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Vipers run : a Skulls Creek novel
A member of the Vipers Motorcycle Club, former Army Ranger Christian Cage Owens must protect Calla Benson from the meth dealers he plans to bring to justice, which forces him to choose between loyalty to his club and the woman he's come to love.
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O21 Navigating a procaine penicillin shortage: clinical outcomes in ceftriaxone-treated neurosyphilis
IntroductionRates of syphilis, including neurosyphilis, have increased significantly over the past 20 years. Outpatient first line treatment for neurosyphilis is procaine penicillin with oral probenecid, however access to these can be limited and evidence for alternative parenteral regimens is required. A supply issue with procaine penicillin from October 2021 compromised treatment options, leading to use of once daily ceftriaxone in order to facilitate outpatient administration.MethodsRetrospective case note review of patients prescribed intravenous (IV) or intramuscular (IM) ceftriaxone for treatment of neurosyphilis between March 2021-March 2022. Anonymised data was collected from 6 sexual health clinics including demographics, symptoms, serological and CSF results, regimen of ceftriaxone and outcomes.ResultsThere were nine cases of neurosyphilis treated with ceftriaxone : 7 (78%) male, median age 49 (IQR 47-55), 1 (11%) HIV-positive, 1 (11%) previous known syphilis. All patients were symptomatic. Median RPR at diagnosis was 1:64. CSF examination was carried out in 3 (27%) patients (2 had pleocytosis and 2 had positive TPHA: 1:1280, 1:160). Median duration of treatment 14 days (range 10-14): 5/9 (56%) prescribed IV treatment, the remainder IM. Serological and clinical outcome data were available in 4 (4/4 achieved a serological response (RPR reduction of >2 dilutions)) and 8 (8/8 patients achieved a clinical response) respectively.DiscussionAmongst a small cohort of patients with neurosyphilis we have shown that ceftriaxone is being used effectively with adequate clinical and serological responses. As importing of unlicensed medicines becomes more challenging, further work is needed on the alternative treatments for neurosyphilis.
Journal Article
Timing and location of reproduction in African waterfowl: an overview of >100 years of nest records
The timing and location of reproduction are fundamental elements of reproductive success for all organisms. Understanding why animals choose to reproduce at particular times and in particular places is also important for our understanding of other aspects of organismal ecology, such as their habitat requirements, movement strategies, and biogeography. Although breeding patterns in waterfowl are relatively well documented, most studies are from northern temperate regions and the influences of location and time of year on breeding in Afrotropical ducks (Anatidae) are poorly understood. We outline six alternative (but not mutually exclusive) hypotheses that might explain where and when Afrotropical ducks choose to breed. To explore these hypotheses, we assembled and analyzed a new database of c. 22,000 breeding records for 16 Afrotropical ducks and one introduced Palearctic species (the Mallard Anas platyrhynchos). The full database is available on line as an appendix to this article. We identified five distinct breeding strategies as well as two outliers. Peak breeding for 9 of 16 indigenous duck species occurs during the dry season. We found no evidence for spatial synchrony or spatial autocorrelation in breeding, suggesting a high level of flexibility in waterfowl responses to prevailing conditions in any given year. More intensive analyses of alternative hypotheses are needed, but our initial analysis suggests that the timing of breeding for the majority of Afrotropical ducks is driven by a combination of resource availability and predation risk. Based on a new database of c. 22,000 records, African waterfowl show five basic breeding patterns across southern and Eastern Africa. Intriguingly, they do not exhibit spatial synchrony in the timing and location of breeding. Consideration of alternative hypotheses suggests a strong role for predation and juvenile resource availability as drivers of breeding timing and location choices.
