Opt-out of Voluntary HIV Testing: A Singapore Hospital's Experience

INTRODUCTION: Since 2008, the Singapore Ministry of Health (MOH) has expanded HIV testing by increasing anonymous HIV test sites, as well as issuing a directive to hospitals to offer routine voluntary opt out inpatient HIV testing. We reviewed this program implemented at the end of 2008 at Tan Tock Seng Hospital (TTSH), the second largest acute care general hospital in Singapore. METHODS AND FINDINGS: From January 2009 to December 2010, all inpatients aged greater or equal than 21 years were screened for HIV unless they declined or were not eligible for screening. We reviewed the implementation of the Opt Out testing policy. There were a total of 93,211 admissions; 41,543 patients were included based on HIV screening program eligibility criteria. Among those included, 79% (n = 32,675) opted out of HIV screening. The overall acceptance rate was 21%. Majority of eligible patients who were tested (63%) were men. The mean age of tested patients was 52 years. The opt out rate was significantly higher among females (OR: 1.5, 95%CI: 1.4-1.6), aged >60 years (OR: 2.3, 95%CI: 2.2-2.4) and Chinese ethnicity (OR: 1.7, 95%CI:1.6-1.8). The false positive rate of the HIV screening test is 0.56%. The proportion of patients with HIV infection among those who underwent HIV screening is 0.18%. All 16 confirmed HIV patients were linked to care. CONCLUSION: The default opt-in rate of inpatient HIV testing was low at Tan Tock Seng Hospital, Singapore. Efforts to address individual HIV risk perception and campaigns against HIV stigma are needed to encourage more individuals to be tested for HIV

Feasibility of a mass vaccination campaign using a two-dose oral cholera vaccine in an urban cholera-endemic setting in Mozambique.

We conducted a study to assess the feasibility and the potential vaccine coverage of a mass vaccination campaign using a two-dose oral cholera vaccine in an urban endemic neighbourhood of Beira, Mozambique. The campaign was conducted from December 2003 to January 2004. Overall 98,152 doses were administered, and vaccine coverage of the target population was 58.6% and 53.6% for the first and second rounds, respectively. The direct cost of the campaign, which excludes the price of the vaccine, amounted to slightly over 90,000 dollars, resulting in the cost per fully vaccinated person of 2.09 dollars, which is relatively high. However, in endemic settings where outbreaks are likely to occur, integrating cholera vaccination into the routine activities of the public health system could reduce such costs

Ignition conditions for inertial confinement fusion targets with a nuclear spin-polarized DT fuel

The nuclear fusion cross-section is modified when the spins of the interacting nuclei are polarized. In the case of deuterium?tritium it has been theoretically predicted that the nuclear fusion cross-section could be increased by a factor d = 1.5 if all the nuclei were polarized. In inertial confinement fusion this would result in a modification of the required ignition conditions. Using numerical simulations it is found that the required hot-spot temperature and areal density can both be reduced by about 15% for a fully polarized nuclear fuel. Moreover, numerical simulations of a directly driven capsule show that the required laser power and energy to achieve a high gain scale as d-0.6 and d-0.4 respectively, while the maximum achievable energy gain scales as d0.9

Characterization results from several commercial soft x-ray streak cameras

The spatio-temporal performance of four soft x-ray streak cameras has been characterized. The objective in evaluating the performance capability of these instruments is to enable us to optimize experiment designs, to encourage quantitative analysis of streak data and to educate the ultra high speed photography and photonics community about the x-ray detector performance which is available. These measurements have been made collaboratively over the space of two years at the Forge pulsed x-ray source at Los Alamos and at the Ketjak laser facility an CEA Limeil-Valenton. The x-ray pulse lengths used for these measurements at these facilities were 150 psec and 50 psec respectively. The results are presented as dynamically-measured modulation transfer functions. Limiting temporal resolution values were also calculated. Emphasis is placed upon shot noise statistical limitations in the analysis of the data. Space charge repulsion in the streak tube limits the peak flux at ultra short experiments duration times. This limit results in a reduction of total signal and a decrease in signal to noise ratio in the streak image. The four cameras perform well with 20 1p/mm resolution discernable in data from the French C650X, the Hadland X-Chron 540 and the Hamamatsu C1936X streak cameras. The Kentech x-ray streak camera has lower modulation and does not resolve below 10 1p/mm but has a longer photocathode. The C650X bi-lamellar design shows uniform high fidelity recording across both spatial and temporal dimensions. The other three streak cameras show resolution degradation off axis. This must be weighed against a 10X lower streak tube throughput for the C650X

P 600/650 X-ray streak camera with optimized spatio-temporal resolution

SIGLEAvailable from CEN Saclay, Service de Documentation, 91191 Gif-sur-Yvette Cedex (France) / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc

Improving community coverage of oral cholera mass vaccination campaigns: lessons learned in Zanzibar

BACKGROUND: Recent research in two cholera-endemic communities of Zanzibar has shown that a majority (?94%) of the adult population was willing to receive free oral cholera vaccines (OCVs). Since OCV uptake in the 2009 campaign reached only ?50% in these communities, an evaluation of social and cultural factors and of barriers was conducted to understand this difference for future cholera control planning.METHODOLOGY/PRINCIPAL FINDINGS: A random sample of 367 adult peri-urban and rural community residents (46.6% immunized vs. 53.4% unimmunized) was studied with a semi-structured interview that inquired about social and cultural features of cholera depicted in a vignette and barriers to OCV uptake. Symptoms (rectal pain, loose skin only in rural community) and perceived causes (uncovered food, contact with contaminated water) specific for severe diarrhea were associated with uptake. Purchasing drugs from pharmacies to stop diarrhea and vomiting was negatively associated with uptake. Increasing household size, age and previous enteric illness episode were positively related to uptake, the latter only at the rural site. The most prominent barrier to uptake was competing obligations or priorities (reported by 74.5%, identified as most important barrier by 49.5%). Next most prominent barriers were lacking information about the campaign (29.6%, 12.2%), sickness (14.3%, 13.3%) and fear of possible vaccine side effects (15.3%, 5.6%). The majority of unvaccinated respondents requested repetition of the vaccination with free OCVs. CONCLUSIONS/SIGNIFICANCE: Factors associated with uptake indicated a positive impact of the vaccination campaign and of sensitization activities on vaccine acceptance behavior. Unlike communities opposed to cholera control or settings where public confidence in vaccines is lacking, identified barriers to uptake indicated a good campaign implementation and trust in the health system. Despite prospects and demand for repeating the vaccination, local decision-makers should reconsider how careful logistical arrangements may improve community coverage and thus effectiveness of vaccination campaigns

The soft X-ray P 550 streak camera. Characteristics and applications

SIGLEAvailable from CEN Saclay, Service de Documentation, 91191 Gif-sur-Yvette Cedex (France) / INIST-CNRS - Institut de l'Information Scientifique et TechniqueFRFranc