Isolated Ocular Mpox without Skin Lesions, United States.

We report a case of a 53-year-old HIV-negative patient in San Francisco, California, USA, with no classic mpox prodromal symptoms or skin lesions who experienced fulminant, vision-threatening scleritis, keratitis, and uveitis. Deep sequence analysis identified monkeypox virus RNA in the aqueous humor. We confirmed the virus on the cornea and sclera by PCR.

When WE See Us: Commentary on Black Adolescent Research by Black Male Youth Activists.

Research viewed exclusively through the lenses of adults, even good-meaning adults, in some respects can strip young people of their agency to create knowledge about their world and their conditions. Given this reality, this commentary departs from traditional forms of research about adolescents to make spaces for Black male adolescents and young men to make sense of, and highlight their own connection to, research. It is our hope that scholars and practitioners who are interested in supporting Black youth will gather insights from our experiences, and hopefully use them to elevate the agency of Black youth in their schools and communities.

A randomised controlled trial of computer-assisted interviewing in sexual health clinics.

OBJECTIVES: To assess the impact of computer-assisted interview compared with pen and paper on disclosure of sexual behaviour, diagnostic testing by clinicians, infections diagnosed and referral for counselling. METHODS: Two-centre parallel three-arm randomised controlled open trial. Computer-generated randomisation with allocation concealment using sealed envelopes. SETTING: Two London teaching hospital sexual health clinics. PARTICIPANTS: 2351 clinic attenders over the age of 16 years. INTERVENTIONS: Computer-assisted self-interview (CASI). Computer-assisted personal interview (CAPI). Pen and paper interview (PAPI). MAIN OUTCOME MEASURES: Diagnostic tests ordered, sexually transmitted infections (STI). SECONDARY OUTCOMES: Disclosure of sexual risk, referral for counselling. RESULTS: 801, 763 and 787 patients randomly allocated to receive CASI, CAPI and PAPI. 795, 744 and 779 were available for intention-to-treat analysis. Significantly more diagnostic testing for hepatitis B and C and rectal samples in the CAPI arm (odds for more testing relative to PAPI 1.32; 95% CI 1.09 to 1.59). This pattern was not seen among CASI patients. HIV testing was significantly lower among CASI patients (odds for less testing relative to PAPI 0.73; 95% CI 0.59 to 0.90). STI diagnoses were not significantly different by trial arm. A summary measure of seven prespecified sensitive behaviours found greater reporting with CASI (OR 1.4; 95% CI 1.2 to 1.6) and CAPI (OR 1.4; 95% CI 1.2 to 1.7) compared with PAPI. CONCLUSION: CASI and CAPI can generate greater recording of risky behaviour than traditional PAPI. Increased disclosure did not increase STI diagnoses. Safeguards may be needed to ensure that clinicians are prompted to act upon disclosures made during self-interview.

Scalable MSC-derived bone tissue modules: In vitro assessment of differentiation, matrix deposition, and compressive load bearing.

Enhancements to the mechanical properties of modular designs for bone tissue engineering could increase their clinical applications. In this study, bone marrow mesenchymal stem cells (MSCs) and hydroxyapatite (HAP) microgranules were encapsulated in polyelectrolyte complex membranes composed of chondroitin 4-sulfate (C4S), carboxymethyl cellulose (CMC) and chitosan. Microcapsules were formed with and without HAP microgranules, and cultured in either osteoinduction medium (Osteo) or expansion medium (Exp) to produce four microcapsule conditions: Osteo, Osteo+HAP, Exp, and Exp+HAP. Microcapsules facilitated alkaline phosphatase secretion and deposition of bone specific proteins (osteocalcin and osteopontin) by encapsulated MSCs over 28 days of osteogenic culture. SEM and micro-CT analysis showed cell-deposited mineral covering the surfaces of the HAP microgranules and interior of the microcapsule membrane. The mineralized microcapsules could be combined and fused into cylindrical constructs (4 × 5 mm, W × H), and uniaxial compression tests confirmed that microcapsule mineralization greatly enhanced the yield stresses of Osteo and Osteo+HAP fused constructs (10.4 ±â€¯4.4 MPa and 6.4 ±â€¯2.8 MPa), compared to only HAP microgranules (Exp+HAP, 0.5 ±â€¯0.3 MPa). The C4S/CMC/Chitosan microcapsules provide a platform allowing pre-mineralization of microcapsules in vitro for later assembly of larger load-bearing constructs, or for use as an injectable bone regeneration strategy. STATEMENT OF SIGNIFICANCE: Clinical translation of bone tissue engineering is limited by the difficulty of generating space filling implants that both resist compressive loading, and simultaneously deliver cells throughout the bone defect. Here, we present the design of a microcapsule system containing both stem cells capable of rebuilding bone tissue, and a mechanically tough bone-like mineral, that imparts compression resistance to the microcapsules. The microcapsules support stem cell differentiation to an osteogenic phenotype, that can mineralize the microcapsule membrane and interior. The mineralized microcapsules can be assembled into larger bone constructs, and have mechanical properties on par with trabecular bone.

