Rapid Start Research Articles

Real-world clinical and economic outcomes from rapid start antiretroviral therapy in HIV: systematic review and meta-analysis.

We aimed to synthesize clinical and economic outcomes of rapid start versus non-rapid antiretroviral therapy (ART) in people with HIV (PWH) in real-world settings. A search was conducted in PubMed, Embase, Web of Science, and ProQuest from January 2017 to January 2023, supplementing a previous search by Ford et.al, 2018. Observational studies investigating clinical or economic outcomes of rapid start ART versus non-rapid ART in PWH were included. Clinical outcomes were mortality, loss-to-follow-up (LTFU), and viral suppression. Economic outcomes were Incremental cost-effectiveness ratio (ICER) values and per patient per month (PPPM) costs. Meta-analyses using random-effects models were performed for clinical outcomes, while qualitative syntheses were conducted for economic outcomes. The quality of clinical and economic studies was assessed. Sixty-two studies were included. The pooled adjusted risk ratio (aRR) for mortality demonstrated a significant reduction in risk of mortality among participants who received rapid start ART compared to non-rapid ART (0.80, 95%CI, 0.65-0.98). For LTFU at 6 and 12 months, the pooled aRR showed increased LTFU for rapid start ART (1.33, 95%CI, 1.15-1.55 and 1.18, 95%CI, 0.74-1.89 respectively). All cost-effectiveness studies reported cost-saving or cost-effective findings. The PPPM costs of rapid start ART across the first 36 months of treatment were consistently lower than non-rapid ART. Rapid ART is associated with reduced mortality and is cost-effective compared to non-rapid ART in real-world settings. Clinicians and policymakers should consider these findings to facilitate rapid start of ART in PWH. Further research on LTFU in PWH is needed.

Magnetic Induction Heating-Driven Rapid Cold Start of Ammonia Decomposition for Hydrogen Production.

The advantages of ammonia as a hydrogen carrier have led to proposals for on-site hydrogen production through its decomposition. Rapid cold start of ammonia decomposition is crucial for applications such as ammonia-powered vehicles, but conventional heating methods are challenged by the high decomposition temperature of ammonia. In this study, we successfully achieved the rapid cold start of ammonia decomposition using Co nanoparticle catalysts driven by magnetic induction heating, demonstrating excellent catalytic performance and stability. The magnetic induction heating-driven ammonia decomposition system was integrated with a hydrogen fuel cell, proving its ability to achieve the cold start of ammonia decomposition within 10 s, as demonstrated by comparative experiments using 75% H2-25% N2 from a gas cylinder as the control. This study provides a deeper understanding of hysteresis heating catalysis, promoting the practical use of ammonia as a hydrogen carrier for rapid hydrogen production in the energy industry.

A cache-aware congestion control mechanism using deep reinforcement learning for wireless sensor networks

In Wireless Sensor Networks (WSN) communication protocols, rule-based approaches have been traditionally used for managing caching and congestion control. These approaches rely on explicitly defined, unchanging models. Recently, a trend has been toward incorporating adaptive methods that leverage machine learning (ML), including its subset deep learning (DL), during network congestion conditions. However, an adaptive cache-aware congestion control mechanism using Deep Reinforcement Learning (DRL) in WSN has not yet been explored. Therefore, this study developed a DRL-based adaptive cache-aware congestion control mechanism called DRL-CaCC to alleviate WSN during congestion scenarios. The DRL-CaCC uses intermediate caching parameters as its state space and adaptively moves the congestion window as its action space through the Rapid Start and DRL algorithms. The mechanism aims to find the optimal congestion window movement to avoid further network congestion while ensuring maximum cache utilization. Results show that DRL-CaCC achieved an average improvement gain between 20% and 40% compared to its baseline protocol, RT-CaCC. Finally, DRL-CaCC outperformed other caching-based and DRL-based congestion control protocols in terms of cache utilization, throughput, end-to-end delay, and packet loss metrics, with improvement gains between 10% and 30% in various congestion scenarios in WSN.

