bluuebunny/crossref_metadata_2025_split huggingface dataset:
4. Tuberous Sclerosis Presenting as a Suspicious Sudden Death — A Case Report and Review of Sudden Deaths in Epilepsy
Authors: Denmark Lloyd N 
Published: January 2017

A case of a suspicious sudden death in a 19-year-old Caucasian female epileptic is presented The brain showed characteristic lesions of tuberous sclerosis. In most sudden deaths in idiopathic epilepsy no causative lesion is found in the brain A review of the past five years' cases attributed to sudden deaths in epilepsy from our department is presented, with particular reference to findings which might be construed as suspicious, e.g., signs of asphyxia and bruising in neck muscles, and to findings which support the diagnosis, e.g. biting of the tongue, voiding of urine, low levels of medication.
Trends in Suicide (1983–1987)
Authors: Martinez A P , Cameron J M 
Published: January 2017

From over 20,000 autopsies performed by the Department of Forensic Medicine of The London Hospital Medical College over a period of 5 years from 1983 to 1987, 7.4 per cent were classified as unnatural deaths, and from these 659 (3.2 per cent) were suicides. The object of this paper is to study the different methods of self-destruction, the incidence of these methods by sex and age, and evidence left by the deceased.
Facial Injuries Due to Criminal Violence: A Retrospective Study of Hospital Attenders
Authors: Ström C , Johanson G , Nordenram Å 
Published: January 2017

The material comprised 222 assault victims whose injuries required attention at the Departments of Oral Surgery and Ear, Nose, and Throat diseases, the Central Hospital in Falun or corresponding departments at the Karolinska Institutet, Stockholm or the University Hospital in Huddinge. Information was obtained from patient records. One hundred and thirty-eight patients had fractures and the remainder had flesh-wounds, haematomas or swellings. The most frequent fracture site was the nasal bone followed by the jaws. Forty-one per cent of the patients in Falun and 28 per cent in Stockholm reported the assaults to the police: in Falun the proportion of women victims who reported the assault was significantly higher than those who did not. The willingness to notify the police of the violence was not influenced by the use of drugs or the seriousness of the injuries. The study showed that violence in suburban Stockholm was aggravated: one-third of the patients in the study required hospitalization compared to a quarter in a rural area.
Police May Underuse Section 136
Authors: Mokhtar A S E , Hogbin P 
Published: January 2017

A one-year prospective study comparing Section 136 patients (39) and the severe Section 2 or 4 patients (29) of the Mental Health Act 1983 in a hospital with inner London catchment areas. The assessments were clinical, nurses' ratings and socio-demographic. The results showed that clinical and nursing ratings did not differentiate the two groups. Most social/demographic data showed similar trends with both groups being disadvantaged but Section 136 patients slightly more so. The differences were smaller than anticipated, suggesting a recent shift of patients admitted under Section 2 or 4 towards a more socially disadvantaged position. In conclusion, police did not overuse Section 136. Our comparison suggests: (a) police may underuse Section 136, and (b) Section 136 acts as a valuable ‘back-up’ for those patients who would otherwise fail to benefit from the Mental Health Act.
Cellular Changes and Time since Death
Authors: Babapulle C J , Jayasundera N P K 
Published: January 2017

Based on a hypothesis that post-mortem cellular (chiefly nuclear) changes in the white blood cells could reliably be correlated with the time interval since death, (ti), serial observations were made on the counts (total, differential) and light-microscopically observable ‘degenerations’ of white blood cells obtained from 30 non-refrigerated cadavers (experimental group) and similar cells obtained from 200 hospital patients (control group). While neutrophils degenerated rapidly, lymphocytes did so slowly; the eosinophils and monocytes degenerated at rates between these extremes. In cadaveric blood total counts of identifiable leucocytes on average dropped to zero by 84 hours, identifiable eosinophils and monocytes were first to ‘disappear’ (by 60 hours), followed by neutrophils (by 66 hours), and finally lymphocytes: identifiable lymphocytes disappeared completely at or around 84 hours from the time of death. This ‘differential degeneration’ was surprising but useful. Based on the use of all four characteristics — total and differential white cell counts, differential degeneration and morphology of cells — a method for a reasonably exact estimation of ti is presented. The method is appropriate for ti up to 84 hrs (31/2 days). Zero white cell counts (total, differential) and bizarre morphology (unidentifiable white blood cells) indicate a ti > 84 hrs. Avenues for further research are indicated.
Glue Sniffing Deaths in Singapore — Volatile Aromatic Hydrocarbons in Post-Mortem Blood by Headspace Gas Chromatography
Authors: Chao Tzee Cheng , Lo Danny S T , Koh J , Ting T C , Quek L M , Koh T H , Koh-Tan C Y , Zubaidah A 
Published: January 2017

