The disproportionate burden of HIV and STIs among male sex workers in Mexico City and the rationale for economic incentives to reduce risks

Introduction

The objective of this article is to present the rationale and baseline results for a randomized controlled pilot trial using economic incentives to reduce HIV and sexually transmitted infection (STI) risk among male sex workers (MSWs) in Mexico City.

Methods

Participants (n=267) were tested and treated for STIs (chlamydia, gonorrhoea, syphilis and HIV) and viral hepatitis (hepatitis B and C), received HIV and STI prevention education and were randomized into four groups: (1) control, (2) medium conditional incentive ($50/six months), (3) high conditional incentive ($75/six months) and (4) unconditional incentive ($50/six months). In the conditional arms, incentives were contingent upon testing free of new curable STIs (chlamydia, gonorrhoea and syphilis) at follow-up assessments.

Results

Participants’ mean age was 25 years; 8% were homeless or lived in a shelter, 16% were unemployed and 21% lived in Mexico City less than 5 years. At baseline, 38% were living with HIV, and 32% tested positive for viral hepatitis or at least one STI (other than HIV). Participants had a mean of five male clients in the previous week; 18% reported condomless sex with their last client. For 37%, sex work was their main occupation and was conducted mainly on the streets (51%) or in bars/discotheques (24%) and hotels (24%). The average price for a sex transaction was $25 with a 35% higher payment for condomless sex.

Conclusions

The findings suggest that economic incentives are a relevant approach for HIV prevention among MSWs, given the market-based inducements for unprotected sex. This type of targeted intervention seems to be justified and should continue to be explored in the context of combination prevention efforts.     

Neural network for solving convex quadratic bilevel programming problems

In this paper, using the idea of successive approximation, we propose a neural network to solve convex quadratic bilevel programming problems (CQBPPs), which is modeled by a nonautonomous differential inclusion. Different from the existing neural network for CQBPP, the model has the least number of state variables and simple structure. Based on the theory of nonsmooth analysis, differential inclusions and Lyapunov-like method, the limit equilibrium points sequence of the proposed neural networks can approximately converge to an optimal solution of CQBPP under certain conditions. Finally, simulation results on two numerical examples and the portfolio selection problem show the effectiveness and performance of the proposed neural network.     

A new method for computer-assisted detection,definition and differentiation of the urinary calculi

Purpose: Urinary stones are common and can be diagnosed with computed tomography (CT) easily. In this study, we aimed to specify the opacity characteristics of various types of calcified foci that develop through the urinary system by using an image analysis program. With this method, we try to differentiate the calculi from the non-calculous opacities and also we aimed to present how to identify the characteristic features of renal and ureteral calcules. Materials and methods: We obtained the CT studies of the subjects (n?=?48, mean age?=?41 years) by using a dual source CT imaging system. We grouped the calculi detected in the dual-energy CT sections as renal (n?=?40) or ureteric (n?=?45) based on their locations. Other radio-opaque structures that were identified outside but within close proximity of the urinary tract were recorded as calculi “mimickers”. We used ImageJ program for morphological analysis. All the acquired data were analyzed statistically. Results: According to thorough morphological parameters, there were statistically significant differences in the angle and Feret angle values between calculi and mimickers (p?p?=?0.003) and kidney (p?=?0.001) stones. Conclusions: Computer-based morphologic parameters can be used simply to differentiate between calcular and noncalcular densities on CT and also between renal and ureteric stones.     

Incidence estimation using a single cross‐sectional age‐specific prevalence survey with differential mortality

Here, we present a method for incidence estimation of a curable, non‐recurring disease when data from a single cross‐sectional survey are used together with population‐level mortality rates and an assumption of differential mortality of diseased versus non‐diseased individuals. The motivating example is cataract, and the VISION2020 goal to eliminate avoidable blindness globally by 2020. Reliable estimates of current and future cataract disease burden are required to predict how many surgeries would need to be performed to meet the VISION2020 goals. However, incidence estimates, needed to derive future burden, are not as easily available, due to the cost of conducting cohort studies. Disease is defined at the person‐level in accordance with the WHO person‐level definition of blindness. An extension of the standard time homogeneous illness–death model to a four‐state model is described, which allows the disease to be cured, whereby surgery is performed on at least one diseased eye. Incidence is estimated, and the four‐state model is used to predict disease burden assuming different surgical strategies whilst accounting for the competing risk of death. The method is applied to data from approximately 10 000 people from a survey of visual impairment in Nigeria. Copyright © 2013 John Wiley & Sons, Ltd.     