Barriers to HIV rapid start among New Jersey providers

Background Rapid Start ensures that persons with HIV initiate antiretroviral therapy in less than seven days after diagnosis. Benefits of Rapid Start include timely linkage to medical care, viral suppression in a shorter time and improved retention to medical care. Despite these benefits, there is a slow uptake of Rapid Start, in New Jersey. Objective Identify barriers to Rapid Start among New Jersey providers. Methods An electronic survey, consisting of 28 questions, with the following domains was administered to New Jersey providers, using Qualtrics: provider and practice characteristics (10), knowledge (1), barriers (8) and attitudes to diverse patient types (9). The results were analyzed using descriptive statistics due to small numbers over strata. Approval to conduct the survey was obtained from the William Paterson University Institutional Review Board. Results There were 69 responses to the survey. Providers were at least 45 years old (48%), female (44/60, 73%), nurse practitioners or physician assistants (41/59, 69%). Overall, 44/63 (70%) providers did not correctly identify that integrase inhibitors had the lowest prevalence of transmitted drug resistance. Newly diagnosed patients were referred for medical care in 37 (65%) of the medical sites. Only providers from Ryan White (federally funded clinics for persons with HIV) (64%) and non-Ryan White (73%) public sites reported co-located HIV testing sites. Seventy percent of medical sites offered same-day medical appointments. However, a lower proportion of private (62%), public Ryan White (55%), and other medical sites (36%) offered same-day appointments compared to public non-Ryan White sites (82%). Despite having staff available 40 h per week (91%), only 55% of Ryan White sites offered extended office hours in the early morning, evenings, or on Saturdays. When compared to providers in public non-Ryan White sites, a lower proportion of providers in Ryan White sites were comfortable doing Rapid Start either on the day of or within one week of diagnosis, 82% and 72%, respectively, or starting antiretroviral therapy before genotype results were available, 55% and 46%, respectively. Overall, providers were not comfortable with Rapid Start for persons engaging in condomless sex (60%). Conclusions Policy and administrative decisions are needed to eliminate barriers at the clinic level. An HIV clinical scholar program, to increase providers knowledge, may increase uptake of Rapid Start.

Real world community-based HIV Rapid Start Antiretroviral with B/F/TAF versus prior models of antiretroviral therapy start – the RoCHaCHa study, a pilot study

BackgroundThe rapid start of antiretroviral therapy (RSA) model initiates antiretroviral therapy (ART) as soon as possible after a new or preliminary diagnosis of HIV, in advance of HIV-1 RNA and other baseline laboratory testing. This observational study aims to determine if RSA with a single tablet regimen of bictegravir, emtricitabine, and tenofovir alafenamide (B/F/TAF) is an effective regimen for achieving viral suppression and accepted by patients at the time of diagnosis.MethodsAdults newly or preliminarily diagnosed with HIV were enrolled from October 2018 through September 2021. Real world advantage, measured in days between clinical milestones and time to virologic suppression, associated with B/F/TAF RSA was compared to historical controls.ResultsAll Study RSA participants (n = 45) accepted treatment at their first visit and 43(95.6%) achieved virologic suppression by week 48. Study RSA participants had a significantly shorter time (median 32 days) from diagnosis to ART initiation and virologic suppression, in comparison to historical controls (median 181 days) (n = 42). Qualitative feedback from study RSA participants showed high acceptance positive response to RSA.ConclusionsRSA is feasible and well accepted by patients in a real-world community-based clinic setting. Promoting RSA in community-based clinics is an important tool in ending the HIV epidemic.

Numerical simulation of comprehensive performance of proton exchange membrane electrolytic cell with microporous layer

Proton exchange membrane electrolytic cell (PEMEC) is considered a promising way to produce green hydrogen due to its advantages of high current density, rapid start and stop, and high purity of hydrogen production. However, the existing macroscopic modeling of the PEMEC lacks the consideration of MPLs and the comprehensive study of heat and mass transport. In this paper, a one-dimensional two-phase non-isothermal PEMEC model with microporous layers is established, which accounts for a complete description of mass, charge, and heat transport. The polarization curves of numerical simulation are in good agreement with the experimental data. Then, the model is used to parametric analyze the effects of operating conditions and component parameters on heat and mass transfer, voltage loss, and efficiency for the PEMEC. The results show that operating pressure has a significant influence on the electrolytic performance. Voltage loss reduced of 30.75 mV and maximum temperature of 1.74 K occur when operating pressure increases from 1atm to 3atm, respectively. The characteristics of PTL and MPL mainly affect mass transport, and when PTL thickness and MPL thickness reduce by 100 μm and 20 μm respectively, the oxygen molar fraction reduces by 4.96% and 0.94%, respectively. The application of higher porosity, permeability, and thinner PTL with a thinner microporous layer (MPL) can effectually improve the operation efficiency of PEMEC. The model results presented in this study provide a theoretical basis for the optimization and design of the PEMEC.