Journal Article
O23 Complex pre-exposure prophylaxis MDT clinic – 6 months data review
IntroductionA complex virtual pre-exposure prophylaxis (PrEP) MDT clinic was set up to review patients with medical complexities including renal or bone impairment, side effects and intolerances. We reviewed 6 months of data.MethodA retrospective case note review was conducted of all patients referred to the complex clinic from July 2022-Feb 2023. Data collected included patient demographics, reason for referral, PrEP outcomes and discontinuation rates.Results2,521 patients received PrEP over 6 months - 618 referrals were made for 563 (22%) patients; 97% male, median age of 36 years and 75% on daily dosing.Abstract O23 Table 1Reason for referral and PrEP outcomes. Reason Referrals Outcome Renal impairmentE.g. Renal transplants, IgA nephropathy, UPCR>30, eGFR<70ml/min or significant decline in eGFR>10ml/min 527 3 discontinued PrEP: • 2 self-sourced Descovy • 1 approved for compassionate use cabotegravir (CAB) 4 referred to nephrology Bone impairment • Osteoporosis 2 2 self-sourced Descovy Co-morbidities & drug-drug interactions 10 All safely continued on PrEP Hepatitis B 3 All safely continued daily PrEP Side effects • Gastro-intestinal • Musculoskeletal • Neurological • Erectile dysfunction 6211 2 (Neurological/GI) discontinued PrEP – CAB application pending8 continuing PrEP with support Lactose intolerance 10 1 discontinued PrEP – due to no longer requiring PrEP9 continuing PrEP (8 on low lactate brands, 1 on lactase tablets) Absorption concerns 2 Therapeutic drug monitoring within range, continued with daily dosing Results review only 37 All safely continued on PrEP Other 5 All safely continued on PrEP DiscussionNearly a quarter of patients seen for PrEP required a virtual review due to medical complexities most commonly renal impairment. The clinic has been able to provide more options such as alternative generic brand formulations and CAB, acting as a safety net enabling patients to access and remain on PrEP.
Journal Article
P069 The role of a specialist HIV pre-exposure prophylaxis pharmacist
IntroductionThe efficacy of HIV Pre-Exposure Prophylaxis (PrEP) is well established, however success largely depends on reach, access and medication adherence. This review describes the expanding role of a pharmacist within a sexual and reproductive health (SRH) clinic including the benefits of improved quality of care and access to PrEP.MethodData was collected on successful service improvements implemented by a specialist HIV PrEP pharmacist.ResultsSince being in post from July 2022 the pharmacist alongside members of the MDT has led on the following service improvements:-• Implementation of a streamlined all-day nurse led clinic for routine PrEP through patient group directive sign offs and education and training. This has led to an increase in uptake of PrEP by 30%.• Establishing a weekly virtual complex PrEP MDT clinic to review medical complexities such as side effects and renal impairment. This has allowed us to provide options and nephrology referrals for patients who cannot take NHS PrEP. Over 500 patients which is over 20% of our cohort has been reviewed over a 6-month period.• Creation of an online appointment system for PrEP appointments.• Implementation of a weekly Pharmacist PrEP clinic for training new staff and reviewing complex patients (up to 5 patients/week).• Strategic planning for novel deliveries of PrEP to increase capacity and access for marginalised communities (e.g. via medication lockers and remote pathways).DiscussionPharmacists are experts in medication, adherence counselling, adverse effects and monitoring which are critical to clinically successful and safe PrEP usage. PrEP service leadership by a pharmacist skilled in HIV/SRH with an understanding of contracts and supply chain has proven to be beneficial. Together with other clinicians, pharmacists should be directly involved in driving PrEP service development to improve access, reach and lead complex MDTs.
Journal Article
P063 Implementation of a nurse-led pre-exposure prophylaxis clinic in a London sexual health clinic
IntroductionPre-exposure prophylaxis (PrEP) has been shown to be effective at preventing HIV such that it is now recognised as essential to eradicate new transmissions by 2030. We aim to describe successful implementation of a nurse-led PrEP clinic (NLC-PrEP) delivered by patient group directive (PGD).MethodRetrospective data was collected for 3 months (Aug–Nov 2022) from patients attending NLC-PrEP and compared to PrEP provision pre-implementation of NLC-PrEP. Data collected included patient demographics, PrEP provision (PGD or prescription), waiting and consultation times, PrEP coding, vaccinations, STI treatments and HIV testing.Result245 patients attended NLC-PrEP; 97% male, 74% of white ethnicity, 93% MSM with a median age of 36 years. Including those opportunistically supplied PrEP in other clinics this resulted in a 40% monthly increase in PrEP supply with a threefold increase in PrEP delivered by PGD (figure 1). Compared to the previous 3 months, during NLC-PrEP there was a 29% improvement in PrEP activity coding capture and in-clinic HIV testing decreased by 15% (where testing was performed elsewhere). 71 vaccinations and 8 STI treatments were given during NLC-PrEP. The average time to see a new patient for PrEP and a returning patient for PrEP was 54 minutes and 46 minutes respectively.Abstract P063 Figure 1DiscussionImplementation of NLC-PrEP increased patient access to PrEP with delivery through PGD. Improvements were seen in accuracy of PrEP coding and the HIV self-testing commissioner target compliance however it was still not achieved. Patients should be encouraged to take self-STI tests prior to clinic attendance. A nurse led PrEP model allowed for opportunistic vaccinations and treatment of STIs. Even with this nurse-led model PrEP demand has still not been met. Focus should be placed on ensuring equity of access for all eligible patient groups and expanding clinics as this will help meet the 2030 goal of ending HIV transmission.
