Development of a Citywide Rapid Antiretroviral Therapy Initiative in San Francisco.

INTRODUCTION: Ending the HIV epidemic in the U.S. holds rapid antiretroviral therapy as a key strategy to improve the health of those with HIV and to decrease transmission. In 2015, Getting to Zero San Francisco, a multisector consortium, expanded rapid antiretroviral therapy citywide. METHODS: A Getting to Zero San Francisco Rapid ART Program Initiative for HIV Diagnoses Committee (academic, community, service delivery, health department partners) designed the program, protocol, dissemination plan, and monitoring strategy. Newly diagnosed patients were linked to an HIV medical home or Rapid ART Program Initiative for HIV Diagnoses initiation hub to best deliver rapid antiretroviral therapy across a diverse patient mix, with a goal of ≤5 working days from diagnosis to care and ≤1 day from care to antiretroviral therapy. Stakeholders were trained on rapid antiretroviral therapy via Getting to Zero San Francisco meetings, in-services, public health detailing, and peer-to-peer recruiting, prioritizing HIV clinics serving patients of color, Latinx ethnicity, youth, and the uninsured or publicly insured. Rapid ART Program Initiative for HIV Diagnoses-specific metrics were derived from surveillance data; stratified by sex/gender, age, race/ethnicity, and housing status; and presented at public meetings. Data were analyzed between January and April 2021. RESULTS: From 2014 to 2018, median time from diagnosis to care decreased 71% (7 to 2 days), care to antiretroviral therapy decreased from 19 to 0 days, and diagnosis to virologic suppression decreased 51% (94 to 46 days). Improvements occurred regardless of age, race/ethnicity, sex/gender, exposure, or housing status. CONCLUSIONS: During a citywide initiative to optimize antiretroviral therapy initiation, time from HIV diagnosis to care, antiretroviral therapy, and virologic suppression decreased across all affected groups to varying degrees. The Rapid ART Program Initiative for HIV Diagnoses Committee continues to address challenges to retention and expand implementation.

Tensile mechanical properties of human forearm tendons.

Previous studies of the mechanical properties of tendons in the upper limb have used embalmed specimens or sub-optimal methods of measurement. The aim of this study was to determine the biomechanical properties of all tendons from five fresh frozen cadaveric forearms using updated methodology. The cross-sectional area of tendons was accurately measured using a laser reflectance system. Tensile testing was done in a precision servo-hydraulic device with cryo-clamp fixation. We determined that the cross-sectional area of some tendons is variable and directly influences the calculated material properties; visual estimation of this is unreliable. Data trends illustrate that digital extensor tendons possess the greatest tensile strength and a higher Young's modulus than other tendon types.

Evaluation of a dynamic armrest for hydraulic-actuation controller use.

The efficacy of a newly designed dynamic armrest was evaluated during joystick operation of a typical North American hydraulic-actuation joystick. The dynamic design was evaluated against a stationary armrest condition as well as no armrest condition. Electromyography (EMG) and subjective measurements were used to make the evaluation. The dynamic armrest, which mimics the natural pendulation of a joystick operator's arm in the forward and backward directions, was shown to significantly decrease the muscular activation in the upper trapezius, posterior deltoid, and anterior deltoid (p ≤ 0.01) over a stationary armrest. A questionnaire revealed that subjects significantly (p = 0.01) preferred the dynamic armrest design over either a standard armrest or no armrest with 17 of 21 operators preferring the dynamic armrest. Ratings from the questionnaire indicated that subjects felt that the dynamic armrest required less effort, was more comfortable, and was more effective than either of the other two armrest conditions.

Development and design of a dynamic armrest for hydraulic-actuation joystick controlled mobile machines.

Standard armrests used in conjunction with joysticks of heavy mobile machinery have been proven to inadequately meet operator needs, resulting in excessive static loading of shoulder musculature. During joystick operation, the trajectory of the user's forearm is governed by the motion of the controller, which creates horizontal and vertical movement of the forearm. The vertical motion of the forearm in the forward and backward motion create postures that stationary armrests cannot support thereby generating increased muscle activation and risk of repetitive strain injuries. The current paper describes the design process used in creating a dynamic armrest that replicates the operator's natural motion trajectories. By incorporating the natural motion paths into a dynamic armrest, the postural requirements and muscular activation of the operator's shoulder may be reduced.

Calibration of a Hall effect displacement measurement system for complex motion analysis using a neural network.

Biomechanics studies often require the analysis of position and orientation. Although a variety of transducer and camera systems can be utilized, a common inexpensive alternative is the Hall effect sensor. Hall effect sensors have been used extensively for one-dimensional position analysis but their non-linear behavior and cross-talk effects make them difficult to calibrate for effective and accurate two- and three-dimensional position and orientation analysis. The aim of this study was to develop and calibrate a displacement measurement system for a hydraulic-actuation joystick used for repetitive motion analysis of heavy equipment operators. The system utilizes an array of four Hall effect sensors that are all active during any joystick movement. This built-in redundancy allows the calibration to utilize fully connected feed forward neural networks in conjunction with a Microscribe 3D digitizer. A fully connected feed forward neural network with one hidden layer containing five neurons was developed. Results indicate that the ability of the neural network to accurately predict the x, y and z coordinates of the joystick handle was good with r(2) values of 0.98 and higher. The calibration technique was found to be equally as accurate when used on data collected 5 days after the initial calibration, indicating the system is robust and stable enough to not require calibration every time the joystick is used. This calibration system allowed an infinite number of joystick orientations and positions to be found within the range of joystick motion.

Effect of local conjugated estrogens on vaginal pH in elderly women.

OBJECTIVE: The decline in estrogens during and after menopause is associated with an increase in vaginal pH and an increased susceptibility to urinary tract infections (UTIs). Decreased vaginal pH following short-term treatment with topical estrogens may reduce the incidence of such infections. This study was undertaken to evaluate the effect of low-dose, topical conjugated estrogens vaginal cream (CEVC) on vaginal pH in older, postmenopausal women. DESIGN: We conducted a retrospective analysis of initial and follow-up evaluations of older, postmenopausal women residing in 19 long-term care facilities who were referred to Seton Health System's Incontinence Treatment Center between January 2, 1997, and June 13, 1998. Patients were untreated or were administered conjugated estrogens intravaginally (0.5 g/d, 3 days per week). SETTING: Incontinence Treatment Center, Seton Health System. PARTICIPANTS: Two hundred fifty-eight postmenopausal women (mean age 83 years), residents of skilled nursing facilities, who were diagnosed with urinary incontinence, were included in the study. MEASUREMENTS: Measurements included age, CEVC treatment, vaginal pH, and history of UTIs or hysterectomy. RESULTS: In the CEVC-treated women, vaginal pH was reduced from a mean of 7.41 +/- 0.71 to 6.80 +/- 0.70 after 6 weeks (n = 213; P = 0.0001). No differences in vaginal pH were observed in untreated women (n = 45). Continuation of CEVC treatment for an additional 6 weeks (n = 93) resulted in further decreases in vaginal pH (P = 0.017). Women who discontinued treatment after 6 weeks maintained a lower vaginal pH for 6 weeks (P = 0.0004), and there was no significant difference between groups at Week 12. CONCLUSIONS: Low-dose CEVC for 6 and 12 weeks reduces vaginal pH in older women residing in long-term care facilities. The decreased vaginal pH following short-term treatment with topical estrogens may reduce the incidence of recurrent UTIs.