The use of oral nomegestrol acetate/estradiol in rapid and random start preparation of endometrium before office hysteroscopic polypectomies: A multicenter, prospective, randomized controlled trial

ObjectiveTo evaluate the use of oral nomegestrol acetate/estradiol in random start rapid preparation of endometrium before office hysteroscopic polypectomy. Study designMulticenter, prospective, randomized controlled trial. SettingUniversity hospitals. Participants80 adult women undergoing office hysteroscopic polypectomy between January 2023 and March 2024 were randomized to intervention (n = 40) or control (n = 40). Exclusion criteria included the presence of endouterine pathology other than endometrial polyps solely. MethodsSubjects in the intervention group were treated with oral nomegestrol acetate/estradiol 1.5 mg/2.5 mg/day started taking the drug from an indefinite time in the menstrual cycle (random start) for 14 days. Subjects in the control group did not receive any pharmaceutical treatment and underwent polypectomy between days 8 and 11 of the menstrual cycle. ResultsOn the day of the procedure, the difference in pre- and post-office hysteroscopic polypectomy endometrial ultrasound thickness was statistically significant between the two groups, with endometrial thickness in both measurements being thinner for the intervention group (p < 0.001). In the nomegestrol acetate/estradiol-treated group, compared with the control, there was also a statistically significant difference in the physician’s assessment of the quality of endometrial preparation (p < 0.001), the quality of visualization of the uterine cavity (p < 0.001), and satisfaction with the performance of the procedure (p < 0.001). Finally, all surgical outcomes analyzed were better in the treatment group. ConclusionTreatment with nomegestrol acetate/estradiol could provide rapid, satisfactory and low-cost preparation of the endometrium before office polypectomy, thus improving surgical performance and woman’s compliance. Trial registrationClinicalTrials.gov NCT06316219.

Knowledge and Preparedness of Physicians in Relation to Anaphylaxis at Primary Healthcare Centers in Al-Qassim, Saudi Arabia.

Background Anaphylaxis is a significant, often fatal, systemic allergic reaction with a rapid start that may affect the respiratory and/or circulatory systems; for patients to survive, emergency management must be done properly. When anaphylaxis is confirmed or highly suspected, epinephrine should be injected intramuscularly. This study aimed to assess the preparedness of primary healthcare physicians for anaphylaxis in terms of recognition and management of this condition in Al-Qassim, Saudi Arabia. Methods This cross-sectional study was carried out among primary healthcare physicians in the Qassim region of Saudi Arabia. A self-administered questionnaire was distributed among the targeted physicians. The questionnaire comprised sociodemographic characteristics, general awareness and management of anaphylaxis, and a 10-item questionnaire to assess physicians' knowledge of anaphylaxis. Results Out of 121 primary healthcare physicians, 61.2% were male, and 47.9% were aged between 25 and 35 years. Nearly all physicians (97.5%) believed that anaphylaxis is a life-threatening situation. The overall mean knowledge score was 4.74 out of 10 points. Nearly half (48.8%) were categorized as having poor knowledge levels, 43% as moderate, and only 8.3% as having good knowledge. Being specialists/consultants and being trained in managing anaphylaxis were the factors associated with increased knowledge. Conclusion The knowledge of primary care physicians regarding anaphylaxis was deficient. However, increased knowledge of anaphylaxis was seen more frequently among consultants or specialists who attended training for managing anaphylaxis cases. A multi-center study involving a bigger sample size is needed to establish physicians' knowledge of anaphylaxis.

