Abstract Background The Kirketon Road Centre (KRC) is a community-based public health facility in Sydney, Australia, that provides healthcare to people who inject drugs (PWID) care, including ...hepatitis C virus (HCV) treatment. From March 2016, the Australian Government has provided access to direct-acting antivirals (DAA) for adults with chronic HCV, without liver disease stage or drug and alcohol use restrictions. The aim of this study was to report DAA treatment outcomes among highly marginalised PWID treated at KRC. Methods All individuals initiating DAA treatment at KRC and due for sustained virological response (SVR12) testing by end 2016 were included. Demographic, drug use behaviour, clinical parameters, adherence support and HCV treatment outcomes, including SVR12 were recorded. Factors associated with SVR12, loss-to-follow-up (LTFU) and delayed SVR12 testing (>SVR16) were assessed by multivariate analysis. SVR12 was assessed by intention-to-treat (ITT) and modified ITT, the latter excluding individuals with an end-of-treatment response (ETR) but no SVR12 assessment, or who postponed their SVR12 date due to treatment interruption. Results A total of 72 individuals commencing DAAs were included, of whom 67% were male, 30% homeless, and 32% Aboriginal. All had a lifetime history of injecting drug use, with 75% having injected within the last six months, and 44% injecting at least weekly; 25% were also enrolled in opioid substitution therapy. Twenty-five (35%) individuals elected to receive an enhanced adherence-support package. Fifty-nine of 72 (82%) individuals due for SVR12 attended for testing, of whom 59/59 (100%) achieved SVR, providing an ITT SVR of 82%. A further six individuals had undetectable HCV RNA at ETR, but no SVR12 assessment, and one interrupted treatment, providing a mITT SVR of 91%. Homelessness was associated with delayed SVR12 testing (OR 24.9 95%CI 2.9–212.8, p = 0.003). There was no association between LTFU and frequency of drug injection, last drug injected, or planned treatment duration. Conclusion This study confirms that PWID can be successfully treated for HCV in a real-world setting using an integrated primary health care model. It also demonstrates feasibility to upscale DAA therapy in high-risk PWID populations, with potential individual and population-level public health benefits. Enhanced efforts are required to optimise post-treatment follow-up.
A community‐based public health facility in Sydney, Australia, the Kirketon Road Centre (KRC), provides health care to people who inject drugs (PWID), homeless and other marginalized people. Since ...March 2016, KRC has provided treatment for chronic hepatitis C virus (HCV) with direct‐acting antivirals (DAAs). We aimed to evaluate treatment adherence amongst clients taking DAAs in a highly marginalized population. All clients who commenced DAA therapy prior to March 2018 at KRC were included in this observational cohort with a subset of clients attending daily or weekly for enhanced adherence support and dosing. Demographic, behavioural, clinical measures and medication dosing were recorded, and adherence was calculated as the proportion of doses taken during the expected treatment duration. Factors associated with adherence were examined using logistic regression. A total of 242 individuals commenced DAA therapy, of whom 79 (32%) received enhanced adherence support. Enhanced support was associated with homelessness, daily injecting, Aboriginality, mental health co‐morbidity and poly‐drug use (all P < .001). Overall adherence was 86%, and 92% of patients missed one or more doses (median 10, IQR 4‐24). At least 90% adherence during planned duration was seen in 38%, but increased to 66% by continuing therapy beyond planned duration. Intention‐to‐treat SVR12 was 68% and 66% in the enhanced adherence support sub‐population, with 29% lost to follow‐up by SVR12 testing. There were only 2 (0.8%) documented virological failures. Per‐protocol SVR12 was 99% and 96% in the enhanced adherence support sub‐population. In conclusion, adherence support may benefit those with multiple markers of marginalization. Extension of therapy beyond planned duration is a pragmatic strategy to enhance completion. Strategies to improve follow‐up, particularly post‐treatment are required.
