Need for informed providers: exploring LA-PrEP access in focus groups with PrEP-indicated communities in Baltimore, Maryland.

BACKGROUND: The approval of long-acting pre-exposure prophylaxis PrEP (LA-PrEP) in the United States brings opportunities to overcome barriers of oral PrEP, particularly among sexual and gender minority communities who bear a higher HIV burden. Little is known about real-time decision-making among potential PrEP users of LA-PrEP post-licensure. METHODS: We held focus group discussions with people assigned male at birth who have sex with men in Baltimore, Maryland to explore decision-making, values, and priorities surrounding PrEP usage. A sexual and gender minority-affirming health center that provides PrEP services supported recruitment. Discussions included a pile-sorting activity and were audio-recorded. Recordings were transcribed and analyzed iteratively, combining an inductive and deductive approach. RESULTS: We held five focus groups from Jan-June 2023 with 23 participants (21 cisgender men who have sex with men, two transgender women who have sex with men; mean age 37). Among participants, 21 were on oral PrEP, one was on injectable PrEP, and one had never taken PrEP. Most had never heard about LA-PrEP. When making decisions about PrEP, participants particularly valued efficacy in preventing HIV, side effects, feeling a sense of security, and ease of use. Perceptions varied between whether oral or injectable PrEP was more convenient, but participants valued the new opportunity for a choice in modality. Factors influencing PrEP access included cost, individual awareness, provider awareness, and level of comfort in a healthcare environment. Participants emphasized how few providers are informed about PrEP, placing the burden of being informed about PrEP on them. Comfort and trust in a provider superseded proximity as considerations for if and where to access PrEP. CONCLUSIONS: There is still low awareness about LA-PrEP among sexual and gender minority communities; thus, healthcare providers have a critical role in influencing access to LA-PrEP. Despite this, providers are still vastly underinformed about PrEP and underprepared to support clients in contextualized ways. Clients are more likely to engage in care with affirming providers who offer non-judgmental conversations about sex and life experiences. Provider education in the United States is urgently needed to better support clients in choosing a PrEP modality that is right for them and supporting adherence for effective HIV prevention.

Impact of treatment chemicals on the morphology and molecular structure of microfibers and microplastic films in wastewater.

This study investigated the impact of commonly used treatment chemicals on the morphology and molecular structure of microfibers (MFs) and microplastic films (MPFs) to determine whether significant changes could occur during wastewater treatment. MFs and MPFs were exposed to sodium hypochlorite (NaOCl), hydrogen peroxide (H2O2), calcium hydroxide (Ca(OH)2, pH 11), sodium hydroxide (NaOH, pH11), and hydrochloric acid (HCl, pH 3) at typical doses and exposure times used at wastewater treatment plants. Scanning electron microscopy (SEM) analysis and attenuated total reflectance-Fourier-transform infrared (ATR-FTIR) were used to examine any morphological or chemical changes after the treatment. Morphological changes were observed in the form of cracks, and increased roughness was revealed in the SEM and 3-D surface images. The results showed that MFs were more resistant to surface degradation than MPFs. Moreover, intensity peaks of ATR-FTIR revealed some partial dislodgement of the bonds in both MFs and MPFs after chemical treatment, but the overall polymer structure remained intact. The changes that occur on the surface of MFs and MPFs during chemical treatment can impact their fate, removal, and transportation behavior both at the treatment plant and after discharge to the environment.

Long-term impact of the adoption of bedaquiline-containing regimens on the burden of drug-resistant tuberculosis in China.