Epidural administration of ropivacaine and midazolam is superior to intra-articular administration as postoperative analgesia after isolated arthroscopic anterior cruciate ligament reconstruction with hamstrings autograft: a randomized controlled clinical trial

ObjectiveReconstructive surgery of the anterior cruciate ligament (ACL) is quite common, previous studies have documented that adequate pain control in the early phases of the postoperative period translates into early mobility and a rapid start of rehabilitation. Therefore, the search for new strategies for postoperative pain control is justified. The aim of this study was to compare intra-articular to the epidural administration of ropivacaine and midazolam as postoperative analgesia after arthroscopic ACL reconstruction with hamstring autograft (HA). Material and methodsDouble-blinded, prospective randomized clinical trial included 108 consecutive patients aged from 18 to 50 years that had undergone arthroscopic ACL reconstruction with HA. The patients were randomly assigned to 2 groups. The first group received intraarticular ropivacaine and midazolam. The second group received epidural ropivacaine and midazolam. The need for rescue analgesia, the postoperative pain experienced, side effects and complications of the analgesic drugs were evaluated. ResultsThe intra-articular group received statistically significantly higher mean doses of rescue analgesia on the first two days (2.8 ​± ​1.0 vs. 1.3 ​± ​0.6 in the epidural group; p ​= ​0.001). Visual Analogue Scale scores at flexion were statistically significantly higher in the intra-articular group over the entire study period. The intra-articular group also reported a statistically significantly lower range-of-motion 87 ​± ​15 vs. 102 ​± ​11 in the epidural group (p ​= ​0.001). ConclusionsEpidural administration of ropivacaine combined with midazolam in patients undergoing primary ACL reconstruction with HA was clinically and significantly better relative to rescue analgesia and the intensity of pain in the first 48 postoperative hours when compared to intraarticular administration. There was no difference in terms of adverse effects and complications. Level of evidence2.

Renal outcome in multiple myeloma patients with cast nephropathy: a retrospective analysis of potential predictive values on clinical and renal outcome

ABSTRACT Objective Cast nephropathy (CN) is the leading cause of acute kidney injury (AKI) in multiple myeloma (MM). Since it is sparsely documented why some patients with CN do achieve a renal response while others do not, we describe a single-center cohort of patients with multiple myeloma and biopsy-confirmed CN to evaluate potential markers of renal response. Methods The data was collected as a retrospective, single-center analysis of CN-patients treated at the Medical University Vienna between 01/01/2004 and 01/01/2022. Baseline parameters and clinical outcome was compared between renal responders and non-responders. Results Among 28 patients with CN, n = 23 were assessed for renal response (14 responders; 9 non-responders). Renal responders were younger (median age: 61 years; 77 years, p = 0.039), showed higher overall survival (153months; 58months, p = 0.044) and achieved hematologic response (≥PR) to first-line therapy (p = 0.029), and complete hematologic response (CR) at any time (p = 0.025) significantly more often. Further, we could show that rapid initiation of anti-myeloma therapy after initial presentation correlated significantly with renal response (median 9 days; 27 days, p = 0.016). Analyses of kidney biopsy specimens revealed that patients with a high IF/TA score showed end stage renal disease (dialysis ≥ 3 months) significantly more often (p = <0.001). Discussion In summary, our data suggests, that a rapid start with systemic hematologic treatment in patients with MM and CN is crucial and achieving an early hematologic response is important for renal recovery. Moreover, achieving a deep hematologic response and subsequent renal recovery improves clinical outcome as reflected by an overall survival benefit.

Rapid Start of Antiretroviral Therapy in a Large Urban Clinic in the US South: Impact on HIV Care Continuum Outcomes and Medication Adherence.

Rapid start of antiretroviral therapy (ART) has been associated with improvement in several HIV-related outcomes in clinical trials as well as demonstration projects, but how regional and contextual differences may affect the effectiveness of this intervention necessitates further study. In this study of a large, urban, Southern US clinic-based retrospective cohort, we identified 544 patients with a new diagnosis of HIV during 2016 to 2019 and compared HIV care continuum outcomes for the first 12 months of care before and after rapid start implementation. Kaplan-Meier time-to-event curves were used to summarize time to virologic suppression, and stepwise Cox, linear, and logistic regression models were used to create multivariate models to evaluate the association between rapid start and time to virologic suppression, medication adherence, and retention in care and sustained virologic suppression, respectively. We found that rapid start was significantly associated with improved medication adherence scores (+15.37 points, 95% confidence interval [CI] 9.36-21.39, P < .01) and retention in care (adjusted odds ratio = 1.51, 95% CI 1.05-2.19, P = .03). Time to virologic suppression (median 2.46 months before, 2.56 months after rapid start) and sustained virologic suppression were not associated with rapid start in our setting. Though rapid start was associated with improved medication adherence and retention in care, more support may be needed to achieve the same outcomes seen in other studies and sustained over the entire HIV care continuum, especially in settings with significant patient and systemic barriers to care such as unstable housing, lack of Medicaid expansion, and frequent coverage interruptions.

