Health care providers acceptance of default prescribing of TB preventive treatment for people living with HIV in Malawi: a qualitative study.

BACKGROUND: Tuberculosis (TB) preventive treatment (TPT) substantially reduces the risk of developing active TB for people living with HIV (PLHIV). We utilized a novel implementation strategy based on choice architecture (CAT) which makes TPT prescribing the default option. Through CAT, health care workers (HCWs) need to "opt-out" when choosing not to prescribe TPT to PLHIV. We assessed the prospective, concurrent, and retrospective acceptability of TPT prescribing among HCWs in Malawi who worked in clinics participating in a cluster randomized trial of the CAT intervention. METHODS: 28 in-depth semi-structured interviews were conducted with HCWs from control (standard prescribing approach) and intervention (CAT approach) clinics. The CAT approach was facilitated in intervention clinics using a default prescribing module built into the point-of-care HIV Electronic Medical Record (EMR) system. An interview guide for the qualitative CAT assessment was developed based on the theoretical framework of acceptability and on the normalization process theory. Thematic analysis was used to code the data, using NVivo 12 software. RESULTS: We identified eight themes belonging to the three chronological constructs of acceptability. HCWs expressed no tension for changing the standard approach to TPT prescribing (prospective acceptability); however, those exposed to CAT described several advantages, including that it served as a reminder to prescribe TPT and routinized TPT prescribing (concurrent acceptability). Some felt that CAT may reduce HCW´s autonomy and might lead to inappropriate TPT prescribing (retrospective acceptability). CONCLUSIONS: The default prescribing module for TPT has now been incorporated into the point-of-care EMR system nationally in Malawi. This seems to fit the acceptability of the HCWs. Moving forward, it is important to train HCWs on how the EMR can be leveraged to determine who is eligible for TPT and who is not, while acknowledging the autonomy of HCWs.

A scoping review of interventions to mitigate common non-communicable diseases among people with TB.

BACKGROUND: Recommendations have been made to integrate screening for common non-communicable diseases (NCDs) within TB programs. However, we must ensure screening is tied to evidence-based interventions before scale-up. We aimed to map the existing evidence regarding interventions that address NCDs that most commonly affect people with TB.METHODS: We systematically searched PubMed, Medline, and Embase for studies that evaluated interventions to mitigate respiratory disease, cardiovascular disease, alcohol and substance use disorder, and mental health disorders among people with TB. We excluded studies that only screened for comorbidity but resulted in no further intervention. We also excluded studies focusing on smoking cessation interventions for which evidence-based guidelines are well established.RESULTS: The search identified 20 studies that met our inclusion criteria. The most commonly evaluated intervention was referral for diabetes care (6 studies). Other interventions included pulmonary rehabilitation (5 studies), care programs for alcohol use disorder (4 studies), and psychosocial support or individual counselling (5 studies).CONCLUSION: There is limited robust evidence to support identified interventions in changing individual outcomes, and a significant knowledge gap remains on the long-term durability of the interventions´ clinical benefit, reach, and effectiveness. Implementation research demonstrating feasibility and effectiveness is needed before scaling up.

Phenazepam: A review of medico-legal deaths in South Scotland between 2010 and 2014.

Phenazepam is a long acting benzodiazepine that is not prescribed in the United Kingdom. In Scotland it has been detected in a large number of post mortem cases, but very little data has been published looking at post mortem concentrations of this drug and indeed concentrations that may be associated with causing death. We looked at all post mortem cases between 2010 and 2014 where phenazepam was found in blood and correlated these with the given cause of death. The data collected shows the variability in reporting of phenazepam deaths and will provide a useful tool for those deciding when phenazepam should or should not be included as a cause of death. Cases discussed include drug related deaths with phenazepam as the sole cause of death (as is), drug related death when the cause of death was noted as being from a combination of phenazepam plus one or more other drugs (range <0.005-0.9mg/L, median 0.10mg/L) and causes of death in non-drug related deaths where phenazepam was detected (hangings range <0.05-0.39mg/L, median 0.09mg/L and deaths due to ischaemic heart disease range 0.05-0.1mg/L, median 0.04mg/L).

The expression and roles of Nde1 and Ndel1 in the adult mammalian central nervous system.

