TestMeEast: a campaign to increase HIV testing in hospitals and to reduce late diagnosis.

Late diagnosis occurs in almost half of those diagnosed in the UK (HIV Prevention England, 2013. Retrieved June 22, 2014, from HIV Prevention England: http://www.hivpreventionengland.org.uk/Campaigns-Current/National-HIV-Testing-Week ). Testing occurs mainly in sexual health and antenatal clinics despite recommendations to test more broadly [Ellis, S., & Curtis, H. (2012). HIV diagnoses and missed opportunities. Results of the British HIV association (BHIVA) National Audit 2010. Clinical Medicine, 12(5), 430-434]. We report the findings of an HIV-testing week campaign to offer testing to those who have blood tests as part of routine care within outpatient clinics and emergency departments of six London hospitals. The campaign target was to test 500 patients a day during the 2013 National HIV Testing Week (NHTW). Clinic staff and medical students were trained to offer routine HIV testing. Linkage to care was arranged for those who tested HIV-positive. During NHTW we tested 2402 of the planned 2500 test target. 2402/4317 (55.6% 95% CI 54.1-57.1%) of those who had routine blood tests were tested for HIV. There were eight HIV-positive tests; three were new diagnoses (all linked to care). The campaign hashtag #TestMeEast achieved a total Twitter "reach" of 238, 860 and the campaign had widespread news coverage. Our campaign showed that staff and students could be trained and mobilised to do thousands of routine HIV tests during a campaign.

Routine HIV testing within the emergency department of a major trauma centre: a pilot study.

OBJECTIVES: UK guidelines recommend routine HIV testing for all medical admissions where the local prevalence exceeds 2 per 1000. We aimed to review uptake of HIV testing in the emergency department (ED) of one of the country's major trauma centres in a 3-month pilot study (March-June 2013). METHODS: ED attendees already having blood tests were routinely tested for HIV (based on the recommendation being made to all to test when having blood taken). Uptake was determined using the surrogate marker of ED attendees who had full blood counts (FBCs) as the denominator. Newly diagnosed patients were linked to care and contacts tested. Staff completed an anonymous online survey to determine acceptability at the end of the pilot study. RESULTS: A total of 2828 patients were tested over 3 months. Nineteen HIV-positive individuals were identified. Eight were newly diagnosed, of whom two were thought to be seroconverting. The prevalence of new diagnoses was 8/2828 (0.28%); for comparison, the Public Health England (PHE) actual prevalence for Tower Hamlets is 6.25/1000 (0.625%). Uptake for HIV testing was 30%, a significant increase from 72 tests performed in the 2 months prior (P < 0.001). Ninety-five per cent of respondents to the staff survey agreed that routine HIV testing should be rolled out permanently in the ED. CONCLUSIONS: Despite an average uptake rate, there were 19 positive tests: eight in patients who were newly diagnosed, six in patients who had been lost to follow-up, and five in patients who were known to be positive and linked to care. The staff survey indicated recognition of the importance of HIV testing in the ED. These persuasive data achieved short-term Clinical Commissioning Group (CCG) funding for routine ED testing.

Doe's quality system program: cooperative development and implementation.

Implementation of a Quality Systems approach to making defensible environmental program decisions depends upon multiple, interrelated components. Often, these components are developed independently and implemented at various facility and program levels in an attempt to achieve consistency and cost savings. The U.S. Department of Energy, Office of Environmental Management (DOE-EM) focuses on three primary system components to achieve effective environmental data collection and use. (1) Quality System guidance, which establishes the management framework to plan, implement, and assess work performed; (2) A Standardized Statement of Work for analytical services, which defines data generation and reporting requirements consistent with user needs; and (3) A laboratory assessment program to evaluate adherence of work performed to defined needs, e.g., documentation and confidence. This paper describes how DOE-EM fulfills these requirements and realizes cost-savings through participation in interagency working groups and integration of system elements as they evolve.

The radiochemist's role in the quality evaluation and assessment of radiological data in environmental decision making.

The quality evaluation and assessment of radiological data is the final step in the overall environmental data decisionprocess. This quality evaluation and assessment process is performed outside of the laboratory, and generally the radiochemist is not involved. However, with the laboratory quality management systems in place today, the data packages of radiochemical analyses are frequently much more complex than the project/program manager can effectively handle and additionally, with little involvement from radiochemists in this process, the potential for misinterpretation of radiological data is increasing. The quality evaluation and assessment of radiochemistry data consists of making three decisions for each sample and result, remembering that the laboratory reports all the data for each analyses as well as the uncertainty in each of these analyses. Therefore, at the data evaluation and assessment stage, the decisions are: (1) is the radionuclide of concern detected (each data point always has a number associated with it?); (2) is the uncertainty associated with the result greater than would normally be expected; and (3) if the laboratory rejected the analyses is there serious consequences to other samples in the same group? The need for the radiochemist's expertise for this process is clear. Quality evaluation and assessment requires the input of the radiochemist particularly in radiochemistry because of the lack of redundancy in the analytical data. This paper describes the role of the radiochemist in the quality assessment of radiochemical data for environmental decision making.