Over a period from 1983 to 1991, of a total of 19,000 post-mortems, 33 were found to have at least one aromatic hydrocarbon (benzene, toluene or xylenes) in the blood. Of the 33 deceased, 22 had a history of toluene or petrol abuse while most of the remaining 11 were suspected to be glue sniffers through evidence found at the scene. This number, which represented 0.17 per cent of all the unnatural deaths, is considered small for a nation having a glue sniffing epidemic. The low death rate, as compared to 2.1 per cent through drug and chemical poisoning during the same period, is attributed to the timely intervention by the Government who outlawed glue sniffing and the effectiveness of compulsory rehabilitation. The male gender predominates (81.8 per cent) among the 33 deceased with a mean age of 20.1 years (range 15 to 33). The mean age for the female gender is 17.7 years (range 16 to 20). The blood toluene levels were found to be in the range 0.2 to 92μg per ml blood. The causes of death are: 63.6 per cent due to falling or suicide by jumping; 18.2 per cent drowning; 6.1 per cent hanging; 6.1 per cent homicide; and 6.1 per cent acute toluene poisoning. The high proportion of traumatic deaths are discussed. Headspace gas chromatography with a suitable GC column was used for the analysis. Calibration blood standards were prepared in situ or in bulk stabilized by 10 per cent (v/v) methanol to overcome the hydrophobic and volatile nature of the aromatic hydrocarbons. Both methods of calibration gave analogous calibration factors, (slope for toluene: 0.092 to 0.095; slope for m-xylene: 0.070 to 0.071; and slope for o-xylene: 0.064 to 0.065), correlation coefficients of 0.9997 or better and standard deviation of 3.1 per cent or less. The consequences of different ways of blood standards preparations are discussed.
Patient Perceptions and Acceptance of Routine Emergency Department HIV Testing
Authors: Brown Jeremy , Kuo Irene , Bellows Jennifer , Barry Ryan , Bui Peter , Wohlgemuth Joshua , Wills Emily , Parikh Nirav 
Published: January 2017

Objectives. We report on the rates of patient acceptance and their perceptions of routine emergency department (ED) human immunodeficiency virus (HIV) testing in a high-prevalence area. Methods. We analyzed the race/ethnicity of patients who either accepted or declined a routine HIV test that was offered to all patients in the ED of a large academic center. We also distributed a patient perception survey about ED HIV testing. Results. During the study period, an HIV screening test was offered to 9,826 patients. Of these, 5,232 patients (53%) accepted the test. The acceptance rate of HIV testing was highest among African American patients (55%), followed by 52% for white, 50% for Hispanic, and 42% for Asian patients. A total of 1,519 completed surveys were returned for analysis. The most common reasons for declining a test were that patients did not perceive themselves to be at risk for HIV (49%) or they had recently been tested for HIV (18%). Overall, 84% of patients stated they would recommend to a friend to get an HIV test in the ED. When analyzed by ethnicity, 89% of African American patients stated they would recommend to a friend to get an HIV test if the friend went to the ED, but only 74% of white patients would do so. Conclusions. The Centers for Disease Control and Prevention's 2006 recommendations on HIV screening are well accepted by the target populations. Further work at explaining the risk of HIV infection to ED patients should be undertaken and may boost the acceptance rate of ED HIV screening.
Emergency Department Patient Acceptance of Opt-in, Universal, Rapid HIV Screening
Authors: Merchant Roland C. , Seage George R. , Mayer Kenneth H. , Clark Melissa A. , DeGruttola Victor G. , Becker Bruce M. 
Published: January 2017

