Human Papillomavirus and Associated Cancers: A Review.

The human papillomavirus is the most common sexually transmitted infection in the world. Most HPV infections clear spontaneously within 2 years of infection; however, persistent infection can result in a wide array of diseases, ranging from genital warts to cancer. Most cases of cervical, anal, and oropharyngeal cancers are due to HPV infection, with cervical cancer being one of the leading causes of cancer death in women worldwide. Screening is available for HPV and cervical cancer, but is not available everywhere, particularly in lower-resource settings. HPV infection disproportionally affects individuals living with HIV, resulting in decreased clearance, increased development of cancer, and increased mortality. The development of the HPV vaccine has shown a drastic decrease in HPV-related diseases. The vaccine prevents cervical cancer with near 100% efficacy, if given prior to first sexual activity. Vaccination uptake remains low worldwide due to a lack of access and limited knowledge of HPV. Increasing awareness of HPV and access to vaccination are necessary to decrease cancer and HPV-related morbidity and mortality worldwide.

Human Papillomavirus Perceptions, Vaccine Uptake, and Sexual Risk Factors in Students Attending a Large Public Midwestern University.

Background: It was to understand HPV vaccination patterns, uptake, perceptions, and sexual risk factors in students at a Midwest public university. Participants: Students were enrolled during the spring 2024 semester at the University of Iowa. Methods: A survey was developed and emailed to 28,095 students asking demographic, general and sexual health, and HPV-related questions. Results: The response rate was 4.9%, with 76% females and a median age of 22. The HPV vaccine uptake was 82%, with 88% recommending the vaccine. Parental preference was the main reason for being unvaccinated. The median age of sexual debut was 17 years, with a median of 2 sexual partners. Vaccination was associated with female, health science, sexually active, and COVID-19/influenza vaccinated students. Conclusions: HPV vaccine uptake at University of Iowa students is higher than the national and Iowa averages. Increased education regarding HPV vaccination is still needed, particularly in males, those not having sex, and those not receiving other vaccines.

Effects of Tourniquet Features on Application Processes.

BACKGROUND: We investigated emergency-use limb tourniquet design features effects on application processes (this paper) and times to complete those processes (companion paper). METHODS: Sixty-four appliers watched training videos and then each applied all eight tourniquets: Combat Application Tourniquet Generation 7 (CAT7), SOF™ Tactical Tourniquet-Wide Generation 3 (SOFTTW3), SOF™ Tactical Tourniquet-Wide Generation 5 (SOFTTW5), Tactical Mechanical Tourniquet (TMT), OMNA Marine Tourniquet (OMT), X8T tourniquet (X8T), Tactical Ratcheting Medical Tourniquet (Tac RMT), and RapidStop™ Tourniquet (RST). Application processes were scored from videos. RESULTS: Thirty-three appliers had no prior tourniquet experience. All 512 applications were placed proximal to the recipient's simulated distal thigh injury. Thirty-one appliers (13 with no experience) had 66 problem-free applications (18 by no experience appliers). Tightening-system mechanical problems were more frequent with windlass rod systems (26 losing hold of the rod, 27 redoing rod turns, and 58 struggling to secure the rod) versus ratchet systems (3 tooth skips and 16 advance failures). Thirty-five appliers (21 with no experience) had 68 applications (45 by no experience appliers) with an audible Doppler pulse when stating "Done"; causes involved premature stopping (53), inadequate strap pull (1 SOFTTW3, 1 RST), strap/redirect understanding problem (1 SOFTTW5, 1 X8T, 4 Tac RMT, 1 RST), tightening-system understanding problem (2 CAT7, 1 SOFTTW3, 1 TMT, 1 RST), and physical inability to secure (1 SOFTTW3). Fifty-three appliers (32 no experience) had 109 applications (64 by no experience appliers) not correctly secured. Six involved strap/redirect understanding problems: 4 Tac RMT, 1 X8T, 1 SOFTTW5; 103 involved improper securing of non-self-securing design features: 47 CAT7 (8 strap, 45 rod), 31 TMT (17 strap, 19 rod), 22 OMT (strap), and 3 SOFTTW3 (rod). CONCLUSION: Self-securing systems have process advantages. Because most emergent tourniquet recipients require transport, we believe tourniquet security is a critical design aspect. Decisions regarding tourniquet choices may become very different when both occlusion and tourniquet security are considered.

