Epidemiology of Neisseria gonorrhoeae Gyrase A Genotype, Los Angeles, California, USA.

We investigated the epidemiology of the mutant gyrase A gene, a reliable predictor of ciprofloxacin resistance, in Neisseria gonorrhoeae infections at UCLA Health in Los Angeles, California, USA, during November 1, 2015-August 31, 2016. Among 110 patients with N. gonorrhoeae infections, 48 (44%) had the mutant gyrase A gene.

Environmental, Economic, and Social Aspects of Human Urine Valorization through Microbial Fuel Cells from the Circular Economy Perspective.

Population growth increases the challenge of meeting basic human needs, such as water, a limited resource. Consumption habits and water pollution have compromised natural resources to unsustainable levels. Sustainable effluent treatment practices, such as decentralized systems focused on energy, nutrients, and water recovery, have attracted the attention of the scientific community. Human urine (HU) is a physiological liquid waste whose main component is water (~95%). HU has a significant amount of nutrients, such as N, P, K, and organic matter, which are usually lacking in fecal coliforms. Therefore, the possibility exists of recovering nutrients and energy from HU using sustainable and non-sustainable technologies. Treating HU in bioelectrochemical systems (BES) is a novel alternative to obtaining byproducts from this effluent more sustainably than in electrochemical systems. Microbial fuel cells (MFCs) are an interesting example, contributing to HU revalorization from unwanted waste into a valuable resource of nutrients, energy, and water. Even when urine-operated MFCs have not generated attractive potential outputs or produced considerable amounts of bioelectricity, this review emphasizes HU advantages as nutrients or water sources. The aim of this review was to analyze the current development of BES for HU treatment based on the water circular economy, discussing challenges and perspectives researchers might encounter.

The Implications of Membranes Used as Separators in Microbial Fuel Cells.

Microbial fuel cells (MFCs) are electrochemical devices focused on bioenergy generation and organic matter removal carried out by microorganisms under anoxic environments. In these types of systems, the anodic oxidation reaction is catalyzed by anaerobic microorganisms, while the cathodic reduction reaction can be carried out biotically or abiotically. Membranes as separators in MFCs are the primary requirements for optimal electrochemical and microbiological performance. MFC configuration and operation are similar to those of proton-exchange membrane fuel cells (PEMFCs)-both having at least one anode and one cathode split by a membrane or separator. The Nafion® 117 (NF-117) membrane, made from perfluorosulfonic acid, is a membrane used as a separator in PEMFCs. By analogy of the operation between electrochemical systems and MFCs, NF-117 membranes have been widely used as separators in MFCs. The main disadvantage of this type of membrane is its high cost; membranes in MFCs can represent up to 60% of the MFC's total cost. This is one of the challenges in scaling up MFCs: finding alternative membranes or separators with low cost and good electrochemical characteristics. The aim of this work is to critically review state-of-the-art membranes and separators used in MFCs. The scope of this review includes: (i) membrane functions in MFCs, (ii) most-used membranes, (iii) membrane cost and efficiency, and (iv) membrane-less MFCs. Currently, there are at least 20 different membranes or separators proposed and evaluated for MFCs, from basic salt bridges to advanced synthetic polymer-based membranes, including ceramic and unconventional separator materials. Studies focusing on either low cost or the use of natural polymers for proton-exchange membranes (PEM) are still scarce. Alternatively, in some works, MFCs have been operated without membranes; however, significant decrements in Coulombic efficiency were found. As the type of membrane affects the performance and total cost of MFCs, it is recommended that research efforts are increased in order to develop new, more economic membranes that exhibit favorable properties and allow for satisfactory cell performance at the same time. The current state of the art of membranes for MFCs addressed in this review will undoubtedly serve as a key insight for future research related to this topic.

Implementation of a Large System-Wide Hepatitis C Virus Screening and Linkage to Care Program for Baby Boomers.

BACKGROUND: We implemented and evaluated a large health system-wide hepatitis C virus (HCV) screening and linkage to care program for persons born between 1945 and 1965 ("baby boomers"). METHODS: An electronic health record (EHR) clinical decision support (CDS) tool for HCV screening for baby boomers was introduced in August 2015 for patients seen in the outpatient University of California, Los Angeles healthcare system setting. An HCV care coordinator was introduced in January 2016 to facilitate linkage to HCV care. We compared HCV testing in the year prior (August 2014-July 2015) to the year after (August 2015-July 2016) implementation of the CDS tool. Among patients with reactive HCV antibody testing, we compared outcomes related to the care cascade including HCV ribonucleic acid (RNA) testing, HCV RNA positivity, and linkage to HCV specialty care. RESULTS: During the study period, 19606 participants were screened for HCV antibody. Hepatitis C virus antibody screening increased 145% (from 5676 patients tested to 13930 tested) after introduction of the CDS intervention. Screening increased across all demographic groups including age, sex, and race/ethnicity, with the greatest increases among those in the older age groups. The addition of an HCV care coordinator increased follow-up HCV RNA testing for HCV antibody positive patients from 83% to 95%. Ninety-four percent of HCV RNA positive patients were linked to care postimplementation. CONCLUSIONS: Introduction of an EHR CDS tool and care coordination markedly increased the number of baby boomers screened for HCV, rates of follow-up HCV RNA testing, and linkage to specialty HCV care for patients with chronic HCV infection.

Human immunodeficiency virus and nodular regenerative hyperplasia of liver: A systematic review.

AIM: To investigate the diagnosis, pathogenesis, natural history, and management of nodular regenerative hyperplasia (NRH) in patients with human immunodeficiency virus (HIV). METHODS: We performed a systematic review of the medical literature regarding NRH in patients with HIV. Inclusion criteria include reports with biopsy proven NRH. We studied the clinical features of NRH, in particular, related to its presenting manifestation and laboratory values. Combinations of the following keywords were implemented: "nodular regenerative hyperplasia", "human immunodeficiency virus", "noncirrhotic portal hypertension", "idiopathic portal hypertension", "cryptogenic liver disease", "highly active antiretroviral therapy" and "didanosine". The bibliographies of these studies were subsequently searched for any additional relevant publications. RESULTS: The clinical presentation of patients with NRH varies from patients being completely asymptomatic to the development of portal hypertension - namely esophageal variceal bleeding and ascites. Liver associated enzymes are generally normal and synthetic function well preserved. There is a strong association between the occurrence of NRH and the use of antiviral therapies such as didanosine. The management of NRH revolves around treating the manifestations of portal hypertension. The prognosis of NRH is generally good since liver function is preserved. A high index of suspicion is required to make a identify NRH. CONCLUSION: The appropriate management of HIV-infected persons with suspected NRH is yet to be outlined. However, NRH is a clinically subtle condition that is difficult to diagnose, and it is important to be able to manage it according to the best available evidence.