Does using self-completed sexual history questionnaires in HIV-positive men who have sex with men affect clinical outcomes?

This audit compared sexual histories taken by self-completed questionnaires (SQ) versus the 'gold-standard' of 'traditional' face-to-face interviews by health-care professionals (HP). It compared reporting of symptoms and sexual behaviour and looked at outcomes in terms of diagnoses of sexually transmitted infections. SQ were at least equal to HP and might therefore be a valuable tool in streamlining services.

'Catapulted into sexual health nursing leadership'.

Kevin Miles, nurse consultant and lead clinician for genitourinary medical services at Camden Primary Care Trust, explains why he feels he is in a position to lead evidence-based changes.

Perceptions of incentives offered in a community-based malaria diagnosis and treatment program in the Highlands of Papua New Guinea.

What motivates community-based health workers to provide care in rural and remote areas, often on a voluntary or casual basis, is a key question for program managers and public health officials. This paper examines how a range of incentives offered as part of the Marasin Stoa Kipa program, a community-based malaria diagnosis and treatment program that has been implemented since 2007 within a major oil and gas development area in Papua New Guinea, are perceived and critiqued by community-based health workers. Nineteen interviews and seven focus group discussions with the workers who deliver services and members of the communities served by the program, conducted between November 4 and 25, 2015, reveal a pattern of mixed motivations and changes in motivation over time. This can be attributed partly to the unique social and economic circumstances in which the program is operating. Changes in the burden of disease as well as in global and national health services policy with implications for local level program operations also had an impact, as did the nature of relationships between program managers, community-based health workers, and program beneficiaries. Overall, the findings suggest that while financial and in-kind incentives can be a useful tool to motivate voluntary or minimally-compensated community-based health workers, they must be carefully structured to align with local social, economic, and epidemiological realities over the long-term.

The Epidemiology of Malaria in Kutubu, Southern Highlands Province, Papua New Guinea, before and during a Private Sector Initiative for Malaria Control.

Papua New Guinea (PNG) has a significant malaria burden, is resource constrained, and has isolated populations with limited access to health services. Home-based management is a key element of the national program that supports strategies of early detection, diagnosis and treatment. We describe the epidemiology of malaria near Lake Kutubu in the Southern Highlands Province through reported data on suspected and confirmed malaria in patients accessing public health facilities or using a novel, incentivised, social marketing approach for malaria treatment at the village level. Monthly case data reported by nine health facilities and 14 village-based providers, known as Marasin Stoa Kipas (MSK), were extracted from outpatient registers and MSK malaria case forms. Descriptive statistics of diagnostic use, monthly incidence, test positivity rate and species distribution were estimated. Summary statistics of service delivery demonstrate patient access and diagnostic coverage in program areas. From May 2005 to September 2013, 15,726 individuals were tested with either rapid diagnostic test and/or microscopy at health facilities, and 42% had a positive result for malaria (n = 6604); of these 67.1% (n = 4431) were positive for P. falciparum (alone or mixed) and 32.9% were positive for non-P. falciparum species (alone or mixed). From October 2007 to September 2013, 9687 individuals were tested with either RDT and/or microscopy at MSK sites and 44.2% (n = 4283) tested positive for malaria; of these, 65.3% (n = 2796) were positive for P. falciparum, while 34.7% (n = 1487) were positive for non-P. falciparum species. Up to April 2010 there was an intermittent and upward trend in the reported incidence of all species of confirmed malaria, reaching 50 per 1000 population per month for both sites combined, followed by a steady decline to four per 1000 population per month in 2013, with P. vivax the most common infection. This study is the most recent longitudinal overview of malaria in the Southern Highlands since 2003. It outlines patient access to a community-based model of care. The analysis shows changes in health facility versus MSK use, a strongly decreasing trend in incidence of confirmed malaria from 2010 to 2013, and a shift from predominantly P. falciparum to P. vivax infection.

Chitosan films with improved tensile strength and toughness from N-acetyl-cysteine mediated disulfide bonds.

To improve the mechanical properties of chitosan (Ct) materials without the use of cytotoxic crosslinkers, disulfide cross-linkable Ct was synthesized by grafting N-acetyl-cysteine (NAC) to Ct using carbodiimide chemistry. Cast films of NAC-Ct conjugates were prepared with degrees of substitution (DS) of 0%, 6%, 15%, and 20%, and the disulfide bond formation was induced by increasing the reaction media pH to 11. The tensile strength, breaking strain, elastic moduli and toughness of disulfide cross-linked polymers were analyzed by monotonic tensile testing of hydrated NAC-Ct films. Crystallinity was determined via XRD. Results demonstrated that NAC incorporation and crosslinking in chitosan produced tougher polymer films with 4-fold higher tensile strength (10 MPa) and 6-fold greater elongation (365%), but reduced crystallinity, compared to unmodified chitosan. The resilience of NAC-Ct films was evaluated by cyclic testing, and results demonstrate that increasing NAC content produced a more resilient material that dissipated less energy when deformed. These improved mechanical properties broaden chitosan's applicability towards the construction of mechanically robust implantable scaffolds for tissue regeneration.