Leber hereditary optic neuropathy. The Dutch approach

Aims/Purpose: To share the structure of care for patients with Leber Hereditary Optic neuropathy (LHON) in the Netherlands. This includes the role of Expertise centers in coordinating rapid diagnosis and start of treatment, as well at the introduction of a specific database to track data of patients with LHON.Methods: Dutch LHON Expertise centres are organized to act as central points for patient referrals from regional hospitals with the aim to speed up the diagnostics and treatment of LHON patients. The database of Dutch LHON patients has been created and is online today, to provide demographical, epidemiological, clinical characteristics and effects of treatment with Idebenone on disease progression.Results: Three LHON Expertise centers provide fast diagnostic, coaching and treatment services in the whole of the Netherlands. Patient referral is done easily due to the small geography. A DNA test on primary and non‐primary mtDNA mutations is performed as standard, including the DNAJC30 gen. Additional parameters are obtained to monitor disease progression: Visual Acuity Score by ETDRS letters chart, HRR colour tests, OCT of ganglion cell layer and retinal neurofibral layer, Visual field by Goldmann kinetic perimetry or Humphry static perimetry. All patients have access to a social worker. They are provided with a flyer about LHON disease and contact details of the relevant patient association.Conclusion: A thoroughly organized clinical path for LHON patients provides rapid diagnostics and start of treatment. Patients referrals is done easily and treatment delay minimized. The centralization of Dutch LHON patients in three expertise centres enables us to maintain a central database with important clinical and epidemiological data. This information is relevant to optimize current therapy options with Idebenone and also for supporting future studies on novel therapy options.

High rates of deferring antiretroviral treatment for patients with HIV and substance use disorders: Results from a national sample of HIV physicians in Ukraine.

HIV incidence and mortality are increasing in Ukraine despite their reductions globally, in part due to suboptimal antiretroviral therapy (ART) coverage in key populations of people with HIV (PWH) where the epidemic is concentrated. As physicians are gatekeepers to ART prescription, stigma and discrimination barriers are understudied as a key to meeting HIV treatment targets in key populations. A national sample (N = 204) of ART-prescribing physicians in Ukraine were surveyed between August and November 2019. Participants underwent a series of randomized, hypothetical HIV clinical scenarios and decided whether to initiate or defer (or withhold) ART. Scenarios varied based on 5 distinct CD4 counts (CD4: 17, 176, 305, 470, or 520 cells/mL) and 10 different PWH key populations. Z scores and McNemar's test for paired samples were used to assess differences between key populations and CD4 count. Feeling thermometers were used to assess stigma-related measures toward key populations among physicians. Physicians were highly experienced (mean = 19 years) HIV treaters, female (80.4%), and trained in infectious diseases (76.5%). Patients who drink alcohol (range: 21.6%-23.5%) or use (PWUD range: 16.7%-20.1%) or inject (PWID range: 15.5%-20.1%) drugs were most likely to have ART deferred, even at AIDS-defining CD4 counts. PWID maintained on methadone, however, were significantly (p<0.001) less likely to have ART deferred compared with those who were not (range: 7.8%-12.7%) on methadone. Men who have sex with men (range: 5.4%-10.8%), transgender women (range: 4.9%-11.3%), sex workers (range: 3.9%-10.3%),and having an HIV-uninfected sex partner (range: 3.9%-9.3%) had the lowest likelihood of ART deferral. Increasing levels of stigma (i.e., feeling thermometers) towards a key population was correlated with ART deferral (i.e., discrimination). Despite international and Ukrainian guidelines recommending ART prescription for all PWH, irrespective of risk or CD4 count, ART deferral by experienced HIV experts remains high in certain key populations, especially in PWH and substance use disorders. Strategies that initiate ART immediately after diagnosis (i.e., rapid start antiretroviral therapy), independent of risk group, should be prioritized to truly mitigate the current epidemic.

