Late diagnosis among our ageing HIV population: a cohort study

INTRODUCTION: With the advent of combined antiretroviral therapy (cART), more people infected with HIV are living into older age; 22% of adults receiving care in the UK are aged over 50 years [1]. Age influences HIV infection; the likelihood of seroconversion illness, mean CD4 count and time from infection to development of AIDs defining illnesses decreases with increasing age. A UK study estimates that half of HIV infections in persons over 50 years are acquired at an age over 50 [2]. Studies exploring sexual practices in older persons have repeatedly shown that we cannot assume there is no risk of STI and HIV infection [3,4]. Physicians should be alert to risk of HIV even in the older cohort, where nearly half diagnoses are made late [2]. Local audit has demonstrated poor testing rates in the over 50's on the Acute Medical Unit. Late diagnosis (CD4<350) results in poorer outcomes and age confounds further; older late presenters are 2.4 times more likely to die within the first year of diagnosis than younger counterparts [2]. MATERIALS AND METHODS: A retrospective case notes review was conducted of all patients aged 60 years and over attending HIV clinic in the last 2 years. Outcomes audited included features around diagnosis; age, presentation, missed testing opportunities and CD4 count at diagnosis. RESULTS: Of the current cohort of 442 patients, 34 were over 60 years old (8%). Age at diagnosis in this group ranged from 36 to 80 years, mean 56.6 years. Presentation triggers included opportunistic infections or malignancies (n=10), constitutional symptoms (n=6), diagnosis of another STI (n=4), seroconversion illness (n=2), partner status (n=3). Eight patients were diagnosed through asymptomatic screening at Sexual Health. We identified missed opportunities in five patients who were not tested despite diagnoses or symptoms defined as clinical indicators for HIV. Half of older patients had a CD4 count of <200 at diagnosis. CONCLUSIONS: It is imperative that general medical physicians and geriatricians are alert to enquiring about risk and testing for HIV where clinical indicators are present, irrespective of age. The oldest patient in the cohort was diagnosed with HIV aged 80 years. All patients with missed opportunities for testing were over 47 years old

Barriers and facilitators to HIV testing in people age 50 and above: a systematic review

Background: Approximately 13% of people living with HIV in the UK are unaware of their infection. New diagnoses among people ≥50 years is increasing. Unique factors may be associated with testing in this group. This review aims to identify patient and clinician-related barriers/facilitators to HIV testing in people aged ≥50 years. Methods: A systematic electronic search was conducted. Papers were assessed for eligibility and data from eligible studies were extracted. Barriers/facilitators were grouped, and number of times reported was noted. Due to considerable heterogeneity, a narrative approach has been undertaken to synthesise data. Findings: 17 studies were included. Main barriers to testing were low perceived risk, and clinicians’ preconceptions about older people. Main facilitators were regular use of healthcare services or being offered/encouraged to test by a healthcare provider. Interpretation: Although being encouraged to test was a common facilitator, clinicians’ preconceptions about older people was the biggest barrier, showing a divide between clinicians’ preconceptions and patient’s expectations, which may impact on testing rates. This review is an important first step to identify potential barriers/facilitators for further study or to be addressed in the design of future interventions

Catalytic and conductivity studies in two dimensional coordination polymers built with a thiazole based ligand

The employment of the commercial availiable organic ligand 2-mercapto-4-methyl-5-thiazoleacetic acid (H2L) in Zn and Cd chemistry yields two-dimensional (2D) coordation polymers (CPs) with pseudopolymorphic character. Thermal, catalytic and conductivity studies are discussed

Estimating age of mature adults from the degeneration of the sternal end of the clavicle

