ABSTRACT
SummaryThe United States Air Force HIV programme has several features that may enhance antiretroviral therapy outcomes, including free access to healthcare and mandatory clinical visits every six months at a single centre. We evaluated viral load suppression (<50 copies/ml) after 12 months of initial antiretroviral therapy, with extension to 18 and 24 months. Active duty Air Force members were categorised by year of antiretroviral therapy initiation: 2000-2005 (n = 95, 36.1%) and 2006-2011 (n = 168, 63.9%). The median months from HIV diagnosis to initial antiretroviral therapy were shorter in the 2000-2005 group (2.4, IQR 1.2-5.9) compared with the 2006-2011 group (12.6, IQR 2.6-29.0; p < 0.001). Viral load suppression was greater in the 2006-2011 group compared with the 2000-2005 group at 12 months (93.2% versus 78.6%, p = 0.002) and 18 months (91.8% versus 80.3%, p = 0.03), and trended higher at 24 months (90.8% versus 82.5%; p = 0.15). Factors associated with viral load suppression at 12 months in multivariate models included antiretroviral therapy initiation during 2006-2011 (OR 5.22, 95% CI 1.50-18.18) and CD4 count at antiretroviral therapy initiation (OR 2.29, 95% CI 1.19-14.43 per 100 cells/µl increase). Structured programmes that minimise traditional barriers to care combined with the use of contemporary antiretroviral therapy regimens can achieve clinic-wide viral load suppression in >90% of patients.
Subject(s)
Anti-HIV Agents/therapeutic use , Continuity of Patient Care , HIV Infections/drug therapy , Military Personnel , Viral Load/drug effects , Adult , Antiretroviral Therapy, Highly Active , CD4 Lymphocyte Count , Female , HIV Infections/virology , Health Services Accessibility , Hospitals, Military , Humans , Male , Program Evaluation , RNA, Viral , Time Factors , Treatment Outcome , United StatesABSTRACT
The effectiveness of previously untested disaster plans was demonstrated during the aftermath of the crash of Delta Airlines Flight 191 at D/FW International Airport on Friday, August 2, 1985. These plans, in effect for years and subjected to periodic review, were as yet untried before this first disaster at D/FW International since its opening. This paper outlines the disaster plans, the actual problems encountered, the logistics of a disaster of this kind, and insights gained from the experience.
Subject(s)
Accidents, Aviation , Disaster Planning , Humans , Retrospective StudiesABSTRACT
A series of tests were conducted to determine the velocities necessary for lead air gun pellets (calibers .177 and .22) and caliber .38 lead bullets to perforate skin. Human lower extremities were used. Caliber .177 air gun pellets weighing 8.25 grains required a minimum velocity of 101 m/s (331 ft/s) to perforate skin. The energy per area of presentation ratio E/a was 1:86 m X kg/cm2. Caliber .22 air gun pellets weighing 16.5 grains needed a minimum velocity of 75 m/s (245 ft/s). The E/a was 1:3 m X kg/cm2. A round nose, caliber .38 lead bullet weighing 113 grains perforated skin at 58 m/s (191 ft/s). The E/a was 1.95 m X kg/cm2. These studies appear to indicate that lightweight projectiles need greater velocity to perforate skin than do larger caliber, heavier bullets.