Objectives. We assessed emergency department (ED) patient acceptance of opt-in, rapid human immunodeficiency virus (HIV) screening and identified demographic characteristics and HIV testing-history factors associated with acceptance of screening. Methods. A random sample of 18- to 55-year-old ED patients was offered rapid HIV screening. Patient acceptance or decline of screening and the reasons for acceptance or decline were analyzed with multivariable regression models. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated for the logistic regression models. Results. Of the 2,099 participants, 39.3% accepted HIV screening. In a multinomial regression model, participants who were never married/not partnered, did not have private health insurance, and had 12 or fewer years of education were more likely to be screened due to concern about a possible HIV exposure. In a multivariable logistic regression model, the odds of accepting screening were greater among those who were younger than 40 years old (OR=1.61, 95% CI 1.32, 2.00), nonwhite (OR=1.28, 95% CI 1.04, 1.58), not married (OR=1.82, 95% CI 1.44, 2.28), lacking private health insurance (OR=1.40, 95% CI 1.13, 1.74), and who had 12 or fewer years of education (OR=1.43, 95% CI 1.16, 1.75). Despite use of a standardized protocol, patient acceptance of screening varied by which research assistant asked them to be screened. Patients not previously tested for HIV who were white, married, and 45 years or older and who had private health insurance were more likely to decline HIV screening. Conclusions. In an opt-in, universal, ED HIV screening program, patient acceptance of screening varied by demography, which indicates that the impact of such screening programs will not be universal. Future research will need to determine methods of increasing uptake of ED HIV screening that transcend patient demographic characteristics, HIV testing history, and motivation for testing.
Prevalence and Correlates of Unknown HIV Infection among Patients Seeking Care in a Public Hospital Emergency Department
Authors: Zetola Nicola M. , Kaplan Beth , Dowling Teri , Jensen Trevor , Louie Brian , Shahkarami Mahtab , Colfax Grant , Klausner Jeffrey D. 
Published: January 2017

Objectives. Screening for human immunodeficiency virus (HIV) infection in the emergency department (ED) has been proposed as an effective approach to increase early HIV diagnosis. To evaluate the potential for the implementation of routine screening, we determined the prevalence of unknown HIV infection among patients being seen in an urban public hospital ED. Methods. We conducted a cross-sectional study among patients presenting to the San Francisco General Hospital's ED during March 2007. We reviewed patients' medical records to determine HIV infection status. In patients with unknown or negative HIV-infection status, we tested de-identified remnant blood specimens by HIV-antibody and nucleic-acid assays. We used a sensitive/less sensitive testing algorithm to determine the duration of HIV infection. Results. During the study period, 1,820 patients had blood collected for clinical evaluation. Of those patients, 146 (8.0%) were known to be HIV-infected. Among the remaining 1,674 patients with unknown HIV-infection status, HIV-infection prevalence was 0.9% (15 of 1,674, 95% confidence interval [CI] 0.55, 1.47). In addition, one case of acute HIV infection (HIV-antibody negative, HIV RNA detected) was identified. Patients with unknown HIV infection vs. those who were uninfected were more likely to be homeless (odds ratio [OR] = 3.89, 95% CI 1.32, 11.45, p<0.05) and 18 to 30 years of age (OR=3.15, 95% CI 1.03, 9.61, p<0.05). Conclusions. In a sample of patients visiting a county ED, the relative prevalence of unknown HIV infection (10%) was modest and less than national estimates (25%). Acutely HIV-infected patients might account for a significant proportion of those with unknown HIV infection in an ED setting.
Comparing the Costs of HIV Screening Strategies and Technologies in Health-Care Settings
Authors: Farnham Paul G. , Hutchinson Angela B. , Sansom Stephanie L. , Branson Bernard M. 
Published: January 2017

