The success of HIV combination prevention: The Dean Street model

The 56 Dean Street combination prevention model, a strong engagement with the LGBTQI community and flexible services adapted to users’ changing needs led to an 80% drop in HIV diagnoses in gay, bisexual and other men who have sex with men (GBMSM) from 2015 to 2017. We describe the service changes at 56 Dean Street since 2012 which resulted in an increase in the frequency of HIV testing, the introduction of pre-exposure prophylaxis, earlier HIV diagnosis and a shorter time to viral suppression in those living with HIV. This model could be adapted to deliver similar results in those settings of high HIV prevalence among GBMSM and where access to technological innovation in healthcare and engagement with the community can be achieved

Evolution of a pre-exposure prophylaxis (PrEP) service in a community-located sexual health clinic: Concise report of the PrEPxpress

Screening and treatment of sexually transmissible infections, including HIV, are free in the UK nations pre-exposure prophylaxis (PrEP) became free in England in October 2017 through the PrEP Impact trial. Doctor-led PrEP clinics started at 56 Dean Street in September 2015, with the drug purchased privately at full price. The service was expanded to other staff to support initiation and monitoring of increasing numbers of attendees purchasing PrEP from online pharmacies. Nonetheless, when the clinic was given a target of 1700 for the PrEP Impact trial, it was clear this could not be achieved in a timely manner through 56 Dean Street alone. To prepare for the trial, all staff with HIV testing competencies were trained in good clinical practice and trial-specific procedures, and a patient group directive was approved to facilitate nurse prescribing and dispensing. Electronic pro formas to capture eligibility for starting or continuing PrEP were adapted for the Dean Street Express clinic, with some information collected directly from service users using touch screens. These interventions, together with an update to the 2016 information leaflet developed by the community, enabled enrolment and follow-up of 1700 participants in 4 months. PrEP advice and monitoring were easily accommodated in the 56 Dean Street sexual health service, but did require additional training and approval for nurse prescribing and dispensing drug in order to achieve the target, which still fell short of the demand

Stress perfusion cardiovascular magnetic resonance and serial fractional flow reserve assessment of the left anterior descending artery in patients undergoing right coronary artery chronic total occlusion revascularization

Background: Fractional flow reserve (FFR) assessment of remote arteries, in the context of a bystander chronic total occlusion (CTO), can lead to false positive results. Adenosine stress cardiovascular magnetic resonance (CMR) evaluates perfusion defects across the entire myocardium and may therefore be a reliable tool in the work-up of remote lesions in CTO patients. The IMPACT-CTO study investigated donor artery invasive physiology before, immediately post, and at 4 months following right coronary artery (RCA) CTO percutaneous coronary intervention (PCI). The aim of this subanalysis was to assess the concordance between baseline perfusion CMR and serial FFR evaluation of left anterior descending artery (LAD) ischemia in patients from the IMPACT-CTO study.Methods: Baseline adenosine stress CMR examinations from 26 patients were analyzed for qualitative evidence of LAD ischemia. The results were correlated with the serial LAD FFR measurements.Results: The present findings demonstrated that before RCA CTO PCI, there was 62% agreement between perfusion CMR and FFR (ischemic threshold £ 0.8) in the assessment of LAD ischemia (k = 0.29; fair concordance). At 4 months after revascularization, there was 77% agreement (k = 0.52; moderate concordance) between the index CMR assessment of LAD ischemia and the follow-up LAD FFR. Concordance was improved at a LAD FFR ischemic threshold of £ 0.75.Conclusions: In this hypothesis generating study, baseline CMR assessment of LAD ischemia correlated better with the 4 months LAD FFR data (threshold £ 0.8) as compared to the FFR measurements taken prior to RCA CTO revascularization

Comparing mathematical modeling approaches for compact objects: vanishing complexity and embedding class one approaches in spherically symmetric systems with static background

Abstract This study delves into the realm of solving Einstein’s field equations within the framework of general relativity. In this paper, we present an exact solution derived through the vanishing complexity approach and offer a comparative analysis with the established embedding class one approach. This exploration sheds light on the efficacy and validity of these methods in generating solutions for Einstein’s field equations. Our study involves a comprehensive exploration of several key parameters, encompassing thermodynamic factors, causality conditions, stability evaluations, as well as analyses of the mass function. Based on our findings, it can be suggested that the vanishing complexity approach could serve as a viable alternative method to the embedding class one approach for the derivation of exact solutions of Einstein’s field equations

Analytical solutions to Einstein field equations for spherically symmetric anisotropic matter: a comparative study using Tolman VII metric potential

In this paper, we present analytical solutions to the Einstein field equations for spherically symmetric anisotropic matter distributions using the well-established Tolman VII metric potential, chosen for its strong physical and mathematical foundations. Our solutions are derived using three distinct approaches: the vanishing complexity factor condition (VCC), the embedding class I condition (ECC), and the conformally flat condition (CFC). We conduct a comprehensive comparative analysis of these three approaches. By ensuring a smooth match between the interior spacetime metric and the exterior Schwarzschild metric, and applying the condition of vanishing radial pressure at the boundary, we determine the model parameters. We graphically assess the model’s stability by examining conditions such as causality, the adiabatic index, equations of state, and the generalized Tolman–Oppenheimer–Volkov (TOV) equation, considering the forces acting within the system. Additionally, the effects of anisotropy on the stars’ physical characteristics are investigated through graphical representations

Stellar modelling of PSR J1614-2230 using the Karmarkar condition

The main objective of the paper is to provide a new family of solutions of embedding class one describing the interior of a spherically symmetric anisotropic stellar configuration. For $n= 6, 8, 10$ and 12, all the physical parameters are well-behaved within the stellar interior and our model satisfies all the required conditions to be physically viable. Due to the well-behaved nature of the solution of the above n values, we develop the model of PSR J1614-2230 (Nature 467, 1081 (2010)) and discuss the behavior of the class of solutions extensively. By analyzing the adiabatic index ($\Gamma$) we observe that for lower values of n, i.e., $n=6$, the star is soft and as we increase the value of n the star becomes stiff