No abstract

These data strongly support the use of formal screening and drug service referral pathways at the time of admission to hospital to engage HIV-positive drug users.

While azithromycin is the most used treatment, microbiological treatment failure in rectal CT is common and its drivers remain unclear. Methods This study is part of a prospective multicentre cohort study (FemCure). Current analyses included 112 women clinically-diagnosed (by nucleic acid amplification test [NAAT]) with rectal and vaginal CT, who not vomited and denied rectal and vaginal unprotected sex. Four weeks after azithromycin treatment (1g single dose) participants self-collected vaginal and rectal samples. Samples were tested for CT-DNA (NAAT) and viable CT-load (viability polymerase chain reaction [V-PCR]). We evaluated two endpoints: (1) failure by NAAT-positivity and (2) failure by V-PCR-positivity. Enrolment-risk-factors associated with failure were assessed using multivariable logistic regression; i.e., age, education, migratory-background, previous CT, NAAT Cq-value [marker CT-DNA load], culture, viable CT [V-PCR positive], viable load [log 10 copies/ml], vaginal CT.Results (1) Failure by NAAT (21.4%; 24/112) was independently associated with both rectal and vaginal NAAT Cq-values; both aOR: 0.8 per unit decrease in the NAAT Cq-value (95% CI:0.7-0.9, p<0.01). Of the 49 women with a rectal or vaginal Cq-value !36 at clinic-diagnosis (43.8% of patients), 8.1% had rectal failure, compared to 31.7% when having Cq values <=36 (p<0.01). (2) Failure by V-PCR (16.1%;18/112) was independently associated with the rectal viable load; aOR: 1.7 per log 10 copies/ml increase (95%CI:1.3-2.3). Of the 47 (42.0%) women without a viable rectal CT at diagnosis, 4.3% had failure, compared to 24.6% when having viable rectal CT at diagnosis (p<0.01). Vaginal failure by NAAT was 7.1% (8/ 112); failure by V-PCR was 2.7% (3/112). Conclusion In an outpatient clinical setting, azithromycin rectal CT microbiological treatment failure was common and associated with higher pre-treatment (viable) loads. The lower azithromycin treatment failure in patients with NAAT Cqvalues!36 or non-viable rectal CT might result in different treatment choices. Disclosure No significant relationships.

Bipolar disorder (BD) is a mood disorder involving recurring (hypo)manic and depressive episodes. The inherently temporal nature of BD has inspired its conceptualization using dynamical systems theory, which is a mathematical framework for understanding systems that evolve over time. In this paper, we provide a critical review of the dynamical systems models of BD. Owing to the heterogeneity of methodological and experimental designs in computational modeling, we designed a structured approach that parallels the appraisal of animal models by their face, predictive, and construct validity. This tool, the validity appraisal guide for computational models (VAG-CM), is not an absolute measure of validity, but rather a guide for a more objective appraisal of models in this review. We identified 26 studies published before November 18, 2021 that proposed generative dynamical systems models of time-varying signals in BD. Two raters independently applied the VAG-CM to the included studies, obtaining a mean Cohen’s κ of 0.55 (95% CI [0.45, 0.64]) prior to establishing consensus ratings. Consensus VAG-CM ratings revealed three model/study clusters: data-driven models with face validity, theory-driven models with predictive validity, and theory-driven models lacking all forms of validity. We conclude that future modeling studies should employ a hybrid approach that first operationalizes BD features of interest using empirical data to achieve face validity, followed by explanations of those features using generative models with components that are homologous to physiological or psychological systems involved in BD, to achieve construct validity. Such models would be best developed alongside long-term prospective cohort studies involving a collection of multimodal time-series data. We also encourage future studies to extend, modify, and evaluate the VAG-CM approach for a wider breadth of computational modeling studies and psychiatric disorders.

ObjectiveTo evaluate the clinical performance of the novel PivNG primers and probes set (PivNG test) used in the cobas omni Utility Channel for supplemental testing ofNeisseria gonorrhoeae(NG).MethodsOropharyngeal, urogenital and rectal samples were self-collected during routine testing at Barts Health sexual health clinics, London, UK. Samples were tested by the cobas CT/NG test and PivNG cobas omni Utility Channel test on cobas 6800/8800 Systems. Supplemental testing was carried out with the Xpert CT/NG test. PivNG overall percent agreements, positive percent agreements (PPAs)/negative percent agreements (NPAs) and positive/negative predictive values were calculated for each sample type. Microscopy and/or culture data were included for a randomised subset of concordant/discordant results, and a composite reference standard (cobas CT/NG, Xpert CT/NG and culture results) adjusted for partial verification bias was used to determine PivNG PPA and NPA.ResultsOf 447 evaluable samples with valid results from all three assays (cobas CT/NG, PivNG and Xpert CT/NG), 288 (64.4%) were NG-positive by both PivNG and cobas CT/NG; 117 (26.2%) were NG-negative in both tests; and 42 (9.4%) had discordant results (with NG-negative supplementary Xpert) CT/NG results in 40/42 instances). Of 19 PivNG/Xpert CT/NG-discordant samples, 11 were confirmed NG-positive by microscopy and/or culture results. PivNG PPA and NPA were 100% and 91% for oropharyngeal swabs, 100% and 100% for vaginal swabs, 100% and 100% for male urine samples, and 100% and 97% for rectal swabs, respectively, compared with the partially adjusted composite reference standard.ConclusionsPivNG is a reliable supplementary test with high sensitivity for confirming NG infection when used in conjunction with the cobas CT/NG test and samples collected in cobas PCR Media. Moreover, the PivNG test offers a convenient, high-throughput solution for supplemental NG testing of various sample types, with the potential to reduce the number of indeterminate reports.