Sentinel surveillance of HIV-1 transmitted drug resistance, acute infection and recent infection.

BackgroundHIV-1 acute infection, recent infection and transmitted drug resistance screening was integrated into voluntary HIV counseling and testing (VCT) services to enhance the existing surveillance program in San Francisco. This study describes newly-diagnosed HIV cases and characterizes correlates associated with infection.Methodology/principal findingsA consecutive sample of persons presenting for HIV VCT at the municipal sexually transmitted infections (STI) clinic from 2004 to 2006 (N = 9,868) were evaluated by standard enzyme-linked immunoassays (EIA). HIV antibody-positive specimens were characterized as recent infections using a less-sensitive EIA. HIV-RNA pooled testing was performed on HIV antibody-negative specimens to identify acute infections. HIV antibody-positive and acute infection specimens were evaluated for drug resistance by sequence analysis. Multivariable logistic regression was performed to evaluate associations. The 380 newly-diagnosed HIV cases included 29 acute infections, 128 recent infections, and 47 drug-resistant cases, with no significant increases or decreases in prevalence over the three years studied. HIV-1 transmitted drug resistance prevalence was 11.0% in 2004, 13.4% in 2005 and 14.9% in 2006 (p = 0.36). Resistance to non-nucleoside reverse transcriptase inhibitors (NNRTI) was the most common pattern detected, present in 28 cases of resistance (59.6%). Among MSM, recent infection was associated with amphetamine use (AOR = 2.67; p<0.001), unprotected anal intercourse (AOR = 2.27; p<0.001), sex with a known HIV-infected partner (AOR = 1.64; p = 0.02), and history of gonorrhea (AOR = 1.62; p = 0.03).ConclusionsNew HIV diagnoses, recent infections, acute infections and transmitted drug resistance prevalence remained stable between 2004 and 2006. Resistance to NNRTI comprised more than half of the drug-resistant cases, a worrisome finding given its role as the backbone of first-line antiretroviral therapy in San Francisco as well as worldwide. The integration of HIV-1 drug resistance, recent infection, and acute infection testing should be considered for existing HIV/STI surveillance and prevention activities, particularly in an era of enhanced efforts for early diagnosis and treatment

The role of network density and betweenness centrality in diffusing new venture legitimacy: an epidemiological approach

To survive and grow, new ventures must establish initial legitimacy, and subsequently diffuse this legitimacy through a given population. While the notion of initial legitimacy has received substantial attention in the recent literature, diffusion has not. This work endeavors to outline the legitimacy diffusion process via drawing parallels with the field of epidemiology. Ultimately, to effectively diffuse legitimacy (and grow) a firm must gain positive judgments of appropriateness from members of a given network. Importantly, as with diseases, the characteristics of the network are critical to the diffusion process. A relatively dense network is posited to invoke a normative evaluation process by its members, and can be difficult for new ventures to access, but subsequent diffusion of new venture legitimacy can be rapid. A less dense network, on the other hand, is posited to invoke a pragmatic evaluation process by its members, and is likely easier for new ventures to access initially, but may result in lower levels of new venture legitimacy diffusion in the long run. Theoretical and practical implications are discussed

Engineering for a Science-Centric Experimentation Platform

Netflix is an internet entertainment service that routinely employs experimentation to guide strategy around product innovations. As Netflix grew, it had the opportunity to explore increasingly specialized improvements to its service, which generated demand for deeper analyses supported by richer metrics and powered by more diverse statistical methodologies. To facilitate this, and more fully harness the skill sets of both engineering and data science, Netflix engineers created a science-centric experimentation platform that leverages the expertise of data scientists from a wide range of backgrounds by allowing them to make direct code contributions in the languages used by scientists (Python and R). Moreover, the same code that runs in production is able to be run locally, making it straightforward to explore and graduate both metrics and causal inference methodologies directly into production services. In this paper, we utilize a case-study research method to provide two main contributions. Firstly, we report on the architecture of this platform, with a special emphasis on its novel aspects: how it supports science-centric end-to-end workflows without compromising engineering requirements. Secondly, we describe its approach to causal inference, which leverages the potential outcomes conceptual framework to provide a unified abstraction layer for arbitrary statistical models and methodologies.Comment: 10 page