Journal Article
Validity, reliability, and sensitivity-to-change properties of the psoriatic arthritis screening and evaluation questionnaire
Psoriatic arthritis (PsA) is an inflammatory arthritis associated with irreversible joint damage in a subset of individuals. There is a need to screen early for this condition to prevent damage. To meet this need, we have developed the psoriatic arthritis screening and evaluation (PASE) questionnaire. The 15-item PASE questionnaire was administered to 190 individuals with either psoriasis or PsA. The PASE questionnaire was readministered to a subset of individuals with PsA in order to assess test-retest reliability and sensitivity-to-change. Receiver operator curves were constructed to optimize sensitivity and specificity for the diagnosis of PsA. Of the 190 participating in the study, 19.5% (37/191) participants were diagnosed with PsA. PASE total scores ranged from 15 to 74 (possible range, 15-75). The PsA group had a median Total score of 51 (25th and 75th percentile 44 and 57), and non-PsA group had a median total score of 34 (25th and 75th percentile 21 and 49) (p < 0.001). A PASE total score of 44 was able to distinguish PsA from non-PsA participants with 76% sensitivity and 76% specificity. Furthermore, 13 of the 15 items demonstrated significant test-retest reliability as assessed by Pearson correlation coefficient (r >= 0.5). PASE was sensitive-to-change with therapy; PASE scores were significantly lower for PsA individuals after systemic therapy (p < 0.034). The PASE questionnaire is a valid and reliable tool to screen for active PsA among individuals with psoriasis. PASE scores may be used as a marker of therapeutic response.
Journal Article
A revision of the new genus Amiga Nakahara, Willmott & Espeland, gen. n., described for Papilio arnaca Fabricius, 1776 (Lepidoptera, Nymphalidae, Satyrinae)
We here propose a new, monotypic genus, Amiga Nakahara, Willmott & Espeland, gen. n. , to harbor a common Neotropical butterfly, described as Papilioarnaca Fabricius, 1776, and hitherto placed in the genus Chloreuptychia Forster, 1964. Recent and ongoing molecular phylogenetic research has shown Chloreuptychia to be polyphyletic, with C.arnaca proving to be unrelated to remaining species and not readily placed in any other described genus. Amigaarnaca gen. n. et comb. n. as treated here is a widely distributed and very common species ranging from southern Mexico to southern Brazil. A neotype is designated for the names Papilioarnaca and its junior synonym, Papilioebusa Cramer, 1780, resulting in the treatment of the latter name as a junior objective synonym of the former. A lectotype is designated for Euptychiasericeella Bates, 1865, which is treated as a subspecies, Amigaarnacasericeella (Bates, 1865), comb. n. et stat. n. , based on molecular and morphological evidence. We also describe two new taxa, Amigaarnacaadela Nakahara & Espeland, ssp. n. and Amigaarnacaindianacristoi Nakahara & Marín, ssp. n. , new subspecies from the western Andes and eastern Central America, and northern Venezuela, respectively.
Journal Article
A revision of the new genus Amiga Nakahara, Willmott amp; Espeland, gen. n., described for Papilio arnaca Fabricius, 1776 (Lepidoptera, Nymphalidae, Satyrinae)
We here propose a new, monotypic genus, Amiga Nakahara, Willmott & Espeland, gen. n., to harbor a common Neotropical butterfly, described as Papilio arnaca Fabricius, 1776, and hitherto placed in the genus Chloreuptychia Forster, 1964. Recent and ongoing molecular phylogenetic research has shown Chloreuptychia to be polyphyletic, with C. arnaca proving to be unrelated to remaining species and not readily placed in any other described genus. Amiga arnaca gen. n. et comb. n. as treated here is a widely distributed and very common species ranging from southern Mexico to southern Brazil. A neotype is designated for the names Papilio arnaca and its junior synonym, Papilio ebusa Cramer, 1780, resulting in the treatment of the latter name as a junior objective synonym of the former. A lectotype is designated for Euptychia sericeella Bates, 1865, which is treated as a subspecies, Amiga arnaca sericeella (Bates, 1865), comb. n. et stat. n., based on molecular and morphological evidence. We also describe two new taxa, Amiga arnaca adela Nakahara & Espeland, ssp. n. and Amiga arnaca indianacristoi Nakahara & Marín, ssp. n., new subspecies from the western Andes and eastern Central America, and northern Venezuela, respectively.
Journal Article