BACKGROUND: Currently available injectable agents are inadequate to address the high drug-resistant tuberculosis (DR-TB) burden in China. Regimens including the oral agent bedaquiline have been shown to be efficacious and safe, leading to its incorporation into multiple national TB treatment programs. This analysis evaluated the impact of increased adoption of bedaquiline-containing regimens on the DR-TB burden in China. METHODS: A state-transition model was developed that permits movement and interaction between susceptible, latent, and active TB disease states, while distinguishing between drug-sensitive (DS) and DR-TB. Model inputs were obtained from the published literature or derived such that model metrics approximated those published by the WHO. Expected improvements in infrastructure were built into the model to forecast the epidemiology of DR-TB in China through 2040 in the absence of bedaquiline (baseline forecast). The impact of higher utilization of bedaquiline-containing regimens (85% peak share) was then assessed in two scenarios that differed with regard to treatment success rates of the regimens: 61% (reflecting findings of clinical trials) and 80% (reflecting data from observational studies), versus the 44% success rate associated with standard-of-care treatment. RESULTS: In the baseline scenario, the model predicted increases in annual incidence of DR-TB by 6-8% during each five-year period between 2020 and 2040, with an increase of 30% over the entire study duration. Adoption of bedaquiline-based regimens limits the incidence increases to only 1-3% in each five-year period and to 8% over the study duration in the 61% success rate scenario. Incidence declines by 1-6% during each five-year period and by 12% over the study duration in the 80% success rate scenario. Similar effects on DR-TB prevalence (4-5% increase in baseline, 0-7% decline in scenario 1, and 4-19% decline in scenario 2) and mortality (5-7% increase in baseline, 0-16% decline in scenario 1, and 6-40% decline in scenario 2) were seen following bedaquiline adoption. CONCLUSIONS: Incorporation of bedaquiline into DR-TB treatment regimens will significantly reduce the DR-TB burden in China, helping to counter the expected increase in burden in the absence of bedaquiline. The study will provide valuable information to public health policy planners.

Time series-based prediction of antibiotic degradation via photocatalysis using ensemble gradient boosting.

This study aims to evaluate the effectiveness of the laboratory-made catalyst Ni2P-ZrO2 (NPZ) in the degradation of an antibiotic in an aqueous suspension when exposed to ultraviolet (UV) light. The degradation of amoxicillin (AMX) was predicted using time series forecasting through the ensemble gradient boosting model. The degradation experiments were conducted utilizing two distinct photocatalyst compositions of Nickel phosphide-zirconium dioxide (NPZ) in the proportions of 1:9 and 2:8. The most effective experimental results were obtained using a natural pH, a catalyst concentration of 0.20 g/L and reaction duration of 0.5 h after testing the different catalysts. Experimental data were used for training, validating and confirming time series predictions. The use of ensemble technique highly affected the experimental findings. The model's performance was quite satisfactory in terms of correlation coefficient (94.00%), normalized mean square error (0.01) and mean square root error (0.0911) which significantly contributed to the model's accuracy. All input variables, such as pH, catalyst dose and irradiation time, had a significant impact on the degrading efficacy. The study has demonstrated that time series forecasting can be used for predicting the degradation process precisely.

Preexposure Prophylaxis for HIV Prevention in the United States: An Overview and Update.

ABSTRACT: There were 36,136 new HIV diagnoses in the United States and dependent areas in 2021, despite a 12% reduction in estimated HIV incidence from 2017 to 2021. The burden of HIV remains disproportionately high among certain populations, including gay and bisexual men, Black/African American individuals, and Hispanic/Latino individuals, and racial and ethnic health care disparities persist. The Ending the HIV Epidemic initiative aims to significantly reduce new infections, with a focus on HIV prevention, particularly the use of preexposure prophylaxis (PrEP). However, challenges remain in achieving equitable PrEP distribution. As frontline health care providers, nurses play a pivotal role in this battle against HIV. This article provides an update on PrEP screening recommendations, the types of PrEP available, dosing, adverse effects, and the role of nurses in patient support and monitoring.

Removal of carbamazepine, venlafaxine and iohexol from wastewater effluent using coupled microalgal-bacterial biofilm.