Mental and neurological illnesses affect one in four people. While genetic linkage analyses have shown an association of nuclear distribution factor E (NDE1, or NudE) and its ohnolog NDE-like 1 (NDEL1, or Nudel) with mental disorders, the cellular mechanisms remain unclear. In the present study, we have demonstrated that Nde1 and Ndel1 are differentially localised in the subventricular zone (SVZ) of the forebrain and the subgranular zone (SGZ) of the hippocampus, two regions where neurogenesis actively occurs in the adult brain. Nde1, but not Ndel1, is localized to putative SVZ stem cells, and to actively dividing progenitors of the SGZ. The influence of these proteins on neural stem cell differentiation was investigated by overexpression in a hippocampal neural stem cell line, HCN-A94. Increasing Nde1 expression in this neural stem cell line led to increased neuronal differentiation while decreasing levels of astroglial differentiation. In primary cultured neurons and astrocytes, Nde1 and Ndel1 were found to have different but comparable subcellular localizations. In addition, we have shown for the first time that Nde1 is heterogeneously distributed in cortical astrocytes of human brains. Our data indicate that Nde1 and Ndel1 have distinct but overlapping distribution patterns in mouse brain and cultured nerve cells. They may function differently and therefore their dosage changes may contribute to some aspects of mental disorders.

Understanding knowledge management and information management: the need for an empirical perspective

It summarizes empirical evidence of how KM is practiced in several types of organizations demonstrating the variety of organizational approaches that are used and the processes that are involved.

Relationship of insulin-like growth factor-I and insulin to size and adiposity of under-yearling chinook salmon.

Sub-yearling spring chinook salmon were fed either a LoFat or HiFat diet from February to November. Fish were sampled over 2 days in November, following 24- and 48-h fasts. Length vs. weight relationships between fish fed the two diets were similar; however, fish fed the HiFat diet had roughly twice the body lipid as fish fed the LoFat diet (9% vs. 4.5%, respectively). Plasma IGF-I vs. length relations between fish fed the two diets were similar; overall, there was a strong relation between plasma IGF-I and length (r(2)=0.53). Similarly, plasma log (insulin) vs. length relations did not vary between the two diets; however, the relationship of log (insulin) vs. length was weak (r(2)=0.2). There was little or no relationship between plasma IGF-I or log (insulin) and body adiposity. Finally, there was a weak relationship between plasma IGF-I and log (insulin) (r(2)=0.23).

Effects of ration on somatotropic hormones and growth in coho salmon.

We examined the response of growth hormone (GH), total plasma insulin-like growth-factor I (IGF-I), and growth rate to a change in ration in coho salmon. Tanks of individually tagged fish were placed on high, medium, or low ration, and sampled every 2 weeks for 8 weeks to create a range of growth rates. Some fish received non-lethal blood draws, while others were sampled terminally. Plasma IGF-I levels were higher in high ration fish than in low ration fish from 4 weeks after the beginning of experimental diets to the end of the experiment. GH levels were low and similar in all fish after changing rations, except for the fish in the low ration group at week 2. IGF-I was strongly correlated with specific growth rate in weight in terminally sampled fish after 4 weeks. GH did not correlate with growth rate or IGF-I levels. Growth parameters (length, weight, specific growth rates in weight and length, and condition factor) responded to ration. Serial sampling reduced growth rates and hematocrit, but did not change hormone levels. This study shows that IGF-I responds to changed rations within 2-4 weeks in salmonids.

Screening-level ecological risk assessment of polychlorinated dibenzo-p-dioxins and dibenzofurans in sediments and aquatic biota from the Venice Lagoon, Italy.

Recent monitoring data indicate that portions of Italy's Venice Lagoon ecosystem have been degraded due to biological and chemical pollution from a variety of potential sources. Using polychlorinated dibenzo-p-dioxin (PCDD) and dibenzofuran (PCDF) data collected from sediment, fish and shellfish in the Lagoon, a screening-level ecological risk assessment (ERA) was performed to evaluate the risks to representative aquatic biota and wildlife receptors. Risks to aquatic invertebrates posed by PCDD/Fs in sediment were evaluated by comparing measured tissue concentrations in fish and shellfish to appropriate ecotoxicological reference values. For mammalian and avian receptors, risks posed by theoretical exposures to PCDD/Fs through the food chain were calculated using conservative wildlife exposure models. Results of the screening-level approach indicate that the potential for adverse effects to fish and aquatic invertebrate receptors from PCDD/Fs in surficial sediments are unlikely. Adverse effects to wildlife are possible but highly uncertain, and warrants further investigation in a more comprehensive ERA.