The growing HIV pandemic.

Well into the third decade of the HIV pandemic, there is still no cure on the horizon and recent results of preventive vaccine studies have been disappointing. HIV diagnoses continue to escalate and a significant proportion of individuals with HIV remain undiagnosed. New antiretroviral treatments have extended the life expectancy of those infected with HIV in developed countries, although the vast number of individuals in low-resource settings have no access at all. Recent prevention initiatives include community studies of vaginal and rectal microbicides, and the provision of antiretrovirals for post-exposure prophylaxis following sexual exposure (PEPSE). Other developments are discussed to provide practitioners with an update on the contemporary issues related to HIV/AIDS.

Career pathways in sexual health.

WITH SO MANY CHANGES taking place in the NHS, the thought of making yet another bleating call for change is almost bad enough to make me stop writing.

Nurse-led sexual health care: international perspectives.

Nurses as first-line care providers for the treatment of sexually transmitted infections are a relatively new concept in the United Kingdom (UK). However, for over 25 years, services in other countries have been empowering nurses to work as autonomous practitioners, capable of dealing with patients presenting with a range of sexual health conditions and issues without necessarily seeking the advice or input of a doctor. This paper will present the observations of nurse-led services in Amsterdam, Seattle and Sydney. It will discuss how service providers in the UK can learn from the experiences of international colleagues and will argue why trained and experienced genitourinary medicine nurses need to advance their role and be better integrated as first-line care providers.

Effect of environmental temperature on shock absorption properties of running shoes.

OBJECTIVE: To determine the effect of temperature changes on the shock attenuation of 4 running shoe shock absorption systems. DESIGN: Prospective. SETTING: Motion analysis laboratory. INTERVENTIONS: The shock attenuation of 4 different running shoes representing common shock absorption systems (Nike Air Triax, Asics Gel Nimbus IV, Adidas a3 cushioning, Adidas Supernova cushion) was measured at ambient temperatures of -20 degrees C, -10 degrees C, 0 degrees C, +10 degrees C, +20 degrees C, +30 degrees C, +40 degrees C, and +50 degrees C. Repeated-measures analysis of variance was used to determine differences between shoes. OUTCOME MEASURES: Shock attenuation as indicated by peak deceleration (g) measured by a mechanical impactor following ASTM Standard F1614-99. RESULTS: Shock attenuation decreased significantly with reduced temperature for each shoe tested. The Adidas a3 shoe exhibited significantly higher peak decelerations (lower shock attenuation) at cold temperatures compared with the other shoes. CONCLUSIONS: Cold ambient temperatures significantly reduce the shock attenuation of commonly used running shoes. These findings have important clinical implications for individuals training in extreme weather environments, particularly those with a history of lower limb overuse injuries.

Comparing doctor- and nurse-led care in a sexual health clinic: patient satisfaction questionnaire.

BACKGROUND: A new model of comprehensive care nurse-led clinics has enabled experienced genitourinary medicine nurses to co-ordinate the first-line, comprehensive care of female patients presenting with sexually transmitted infections and other sexual health conditions and issues. AIM: This paper describes the development of a patient satisfaction questionnaire to compare the satisfaction of women attending nurse-led or doctor-led clinics at a central London genitourinary medicine clinic. METHODS: A previously validated questionnaire was adapted using the findings of qualitative interviews exploring patient expectations of the service. The draft questionnaire was tested for internal consistency, sub-scale homogeneity, construct validity and stability. The final version consisted of a 34 item, five-point Likert scale, which was found to be both reliable (Cronbach's alpha 0.91) and stable (test-retest 0.95). There was some evidence of construct validity. The questionnaire was then distributed to a convenience sample of 132 women attending a nurse-led clinic and 150 seen at a doctor-led clinic. RESULTS: There was a 90% response rate. The median total satisfaction scores, out of a total of five, were 4.47 and 4.30 for the nurse-led and doctor-led groups, respectively (P = 0.05). Significantly higher scores on the sub-scales measuring quality and competence of technical care (P < 0.001), provision of information (P = 0.01) and overall satisfaction (P = 0.01) were seen for the nurse-led group. No significant differences were found in the sub-scales measuring service attributes and specific attributes of interpersonal relationships. CONCLUSION: The rigorous development, piloting and testing phases of this satisfaction questionnaire led to reliable and valid results. This study demonstrated that nurse-led clinics within this service are an acceptable alternative to the existing doctor-led clinics.