A randomized trial comparing the effect of rofecoxib, a cyclooxygenase 2-specific inhibitor, with that of ibuprofen on the gastroduodenal mucosa of patients with osteoarthritis. Rofecoxib Osteoarthritis Endoscopy Study Group.

BACKGROUND & AIMS: Prostaglandin production in the normal gastrointestinal tract, believed to be critical for mucosal integrity, is mediated by cyclooxygenase (COX)-1, whereas prostaglandin production at inflammatory sites seems to occur via induction of COX-2. We hypothesized that COX-2-specific inhibition with rofecoxib (25 mg once daily) in the treatment of patients with osteoarthritis would cause fewer gastroduodenal ulcers than an equally effective dose of ibuprofen (800 mg 3 times a day), a nonspecific COX inhibitor. METHODS: A total of 742 osteoarthritis patients without ulcers on baseline endoscopy were randomly assigned to receive rofecoxib (25 or 50 mg once daily), ibuprofen (800 mg 3 times daily), or placebo. Endoscopy was repeated at 6, 12, and 24 weeks. At 16 weeks, by study design, 95% of the placebo group and 5% of the other groups were discontinued. RESULTS: The cumulative incidence of gastroduodenal ulcers >/=3 mm with rofecoxib (25 or 50 mg once daily) was significantly (P < 0.001) lower than with ibuprofen and was statistically equivalent to placebo at week 12 (placebo, 9.9%; 25 mg rofecoxib, 4.1%; 50 mg rofecoxib, 7.3%; and ibuprofen, 27.7%). At 24 weeks, ulcer rates were 25 mg rofecoxib, 9. 6%; 50 mg rofecoxib, 14.7%; and ibuprofen, 45.8% (P < 0.001, ibuprofen vs. 25 and 50 mg rofecoxib). CONCLUSIONS: Rofecoxib, at doses 2-4 times the dose demonstrated to relieve symptoms of osteoarthritis, caused significantly less gastroduodenal ulceration than ibuprofen, with ulcer rates comparable to placebo.

Nocturnal enuresis and the use of desmopressin: is it helpful?

We assessed the outcome of the use of an enuretic alarm and desmopressin according to conventional guidelines and investigated the reasons for resistance to desmopressin. Children were given a 4 month course using an enuretic alarm if they had not previously used one; 12 out of 21 were dry (57%) after 4 months and one relapsed 1 month later. Those who had previously failed with an alarm or were considered poorly motivated to use it, were given a 4 month course of intranasal desmopressin. Of these 26 children, 10 (38%) were dry at the end of 4 months but only two (7%) remained dry after this was withdrawn. After the initial treatment with alarm or desmopressin, 27 children were still enuretic and attending the clinic. They were shown how to use the alarm and eight also used the dry bed training technique: 15 had become dry after a further 6 months. Of the 12 children who made no response to intranasal desmopressin, nine were given this medication under supervision in hospital; seven of these children still wet the bed despite producing small amounts of concentrated urine overnight. They also had small measured diurnal bladder capacities. We conclude that if a 4 month course with an enuretic alarm is unsuccessful, rather than using desmopressin, the alarm should be continued with relearning and consideration given to additional use of the dry bed training technique. The major factor causing nocturnal enuresis in children is likely to be a small nocturnal bladder capacity.

Transport of nitrite across fish gills.

The results show that rainbow trout (Salmo gairdneri) are able to concentrate NO2- ions in the blood plasma. After 24 hr in water containing 0.7 mM/l NO2-, the blood plasma contained about 5 mM/l NO2- suggesting that the gills have the ability to transport NO2 against a concentration gradient.

Identification of drugs and other toxic compounds from their ultraviolet spectra. Part III: Ultraviolet absorption properties of 22 structural groups.

The ultraviolet absorption spectra of 22 different chemical (structural) groups of drugs and toxic compounds were studied. This paper completes a three-part series in which more than 500 individual compounds have been grouped according to structure as it pertains to characteristics of the ultraviolet absorption scan. Each group has a typical absorption profile with respect to the number of bands between 200 and 340 nm, the intensity of the band(s), and the changes in absorption pattern with solvent and pH changes. Phenothiazines, xanthines, coumarins, quinolines, naphthalene derivatives. O-alkyl benzene derivatives, opiates, ergot alkaloids, benzodiazepines, and various heterocyclic compounds are among the groups of compounds covered in this paper.