Engineering for a science-centric experimentation platform

Netflix is an internet entertainment service that routinely employs experimentation to guide strategy around product innovations. As Netflix grew, it had the opportunity to explore increasingly specialized improvements to its service, which generated demand for deeper analyses supported by richer metrics and powered by more diverse statistical methodologies. To facilitate this, and more fully harness the skill sets of both engineering and data science, Netflix engineers created a science-centric experimentation platform that leverages the expertise of scientists from a wide range of backgrounds working on data science tasks by allowing them to make direct code contributions in the languages used by them (Python and R). Moreover, the same code that runs in production is able to be run locally, making it straightforward to explore and graduate both metrics and causal inference methodologies directly into production services. In this paper, we provide two main contributions. Firstly, we report on the architecture of this platform, with a special emphasis on its novel aspects: how it supports science-centric end-to-end workflows without compromising engineering requirements. Secondly, we describe its approach to causal inference, which leverages the potential outcomes conceptual framework to provide a unified abstarction layer for arbitrary statistical models and methodologies

Provision of syndromic treatment of sexually transmitted infections by community pharmacists: a potentially underutilized HIV prevention strategy

Background: Sexually transmitted infections (STIs) are known risk factors for HIV infection. Goal: The goal of this study was to assess the current and potential future role that community pharmacists in Western Cape, South Africa play in the treatment of STIs. Study Design: A cross-sectional survey of community pharmacists in the Western Cape region of South Africa. A face-to-face interview that ascertained experience with requests from patients for STI treatment, current STI treatment practices, and willingness to provide syndromic STI treatment was administered to head pharmacists. Results: Ninety pharmacies were selected and 85 (94%) of the head pharmacists participated; 55 from an urban area and 30 from a rural area. Pharmacists reported a median of 40 urban clients and 25 rural clients who sought STI treatment from community pharmacists. When provided with a hypothetical clinical situation, 13% of urban and 17% of rural pharmacists identified the correct medication for male urethral discharge, 8% of urban pharmacists and none of the rural pharmacists identified correct treatment for genital ulcers, and none of the pharmacists identified the correct medication for vaginal discharge. Fifty-three percent of pharmacists in urban regions and 47% of pharmacists in rural regions expressed willingness to provide syndromic STI treatment. Independent predictors of willingness to provide syndromic treatment were knowledge of the link between HIV transmission and STIs (adjusted odds ratio [OR]: 13.78; 95% CI: 2.69,70.66), past experience prescribing syndromic STI treatment (OR: 11.1; 95% CI: 1.14, 108.6), and male gender (OR: 4.38; 95% CI: 1.15, 16.7). Conclusions: Pharmacists are frequently called upon to provide STI treatment but have limited knowledge of correct treatment recommendations. Training pharmacists to provide syndromic STI treatment may be one strategy to reduce STI morbidity and HIV transmission.IS

National Athletic Trainers\u27 Association Position Statement: Evaluation, Management, and Outcomes of and Return-to-Play Criteria for Overhead Athletes With Superior Labral Anterior-Posterior Injuries

Objective: To present recommendations for the diagnosis, management, outcomes, and return to play of athletes with superior labral anterior-posterior (SLAP) injuries. Background: In overhead athletes, SLAP tears are common as either acute or chronic injuries. The clinical guidelines presented here were developed based on a systematic review of the current evidence and the consensus of the writing panel. Clinicians can use these guidelines to inform decision making regarding the diagnosis, acute and long-term conservative and surgical treatment, and expected outcomes of and return-to-play guidelines for athletes with SLAP injuries. Recommendations: Physical examination tests may aid diagnosis; 6 tests are recommended for confirming and 1 test is recommended for ruling out a SLAP lesion. Combinations of tests may be helpful to diagnose SLAP lesions. Clinical trials directly comparing outcomes between surgical and nonoperative management are absent; however, in cohort trials, the reports of function and return-to-sport outcomes are similar for each management approach. Nonoperative management that includes rehabilitation, nonsteroidal anti-inflammatory drugs, and corticosteroid injections is recommended as the first line of treatment. Rehabilitation should address deficits in shoulder internal rotation, total arc of motion, and horizontal-adduction motion, as well as periscapular and glenohumeral muscle strength, endurance, and neuromuscular control. Most researchers have examined the outcomes of surgical management and found high levels of satisfaction and return of shoulder function, but the ability to return to sport varied widely, with 20% to 94% of patients returning to their sport after surgical or nonoperative management. On average, 55% of athletes returned to full participation in prior sports, but overhead athletes had a lower average return of 45%. Additional work is needed to define the criteria for diagnosing and guiding clinical decision making to optimize outcomes and return to play