Rapid ART initiation with bictegravir/emtricitabine/tenofovir alafenamide in individuals presenting with advanced HIV disease (Rainbow study)

BackgroundA rapid ART initiation approach can be beneficial in people with advanced HIV disease, in consideration of their high morbidity and mortality. The aim of our study was to evaluate the feasibility, efficacy and safety of rapid ART start with BIC/FTC/TAF in this setting. MethodsPilot, single-centre, single-arm, prospective, phase IV clinical trial conducted in a tertiary Italian hospital. Thirty ART-naïve people presenting with advanced HIV-1 diagnosis (defined as the presence of an AIDS-defining event and/or CD4 cell count <200 µL), were enrolled. Main exclusion criteria were active tuberculosis, cryptococcosis and pregnant/breastfeeding women. BIC/FTC/TAF was started within 7 days from HIV diagnosis. The primary endpoint was clinical or virologic failure (VF). Immunological parameters, safety, feasibility, neurocognitive performances and patient-reported outcomes were assessed as well. ResultsOver the study period, 40 (34%) of 116 patients diagnosed with HIV infection at INMI Spallanzani had advanced disease, of whom 30 (26%) were enrolled. The proportion of participants with HIV-RNA <50 cp/mL was 9/30 (30%) at week (w) 4, 19/30 (63%) at w12, 24/30 (80%) at w24, 23/30 (77%) at w36 and 27/30 (90%) at w48. Two unconfirmed VF occurred. No ART discontinuation due to toxicity or VF was observed. No ART modification was performed based on the review of genotype and no mutations for the study drugs were detected. Mean CD4 cells count changed by 133 cells/μL at BL to 309 cells/μL at w 48 and 83% of participants had a CD4 > 200 cells/µL at w 48. Two participants developed IRIS and one was diagnosed with disseminated TB and needed an ART switch. InterpretationsOur results support the feasibility, efficacy and safety of BIC/FTC/TAF as a rapid ART strategy in patients with advanced HIV disease.

Modelling, validation and analysis of preheating strategy of fuel cell vehicle during Subzero cold start

The rapid cold start capability of fuel cell vehicles in low-temperature environments is one of the key factors restricting their commercialization. Reasonable and effective strategies are crucial to improving the low-temperature cold start capability of fuel cell vehicles. In this paper, a cold start model of fuel cell system is established, and the model is verified based on the cold start experiment of a hybrid fuel cell vehicle. The necessity of the coolant preheating strategy in the cold start is analyzed, and the important role of the coolant preheating strategy in helping the fuel cell system to start quickly at -10°C and below is demonstrated. Furthermore, the effects of air inlet temperature, air inlet flow rate, and external heater power on the cold start performance are investigated. The results show that when the air inlet temperature rises from -13°C to 65°C, the start time is shortened from 279 s to 234 s (reduced by 16.13 %). And at low air inlet temperatures, the lower flow rate of air can significantly reduce the temperature difference and maintain uniformity of temperature inside the stack, while at a higher temperature, the higher air flow rate causes the temperature of the cell stack to rise rapidly. For heating power, the start time is shortened from 421 s to 126 s (reduced by 70.07 %) when the heating power is increased from 3 kW to 11 kW. However, it will cause a larger temperature difference between the inlet and outlet of the coolant, which is not conducive to the uniform distribution of the temperature inside the stack. Thus, the start time can be shortened by increasing the air inlet temperature, air inlet flow rate, and heating power with the consideration of the temperature difference that the stack can withstand. The model developed by this study provides an effective way to analyze the fuel cell system during cold start, which is useful for the development of control strategies in the future.

Perceptions of Rapid Antiretroviral Therapy Initiation Among Participants of The Netherlands Cohort Study on Acute HIV Infection.