A written birth plan encourages women to clarify desires and expectations and communicate with their providers to make a realistic plan for care during labor. Tension between health professionals and ...patients caused by birth plans reflects the larger problems with contemporary maternity care: conflicting beliefs about birth, what constitutes safe, effective care, and ethical issues related to informed consent and informed refusal. The focus of birth plans should be to answer three patient‐focused questions: What will I do to stay confident and feel safe? What will I do to find comfort in response to my contractions? Who will support me through labor, and what will I need from them? In this article, the history and purposes of birth plans and approaches to resolving tensions will be discussed. JOGNN, 35, 295‐303; 2006. DOI: 10.1111/J.1552‐6909.2006.00042.x
•The performance of Low Cost Baffles for upstream cyprinid passage was measured.•Fish passed the weir under a range of flow conditions post-LCB installation.•Larger fish were less likely to be ...successful than smaller fish.•No difference in the passage performance or behaviour between wild and stocked fish.•High potential for LCBs to be used as a retrofit fishway for steep sloping weirs.
Weir construction has fragmented many rivers, resulting in the exclusion of some fish populations from suitable habitat. A cheap retrofit fishway for small, sloping weirs is the Low Cost Baffle (LCB) solution – A series of notched baffles perpendicular to flow on the downstream weir face, generating an angled passage route across the weir face. To test the degree to which LCBs can pass upstream-moving, lowland-river fish at steep weirs, LCBs were fitted onto a 1:3.3-sloping gauging-weir face, in an urban tributary of the River Thames, England. The study also compared the passage of wild and stocked fish (the latter are employed to facilitate population recovery in restored English rivers). Passive Integrated Transponder (PIT) antennas were positioned on the weir to record the upstream movement of PIT-tagged barbel (Barbus barbus; nstock = 120), chub (Squalius cephalus; nstock = 119; nwild = 194), dace (Leuciscus leuciscus; nwild = 50), and roach (Rutilus rutilus; nwild = 30). Over six months, more stocked fish attempted passage (58.9%) than wild (14.6%; χ21 = 26.7, p < 0.001), but there was no difference in successful passage of those that attempted (stock = 34.0%; wild = 40.0%; χ21 = 0.5, p = 0.49). Successful passage was achieved under a range of flow conditions. This study finds that LCBs have the potential to facilitate passage for cyprinid fishes at steep urban weirs that cannot readily be removed, but there is need for design improvements. This study also indicates that stocked and wild fish exhibited similar passage success, a finding with important management implications for achieving dispersal of stocked fish as a rehabilitation measure.
Promoting, Protecting, and Supporting Normal Birth: A Look at the Evidence Romano, Amy M.; Lothian, Judith A.
Journal of obstetric, gynecologic, and neonatal nursing,
January-February 2008, 2008-01, January/February 2008, 2008 Jan-Feb, 2008-01-00, 20080101, Letnik:
37, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Interfering with the normal physiological process of labor and birth in the absence of medical necessity increases the risk of complications for mother and baby. Six evidence-based care practices ...promote physiological birth: avoiding medically unnecessary induction of labor, allowing freedom of movement for the laboring woman, providing continuous labor support, avoiding routine interventions and restrictions, encouraging spontaneous pushing in nonsupine positions, and keeping mothers and babies together after birth without restrictions on breastfeeding. Nurses are in a unique position to provide these care practices and to help childbearing women make informed choices based on evidence.
Many rivers are heavily fragmented, resulting from anthropogenic cross‐channel structures. Cost‐effective solutions are needed to restore habitat connectivity for migratory fishes, including those of ...conservation concern, such as the European river lamprey (Lampetra fluviatilis). Studded material is becoming increasingly used as a low‐cost retrofit solution for lamprey passage at sloping weirs, although little is known about the efficacy of the material or what stud arrangements may be most effective. This study tested whether expanding a single‐density studded tile (SDT) lane from 1 to 2‐m width increased passage success (nreleased = 133), and also compared the passage performance between a SDT lane and a dual‐density studded tile (DDT) lane (nreleased = 115) at a sloping weir, using PIT telemetry. No passage was recorded (nattempted = 89) at the 2‐m wide SDT lane, but 61.6% (npassed/attempted = 53/86) passed using DDT/SDT lane combination. However, increased passage efficiency was likely a result of high river flow (Q2.0‐Q30.6) during DDT/SDT comparison versus low (Q8.3‐Q88.5) while the 2‐m wide SDT lane was employed. There was no evidence that passage occurred using solely one stud configuration. It is, therefore, hypothesised that passage of river lamprey at weirs is more dependent on flow regime than the provision of either stud configuration. However, with 46.1% (npassed/released = 53/115) of those released during DDT/SDT comparison passing on the instrumented section (10.5% of weir face), the provision of studded tiles may aid in lamprey passage at high flows, presumably as the tiles generate a low‐velocity boundary layer that can be utilised as lamprey swim above the studs.
