Battling the Stigma: HIV Screening in Resident Primary Care Clinic

INTRODUCTION: HIV affects ~1.2 million in the US, with 25% unaware of their statusand annual incidence of 50,000. Early detection and treatment reduces risk of AIDS-related deaths and transmission. Both the CDC and the US Preventative Service Task Force recommend routine HIV screening. The Providence Medical Group at St Vincent (PMG-STV) resident clinic has no routine screening protocol. • 24% (757/3139) of all clinic patients have ever been screened. • Of active clinic patients seen quarterly, 5% are offered screening with only 3% completing screening. We implemented and measured a clinic-wide HIV screening protocol leveraging existing clinic workflows. We aimed to increase screening of active clinic patients from 3% to 25% at one year. METHODS: Using a time-series design we measured quarterly rates of HIV screening tests ordered and resulted in active clinic patients, ages 18-65 and seen in office, during the study period. We utilized a pre-existing preventative healthcare workflow for routine cancer screening, influenza vaccines, etc. We introduced this workflow to residents and staff prior to our go-live date. RESULTS / DISCUSSION: Our primary outcome was to increase quarterly HIV screening rate of active patients, with a secondary outcome to increase overall clinic HIV screening rate. We increased the quarterly screening rate of active patients from 3.34% to 9.19% (Phttps://digitalcommons.psjhealth.org/psv_internal/1011/thumbnail.jp

Delirium: Delirious Elders, Implementing Reduction Interventions Using Mobility

INTRODUCTION: This quality improvement project involved hiring, training, and managing 3 Delirium Mobility Aids to implement a non-pharmacologic delirium prevention bundle package, including early mobility, on hospitalized patients age \u3e65. Background: Delirium affects 20-30% of older hospitalized patients [1]. Patients with delirium have double the mortality rate [3], which increases with delirium duration [4]. Delirium worsens long term cognitive functioning [9,10,11,12]. Hospital costs increase by $2,500 per patient, totaling$6,900,000,000 in Medicare expenditures [7]. A single delirium episode increases total yearly costs by ~$64,421 [2]. Research suggests the best treatment is non-pharmacologic multicomponent interventions [6], and those with most benefit include early mobility, reorientation, cognitive/sensory stimulation, and hydration [5]. Methods: A delirium prevention protocol was created addressing four main pillars. • Hydration: water placed within patient reach. • Sensory input: • window blinds opened by 9:00 am • hearing-aids and eye-glasses retrieved and utilized. • Soothing music via delirium TV channel for non-communicative patients. • Reorientation: oriented to person/place/time 3 times daily. • Mobility: 20-min walk (mobilization event) 3 times daily Work and time constraints prohibited existing health professionals (CNA, RN, MD, PT, OT) from implementing the protocol. Thus a new job position (Delirium Mobility Aid) was created to implement this protocol for all patients age \u3e65 admitted to Medical A(28-bed medical unit). This was proposed to Providence St. Vincent Medical Foundation who awarded a$170,000 institutional grant for 12 months. The project residents reviewed applications, interviewed, and hired 3 CNA\u27s to fill the position 12 hr/day, 7 days/week. Physical and Occupational Therapy trained the aids for 3 weeks in delirium management and mobilization techniques. Data was collected in Epic flowsheetsand chart notes. Confusion-Assessment-Method (CAM) is a established delirium scoring system utilized on Medical A. Data from intervention year (2019) was compared to baseline data collected 2 years prior (2017, 2018) on the same hospital unit. Results: Preliminary data collected at month 9 of 12: • No statistically significant change in total delirium burden. However there is a trend toward decreased delirium in prolonged hospitalization (measured after day 4). For these patients with LOS \u3e 6 days, there was a 4% reduction in late-stay delirium compared to 2018 and 10% from 2017. • 7.5-13% more patients were completely delirium free after day 4 • Length of Stay (LOS): no significant change (5.5 days) • Patients admitted from home experienced a 4% increase in discharge to home (rather than care-facility) approaching near significance (p-value 0.06). • There was a trend toward reduction in hospital falls: 2017-33. 2018-29. 2019 (present)-19, projected to reach 25 by year’s end. • Press-Ganey patient satisfaction scores remained stable. Conclusion: Non-pharmacologic multicomponent prevention protocols, which include mobilization, implemented by specialized CNA’s, are a potentially viable treatment of delirium in elderly patients with prolonged hospitalization. This may increase rate of discharge to home, without worsening falls, LOS, or patient experience, and has a cost-savings benefit.https://digitalcommons.psjhealth.org/psv_internal/1004/thumbnail.jp

