Limitations of Counseling and Testing in CDC\u27s HIV Prevention Efforts

To the Editor: We were delighted to see that our colleagues at the Centers for Disease Control and Prevention (CDC) had read our article (Darrow et al., 1998a) and responded (Wolitski and Doll, 1999). Their criticisms of our cross-sectional study of 51 HIV-infected men who have sex with men (MSM) and live in South Beach are welcomed and appreciated. In this brief reply, we continue the dialogue by addressing their concerns and recommending an appropriate course of action

HIV Risk among Substance-Using Men Who Have Sex with Men and Women (MSMW): Findings from South Florida

Compared with men who have sex with men only (MSMO), men who have sex with men and women (MSMW) consistently report higher rates of two HIV risk behaviors: transactional sex (TS) and concurrent substance use and sex (CSS). Within MSMW, little is known about how synergistic epidemics ( syndemics ) affect TS and CSS. Using a sample of substance-using MSM (n = 515) in South Florida, we compared TS and CSS among MSMO and MSMW; examined whether, within MSMW (n = 86), TS and CSS predict unprotected anal intercourse with partners of serodiscordant/unknown HIV status (SU-UAI); and tested whether syndemics predict TS and CSS. MSMW reported higher rates of engaging in both TS and CSS (AOR = 1.7; 95 % CI 1.0-3.0). Within MSMW, engagement in both TS and CSS predicted SU-UAI (AOR = 3.3; 95 % CI 1.2-9.6); and syndemics predicted TS and CSS involvement (p \u3c 0.01). Substance-using MSMW may benefit from interventions targeting TS, CSS, and background syndemics

Ultrasound-triggered antibiotic release from PEEK clips to prevent spinal fusion infection: Initial evaluations.

Despite aggressive peri-operative antibiotic treatments, up to 10% of patients undergoing instrumented spinal surgery develop an infection. Like most implant-associated infections, spinal infections persist through colonization and biofilm formation on spinal instrumentation, which can include metal screws and rods for fixation and an intervertebral cage commonly comprised of polyether ether ketone (PEEK). We have designed a PEEK antibiotic reservoir that would clip to the metal fixation rod and that would achieve slow antibiotic release over several days, followed by a bolus release of antibiotics triggered by ultrasound (US) rupture of a reservoir membrane. We have found using human physiological fluid (synovial fluid), that higher levels (100–500 μg) of vancomycin are required to achieve a marked reduction in adherent bacteria vs. that seen in the common bacterial medium, trypticase soy broth. To achieve these levels of release, we applied a polylactic acid coating to a porous PEEK puck, which exhibited both slow and US-triggered release. This design was further refined to a one-hole or two-hole cylindrical PEEK reservoir that can clip onto a spinal rod for clinical use. Short-term release of high levels of antibiotic (340 ± 168 μg), followed by US-triggered release was measured (7420 ± 2992 μg at 48 h). These levels are sufficient to prevent adhesion of Staphylococcus aureus to implant materials. This study demonstrates the feasibility of an US-mediated antibiotic delivery device, which could be a potent weapon against spinal surgical site infection. Statement of Significance: Spinal surgical sites are prone to bacterial colonization, due to presence of instrumentation, long surgical times, and the surgical creation of a dead space (≥5 cm 3 ) that is filled with wound exudate. Accordingly, it is critical that new approaches are developed to prevent bacterial colonization of spinal implants, especially as neither bulk release systems nor controlled release systems are available for the spine. This new device uses non-invasive ultrasound (US) to trigger bulk release of supra-therapeutic doses of antibiotics from materials commonly used in existing surgical implants. Thus, our new delivery system satisfies this critical need to eradicate surviving bacteria, prevent resistance, and markedly lower spinal infection rates

New ADS Functionality for the Curator

In this paper we provide an update concerning the operations of the NASA Astrophysics Data System (ADS), its services and user interface, and the content currently indexed in its database. As the primary information system used by researchers in Astronomy, the ADS aims to provide a comprehensive index of all scholarly resources appearing in the literature. With the current effort in our community to support data and software citations, we discuss what steps the ADS is taking to provide the needed infrastructure in collaboration with publishers and data providers. A new API provides access to the ADS search interface, metrics, and libraries allowing users to programmatically automate discovery and curation tasks. The new ADS interface supports a greater integration of content and services with a variety of partners, including ORCID claiming, indexing of SIMBAD objects, and article graphics from a variety of publishers. Finally, we highlight how librarians can facilitate the ingest of gray literature that they curate into our system.Comment: Submitted to the Proceedings of Library and Information Services in Astronomy VIII, Strasbourg, Franc

Impact of HIV Counseling and Testing on HIV-Infected Men who have Sex with Men: The South Beach Health Survey

The impact of HIV counseling and testing on sexual risk-taking and related behaviors reported by HIV-infected men who have sex with men (MSM) was examined in a cross-sectional study conducted among a representative sample of residents living in a resort area. Participants provided specimens of oral mucosal transudate for HIV-antibody testing, were interviewed in their homes, and completed a self-administered questionnaire. Specimens were tested by modified ELISA and, if repeatedly positive, confirmed by Western blot. Of 205 men enrolled, 51 (24.9%) tested positive for antibody to HIV. All 51 had been counseled and tested for antibody to HIV-1 (median = 4 tests); 37 (74%) of 50 reported that their most recent test was positive. Twenty (39.2%) said they had engaged in unprotected insertive anal intercourse in the past year; 15 (29.4%) engaged in unprotected insertive anal intercourse with partners who may have been susceptible to HIV infection. Men who reported that their last HIV-antibody test was positive were three times more likely to have engaged in unprotected insertive anal intercourse in the past year (45.9%) as those who did not know they were infected with HIV (15.4%). Counseling and testing is ineffective as a measure for promoting behavior change among HIV-positive MSM in South Beach. More effective social and behavioral interventions must be developed, implemented, and evaluated

Trends in permanent pacemaker implantation in the United States from 1993 to 2009: increasing complexity of patients and procedures.

