Feasibility and assessment of a comprehensive emergency department-based intervention for patients at risk of HIV.

Behavioral factors increase the risk of contracting HIV. A comprehensive prevention services (CPS) intervention includes risk assessment and referral for those with confirmed risk. This project sought to assess the feasibility of an emergency department (ED)-based CPS program. A prospective cross-sectional assessment was conducted from October, 2021 through May, 2023, at a single ED in Birmingham, Alabama. Either of two screening methods were subjected to HIV negative adults: 1) manual chief complaint review or 2) objective electronic medical record (EMR) query. Manual and EMR screening methods considered sexually transmitted infections (STIs) or a positive urine drug test (to observe for commonly injectable drugs) within 12 months of current ED visit. Identified patients were approached in the ED (manual review) or via phone (EMR alert). Persons confirmed at risk for HIV following engagement questionnaire completion were made aware of their risk and offered referral to local CPS clinics. Primary outcome was CPS linkage. Descriptive analysis was performed. Of 184 patients approached, 147 agreed to engagement (79.9%), 117 in-person and 30 via phone; 125 (85.1%) were confirmed at risk for HIV; majority were white (66.4%), male (63.2%), between the ages of 30 and 49 (64.8%), uninsured (78.4%), and without a primary care provider (93.6%). Sexual behavior was identified as a recent (within six months) risk factor in 97 (77.6%) patients. Injection drug use was identified as a recent (within six months) risk factor in 71 (56.8%) patients. Fifty-four (43.2%) expressed interest in obtaining CPS follow-up. To-date, ten patients (18.5%) have connected with a CPS counsellor via phone and five (9.3%) have had a subsequent follow-up appointment to discuss CPS with a medical provider. Thirty at-risk patients (24.0%) received ED-initiated buprenorphine/naloxone. Targeted screening tools can aid in the identification of persons at risk for HIV in the ED; further, subsequent engagement and CPS implementation amongst this cohort is feasible. CPS clinic linkage may be challenging however, a CPS definition inclusive of ED-initiated medication for opioid use disorder, may offer opportunity for increased uptake.

Differential induction of glutathione transferases and glucosyltransferases in wheat, maize and Arabidopsis thaliana by herbicide safeners.

By learning lessons from weed science we have adopted three approaches to make plants more effective in phytoremediation: (1) The application of functional genomics to identify key components involved in the detoxification of, or tolerance to, xenobiotics for use in subsequent genetic engineering/breeding programmes. (2) The rational metabolic engineering of plants through the use of forced evolution of protective enzymes, or alternatively transgenesis of detoxification pathways. (3) The use of chemical treatments which protect plants from herbicide injury. In this paper we examine the regulation of the xenome by herbicide safeners, which are chemicals widely used in crop protection due to their ability to enhance herbicide selectivity in cereals. We demonstrate that these chemicals act to enhance two major groups of phase 2 detoxification enzymes, notably the glutathione transferases and glucosyltransferases, in both cereals and the model plant Arabidopsis thaliana, with the safeners acting in a chemical- and species-specific manner. Our results demonstrate that by choosing the right combination of safener and plant it should be possible to enhance the tolerance of diverse plants to a wide range of xenobiotics including pollutants.

A conversation with Dr Michael Fordham. Interview by James Astor.

In this interview in Dr Fordham's 83rd year he describes how he started to work with children, and how Mrs Jung was supportive. He talks about the initial suspicion this interest generated in the wider Jungian community. He refers to his acceptance of and interest in the psychotic elements in child analysis and his transference-based approach to working with these elements. He reflects on his own birth, his work with evacuee children in hostels during the war years and the politics of supervision. He describes the core Jungian concepts which underpinned his work and the theoretical differences from the Kleinian and Anna Freudian positions.

An interview with Michael Fordham. Interview by Paul Roazen.

In the course of early interviews on the history of psychoanalysis, I saw Michael Fordham in the late summer of 1965. We concentrated primarily on the differences between Freud and Jung, as well as the characteristic distinctions between the two schools that they founded. Fordham also talked about some of his personal contacts with Jung.

Effects of leaf wetting and high humidity on stomatal function in leafy cuttings and intact plants of Corylus maxima.

When rooted cuttings of Corylus maxima Mill. cv. Purpurea are moved from the wet and humid conditions of the rooting environment, the leaves frequently shrivel and die. Since the newly formed adventitious root system has been shown to be functional in supplying water to the shoot, stomatal behaviour in C. maxima was investigated in relation to the failure to prevent desiccation. Stomatal conductance (gs) in expanding leaves (L3) of cuttings increased almost 10-fold over the first 14 days in the rooting environment (fog), from 70 to 650 mmol m-2 s-1. In contrast, gs of expanded leaves (L1) changed little and was in the region of 300 mmol m-2 s-1. Midday leaf water potential was much higher in cuttings than in leaves on the mother stock-plant (-0.5 versus -1.2 MPa) even before any roots were visible. Despite this, leaf expansion of L3 was inhibited by >50% in cuttings and stomata showed a gradual reduction in their ability to close in response to abscisic acid (ABA). To determine whether the loss of stomatal function in cuttings was due to severance or to unnaturally low vapour pressure deficit and wetting in fog, intact plants were placed alongside cuttings in the rooting environment. The intact plants displayed reductions in leaf expansion and in the ability of stomata to close in response to dark, desiccation and ABA. However, in cuttings, the additional effect of severance resulted in smaller leaves than in intact plants and more severe reduction in stomatal closure, which was associated with a 2.5-fold increase in stomatal density and distinctively rounded stomatal pores. The similarities between stomatal dysfunction in C. maxima and that observed in many species propagated in vitro are discussed, as is the possible mechanism of dysfunction.