We evaluated the removal capacity of a coupled microalgal-bacterial biofilm (CMBB) to eliminate three recalcitrant pharmaceuticals. The CMBB's efficiency, operating at different biofilm concentrations, with or without light, was compared and analyzed to correlate these parameters to pharmaceutical removal and their effect on the microorganism community. Removal rates changed with changing pharmaceutical and biofilm concentrations: higher biofilm concentrations presented higher removal. Removal of 82-94% venlafaxine and 18-51% carbamazepine was obtained with 5 days of CMBB treatment. No iohexol removal was observed. Light, microorganism composition, and dissolved oxygen concentration are essential parameters governing the removal of pharmaceuticals and ammonia. Chlorophyll concentration increased with time, even in the dark. Three bacterial phyla were dominant: Proteobacteria, Bacteroidetes and Firmicutes. The dominant eukaryotic supergroups were Archaeplastida, Excavata and SAR. A study of the microorganisms' community indicated that not only do the species in the biofilm play an important role; environment, concentration and interactions among them are also important. CMBB has the potential to provide low-cost and sustainable treatment for wastewater and recalcitrant pharmaceutical removal. The microenvironments on the biofilm created by the microalgae and bacteria improved treatment efficiency.

Performance and emission characteristics of CNG-fueled compression ignition engine with Ricinus communis methyl ester as pilot fuel.

Surge in petroleum prices, its drying sources and degradation in air quality focused interest on renewable energy sources as substitute for existing fuels for internal combustion engines. This study highlights the combustion, performance, and emission characteristics of diesel engines fueled with compressed natural gas (CNG) as primary fuel and castor (Ricinus communis) oil methyl ester (COME) as pilot fuel. COME was produced from non-edible grade Ricinus communis oil. The biodiesel fuel properties and characterization was done as per ASTM D6751 specifications. The CNG was inducted through inlet manifold fumigation at a consistent flow rate of 15 l/min under dual-fuel mode. It is evident from the test results that B20-CNG yields brake thermal efficiency of 23.6% when compared to 25 and 27% for D-CNG and diesel fuel, respectively. The peak cylinder gas pressure was lower in dual-fuel mode when compared to conventional diesel. The emission results show increase in NOx emission by 24.5 and 28.4% for D-CNG and B20-CNG, respectively when compared to baseline diesel fuel at full engine load. There was increase in HC emission by 6.7 and 11% whereas CO emissions decreased by 31.6 and 37.4% for B20-CNG and D-CNG, respectively at similar operating conditions. Reduction in smoke opacity by 49.4 and 59.6% was achieved respectively for D-CNG and B20-CNG under dual-fuel mode. On the whole, COME exhibits a better pilot fuel choice for dual-fuel combustion mode in comparison to conventional fossil petroleum diesel in terms of combustion, performance, and emissions characteristics.

A facile synthesis of Cs loaded TiO2 nanotube photoelectrode for the removal of 4-chloroguaiacol.

In this study, novel Cesium (Cs) doped TiO2 nanotubes photoelectrode (Cs/TiO2NTs) were synthesized by simple electrochemical anodization method and characterized by several physicochemical techniques. In particular, the photocatalytic (PC), electrocatalytic (EC) and photoelectrocatalytic (PEC) activity of newly synthesized Cs/TiO2NTs electrodes was investigated using 4-Chloroguaiacol (4-CG). The effect of operating parameters like Cs concentration, electrolyte concentration, external current and pH on degradation efficacy was examined. PEC oxidation using Cs/TiO2NTs lead to 92% degradation of 4-CG in 6 h of solar light irradiation under optimized conditions (2.5 mM Cs, 160 mg L-1 Na2SO4, 0.03 A current and pH 3). A comparative assessment between PEC, PC and EC process manifested that PEC process was most efficient than the other two processes and Cs/TiO2NTs exhibited higher PEC activity than bare-TiO2 electrodes in terms of degradation and mineralization of organic pollutant. The generation of OH radicals was found to be highest in PEC when compared to EC and PC process. Possible intermediates/byproducts were identified by GC-MS technique and a corresponding tentative degradation pathway has been proposed. Cytotoxicity study showed that PEC has potential to detoxify 4-CG. Hence, combination of TiO2 electrodes decorated with Cs metal can act as a highly efficient photoelectrode for the degradation of hazardous pollutants.

Assessment of reaction intermediates of gamma radiation-induced degradation of ofloxacin in aqueous solution.

