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Objective: To determine the reliability of a delay in the microscopic examination of synovial fluid (SF) to detect and identify crystals. Methods: Ninety one SF samples were examined, 31 with monosodium urate (MSU) crystals, 30 with crystals of calcium pyrophosphate dihydrate (CPPD), and 30 containing no crystals. The specimens were stored with EDTA, sodium heparin, and without anticoagulant at 4ºC before examination at 24 and 72 hours with ordinary and polarised light microscopy. Another aliquot of the same samples was stored in a plastic container without anticoagulant at −80°C and examined after two months. Results: When the samples stored at 4ºC were re-examined after 24 hours, intracellular crystals of MSU were seen in 90/93 (97%) cases where they had been identified previously and 89/93 (96%) cases after 72 hours. Similarly, CPPD crystals were identified in 90/90 (100%) and 87/90 (97%) cases after 24 and 72 hours. Examination of the samples stored at −80°C showed intracellular MSU crystals in 25/31 (81%) of cases and CPPD crystals in 25/30 (83%). No crystals were seen in any sample which had previously been diagnosed as crystal-free. Conclusions: Deferred microscopic examination of refrigerated or deep frozen SF provides a strong probability of detecting MSU or CPPD crystals if these are present initially.

Aims The dental setting is a potentially valuable venue for screening for substance misuse. Therefore, we assessed dentists’ inquiry of substance misuse through their patient medical history forms and their agreement with the compatibility of screening as part of the dentists’ professional role. Design A nationally representative survey of general dentists using a sampling frame obtained from the American Dental Association Survey Center (November 2010 – November 2011). Setting United States of America Participants 1,802 general dentists Measurements A 38 item survey instrument assessing the relationship between dentists’ practice, knowledge, behaviors, and attitudes with their query about substance misuse and their belief that such screening is part of their professional role. Findings Dentists who accepted substance misuse screening as part of their professional role were more likely to query about misuse with their patients (85.8%) compared with those who did not accept such screening as part of their role (68.2%) (p<0.001). Prior experience and knowledge about substance misuse were the strongest predictors of dentists’ inquiry about patient substance use/misuse and acceptance of screening as part of their role in their clinical practice (p<0.05). Conclusion While more than three quarters of U.S. dentists-report that they ask their patients about substance misuse, two-thirds do not agree that such screening is compatible with their professional role.

Introduction Rapid HIV testing in high-risk populations can increase the number of persons who learn their HIV status and avoid spending clinic resources to locate persons identified as HIV-infected. Methods We determined the cost to sexually transmitted disease clinics of point-of-care rapid HIV testing using data from 7 public clinics that participated in a randomized trial of rapid testing with and without brief patient-centered risk-reduction counseling in 2010. Costs included counselor and trainer time, supplies, and clinic overhead. We applied national labor rates and test costs. We calculated median clinic start-up costs and mean cost per patient tested, and projected incremental annual costs of implementing universal rapid HIV testing compared to current testing practices. Results Criteria for offering rapid HIV testing and methods for delivering non-rapid test results varied among clinics prior to the trial. Rapid HIV testing cost an average of $22/patient without brief risk-reduction counseling and $46/patient with counseling in these 7 clinics. Median start-up costs per clinic were $1,100 and $16,100 without and with counseling, respectively. Estimated incremental annual costs per clinic of implementing universal rapid HIV testing varied by whether or not brief counseling is conducted and by current clinic testing practices, ranging from a savings of $19,500 to a cost of $40,700 without counseling and a cost of $98,000 to $153,900 with counseling. Conclusions Universal rapid HIV testing in sexually transmitted disease clinics with same day results can be implemented at relatively low cost to STD clinics, if brief risk-reduction counseling is not offered.

The 3-day WalkSafe educational curriculum implemented in a high-risk district was shown to increase the pedestrian safety knowledge of elementary school age children. From recommendations made by teachers and multiple agencies, the modified 3-day program was approved to implement on a yearly basis in all public elementary schools in Miami-Dade County. Further studies will investigate the transfer of knowledge gain to behavioral change among elementary school-aged children.

Objectives Sexually transmitted infections (STIs) are significant public health and financial burdens in the United States. This manuscript examines the relationship between substance use and prevalent and incident STIs in HIV-negative adult patients at STI clinics. Methods A secondary analysis of Project AWARE was performed based on 5,012 patients from 9 STI clinics. STIs were assessed by laboratory assay and substance use by self-report. Patterns of substance use were assessed using latent class analysis. The relationship of latent class to STI rates was investigated using Poisson regression by population groups at high risk for STIs defined by participant’s and partner’s gender Results Drug use patterns differed by risk group and substance use was related to STI rates with the relationships varying by risk behavior group. Substance use treatment participation was associated with increased STI rates Conclusions Substance use focused interventions may be useful in STI clinics to reduce morbidity associated with substance use. Conversely, gender-specific sexual health interventions may be useful in substance use treatment.

Background Substance use, particularly injection drug use, continues to fuel the HIV/HCV epidemics in San Juan, Puerto Rico (PR). Aim This manuscript examines individual and socio-structural factors that impact HIV/HCV risk among people who use drugs (PWUD) living with or at risk for HIV/HCV in San Juan, PR. Findings were used to inform a community-level intervention to enhance HIV care access and retention for this population. Methods A rapid ethnographic assessment in collaboration with a community-based organization was conducted. Data collection took place between June and December 2013 and included field observations, 49 unstructured interviews with PWUD and 19 key informant interviews with community stakeholders. Fieldnotes, photographs and interview transcripts were analyzed for recurrent themes and to address the intervention planning needs. Study results are presented as fieldnote excerpts, direct quotes from interviews and photographs. Results Findings suggest that PWUD in PR face myriad challenges that affect HIV/HCV risk and hinder linkage to and retention in care. Results describe a layered risk environment where PWUD encounter many barriers to prevention, care and treatment such as transience, social isolation, stigma, limited housing options and inadequate medical and substance use disorders treatment services. Discussion These observed circumstances provide an empirical basis for the development and evaluation of comprehensive interventions that may serve to reduce barriers to care and link individuals to other supportive services. Conclusion New approaches and comprehensive interventions are needed to break the structures that perpetuate risk and lack of engagement and retention in HIV care and SUD treatment in San Juan.