Objectives. In 2006, the Centers for Disease Control and Prevention (CDC) recommended routine human immunodeficiency virus (HIV) screening for people aged 13 to 64 years in all U.S. health-care settings. Earlier recommendations focused on those at high risk for HIV and included more extensive pretest counseling. HIV screening may also involve either rapid or conventional testing. The purpose of this research was to estimate the costs of these different testing procedures and the cost per HIV-infected patient correctly receiving test results in three health-care scenarios that illustrated these policy differences. Methods. The study estimated the costs of rapid and conventional HIV testing in the following scenarios: ( 1) sexually transmitted disease (STD) clinic counseling and testing (CT), ( 2) STD clinic screening, and ( 3) emergency department (ED) screening. Costs were estimated from the provider perspective in 2006 dollars. A decision analytic model was developed to estimate the cost per HIV-infected patient notified of test results using the two testing procedures in the three scenarios. Results. Although the complete rapid testing procedure was more expensive than conventional testing, the cost per HIV-infected patient receiving test results was lower for the rapid test compared with conventional testing in all scenarios. Per-patient costs of receiving results were lowest in the ED screening scenario and highest in the STD CT scenario. These costs were sensitive to changes in test costs, HIV prevalence, and return rates following conventional tests. Conclusion. HIV screening in general health-care settings is economically feasible, particularly with rapid tests that lower the cost of HIV-infected patients receiving their test results.
Implementing Rapid HIV Testing in Outreach and Community Settings: Results from an Advancing HIV Prevention Demonstration Project Conducted in Seven U.S. Cities
Authors: Bowles Kristina E. , Clark Hollie A. , Tai Eric , Sullivan Patrick S. , Song Binwei , Tsang Jenny , Dietz Craig A. , Mir Julita , Mares-DelGrasso Azul , Calhoun Cindy , Aguirre Daisy , Emerson Cicily , Heffelfinger James D. 
Published: January 2017

Objectives. The goals of this project were to assess the feasibility of conducting rapid human immunodeficiency virus (HIV) testing in outreach and community settings to increase knowledge of HIV serostatus among groups disproportionately affected by HIV and to identify effective nonclinical venues for recruiting people in the targeted populations. Methods. Community-based organizations (CBOs) in seven U.S. cities conducted rapid HIV testing in outreach and community settings, including public parks, homeless shelters, and bars. People with reactive preliminary positive test results received confirmatory testing, and people confirmed to be HIV-positive were referred to health-care and prevention services. Results. A total of 23,900 people received rapid HIV testing. Of the 267 people (1.1%) with newly diagnosed HIV infection, 75% received their confirmatory test results and 64% were referred to care. Seventy-six percent were from racial/ethnic minority groups, and 58% identified themselves as men who have sex with men, 72% of whom reported having multiple sex partners in the past year. Venues with the highest proportion of new HIV diagnoses were bathhouses, social service organizations, and needle-exchange programs. The acceptance rate for testing was 60% among sites collecting this information. Conclusions. Findings from this demonstration project indicate that offering rapid HIV testing in outreach and community settings is a feasible approach for reaching members of minority groups and people at high risk for HIV infection. The project identified venues that would be important to target and offered lessons that could be used by other CBOs to design and implement similar programs in the future.
Implementation of Rapid HIV Testing Programs in Community and Outreach Settings: Perspectives from Staff at Eight Community-Based Organizations in Seven U.S. Cities
Authors: Clark Hollie A. , Bowles Kristina E. , Song Binwei , Heffelfinger James D. 
Published: January 2017

Objectives. The goals of this research were to evaluate perceptions of staff about the effectiveness of methods used by eight community-based organizations (CBOs) to implement human immunodeficiency virus (HIV) counseling and rapid testing in community and outreach settings in seven U.S. cities, and to identify operational challenges. Methods. A survey was administered to CBO staff to determine their perceptions about the effectiveness of methods used to select testing venues, promote their testing programs, recruit people for testing, provide test results, and link HIV-positive people to health care. Using a Likert scale, respondents rated the effectiveness of methods, their agreement with statements about using mobile testing units (MTUs) and rapid HIV test kits, and operational challenges. Results. Most respondents perceived the methods they used for selecting testing venues, and particularly using recommendations from people receiving testing, to be effective. Most respondents also thought their promotional activities were effective. Respondents believed that using MTUs improved their capacity to reach high-risk individuals, but that MTUs were associated with substantial challenges (e.g., costs to purchase and maintain them). Programmatic challenges included training staff to provide counseling and testing, locating and providing confirmatory test results to people with reactive rapid tests, and sustaining testing programs. Conclusions. CBO staff thought the methods used to select venues for HIV testing were effective and that using MTUs increased their ability to provide testing to high-risk individuals. However, using MTUs was expensive and posed logistical difficulties. CBOs planning to implement similar programs should take these findings into consideration and pay particular attention to training needs and program sustainability.
Cost-Effectiveness of Finding New HIV Diagnoses Using Rapid HIV Testing in Community-Based Organizations
Authors: Shrestha Ram K. , Clark Hollie A. , Sansom Stephanie L. , Song Binwei , Buckendahl Holly , Calhoun Cindy B. , Hutchinson Angela B. , Heffelfinger James D. 
Published: January 2017