Gamma radiolytic degradation of an antibiotic, ofloxacin (OFX) was investigated under different experimental conditions. The parameters such as initial OFX concentration, solution pH, absorbed dose and the concentrations of inorganic (CO32-) and organic (t-BuOH) additives were optimized to achieve the efficient degradation of OFX. The degradation dose constant values of OFX were calculated as 2.364, 1.159, 0.776 and 0.618 kGy-1 for the initial OFX concentrations of 0.05, 0.1, 0.15 and 0.2 mM with their corresponding (G (-OFX)) values of 0.481, 0.684, 1.755 and 1.971, respectively. Degradation rate of OFX was significantly increased with increase in the absorbed dose and decrease in the initial OFX concentration under acidic condition when compared to neutral or alkaline condition. Reaction of OFX in the presence of CO32- and t-BuOH showed that the degradation was primarily caused by the reaction of OFX with radiolytically generated reactive hydroxyl radicals. Mineralization extent of OFX was determined in terms of percentage reduction in total organic carbon (TOC) and results revealed that the addition of H2O2 enhanced the mineralization of OFX from 29% to 36.1% with H2O2 dose of 0.5 mM at an absorbed dose of 3.0 kGy. Based on the LC-QTOF-MS analysis, gamma radiolytic degradation intermediates/products of OFX were identified and the possible degradation pathways of OFX were proposed. Cytotoxicity study of the irradiated OFX solutions showed that gamma radiation has potential to detoxify OFX.

Decomposition of antibiotic ornidazole by gamma irradiation in aqueous solution: kinetics and its removal mechanism.

An efficient gamma radiolytic decomposition of one of the extensively used pharmaceutical ornidazole (ORZ) was explored under different experimental conditions by varying initial concentrations, solution pHs, and doses and concentrations of inorganic ([Formula: see text]) and organic (t-BuOH) additives. The results showed that low ORZ concentrations could be efficiently decomposed using gamma irradiation. The decomposition was followed by pseudo first-order reaction kinetics with rate constant values of 2.34, 1.48, 1.11, and 0.80 kGy-1 for the following initial concentrations: 25, 50, 75, and 100 mg L-1 with their corresponding (G(-ORZ)) values of 1.004, 1.683, 2.237, and 2.273, respectively. Decomposition rate of ORZ was remarkably improved under acidic condition when compared to neutral or alkaline medium. It was also observed that the decomposition was primarily caused by the reaction of ORZ with radiolytically generated reactive HO• radicals. The addition of H2O2 had a synergistic effect on the decomposition and mineralization extent of ORZ. However, the removal of total organic carbon (TOC) was not as effective as the decomposition of ORZ. Finally, the quantum chemical calculations were employed to optimize the geometry structure of ORZ and liquid chromatography quadrupole time-of-flight mass spectrometry (LC-QTOF-MS) was used to identify the decomposition intermediates. On the basis of Gaussian calculations and analysis of LC-QTOF-MS, it can be inferred that ORZ radiolytic decomposition was mainly attributed to oxidative HO• radicals and the direct cleavage of ORZ molecules. Possible pathways for ORZ decomposition using gamma irradiation in aqueous medium were proposed.

Studies on biogas-fuelled compression ignition engine under dual fuel mode.

Experimental investigation has been carried out to utilize biogas as an alternative source of energy in compression ignition (CI) engine under dual fuel operational mode. Biogas was inducted into the inlet manifold at different flow rates along with fresh air through inlet manifold and diesel was injected as a pilot fuel to initiate combustion under dual fuel mode. The engine performance and emission characteristics of dual fuel operational mode were analyzed at different biogas flow rates and compared with baseline conventional diesel fuel. Based upon the improved performance and lower emission characteristics under the dual fuel operation, the optimum flow rate of biogas was observed to be 2.2 kg/h. The lower brake thermal efficiency (BTE) and higher brake-specific energy consumption (BSEC) were noticed with biogas-diesel fuel under dual fuel mode when compared with neat diesel operation. Test results showed reduced NO x emissions and smoke opacity level in the exhaust tailpipe emissions. However, higher hydrocarbon (HC) and carbon monoxide (CO) emissions were noticed under dual fuel mode at entire engine loads when compared with baseline fossil petro-diesel. Hence, the use of low-cost gaseous fuel such as biogas would be an economically viable proposition to address the current and future problems of energy scarcity and associated environmental concerns.

