HIV Attachment. In this cross section, HIV is shown at the top and a target cell is shown at the bottom in blues. HIV envelope protein (A) has bound to the receptor CD4 (B) and then to coreceptor CCR5 (C), causing a change in conformation that inserts fusion peptides into the cellular membrane Antiretroviral therapy changed the face of HIV/AIDS from that of soon and certain death to that of a chronic disease in the years following introduction of highly active antiretroviral therapy in 1995-1996 (initially termed HAART, but now most often abbreviated to ART since not all combinations of regimens are equally active). Since then, many new agents have been developed and introduced in response to problems of resistance, toxicity, and tolerability, and great advances have been achieved in accessibility of HIV drugs in resource-poor global regions. Potential challenges that providers of HIV therapy will face in the coming decade include continuing problems with resistance, especially where access to drugs is inconsistent, determining how best to combine new and existing agents, defining the role of preventive treatment (pre-exposure prophylaxis or PrEP), and evaluating the potential of strategies for cure in some populations.

A significant portion of eligible HCV patients could not be engaged in treatment after a programmatic outreach effort. These data indicate that more sustained or innovative outreach efforts are needed in order to maximize treatment access, with specific interventions targeting those with unstable housing and active alcohol/substance use disorders.

No abstract

Natural evaporation has recently come under consideration as a viable source of renewable energy. Demonstrations of the validity of the concept have been reported for devices incorporating carbon-based nanocomposite materials. In this study, we investigated the possibility of using polymer thin films to generate electricity from natural evaporation. We considered a polymeric system based on polyvinylidene fluoride (PVDF). Porous PVDF films were created by incorporating a variety of nanocomposite materials into the polymer structure through a simple mixing procedure. Three nanocomposite materials were considered: carbon nanotubes, graphene oxide, and silica. The evaporation-induced electricity generation was confirmed experimentally under various ambient conditions. Among the nanocomposite materials considered, mesoporous silica (SBA-15) was found to outperform the other two materials in terms of open-circuit voltage, and graphene oxide generated the highest short-circuit current. It was found that the nanocomposite material content in the PVDF film plays an important role: on the one hand, if particles are too few in number, the number of channels will be insufficient to support a strong capillary flow; on the other hand, an excessive number of particles will suppress the flow due to excessive water absorption underneath the surface. We show that the device can be modeled as a simple circuit powered by a current source with excellent agreement between the theoretical predictions and experimental data.

BackgroundVISN 22 is comprised of eight VA hospitals serving Southern California, Arizona, and New Mexico. The VISN 22 Antimicrobial Stewardship Workgroup formed in November 2018 with the purpose of sharing strong practices and program strategies. We compared antibiogram compilation strategies and antimicrobial susceptibilities and correlated antimicrobial susceptibilities for Pseudomonas aeruginosa and Escherichia coli with inpatient and outpatient antibiotic use.Methods2018 antibiograms were collected from each hospital. Antibiotic utilization rates (antibiotic days per 1000 patient-days present) were extracted from VA Corporate Data Warehouse data. Pearson correlation coefficients were calculated between 2018 utilization of specific agents and P. aeruginosa and E. coli susceptibilities to those agents at each facility.ResultsAntibiograms varied according to authorship (microbiology and/or infectious diseases), reporting frequency, rules regarding isolate reporting, and location and specimen specificity (Table 1). Facilities reported at least 90% susceptibility to a median of 3 antibiotics (range 1 to 5) for P. aeruginosa and 5 antibiotics (range 1 to 7) for E. coli.The strongest negative correlations between antimicrobial use and susceptibility were observed for meropenem/imipenem (-0.43) and piperacillin–tazobactam (-0.41) with P. aeruginosa and piperacillin–tazobactam (-0.23) and fluoroquinolones (-0.21) with E. coli. A moderate negative correlation was observed between outpatient fluoroquinolone prescriptions per 1000 patients and E. coli susceptibility (-0.24).ConclusionAntibiogram composition is variable across VISN 22; not all reporting is consistent with CLSI recommendations. There was a modest correlation between some categories of antimicrobial use and resistance in P. aeruginosa and E. coli. Sharing antibiogram and antibiotic utilization data are helpful in developing antimicrobial stewardship strategies especially as we examine those hospitals with lower rates of resistance and antibiotic use. Disclosures All authors: No reported disclosures.