The sternal end of the clavicle has been illustrated to be useful in aging young adults, however, no studies have investigated what age-related changes occur to the sternal end post epiphyseal fusion. In this study, three morphological features (i.e., surface topography, porosity, and osteophyte formation) were examined and scored using 564 clavicles of individuals of European ancestry (n = 318 males; n = 246 females), with known ages of 40+ years, from four documented skeletal collections: Hamann-Todd, Pretoria, St. Bride's, and Coimbra. An ordinal scoring method was developed for each of the three traits. Surface topography showed the strongest correlation with age, and composite scores (formed by summing the three separate trait scores) indicated progressive degeneration of the surface with increasing chronological age. Linear regression analyses were performed on the trait scores to produce pooled-sample age estimation equations. Blind tests of the composite score method and regression formulae on 56 individuals, aged 40+ years, from Christ Church Spitalfields, suggest accuracies of 96.4% for both methods. These preliminary results display the first evidence of the utility of the sternal end of the clavicle in aging older adult individuals. However, in the current format, these criteria should only be applied to individuals already identified as over 40 years in order to refine the age ranges used for advanced age. These findings do suggest the sternal end of the clavicle has potential to aid age estimates beyond the traditional "mature adult" age category (i.e., 46+ years), and provides several suggestions for future research

Illuminating hydrological processes at the soil-vegetation-atmosphere interface with water stable isotopes

Funded by DFG research project “From Catchments as Organised Systems to Models based on Functional Units” (FOR 1Peer reviewedPublisher PDFPublisher PD

General Practitioners involvement in enteral tube feeding at home: a qualitative study

<p>Abstract</p> <p>Background</p> <p>Complex medical treatment is moving from hospital to primary care and General Practitioners (GPs) are increasingly asked to undertake new roles. There are now an estimated 19,500 patients being fed in the UK in the community on enteral tube feeding using a variety of different feeding tubes (Percutaneous endoscopic gastrostomy (PEG), Jejunostomy, or nasogastric (NG). The majority of patients are over the age of 65 years when they had artificial feeding initiated and mainly because of dysphagia. The aim of this study was to explore GPs knowledge, attitudes and skills relating to enteral feeding in the community.</p> <p>Methods</p> <p>Semi-structured one-to-one interviews with a convenience sample of GPs in Northern Ireland.</p> <p>Results</p> <p>Twenty-three GPs in three health boards in Northern Ireland participated in the study. Most found dealing with enteral feeding to be a predominantly negative experience. They had little involvement in patient selection for the procedure and poor or no discharge information. GPs felt inadequately trained, there was poor communication between primary and secondary care and little support. There was anger and frustration among GPs about lack of resources (funding and training), and the perception that primary care was used as a dumping ground.</p> <p>Conclusion</p> <p>Moving complex medical treatment from secondary to primary care has major implications for GPs who should be included in the patient selection process, have adequate discharge information about their patients, be adequately resourced and have appropriate support and training.</p

Projected risks to groundwater-dependent terrestrial vegetation caused by changing climate and groundwater abstraction in the Central Perth Basin, Western Australia

The effect of potential climate change on groundwater-dependent vegetation largely depends on the nature of the climate change (drying or wetting) and the level of current ecosystem dependence on groundwater resources. In south-western Australia, climate projections suggest a high likelihood of a warmer and drier climate. The paper examines the potential environmental impacts by 2030 at the regional scale on groundwater-dependent terrestrial vegetation (GDTV) adapted to various watertable depths, on the basis of the combined consideration of groundwater modelling results and the framework for GDTV risk assessment. The methodology was tested for the historical period from 1984 to 2007, allowing validation of the groundwater model results\u27 applicability to such an assessment. Climate change effects on GDTV were evaluated using nine global climate models under three greenhouse gas emission scenarios by applying the climate projections to groundwater models. It was estimated that under dry climate scenarios, GDTV is likely to be under high and severe risk over more than 20% of its current habitat area. The risk is also likely to be higher under an increase in groundwater abstraction above current volumes. The significance of climate change risk varied across the region, depending on both the intensity of the change in water regime and the sensitivity of the GDTV to such change. Greater effects were projected for terrestrial vegetation dependent on deeper groundwater (6-10m)

Molecular and supramolecular chemistry of mono- and di-selenium analogues of metal dithiocarbamates

This bibliographic review summarises the coordination chemistry of mono- and diselenium analogues of metal dithiocarbamate ligands, [RRꞌNCS2]-, as revealed by X-ray crystallography and spectroscopy (77Se NMR and infrared). The Se-ligands are usually chelating but, bridging modes, up to 4, are known. Reflecting the larger size, greater polarisability and presence of a polar-cap (-hole), selenium atoms are more likely to be involved in secondary-bonding (chalcogen-bonding) than sulphur when a competition exists. Isostructural relationships are established across the series in about one-third of the structures