OBJECTIVES: This study sought to define contemporary trends in permanent pacemaker use by analyzing a large national database. BACKGROUND: The Medicare National Coverage Determination for permanent pacemaker, which emphasized single-chamber pacing, has not changed significantly since 1985. We sought to define contemporary trends in permanent pacemaker use by analyzing a large national database. METHODS: We queried the Nationwide Inpatient Sample to identify permanent pacemaker implants between 1993 and 2009 using the International Classification of Diseases-Ninth Revision-Clinical Modification procedure codes for dual-chamber (DDD), single-ventricular (VVI), single-atrial (AAI), or biventricular (BiV) devices. Annual permanent pacemaker implantation rates and patient demographics were analyzed. RESULTS: Between 1993 and 2009, 2.9 million patients received permanent pacemakers in the United States. Overall use increased by 55.6%. By 2009, DDD use increased from 62% to 82% (p \u3c 0.001), whereas single-chamber ventricular pacemaker use fell from 36% to 14% (p = 0.01). Use of DDD devices was higher in urban, nonteaching hospitals (79%) compared with urban teaching hospitals (76%) and rural hospitals (72%). Patients with private insurance (83%) more commonly received DDD devices than Medicaid (79%) or Medicare (75%) recipients (p \u3c 0.001). Patient age and Charlson comorbidity index increased over time. Hospital charges ($2011) increased 45.3%, driven by the increased cost of DDD devices. CONCLUSIONS: There is a steady growth in the use of permanent pacemakers in the United States. Although DDD device use is increasing, whereas single-chamber ventricular pacemaker use is decreasing. Patients are becoming older and have more medical comorbidities. These trends have important health care policy implications

16-year trends in the infection burden for pacemakers and implantable cardioverter-defibrillators in the United States 1993 to 2008.

OBJECTIVES: We analyzed the infection burden associated with the implantation of cardiac implantable electrophysiological devices (CIEDs) in the United States for the years 1993 to 2008. BACKGROUND: Recent data suggest that the rate of infection following CIED implantation may be increasing. METHODS: The Nationwide Inpatient Sample (NIS) discharge records were queried between 1993 and 2008 using the 9th Revision of the International Classification of Diseases (ICD-9-CM). CIED infection was defined as either: 1) ICD-9 code for device-related infection (996.61) and any CIED procedure or removal code; or 2) CIED procedure code along with systemic infection. Patient health profile was evaluated by coding for renal failure, heart failure, respiratory failure, and diabetes mellitus. The infection burden and patient health profile were calculated for each year, and linear regression was used to test for changes over time. RESULTS: During the study period (1993 to 2008), the incidence of CIED infection was 1.61%. The annual rate of infections remained constant until 2004, when a marked increase was observed, which coincided with an increase in the incidence of major comorbidities. This was associated with a marked increase in mortality and in-hospital financial charges. CONCLUSIONS: The infection burden associated with CIED implantation is increasing over time and is associated with prolonged hospital stays and high financial costs

Minority carrier diffusion, defects, and localization in InGaAsN, with 2% nitrogen

Electron and hole transport in compensated, InGaAsN ({approx} 2% N) are examined through Hall mobility, photoconductivity, and solar cell photoresponse measurements. Short minority carrier diffusion lengths, photoconductive-response spectra, and doping dependent, thermally activated Hall mobilities reveal a broad distribution of localized states. At this stage of development, lateral carrier transport appears to be limited by large scale (>> mean free path) material inhomogeneities, not a random alloy-induced mobility edge

Do ceramic femoral heads reduce taper fretting corrosion in hip arthroplasty? A retrieval study.

BACKGROUND: Previous studies regarding modular head-neck taper corrosion were largely based on cobalt chrome (CoCr) alloy femoral heads. Less is known about head-neck taper corrosion with ceramic femoral heads. QUESTIONS/PURPOSES: We asked (1) whether ceramic heads resulted in less taper corrosion than CoCr heads; (2) what device and patient factors influence taper fretting corrosion; and (3) whether the mechanism of taper fretting corrosion in ceramic heads differs from that in CoCr heads. METHODS: One hundred femoral head-stem pairs were analyzed for evidence of fretting and corrosion using a visual scoring technique based on the severity and extent of fretting and corrosion damage observed at the taper. A matched cohort design was used in which 50 ceramic head-stem pairs were matched with 50 CoCr head-stem pairs based on implantation time, lateral offset, stem design, and flexural rigidity. RESULTS: Fretting and corrosion scores were lower for the stems in the ceramic head cohort (p=0.03). Stem alloy (p=0.004) and lower stem flexural rigidity (Spearman\u27s rho=-0.32, p=0.02) predicted stem fretting and corrosion damage in the ceramic head cohort but not in the metal head cohort. The mechanism of mechanically assisted crevice corrosion was similar in both cohorts although in the case of ceramic femoral heads, only one of the two surfaces (the male metal taper) engaged in the oxide abrasion and repassivation process. CONCLUSIONS: The results suggest that by using a ceramic femoral head, CoCr fretting and corrosion from the modular head-neck taper may be mitigated but not eliminated. CLINICAL RELEVANCE: The findings of this study support further study of the role of ceramic heads in potentially reducing femoral taper corrosion