Effectiveness and safety of oral HIV preexposure prophylaxis for all populations.

ObjectivePreexposure prophylaxis (PrEP) offers a promising new approach to HIV prevention. This systematic review and meta-analysis evaluated the evidence for use of oral PrEP containing tenofovir disoproxil fumarate as an additional HIV prevention strategy in populations at substantial risk for HIV based on HIV acquisition, adverse events, drug resistance, sexual behavior, and reproductive health outcomes.DesignRigorous systematic review and meta-analysis.MethodsA comprehensive search strategy reviewed three electronic databases and conference abstracts through April 2015. Pooled effect estimates were calculated using random-effects meta-analysis.ResultsEighteen studies were included, comprising data from 39 articles and six conference abstracts. Across populations and PrEP regimens, PrEP significantly reduced the risk of HIV acquisition compared with placebo. Trials with PrEP use more than 70% demonstrated the highest PrEP effectiveness (risk ratio = 0.30, 95% confidence interval: 0.21-0.45, P < 0.001) compared with placebo. Trials with low PrEP use did not show a significantly protective effect. Adverse events were similar between PrEP and placebo groups. More cases of drug-resistant HIV infection were found among PrEP users who initiated PrEP while acutely HIV-infected, but incidence of acquiring drug-resistant HIV during PrEP use was low. Studies consistently found no association between PrEP use and changes in sexual risk behavior. PrEP was not associated with increased pregnancy-related adverse events or hormonal contraception effectiveness.ConclusionPrEP is protective against HIV infection across populations, presents few significant safety risks, and there is no evidence of behavioral risk compensation. The effective and cost-effective use of PrEP will require development of best practices for fostering uptake and adherence among people at substantial HIV risk

Engaging Patients in Self-Care Management of Type II Diabetes Mellitus in Primary Care

Improving self-care among patients diagnosed with type II diabetes mellitus (DMII) shows improved outcomes for patients. Diabetic self-management education is an effective way to help patients control their blood sugar, the education must be costeffective while satisfying the patient’s needs and desires (Chrvala et al., 2015). In a primary care clinic, chronic care management (CCM) was provided through weekly telephone conversation with a nurse to total 20 minutes of monthly conversation. Over a one-month time frame, a pre and post intervention survey were obtained from patients enrolled in the CCM program. This program allows providers and nurses to have frequent contact with the patient reinforcing education and improving self-care management of DMII patients at the same time receiving reimbursement for documented time spent

Radiochemical stability of the dicyclohexano-18-crown-6 ether (DCH18C6): synthesis and tests in radioactive medium of the DCH18C6 radiolytic products

The cis-syn-cis isomer of the dicyclohexano-18-crown-6 ether (DCH18C6) was subjected to hydrolysis and radiolysis with a 137Cs gamma source, at different doses of irradiation. The cis-syn-cis DCH18C6 radiolytic products previously identified [1], were synthesized in their different configurations. These radiolytic products, all of cis configuration, were tested on aqueous synthetic solutions of spent nuclear fuels. Experiments in radioactive medium showed that, under continuous extraction conditions, the cis-syn-cis DCH18C6 radiolytic products cannot perturb a reprocessing process using the DCH18C6 as selective extractant. Good prospects for the application of DCH18C6 to spent nuclear fuel reprocessing were therefore demonstrated. An X-ray crystallographic study of the DCH18C6 cis-syn-cis-isomer with uranyl nitrate was investigated

Radiochemical stability of the dicyclohexano-18-crown-6 ether (DCH18C6): synthesis and tests in radioactive medium of the DCH18C6 radiolytic products

The cis-syn-cis isomer of the dicyclohexano-18-crown-6 ether (DCH18C6) was subjected to hydrolysis and radiolysis with a 137Cs gamma source, at different doses of irradiation. The cis-syn-cis DCH18C6 radiolytic products previously identified [1], were synthesized in their different configurations. These radiolytic products, all of cis configuration, were tested on aqueous synthetic solutions of spent nuclear fuels. Experiments in radioactive medium showed that, under continuous extraction conditions, the cis-syn-cis DCH18C6 radiolytic products cannot perturb a reprocessing process using the DCH18C6 as selective extractant. Good prospects for the application of DCH18C6 to spent nuclear fuel reprocessing were therefore demonstrated. An X-ray crystallographic study of the DCH18C6 cis-syn-cis-isomer with uranyl nitrate was investigated

Effectiveness and safety of oral HIV preexposure prophylaxis for all populations.

ObjectivePreexposure prophylaxis (PrEP) offers a promising new approach to HIV prevention. This systematic review and meta-analysis evaluated the evidence for use of oral PrEP containing tenofovir disoproxil fumarate as an additional HIV prevention strategy in populations at substantial risk for HIV based on HIV acquisition, adverse events, drug resistance, sexual behavior, and reproductive health outcomes.DesignRigorous systematic review and meta-analysis.MethodsA comprehensive search strategy reviewed three electronic databases and conference abstracts through April 2015. Pooled effect estimates were calculated using random-effects meta-analysis.ResultsEighteen studies were included, comprising data from 39 articles and six conference abstracts. Across populations and PrEP regimens, PrEP significantly reduced the risk of HIV acquisition compared with placebo. Trials with PrEP use more than 70% demonstrated the highest PrEP effectiveness (risk ratio = 0.30, 95% confidence interval: 0.21-0.45, P < 0.001) compared with placebo. Trials with low PrEP use did not show a significantly protective effect. Adverse events were similar between PrEP and placebo groups. More cases of drug-resistant HIV infection were found among PrEP users who initiated PrEP while acutely HIV-infected, but incidence of acquiring drug-resistant HIV during PrEP use was low. Studies consistently found no association between PrEP use and changes in sexual risk behavior. PrEP was not associated with increased pregnancy-related adverse events or hormonal contraception effectiveness.ConclusionPrEP is protective against HIV infection across populations, presents few significant safety risks, and there is no evidence of behavioral risk compensation. The effective and cost-effective use of PrEP will require development of best practices for fostering uptake and adherence among people at substantial HIV risk