Strengthening Screening for HIV, Hepatitis C, and STIs: An Innovative Partnership Between the Health Department and Community Health Centers in New York City.

In New York City, federally qualified health centers (FQHCs) are ideal partners for health departments because of their location in neighborhoods with high rates of HIV, hepatitis C virus (HCV) infection, and gonorrhea. Providers have experienced many barriers to following screening and treatment recommendations. In 2013, the New York City Department of Health and Mental Hygiene partnered with six FQHCs, representing 14 clinics, to make screening for HIV and HCV routine and increase adherence to gonorrhea treatment guidelines through education, electronic health record modification, and progress tracking. After one year, 12 of 14 clinics documented improvement in their HIV offer rate, and 11 clinics documented improvement in their HIV screening rate. Patients who were offered HIV screening increased from 26% at baseline to 56% at follow-up, and patients screened for HIV increased from 25% at baseline to 38% at follow-up. Most clinics improved their HIV screening rate, and progress suggests that local health departments can help FQHCs increase their HIV screening rates.

Insurance and billing concerns among patients seeking free and confidential sexually transmitted disease care: New York City sexually transmitted disease clinics 2012.

BACKGROUND: Historically, New York City (NYC) Department of Health and Mental Hygiene (DOHMH) sexually transmitted disease (STD) clinics have operated completely free of charge but will soon begin billing patients for services. To inform billing strategies, we surveyed NYC DOHMH STD clinic patients in fall 2012 to examine response to the prospect of billing insurance and charging sliding-scale fees for services. METHODS: A total of 5017 individuals were surveyed from all patients accessing clinic services between September and December 2012 at 8 NYC DOHMH STD clinics. The anonymous survey was provided at registration to all patients, in English or Spanish. The data were analyzed to determine patient insurance status and other characteristics related to billing for STD services. RESULTS: More than half of respondents (51.0%) were uninsured, and 42.3% were unemployed. For 20.2% of respondents, billing would pose a considerable barrier to care. Nearly half of those insured (48.4%) said that they would not be willing to share insurance information with the STD clinics. CONCLUSIONS: Respondents who said they would not access STD clinic services if charged represent approximately 13,600 individuals each year who, if not promptly diagnosed and treated elsewhere, could be a continuing source of STIs including HIV. Confidentiality concerns and income are potential obstacles to billing insurance or charging a direct fee for STD services. New York City DOHMH plans to take the concerns raised in the survey findings into account when designing our billing system and carefully evaluate its impact to ensure that the need for accessible, confidential STD services continues to be met.

Bioaccumulation and toxicity of single-walled carbon nanotubes to benthic organisms at the base of the marine food chain.

As the use of single-walled carbon nanotubes (SWNTs) increases over time, so does the potential for environmental release. This research aimed to determine the toxicity, bioavailability, and bioaccumulation of SWNTs in marine benthic organisms at the base of the food chain. The toxicity of SWNTs was tested in a whole sediment exposure with the amphipod Ampelisca abdita and the mysid Americamysis bahia. In addition, SWNTs were amended to sediment and/or food matrices to determine their bioavailability and bioaccumulation through these routes in A. abdita, A. bahia, and the estuarine amphipod Leptocheirus plumulosus. No significant mortality to any species via sediment or food matrices was observed at concentrations up to 100 ppm. A novel near-infrared fluorescence spectroscopic method was utilized to measure and characterize the body burdens of pristine SWNTs in nondepurated and depurated organisms. We did not detect SWNTs in depurated organisms but quantified them in nondepurated A. abdita fed SWNT-amended algae. After a 28-d exposure to [(14) C]SWNT-amended sediment (100 µg/g) and algae (100 µg/g), [(14) C]SWNT was detected in depurated and nondepurated L. plumulosus amphipods at 0.50 µg/g and 5.38 µg/g, respectively. The results indicate that SWNTs are bioaccessible to marine benthic organisms but do not appear to accumulate or cause toxicity.

Population-based surveillance for neonatal herpes in New York City, April 2006-September 2010.

