Protocol for an HIV Pre-exposure Prophylaxis (PrEP) Population Level Intervention Study in Victoria Australia: The PrEPX Study.

Background: Pre-exposure prophylaxis (PrEP) is the use of HIV anti-retroviral therapy to prevent HIV transmission in people at high risk of HIV acquisition. PrEP is highly efficacious when taken either daily, or in an on-demand schedule. In Australia co-formulated tenofovir-emtricitabine is registered for daily use for PrEP, however, this co-formulation is not listed yet on the national subsidized medicines list. We describe a study protocol that aims to demonstrate if the provision of PrEP to up to 3800 individuals at risk of HIV in Victoria, Australia reduces HIV incidence locally by 25% generally and 30% among GBM. Methods: PrEPX is a population level intervention study in Victoria, Australia in which generic PrEP will be delivered to 3800 individuals for up to 36 months. Study eligibility is consistent with the recently updated 2017 Australian PrEP guidelines. Participants will attend study clinics, shared care clinics, or outreach clinics for quarterly HIV/STI screening, biannual renal function tests and other clinical care as required. Study visits and STI diagnoses will be recorded electronically through the ACCESS surveillance system. At each study visit participants will be invited to complete behavioral surveys that collect demographics and sexual risk data. Diagnosis and behavioral data will be compared between PrEPX participants and other individuals testing within the ACCESS surveillance system. A subset of participants will complete in depth surveys and interviews to collect attitudes, beliefs and acceptability data. Participating clinics will provide clinic level data on implementation and management of PrEPX participants. The population level impact on HIV incidence will be assessed using Victorian HIV notification data. Discussion: This study will collect evidence on the real world impact of delivery of PrEP to 3800 individuals at risk of acquiring HIV in Victoria. This study will provide important information for the broader implementation of PrEP planning upon listing of the tenofovir-emtricitabine on the national subsidized list of medicines. The study is registered on the Australian New Zealand Clinical Trials Registry (ACTRN12616001215415).

Incidence and management of intercostal patch aneurysms after repair of thoracoabdominal aortic aneurysms.

OBJECTIVE: The reimplantation of intercostal arteries during the repair of descending thoracic aortic or thoracoabdominal aortic aneurysms preserves spinal cord perfusion and might reduce the risk of spinal cord ischemic injury. However, the retained cuff of native aortic tissue around the intercostal vessels might become aneurysmal. We reviewed our experience with patients who had intercostal patch aneurysms after descending thoracic aortic and thoracoabdominal aortic aneurysm repair. METHODS: From January 1986 to July 2008, 38 patients with descending thoracic aortic aneurysms and 117 patients with thoracoabdominal aortic aneurysms underwent surgical repair with cardiopulmonary bypass, hypothermic circulatory arrest, and intercostal artery reimplantation as a Carrel patch. Eleven (7.1%) of these 155 patients (2 with descending thoracic aortic aneurysms and 9 with thoracoabdominal aortic aneurysms) developed intercostal patch aneurysms that required surgical treatment. Using either a repeat open operation (n = 8) or endovascular stent graft placement (n = 3), we repaired 11 intercostal patch aneurysms a mean of 5.3 years after the initial repair (range, 0.1-13.7 years). Five of the 11 patients had Marfan syndrome. RESULTS: There were no in-hospital deaths or reoperations for bleeding, strokes, or spinal cord ischemic injury, and no patient had renal failure requiring dialysis. Two patients had late aortic graft infections. During the follow-up interval that extended to 7.5 years, there were 6 late deaths from 31 to 90 months postoperatively. CONCLUSIONS: Intercostal patch aneurysms are a complication of the sparing of intercostal arteries during thoracic aneurysm repair. They can be safely repaired with either open or endovascular techniques.

Inactivation of fungi associated with barley grain by gaseous ozone.

The use of gaseous ozone as a fungicide to preserve stored barley was studied. The effects of the following operating parameters on the fungicidal efficacy of ozone were examined: 1) the applied ozone dose, 2) ozonation time, 3) water activity of barley, and 4) temperature of barley. The effect of ozonation on germination of barley was also investigated. The experimental results showed that ozone was very effective in inactivation of fungi associated with the barley regardless of whether the fungi were in the forms of spores or mycelia. However, the mycelia were less resistant to ozone. With 5 minutes of ozonation, 96% of inactivation were achieved for spores as well as for mixtures of spores and small amount of mycelia by applying 0.16 and 0.10 mg of ozone/(g barley) x min, respectively. In addition, for sealed storage silos, inactivation of fungi continued when the ozone-containing gas was held inside the silos following a continuous ozone supply. The experimental results also revealed that increases in water activity and temperature of barley enhanced the fungicidal efficacy of ozone. Results of this study also indicated that the inactivation processes could be controlled by simply monitoring the exit ozone from the reactor instead of performing the time-consuming microbial examination. This finding would make the application of ozone in the preservation of cereal grains easier, simpler, and more practically applicable. The experimental results demonstrated that although ozonation above certain strength may reduce barley germination, inactivation of fungi was achieved with ozonation strengths far below the critical point.