Objective. We assessed the cost-effectiveness of determining new human immunodeficiency virus (HIV) diagnoses using rapid HIV testing performed by community-based organizations (CBOs) in Kansas City, Missouri, and Detroit, Michigan. Methods. The CBOs performed rapid HIV testing during April 2004 through March 2006. In Kansas City, testing was performed in a clinic and in outreach settings. In Detroit, testing was performed in outreach settings only. Both CBOs used mobile testing vans. Measures of effectiveness were the number of HIV tests performed and the number of people notified of new HIV diagnoses, based on rapid tests. We retrospectively collected program costs, including those for personnel, test kits, mobile vans, and facility space. Results. The CBO in Kansas City tested a mean of 855 people a year in its clinic and 703 people a year in outreach settings. The number of people notified of new HIV diagnoses was 19 (2.2%) in the clinic and five (0.7%) in outreach settings. The CBO in Detroit tested 976 people a year in outreach settings, and the number notified of new HIV diagnoses was 15 (1.5%). In Kansas City, the cost per person notified of a new HIV diagnosis was $3,637 in the clinic and $16,985 in outreach settings. In the Detroit outreach settings, the cost per notification was $13,448. Conclusions. The cost of providing a new HIV diagnosis was considerably higher in the outreach settings than in the clinic. The variation can be largely explained by differences in the number of undiagnosed infections among the people tested and by the costs of purchasing and operating a mobile van.
Rapid HIV Testing in Transgender Communities by Community-Based Organizations in Three Cities
Authors: Schulden Jeffrey D. , Song Binwei , Barros Alex , Mares-DelGrasso Azul , Martin Charles W. , Ramirez Ramon , Smith Linney C. , Wheeler Darrell P. , Oster Alexandra M. , Sullivan Patrick S. , Heffelfinger James D. 
Published: January 2017

Objectives. This article describes the demographic and behavioral characteristics, human immunodeficiency virus (HIV) testing history, and results of HIV testing of transgender (TG) people recruited for rapid HIV testing by community-based organizations (CBOs) in three cities. Methods. CBOs in Miami Beach, Florida, New York City, and San Francisco offered TG people rapid HIV testing and prevention services, and conducted a brief survey. Participants were recruited in outreach settings using various strategies. The survey collected information on demographic characteristics, HIV risk behaviors, and HIV testing history. Results. Among 559 male-to-female (MTF) TG participants, 12% were newly diagnosed with HIV infection. None of the 42 female-to-male participants were newly diagnosed with HIV. A large proportion of MTF TG participants reported high-risk behaviors in the past year, including 37% who reported unprotected receptive anal intercourse and 44% who reported commercial sex work. Several factors were independently associated with increased likelihood of being newly diagnosed with HIV infection among MTF TG participants, including having a partner of unknown HIV status in the past year; being 20–29 or ≥40 years of age; having last been tested for HIV more than 12 months ago; and having been recruited at the New York City site. Conclusions. Based on the high proportion of undiagnosed HIV infection among those tested, TG people represent an important community for enhanced HIV testing and prevention efforts. MTF TG people should be encouraged to have an HIV test at least annually or more often if indicated, based upon clinical findings or risk behaviors. Efforts should continue for developing novel strategies to overcome barriers and provide HIV testing and prevention services to TG people.