Starting antiretroviral therapy (ART) same-day, or as soon as possible after HIV diagnosis is advised in guidelines worldwide. Especially during acute HIV infection (AHI), rapid ART start may be more urgent because of a higher risk of transmission or symptoms of acute retroviral syndrome. During this phase, rapid ART start may have additional benefits for viral reservoir size and host immunity. We explored perceptions of rapid ART start among participants of The Netherlands Cohort Study on Acute HIV infection (NOVA study), who started ART rapidly after diagnosis of AHI. We conducted 20 in-depth qualitative interviews with NOVA study participants between October and December 2018. Data were analyzed thematically, using inductive and iterative coding techniques. Roughly half of the participants stated they felt well-informed about the importance of (rapid) ART. Starting ART rapidly was perceived positively by almost all participants, mostly because of the expected benefits on their health, and to prevent HIV transmission. Rapid ART start was seen as a way to cope with the diagnosis. However, a more negative perception was that rapid ART start confronted participants with their diagnosis, when they were still adjusting to a new situation. Our results show that among people diagnosed during AHI, rapid ART is well-accepted. These results should be encouraging to HIV care providers who encounter people with AHI in their clinical practice and to researchers who carry out cure-related studies, in which early ART is often included. The Clinical Trial Registration number is NCT05728996.

Pentadecapeptide BPC 157 as Therapy for Inferior Caval Vein Embolization: Recovery of Sodium Laurate-Post-Embolization Syndrome in Rats.

After inferior caval vein embolization therapy, post-embolization syndrome (sodium laurate 10 mg/kg, 0.1 mL into rat inferior caval vein, assessment at 15, 30, 60 min, prime lung lesions, thromboemboli occluding lung vessels), as a severe occlusion/occlusion-like syndrome, might be resolved as a whole by stable gastric pentadecapeptide BPC 157 therapy. At 5 min after laurate injection, stable gastric pentadecapeptide BPC 157 was implemented as therapy (10 µg/kg, 10 ng/kg intraperitoneally or intragastrically). As before, confronted with the occlusion of major vessel(s) or similar noxious procedures, such as rapidly acting Virchow triad circumstances, the particular effect of the therapy (i.e., collateral pathways activation, "bypassing vascular key", i.e., direct blood flow delivery via activation of azygos vein) assisted in the recovery of the vessel/s and counteracted multiorgan failure due to occlusion/occlusion-like syndrome as a whole in the laurate-injected rats. Along with prime lung lesions and thromboemboli occluding lung vessels, post-embolization syndrome rapidly occurred peripherally and centrally as a shared multiorgan and vessel failure, brain, heart, lung, liver, kidney, and gastrointestinal tract lesions, venous hypertension (intracranial (superior sagittal sinus), portal, and caval), aortal hypotension, progressing thrombosis in veins and arteries and stasis, congested and/or failed major veins, and severe ECG disturbances. Whatever the cause, these were all counteracted, eliminated, or attenuated by the application of BPC 157 therapy. As recovery with BPC 157 therapy commonly and rapidly occurred, reversing the collapsed azygos vein to the rescuing collateral pathway might initiate rapid direct blood delivery and start blood flow reorganization. In conclusion, we suggest BPC 157 therapy to resolve further vascular and embolization injuries.

ANALYSIS OF THE FACTORS AFFECTING THE SELECTION OF THE SITE-LOCATION FOR HEALTH FREE ZONE IN TURKIYE

Purpose- The purpose of this study is to investigate and analyze the factors affecting the location selection for Health Free Zone in Turkey if established. Since 1980’s various transformations are experienced in health sector worldwide with the effects of global neo-liberal policies. New products, new methods, and new markets are emerged. Health tourism and Health Free Zones (SASEB) are at the forefront of these developments. First, the health tourism entered the world agenda in 1990s, and since the 2000s, Health Free Zones have followed this trend. The Health Free Zone project attracts the attention of many countries that want to get a big share from the global health tourism market, to attract foreign direct investments (FDI), to benefit from technology transfer, to increase health quality and standards, to exchange information and experience, and to attract specialist physicians and health personnel. United Arab Emirates was the first country in the world to realize this project in 2002, and in the following years, China, South Korea, Indonesia and Nigeria started the implementation steps, and countries such as Turkey and India could not continue despite their rapid start. Although the Health Free Zone project, which came to the fore in Turkey in 2010, aroused great excitement in the whole country, the project could not be realized. With the change of the minister and senior bureaucrats of the period, the interest of the government in SASEB project decreased. Although attempts have been made by the private sector in various provinces, no results have been achieved until today. Methodology- In this study, an answer has been sought to the question of what are the factors that affect the selection of the location for SASEB. The study was conducted with a sample group consisting of those working in the health sector or related fields in Turkey. A total of 518 persons have participated in the study, in which a 5-point Likert scale and quantitative method was used. Parametric analyses were carried out with the data obtained from the remaining 491 individuals, after subtracting 27 units from the data, which hindered the normal distribution of the data. Frequency charts of demographic data belonging to the sample group were drawn by using SPSS v.23, and the obtained data were also subjected to t-test and ANOVA analysis. Findings- The analysis reveals that the majority of the sample group confirmed that Istanbul (89,6%), Izmir (88,4%), Antalya (87,3%) and Ankara (83,9%) were the most appropriate provinces for the SASEB project. The strategic situation of the location has a significant impact on the decision processes (92,3%), followed by other factors such as the availability of transportation facilities (91,7%) and the availability of airport facilty in the region (90,1%). Conclusion- Based upon the analyisis, it has been revealed that Istanbul is the most appropriate city for SASEB project, due to its sea, airport, road accessibility and other infrastructure possibilities, followed by İzmir. Keywords: Health free zone, sağlık serbest bölgesi, medical tourism, SASEB, health tourism JEL Codes: I11, N22, M21