(1) Background: The field of medicine requires simple cooling materials. However, there is little knowledge documented about phase change materials (PCM) covering the range of 28 to 40 degrees ...Celsius, as needed for medical use. Induced mild hypothermia, started within 6 h after birth, is an emerging therapy for reducing death and severe disabilities in asphyxiated infants. Currently, this hypothermia is accomplished with equipment that needs a power source and a liquid supply. Neonatal cooling is more frequent in low-resource settings, where ~1 million deaths are caused by birth-asphyxia. (2) Methods: A simple and safe cooling method suitable for medical application is needed for the 28 to 37.5 °C window. (3) Results: Using empirical experiments in which the ingredients in Glauber salt were changed, we studied the effects of temperature on material in the indicated temperature range. The examination, in a controlled manner, of different mixtures of NaCl, Na2SO4 and water resulted in a better understanding of how the different mixtures act and how to compose salt solutions that can satisfy clinical cooling specifications. (4) Conclusions: Our Glauber salt solution is a clinically suited PCM in the temperature interval needed for the cooling of infants suffering from asphyxia.
Fishways are commonly employed to improve river connectivity for fishes, but the extent to which they cater for natural phenotypic diversity has been insufficiently addressed. We measured ...differential upstream passage success of three wild brown trout (Salmo trutta) phenotypes (anadromous, freshwater-resident adult and parr-marked), encompassing a range of sizes and both sexes, at a Larinier superactive baffle fishway adjacent to a flow-gauging weir, using PIT telemetry (n = 160) and radio telemetry (n = 53, double tagged with PIT tags). Fish were captured and tagged downstream of the weir in the autumn pre-spawning period, 2017, in a tributary of the River Wear, England, where over 95% of tributary spawning habitat was available upstream of the weir. Of 57 trout that approached the weir-fishway complex, freshwater-resident adult and parr-marked phenotypes were less successful in passing than anadromous trout (25%, 36%, and 63% passage efficiency, respectively). Seventy-one percent of anadromous trout that passed upstream traversed the weir directly. Although the fishway facilitated upstream passage, it was poor in attracting fish of all phenotypes (overall attraction efficiency, 22.8%). A higher proportion (68.2%) of parr-marked trout that approached the weir were male and included sexually mature individuals, compared with that of freshwater-resident (37.8%) and anadromous trout (37.0%). The greater passage success of anadromous trout was likely due to their greater size and locomotory performance compared to the other phenotypes. Barriers and fishways can act as selection filters, likely the case in this study, and greater consideration needs to be given to supporting natural diversity in populations when proposing fishway designs to mitigate river connectivity problems.
•Route choice and passage success was measured for three brown trout phenotypes.•Fishway entrance had low attraction efficiency for all phenotypes.•More fish traversed weir directly than utilised fishway.•Anadromous trout had greater chance of passing weir than other phenotypes.•Differential passage success between phenotypes may have evolutionary consequences.
Conflicts can arise in developmental pathways that prevent an individual entering different developmental life stages that result in the expression of different phenotypes within a specific time ...period. In salmonids, theory suggests that sexual maturation may inhibit subsequent smolting within the same 12‐month period and that this is partly the result of the time and the apparently conflicting physiological changes for these processes to occur, and partly because of the energy requirements for these physiologically taxing processes. This study tested whether sexually mature male Atlantic salmon (Salmo salar L.) parr, caught in the autumn, would subsequently smolt the following spring. Through individual identification using PIT telemetry, minimum estimates of 3.0% (n = 6/203) and 5.9% (n = 1/17) of Atlantic salmon parr that were sexually mature in two river catchments during the autumn were subsequently identified as smolts in the following spring. We therefore suggest that, in line with previous studies on domesticated Atlantic salmon and laboratory‐based experiments, there is no developmental conflict but that life‐history expression is mediated by environmental and genetic processes.
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