Natural soil mediated photo Fenton-like processes in treatment of pharmaceuticals: Batch and continuous approach.

This paper manifests the potential viability of soil as a cost-free catalyst in photo-Fenton-like processes for treating pharmaceuticals at large scale. Naturally available soil without any cost intensive modification was utilized as a catalyst to degrade pharmaceuticals, specifically ornidazole (ORZ) and ofloxacin (OFX). Soil was characterized and found enriched with various iron oxides like hematite, magnetite, goethite, pyrite and wustite, which contributes toward enhanced dissolution of Fe3+ than Fe2+ in the aqueous solution resulting in augmented rate of photo-Fenton reaction. The leached iron concentration in solution was detected during the course of experiments. The degradation of ORZ and OFX was assessed in solar induced batch experiments using H2O2 as oxidant and 95% ORZ and 92% OFX removal was achieved. Elevated efficiencies were achieved due to Fe2+/Fe3+ cycling, producing more hydroxyl radical leading to the existence of homogeneous and heterogeneous reactions simultaneously. The removal efficiency of solar photo-Fenton like process was also compared to photo-Fenton process with different irradiation sources (UV-A and UV-B) and were statistically analysed. Continuous-scale studies were conducted employing soil either in the form of soil beads or as a thin layer spread on the surface of baffled reactor. Soil beads were found to have satisfactory reusability and stability. 84 and 79% degradation of ORZ and OFX was achieved using soil as thin layer while with soil beads 71 and 68% degradation, respectively. HPLC and TOC study confirmed the efficient removal of both the compounds. Toxicity assessment demonstrates the inexistence of toxic intermediates during the reaction.

CE: Sexually Transmitted Infections in the United States: Overview and Update.

OVERVIEW: Sexually transmitted infections (STIs) are the most common infectious diseases in the United States. They have enormous human consequences, including severe reproductive complications, neonatal injury, and death; and because STIs are associated with social stigma, they also have substantial psychological impact. The economic consequences are also enormous: it's estimated that STIs cost the nation about $16 billion in annual health care costs. All communities are affected, although significant racial, ethnic, and other disparities persist. Nurses play a critical role in educating patients on STIs, screening for disease, and providing treatment. Nurses can also help minimize the impact of social stigma by providing informed, confidential, and sensitive care, and by promoting sexual health. This article provides an overview of the symptoms, screening methods, and treatment recommendations for the most common STIs in the United States and describes the most recent relevant findings in order to inform nursing practice.

Coupling of solar-assisted advanced oxidative and biological treatment for degradation of agro-residue-based soda bleaching effluent.

This study evaluates the effect of integrated solar-assisted advanced oxidation process (AOP) and biological treatment on the extent of degradation of effluents from chlorination (C) and first alkaline extraction (E(1)) stages of soda pulp bleaching in agro-residue-based pulp and paper mill. Biodegradation of the effluents was attempted in suspended mode using activated sludge from the functional pulp and paper industry effluent treatment plant acclimatized to effluents in question. The photocatalytic treatment was employed using zinc oxide (ZnO) in slurry mode for decontamination of effluents in a batch manner and the degradation was evaluated in terms of reduction in chemical oxygen demand. The biological treatment (24 h) of C and E(1) effluent resulted in 30 and 57 % of degradation, respectively. Solar-induced AOP of C and E(1) effluents resulted in 53 and 43 % degradation under optimized conditions (2.5 g L(-1) ZnO at pH 8.0) after 6 h of exposure. For C effluent, a short duration of solar/ZnO (1 h) prior to biological treatment reduced the time required at biological step from 24 to 12 h for almost same extent (92 %) of degradation. However, sequential biological treatment (24 h) followed by solar/ZnO (2 h) resulted in 85.5 % degradation. In contrast, in the case of E(1) effluent, sequential biological (24 h)-solar/ZnO (2 h) system effectively degrades effluent to 95.4 % as compared to 84.8 % degradation achieved in solar/ZnO (2 h)-biological treatment (24 h) system. In the present study, the sequencing of photocatalysis with the biological treatment is observably efficient and technically viable process for the complete mineralization of the effluents.