BACKGROUND: Population-based data for neonatal herpes simplex virus (HSV) infection are needed to describe disease burden and to develop and evaluate prevention strategies. METHODS: From April 2006 to September 2010, routine population-based surveillance was conducted using mandated provider and laboratory reports of neonatal HSV diagnoses and test results for New York City resident infants aged ≤60 days. Case investigations, including provider interviews and review of infant and maternal medical charts and vital records, were performed. Hospital discharge data were analyzed and compared with surveillance data findings. RESULTS: Between April 2006 and September 2010, New York City neonatal HSV surveillance detected 76 cases, for an average incidence of 13.3/100,000 (1/7519) live births. Median annual incidence of neonatal HSV estimated from administrative data for 1997 to 2008 was 11.8/100,000. Among surveillance cases, 90.8% (69/76) were laboratory confirmed. Among these, 40.6% (28/69) were HSV-1; 39.1% (27/69) were HSV-2; and 20.3% (14/69) were untyped. The overall case-fatality rate was 17.1% (13/76). Five cases were detected among infants aged >42 days. In all, 80% (20/25) of the case-infants delivered by cesarean section were known to have obstetric interventions that could have increased risk of neonatal HSV transmission to the infant before delivery. Over half (68%, or 52/76) of all cases lacked timely or ideal diagnostics or treatment. CONCLUSIONS: Administrative data may be an adequate and relatively inexpensive source for assessing neonatal HSV burden, although they lack the detail and timeliness of surveillance. Prevention strategies should address HSV-1. Incubation periods might be longer than expected for neonatal HSV. Cesarean delivery might not be protective if preceded by invasive procedures. Provider education is needed to raise awareness of neonatal HSV and to assure appropriate testing and treatment.

Recent Fourier and Laplace perspectives for multidimensional NMR in porous media.

Multidimensional NMR techniques used in the measurement of molecular displacements, whether by diffusion or advection, and in the measurement of nuclear spin relaxation times are categorised. Fourier-Fourier, Fourier-Laplace and Laplace-Laplace methods are identified, and recent developments discussed in terms of the separation, correlation and exchange perspective of multidimensional NMR spectroscopy.

Life-cycle effects of single-walled carbon nanotubes (SWNTs) on an estuarine meiobenthic copepod.

Single-walled carbon nanotubes (SWNT) are finding increasing use in consumer electronics and structural composites. These nanomaterials and their manufacturing byproducts may eventually reach estuarine systems through wastewater discharge. The acute and chronic toxicity of SWNTs were evaluated using full life-cycle bioassays with the estuarine copepod Amphiascus tenuiremis (ASTM method E-2317-04). A synchronous cohort of naupliar larvae was assayed by culturing individual larvae to adulthood in individual 96-well microplate wells amended with SWNTs in seawater. Copepods were exposed to "as prepared" (AP) SWNTs, electrophoretically purified SWNTs, or a fluorescent fraction of nanocarbon synthetic byproducts. Copepods ingesting purified SWNTs showed no significant effects on mortality, development, and reproduction across exposures (p < 0.05). In contrast, exposure to the more complex AP-SWNT mixture significantly increased life-cycle mortality, reduced fertilization rates, and reduced molting success in the highest exposure (10 mg x L(-1)) (p < 0.05). Exposure to small fluorescent nanocarbon byproducts caused significantly increased life-cycle mortality at 10 mg x L(-1) (p < 0.05). The fluorescent nanocarbon fraction also caused significant reduction in life-cycle molting success for all exposures (p < 0.05). These results suggest size-dependent toxicity of SWNT-based nanomaterials, with the smallest synthetic byproduct fractions causing increased mortality and delayed copepod development over the concentration ranges tested.

Reaching out to boys at bars: utilizing community partnerships to employ a wellness strategy for syphilis control among men who have sex with men in New York City.

OBJECTIVE: To explore the impact of a holistic approach for syphilis control to improve the sexual health and well-being of men who have sex with men (MSM). GOAL: The New York City Department of Health & Mental Hygiene (NYC DOHMH) developed Hot Shot! to address a variety of general MSM health issues, including syphilis, gonorrhea, chlamydia, and human immunodeficiency virus (HIV)/acquired immunodeficiency virus. RESULTS: Between November 2003 and June 2004, 9 Hot Shot! events were held throughout NYC. Services delivered at events included STD/HIV screening; relevant adult vaccinations, cardiovascular health screenings; and mental health, tobacco, and other drug use assistance. Of 1634 attendees, 445 persons accessed > or =1 service; 4 persons were newly diagnosed with syphilis and 7 with HIV. CONCLUSIONS: The Hot Shot! approach to syphilis control can facilitate STD education, screening, and treatment of MSM while addressing comprehensive health issues. Future integrated health service delivery programs may be more successful by using stable venues for events to ensure continuity of care for MSM.