Comparison of confidence between mothers who breastfed and formula fed their preterm infants.

Mothers develop confidence to care for their preterm infants in challenging situations. To date no studies have explored the effects of choice of feeding method on the development of maternal confidence in the preterm population. A descriptive, longitudinal design was used to explore the demographic characteristics of a convenience sample of 173 maternal-preterm infant dyads to examine whether confidence increased over time and to compare levels of confidence between mothers who formula fed and mothers who breastfed their preterm infants. There were no significant differences between feeding groups in maternal confidence; however, maternal confidence within each group increased significantly over time.

An audit of drug usage for in-hospital cardiopulmonary resuscitation.

The objective of this study was to assess the changes in outcome of cardiac arrest due to ventricular fibrillation, asystole and electromechanical dissociation in relation to the changing guidelines for drug therapy set by the U.K. Resuscitation Council. It was a retrospective study of 667 resuscitation records for the years 1982, 1986, 1988, 1989, 1990 and 1991. It took place in a large district general hospital with a regional cardio-thoracic centre. We have audited the asystolic cardiac arrests (N = 271) which occurred outside the cardiac care unit (CCU). Adrenaline (intravenous 1 mg) is now the first line drug followed by atropine at an increased dose (2 mg intravenously); calcium is no longer recommended and sodium bicarbonate should be reserved for cases in which an acidosis has been documented. Atropine use has increased over the 9-year period. Bicarbonate use did not change from 1982 to 1986 but fell progressively to no use at all in 1991. Calcium use has declined since 1982. Adrenaline use has remained unchanged. Survival from asystolic arrests (hospital discharge) has remained unchanged at 0-5.5%. Asystole as a primary event in the CCU was uncommon (N = 17) and no patient was discharged. Over the same period, 60% of patients (N = 92) with a cardiac arrest on CCU due to ventricular fibrillation (VF) were discharged and 55% were alive after 6 months. For VF on the wards (N = 192), only 20% of patients were discharged from hospital. A similar proportion was successful for each year.(ABSTRACT TRUNCATED AT 250 WORDS)

The effect of water-borne magnesium on the dietary magnesium requirement of the rainbow trout (Oncorhynchus mykiss).

Rainbow trout (Oncorhynchus mykiss) (mean initial weight 0.84 g) were fed diets containing graded levels of magnesium (Mg) (78 to 725µg/g) while being exposed to one of several levels in the rearing water (1.4 to 1000 mg/l). Uptake of Mg from the water, in Mg-deficient fish, was linearly related to the water Mg concentrated. It appears that the fish's Mg requirement can be met from either or both the diet or water. Under the experimental conditions, a water-borne concentration of 46 mg/l was calculated to be sufficient to meet the Mg requirement of the fish fed a Mg-free diet.

The impact of a manufacturer's revision of pacemaker service life on the workload of a large pacing center.

In certain batches of a manufacturer's pacemakers, inadequate insulation of the battery cell feed-through mechanism led to internal short-circuiting and premature battery depletion. We describe the impact of the consequent reduction in service life and recommended close supervision of these generators on the follow-up clinics and inpatient workload at a large pacing center. One-hundred and ninety patients had Cordis Gamma series pacemakers implanted between September 1981 and July 1985; 135 have had to undergo premature generator replacement. Eleven of these pacemakers had developed early depletion of rate and 12 no-output failure. Within 3 months of their generator change, 12 patients developed wound sepsis, three of them requiring further system replacement. We calculate that at least 540 extra outpatient appointments, 400 in-hospital patient days and 12 full working days in one of our catheterization laboratories were required to deal with the problems. The pacemaker industry, as well as doctors and technicians involved in pacemaker purchase and implantation, should be aware of the consequences of a major recall not only on workload but also on patient morbidity and anxiety.

Comparison of prescription costs within a group practice.

Records of prescriptions that originated from one group practice and were dispensed at one pharmacy were maintained for one year. The information recorded included the age and sex of the patients, the name of the prescribing doctor, and the drug(s) prescribed and their cost. Analysis of the records showed considerable differences in average prescription costs among doctors. For all the major therapeutic groups, repeat prescriptions were more expensive than new prescriptions, children had cheaper prescription costs than adults, and prescriptions for women were cheaper than those for men. Within an age-sex group or a therapeutic group, however, prescription costs were similar for each doctor. These results indicate that the differences in overall prescribing costs among doctors were not due to different management of the same disorders, but were due to different types of patients being seen.