Effects of Tourniquet Features on Application Processes Times.

BACKGROUND: We investigated emergency-use limb tourniquet design features effects on application processes (companion paper) and times to complete those processes (this paper). METHODS: Sixty-four appliers watched training videos then each applied all eight tourniquets: Combat Application Tour- niquet Generation 7 (CAT7), SOF™ Tactical Tourniquet-Wide Generation 3 (SOFTTW3), SOF™ Tactical Tourniquet-Wide Generation 5 (SOFTTW5), Tactical Mechanical Tourniquet (TMT), OMNA Marine Tourniquet (OMT), X8T-Tourniquet (X8T), Tactical Ratcheting Medical Tourniquet (Tac RMT), and RapidStop Tourniquet (RST). Application processes times were captured from videos. RESULTS: From "Go" to "touch tightening system" was fastest with clips and self-securing redirect buckles and without strap/redirect application process problems (n, median seconds: CAT7 n=23, 26.89; SOFTTW3 n=11, 20.95; SOFTTW5 n=16, 20.53; TMT n=5, 26.61; OMT n=12, 25.94; X8T n=3, 18.44; Tac RMT n=15, 30.59; RST n=7, 22.80). From "touch tightening system" to "last occlusion" was fastest with windlass rod systems when there were no tightening system understanding or mechanical problems (seconds: CAT7 n=48, 4.21; SOFTTW3 n=47, 5.99; SOFTTW5 n=44, 4.65; TMT n=38, 6.21; OMT n=51, 6.22; X8T n=48, 7.59; Tac RMT n=52, 8.44; RST n=40, 8.02). For occluded, tightening system secure applications, from "touch tightening system" to "Done" was fastest with self-securing tightening systems tightening from a tight strap (occluded, secure time in seconds from a tight strap: CAT7 n=17, 14.47; SOFTTW3 n=22, 10.91; SOFTTW5 n=38, 9.19; TMT n=14, 11.42; OMT n=44, 7.01; X8T n=12 9.82; Tac RMT n=20, 6.45; RST n=23, 8.64). CONCLUSIONS: Suboptimal processes in- crease application times. Optimal design features for fast, occlusive, secure tourniquet applications are self-securing strap/ redirect systems with an easily identified and easily used clip and self-securing tightening systems.

Limb Position Change Affects Tourniquet Pressure.

BACKGROUND: Limb position changes are likely during transport from injury location to definitive care. This study investigated passive limb position change effects on tourniquet pressure and occlusion. METHODS: Triplicate buddy-applied OMNA® Marine Tourniquet applications to Doppler-based occlusion were done to sitting and laying supine mid-thigh (n=5) and sitting mid-arm (n=3). Tourniqueted limb positions were bent/straight/bent and straight/bent/straight (randomized first position order, 5 seconds/position, pressure every 0.1 second, two-way repeated measures ANOVA). RESULTS: Sitting thigh occlusion pressures leg bent were higher than straight (median, minimum-maximum; 328, 307-403mmHg versus 312, 295-387mmHg, p = .013). In each recipient, the pressure change for each position change for each limb had p < .003. In each recipient, when sitting, leg bent to straight increased pressure (326, 276-415mmHg to 371, 308-427mmHg bent first and 275, 233-354mmHg to 311, 241-353mmHg straight first), and straight to bent decreased pressure (371, 308-427mmHg to 301, 262-388mmHg bent first and 312, 265-395mmHg to 275, 233-354mmHg straight first). When laying, position changes from leg bent first resulted in pressure changes in each recipient but not in the same directions in each recipient. From laying leg straight first, in each recipient changing to bent increased the pressure (295, 210-366mmHg to 328, 255-376mmHg) and to straight decreased the pressure (328, 255-376 mmHg to 259, 210-333 mmHg). Sitting arm bent occlusion pressures were lower than straight (230, 228-252mmHg versus 256, 250-287mmHg, p = .026). Arm position changes resulted in pressure changes in each recipient but not in the same directions in each recipient. Changes in pressure trace character (presence or absence of rhythmically pulsatile traces) and Doppler-based occlusion were consistent with limb position-induced changes in tourniquet pressure (each p ≤ .001 leg, p = .071 arm traces, and p = .188 arm occlusion). CONCLUSIONS: Passive limb position changes can cause significant changes in tourniquet pressure. Therefore, tourniquet adequacy should be reassessed after any limb position change.