonstrates the mounting impact of trauma in Kenya and throughout the developing world

Quantum saturation and condensation of excitons in Cu2_2O: a theoretical study

Recent experiments on high density excitons in Cu$_2$O provide evidence for degenerate quantum statistics and Bose-Einstein condensation of this nearly ideal gas. We model the time dependence of this bosonic system including exciton decay mechanisms, energy exchange with phonons, and interconversion between ortho (triplet-state) and para (singlet-state) excitons, using parameters for the excitonic decay, the coupling to acoustic and low-lying optical phonons, Auger recombination, and ortho-para interconversion derived from experiment. The single adjustable parameter in our model is the optical-phonon cooling rate for Auger and laser-produced hot excitons. We show that the orthoexcitons move along the phase boundary without crossing it (i.e., exhibit a ``quantum saturation''), as a consequence of the balance of entropy changes due to cooling of excitons by phonons and heating by the non-radiative Auger two-exciton recombination process. The Auger annihilation rate for para-para collisions is much smaller than that for ortho-para and ortho-ortho collisions, explaining why, under the given experimental conditions, the paraexcitons condense while the orthoexcitons fail to do so.Comment: Revised to improve clarity and physical content 18 pages, revtex, figures available from G. Kavoulakis, Physics Department, University of Illinois, Urban

Time-Varying Dark Energy Constraints From the Latest SN Ia, BAO and SGL

Based on the latest SNe Ia data provided by Hicken et al. (2009) with using MLCS17 light curve fitter, together with the Baryon Acoustic Oscillation(BAO) and strong gravitational lenses(SGL), we investigate the constraints on the dark energy equation-of-state parameter $w$ in the flat universe, especially for the time-varying case $w(z)=w_0+w_zz/(1+z)$. The constraints from SNe data alone are found to be: (a) $(\Omega_M, w)=(0.358, -1.09)$ as the best-fit results; (b) $(w_0, w_z)=(-0.73^{+0.23}_{-0.97}, 0.84^{+1.66}_{-10.34})$ for the two parameters in the time-varying case after marginalizing the parameter $\Omega_M$; (c) the likelihood of parameter $w_z$ has a high non-Gaussian distribution; (d) an extra restriction on $\Omega_M$ is necessary to improve the constraint of the SNe Ia data on the parameters ($w_0$, $w_z$). A joint analysis of SNe Ia data and BAO is made to break the degeneracy between $w$ and $\Omega_M$, and leads to the interesting maximum likelihoods $w_0 = -0.94$ and $w_z = 0$. When marginalizing the parameter $\Omega_M$, the fitting results are found to be $(w_0, w_z)=(-0.95^{+0.45}_{-0.18}, 0.41^{+0.79}_{-0.96})$. After adding the splitting angle statistic of SGL data, a consistent constraint is obtained $(\Omega_M, w)=(0.298, -0.907)$ and the constraints on time-varying dark energy are further improved to be $(w_0, w_z) = (-0.92^{+0.14}_{-0.10}, 0.35^{+0.47}_{-0.54})$, which indicates that the phantom type models are disfavored.Comment: 24 pages, 9 figures, to be published in JCA

Interprofessional Education: An evaluation of a joint learning workshop for podiatry and pharmacy students

"Interprofessional Education occurs when two or more professionals learn with, from and about each other to improve collaboration and the quality of care" (CAIPE 2002). Interprofessional education forms part of the Standards for the Initial Education and Training of Pharmacists. Working with and understanding the role of another profession has been shown to positively impact on the quality of care of the patient. Following positive pharmacy student feedback from visits to podiatry clinics an interprofessional learning workshop with case - based scenarios was developed. These were based on patients with high risk medical conditions that would impact on the work of both professions. Data from the feedback forms was evaluated and analysed to determine whether the workshop increased knowledge of the British National Formulary (BNF), the prescribing process and gave an insight in to the role of other healthcare professionals. We discuss how the student’s learning has been enhanced by the contribution of another professional group. The workshop was positively received. Students were observed working together discussing the patients’ conditions and issues relating to their care. This initially revolved around the students’ area of knowledge; however, as the session progressed it became apparent that the students were learning with, from and about each other for the benefit of patient care

Entropy and statefinder diagnosis in chameleon cosmology

In this paper, the generalized second law (GSL) of thermodynamics and entropy is revisited in the context of cosmological models with bouncing behavior such as chameleon cosmology where the boundary of the universe is assumed to be enclosed by the dynamical apparent horizon. From a thermodynamic point of view, to link between thermodynamic and geometric parameters in cosmological models, we introduce "entropy rate of change multiplied by the temperature" as a model independent thermodynamic state parameter together with the well known $\{r,s \}$ statefinder to differentiate the dark energy models.Comment: 11 pages, 5 figures. will be published in Astrophys. Space Sc

Direct proton decay of the isoscalar giant dipole resonance in 208Pb

The excitation and subsequent proton decay of the isoscalar giant dipole resonance (ISGDR) in $^{208}$Pb have been investigated via the $^{208}$Pb($\alpha, \alpha^{\prime}p)^{207}$Tl reaction at 400 MeV. Excitation of the ISGDR has been identified by the difference-of-spectra method. The enhancement of the ISGDR strength at high excitation energies observed in the multipole-decomposition-analysis of the singles $^{208}$Pb($\alpha,\alpha^{\prime}$) spectra is not present in the excitation energy spectrum obtained in coincidence measurement. The partial branching ratios for direct proton decay of ISGDR to low-lying states of $^{207}$Tl have been determined and the results are compared with predictions of continuum random-phase-approximation (CRPA) calculations.Comment: 12 pages, 4 figures; accepted for publication in Physics Letters

Production and Decay of D_1(2420)^0 and D_2^*(2460)^0

We have investigated $D^{+}\pi^{-}$ and $D^{*+}\pi^{-}$ final states and observed the two established $L=1$ charmed mesons, the $D_1(2420)^0$ with mass $2421^{+1+2}_{-2-2}$ MeV/c$^{2}$ and width $20^{+6+3}_{-5-3}$ MeV/c$^{2}$ and the $D_2^*(2460)^0$ with mass $2465 \pm 3 \pm 3$ MeV/c$^{2}$ and width $28^{+8+6}_{-7-6}$ MeV/c$^{2}$. Properties of these final states, including their decay angular distributions and spin-parity assignments, have been studied. We identify these two mesons as the $j_{light}=3/2$ doublet predicted by HQET. We also obtain constraints on {\footnotesize $\Gamma_S/(\Gamma_S + \Gamma_D)$} as a function of the cosine of the relative phase of the two amplitudes in the $D_1(2420)^0$ decay.Comment: 15 pages in REVTEX format. hardcopies with figures can be obtained by sending mail to: [email protected]

Measurement of the branching fraction for Υ(1S)→τ+τ−\Upsilon (1S) \to \tau^+ \tau^-

We have studied the leptonic decay of the $\Upsilon (1S)$ resonance into tau pairs using the CLEO II detector. A clean sample of tau pair events is identified via events containing two charged particles where exactly one of the particles is an identified electron. We find $B(\Upsilon(1S) \to \tau^+ \tau^-) = (2.61~\pm~0.12~{+0.09\atop{-0.13}})$. The result is consistent with expectations from lepton universality.Comment: 9 pages, RevTeX, two Postscript figures available upon request, CLNS 94/1297, CLEO 94-20 (submitted to Physics Letters B