Following Black Hole Scaling Relations Through Gas-Rich Mergers

We present black hole mass measurements from kinematic modeling of high-spatial resolution integral field spectroscopy of the inner regions of 9 nearby (ultra-)luminous infrared galaxies in a variety of merger stages. These observations were taken with OSIRIS and laser guide star adaptive optics on the Keck I and Keck II telescopes, and reveal gas and stellar kinematics inside the spheres of influence of these supermassive black holes. We find that this sample of black holes are overmassive ($\sim10^{7-9}$ M$_{Sun}$) compared to the expected values based on black hole scaling relations, and suggest that the major epoch of black hole growth occurs in early stages of a merger, as opposed to during a final episode of quasar-mode feedback. The black hole masses presented are the dynamical masses enclosed in $\sim$25pc, and could include gas which is gravitationally bound to the black hole but has not yet lost sufficient angular momentum to be accreted. If present, this gas could in principle eventually fuel AGN feedback or be itself blown out from the system.Comment: accepted to Ap

Following black hole scaling relations through gas-rich mergers

We present black hole mass measurements from kinematic modeling of high-spatial resolution integral field spectroscopy of the inner regions of nine nearby (ultra-)luminous infrared galaxies in a variety of merger stages. These observations were taken with OSIRIS and laser guide star adaptive optics on the Keck I and Keck II telescopes, and reveal gas and stellar kinematics inside the spheres of influence of these supermassive black holes. We find that this sample of black holes are overmassive (~107–9 ${{M}_{}}$) compared to the expected values based on black hole scaling relations, and suggest that the major epoch of black hole growth occurs in early stages of a merger, as opposed to during a final episode of quasar-mode feedback. The black hole masses presented are the dynamical masses enclosed in ~25 pc, and could include gas which is gravitationally bound to the black hole but has not yet lost sufficient angular momentum to be accreted. If present, this gas could in principle eventually fuel active galactic nucleus feedback or be itself blown out from the system

Geographically widespread C-13-depletion of grazing caddis larvae:a third way of fuelling stream food webs?

Stream ecosystems are supported by both green (i.e. based on grazing) and brown (i.e. detritus) food webs, whereas methane-derived carbon is not considered generally to be important; here, we add circumstantial evidence for this potential third way. Grazing cased-caddis (Trichoptera) larvae in the family Glossosomatidae can be very abundant in springs and headwaters and frequently have much lower stable carbon isotope ratios (i.e. they are depleted in the heavier C-13 stable isotope) than the biofilm (epilithon) on the upper surfaces of the stones on which they live, and which is their presumed diet. Evidence for similar isotopic depletion in other lotic invertebrates is currently limited, however; even for glossosomatids it has been observed so far only in some streams draining the southern English cretaceous chalk and in a few headwaters in northern California. If this phenomenon proves to be more widespread, among streams or taxa, it could imply a more general underpinning of stream food webs by isotopically light carbon derived from methane and accessed via consumers feeding on methanotrophic bacteria. Here, we sampled 58 stream sites to examine whether caddis larvae are also C-13-depleted in streams draining other geologies. We focused mainly on carboniferous limestone and sandstone, as well as on further chalk streams representative of most of the British chalk aquifer: together, these new sites covered an area of almost 90,000 km(2), around three times greater than that surveyed previously. At all 58 sites methane gas was supersaturated relative to the atmospheric equilibrium, and at 49 of them larvae were conspicuously C-13-depleted (from -17.5 parts per thousand to -3.6 parts per thousand) relative to the bulk epilithon (components of which we know can oxidise methane). Although still most pronounced on chalk, this phenomenon was geographically and geologically much more widespread than shown previously and suggests methane-derived carbon could indeed play a prominent role in stream food webs (i.e. the third way)

Reflecting on loss in Papua New Guinea

This article takes up the conundrum of conducting anthropological fieldwork with people who claim that they have 'lost their culture,' as is the case with Suau people in the Massim region of Papua New Guinea. But rather than claiming culture loss as a process of dispossession, Suau claim it as a consequence of their own attempts to engage with colonial interests. Suau appear to have responded to missionization and their close proximity to the colonial-era capital by jettisoning many of the practices characteristic of Massim societies, now identified as 'kastom.' The rejection of kastom in order to facilitate their relations with Europeans during colonialism, followed by the mourning for kastom after independence, both invite consideration of a kind of reflexivity that requires action based on the presumed perspective of another