Sentinel Node Biopsy in Patients With Breast Carcinoma Without Axillary Involvement at Diagnosis Receiving Primary Systemic Therapy

BackgroundPrimary systemic therapy (PST) has acquired great importance in breast cancer (BC) in the last few years. In this scenario, even if it is accepted to perform SLNB before PST, most of the guidelines remark the advantages of this practice after it, such as avoiding another surgery to the patient, a rapid start of the treatment and no need of axillary dissection in cases of pathologic complete response (pCR). Nevertheless, the lack of knowledge of the initial axillary state and the need to practice axillary dissection with any axillary disease are claimed to be some other disadvantages. There are no randomized studies yet that can conclude the optimal timing of SLNB in PST, so for the moment we may settle for our common practice. Patients and MethodsWe studied all the cases attended in the Breast Unit that joined the inclusion criteria between 2011 and 2019 in our hospital and we compared the group with SLNB before PST with the group with SLNB after PST in terms of unnecessary axillary dissection and description features. ResultsWe included 223 female patients diagnosed with BC and without clinical nor radiological axillary disease (cN0), who had received NAC and SLNB performed before or after it. We observed a higher proportion of high-grade histological tumors (G3), tumors with aggressive phenotypes (Basal like and Her 2 enriched), and younger women in the group of SLNB before NAC compared with the SLNB after NAC group (P < .01). Despite this, we did not find any difference in the number of positive SLNBs or in the number of ALND performed between the 2 groups. We found a higher proportion of ALND with all the lymph node (LN) negatives in the SLNB before NAC group. ConclusionTaking into account that in the observation period we did not use ACOSOG Z0011 criteria with all the SLNBs, we figure out what would have been the real results nowadays following these criteria. In this scenario we conclude that patients with luminal phenotype seemed to benefit from practicing SLNB before NAC in terms of avoiding axillary dissections. We could not make any conclusion in the rest of the phenotypes. However, prospective studies are needed to confirm if this affirmation could be proved.

Rapid start antiretroviral therapies for improved engagement in HIV care: implementation science evaluation protocol

BackgroundIn 2020, the Health Resources and Services Administration’s HIV/AIDS Bureau funded an initiative to promote implementation of rapid antiretroviral therapy initiation in 14 HIV treatment settings across the U.S. The goal of this initiative is to accelerate uptake of this evidence-based strategy and provide an implementation blueprint for other HIV care settings to reduce the time from HIV diagnosis to entry into care, for re-engagement in care for those out of care, initiation of treatment, and viral suppression. As part of the effort, an evaluation and technical assistance provider (ETAP) was funded to study implementation of the model in the 14 implementation sites.MethodThe ETAP has used implementation science methods framed by the Dynamic Capabilities Model integrated with the Conceptual Model of Implementation Research to develop a Hybrid Type II, multi-site mixed-methods evaluation, described in this paper. The results of the evaluation will describe strategies associated with uptake, implementation outcomes, and HIV-related health outcomes for patients.DiscussionThis approach will allow us to understand in detail the processes that sites to implement and integrate rapid initiation of antiretroviral therapy as standard of care as a means of achieving equity in HIV care.