Follicular squamous cell carcinoma is an under-recognised common skin tumour

Current thinking assumes most cutaneous squamous cell carcinoma arise from the surface epidermis. Uncommon pilar and tricholemmal carcinomas are well recognised and recently authors have drawn attention to uncommon squamous cell carcinoma with predominant follicular infundibular differentiation. In contrast we propose that follicular (infundibular-tricholemmal) squamous cell carcinoma is exceedingly common and can be defined as follows: cytologically malignant tumour, abrupt connections to the epidermis (at follicular infundibula), infundibular and/or tricholemmal differentiation and lacking co-existent Bowen's disease or distinctive clinical-pathological features of keratoacanthoma. Recognition that many cutaneous squamous cell carcinoma are of follicular origin has major implications for differential diagnosis, staging, prognosis, management and future research.     

Evaluation of automated basophil counting by using fluorescence-labelled monoclonal antibodies

The shortcomings of current methods of basophil enumeration detract from the clinical value of the basophil count. Moreover, sophisticated and costly techniques of automated basophil counting hardly can be validated for lack of a suitable reference method. We investigated whether a flow cytometric technique using double staining with fluorescence-labelled monoclonal antibodies (mAb) CD45-FITC and CD14-PE on a Coulter Epics Profile II could be used to evaluate basophil counting performance of hematology analyzers. The technique was compared with the 800-cell manual differential, the Coulter STKS, and the Cobas Argos 5 Diff. Precision: STKS, Argos and Profile II showed a precision analogous to a 2,173, 2,250-, and 14,705-cell differential, respectively, illustrating the superiority of automated methods. Accuracy (150 normal and abnormal samples): Using the Profile II as reference the STKS showed a notably weaker correlation than the Argos (r = 0.581 and 0.718, respectively), although this difference was nearly concealed when the imprecise manual differential served as reference (r = 0.517 and 0.562, respectively). The Profile 11 correlated relatively well with the manual differential (r = 0.730). Analyzing 137 healthy adult subjects, we obtained a reference range of 0.33 to 1.35% (0.020 to 0.102 × 10⁹, basophils/L) for the mAb-based method. These data would recommend mAb-based basophil counting as a valuable tool for instrument evaluation. However, an observed bias of 0.09% against the manual differential suggests that modifications are necessary before this technique can be considered as new reference method. © 1996 Wiley-Liss, Inc.     

脑部环形强化病灶的磁共振波谱分析

目的:探讨二维化学位移成像氢质子磁共振波谱(2D CSI1H-MRS)对脑内环形强化病变的诊断价值.方法:回顾性分析经临床诊断和(或)手术病理证实的62例脑内环形强化病变的MRS及MRI表现,包括胶质瘤20例、转移瘤18例、脑部炎性病变16例、放射性损伤8例.比较4组乳酸(Lac)峰出现率,计算增强区及增强区内部的胆碱(Cho)、N-乙酰天门冬氨酸(NAA)、肌酐(Cr)的浓度及NAA/Cho、Cho/Cr、NAA/Cr比值.结果:(1)4组病变的Lac峰出现率无明显差异.(2)胶质瘤、转移瘤、炎性病变、放射性损伤的NAA/Cho分别为0.43±0.32、0.69±0.29、1.26±0.53、0.63±0.34,胶质瘤显著低于其他3组病变(P＜0.05);当取NAA/Cho＜0.4时,MRS区分胶质瘤的灵敏度、特异度、阳性预测值(PPV)、阴性预测值(NPV)分别为80.2%、77.4%、71.5%、89.4%,均高于MRI,两种方法联合使用时各项指标均提高.(3)4组病变的Cr浓度分别为0.17±0.05、0.10±0.05、0.21±0.08、0.21±0.09,转移瘤显著低于其他3组病变(P＜0.05);当取Cr＜0.06时,MRS区分转移瘤的灵敏度、特异度、PPV、NPV分别为81.3%、81.9%、74.1%、90.1%,均高于MRI,两种方法联合使用时各项指标均提高.结论:2DCSI1H-MRS在脑内环形病变的鉴别诊断上有重要价值,两种方法联合使用诊断价值更高.