Developing a Short-term International Study-abroad Program: From Beginning to End

TOPIC: Short-term international immersion experiences have proven to be an excellent strategy for nursing programs to use as a way for students to develop cultural competence. PURPOSE: The purpose of this article is to describe a faculty led short-term nursing study abroad program for undergraduate nursing students to Grenada. A two week study abroad program for seven undergraduate nursing students and two faculty member was organized in partnership with St. Georges University School of Nursing in Grenada. SOURCES OF INFORMATION: The author describes the process of program development that includes the selection of the host country to post travel activities. The author describes how immediately upon arriving in Grenada, the students began their transformational process to becoming more culturally competent, and how adopting the home-stay model ensured greater cultural immersion. The home-stay model provided the students with immediate entry into the cultural environment CONCLUSION: Participation in a short-term study abroad program contributed to students’ self-confidence and fostered leadership growth

Trends and predictors of linkage to HIV outpatient care following diagnosis in the era of expanded testing in England, Wales and Northern Ireland: Results of a national cohort study

OBJECTIVES: We explore trends in linkage to HIV care following diagnosis and investigate the impact of diagnosis setting on linkage in the era of expanded testing. METHODS: All adults (aged ≥ 15 years) diagnosed with HIV between 2005 and 2014 in England, Wales and Northern Ireland (EW&NI) were followed up until the end of 2017. People who died within 1 month of diagnosis were excluded (n = 1009). Trends in linkage to outpatient care (time to first CD4 count) were examined by sub-population and diagnosis setting. Logistic regression identified predictors of delayed linkage of > 1 month, > 3 months and > 1 year post-diagnosis (2012-2014). RESULTS: Overall, 97% (60 250/62 079) of people linked to care; linkage ≤ 1 month was 75% (44 291/59 312), ≤ 3 months was 88% (52 460) and ≤ 1 year was 95% (56 319). Median time to link declined from 15 days [interquartile range (IQR): 4-43] in 2005 to 6 (IQR: 0-20) days in 2014 (similar across sub-populations/diagnosis settings). In multivariable analysis, delayed linkage to care was associated with acquiring HIV through injecting drug use, heterosexual contact or other routes compared with sex between men (> 1 month/3 months/1 year), being diagnosed in earlier years (> 1 month/3 months/1 year) and having a first CD4 ≥ 200 cells/μL (> 3 months/1 year). Diagnosis outside of sexual health clinics, antenatal services and infectious disease units predicted delays of > 1 month. By 3 months, only diagnosis in 'other' settings (prisons, drug services, community and other medical settings) was significant. CONCLUSIONS: Linkage to care following HIV diagnosis is relatively timely in EW&NI. However, non-traditional testing venues should have well-defined referral pathways established to facilitate access to care and treatment

Trends in HIV testing and recording of HIV status in the UK primary care setting: a retrospective cohort study 1995-2005

Objectives: To provide nationally representative data on trends in HIV testing in primary care and to estimate the proportion of diagnosed HIV positive individuals known to general practitioners (GPs). Methods: We undertook a retrospective cohort study between 1995 and 2005 of all general practices contributing data to the UK General Practice Research Database (GPRD), and data on persons accessing HIV care (Survey of Prevalent HIV Infections Diagnosed). We identified all practice-registered patients where an HIV test or HIV positive status is recorded in their general practice records. HIV testing in primary care and prevalence of recorded HIV positive status in primary care were estimated. Results: Despite 11-fold increases in male testing and 19-fold increases in non-pregnant female testing between 1995 and 2005, HIV testing rates remained low in 2005 at 71.3 and 61.2 tests per 100 000 person years for males and females, respectively, peaking at 162.5 and 173.8 per 100 000 person years at 25–34 years of age. Inclusion of antenatal tests yielded a 129-fold increase in women over the 10-year period. In 2005, 50.7% of HIV positive individuals had their diagnosis recorded with a lower proportion in London (41.8%) than outside the capital (60.1%). Conclusion: HIV testing rates in primary care remain low. Normalisation of HIV testing and recording in primary care in antenatal testing has not been accompanied by a step change in wider HIV testing practice. Recording of HIV positive status by GPs remains low and GPs may be unaware of HIV-related morbidity or potential drug interactions

Primary care consultations and costs among HIV-positive individulas in UK primary care 1995-2005: a cohort study

Objectives: To investigate the role of primary care in the management of HIV and estimate primary care-associated costs at a time of rising prevalence. Methods: Retrospective cohort study between 1995 and 2005, using data from general practices contributing data to the UK General Practice Research Database. Patterns of consultation and morbidity and associated consultation costs were analysed among all practice-registered patients for whom HIV-positive status was recorded in the general practice record. Results: 348 practices yielded 5504 person-years (py) of follow-up for known HIV-positive patients, who consult in general practice frequently (4.2 consultations/py by men, 5.2 consultations/py by women, in 2005) for a range of conditions. Consultation rates declined in the late 1990s from 5.0 and 7.3 consultations/py in 1995 in men and women, respectively, converging to rates similar to the wider population. Costs of consultation (general practitioner and nurse, combined) reflect these changes, at £100.27 for male patients and £117.08 for female patients in 2005. Approximately one in six medications prescribed in primary care for HIV-positive individuals has the potential for major interaction with antiretroviral medications. Conclusion: HIV-positive individuals known in general practice now consult on a similar scale to the wider population. Further research should be undertaken to explore how primary care can best contribute to improving the health outcomes of this group with chronic illness. Their substantial use of primary care suggests there may be potential to develop effective integrated care pathways

An integrated study of microstructural, geochemical, and seismic properties of the lithospheric mantle above the Kerguelen plume (Indian Ocean)

International audiencePeridotite xenoliths brought up to the surface by the volcanism of the Kerguelen Islands represent a mantle that has been affected by a high degree of partial melting followed by intense melt percolation above the Kerguelen plume. These xenoliths are therefore particularly suitable to investigate effects of melt-rock interaction on crystallographic fabrics (lattice-preferred orientation (LPO)) of peridotite minerals and on the LPO-induced seismic properties of peridotites above a mantle plume. We have studied a suite of 16 ultramafic samples representative of different degrees of partial melting and magma-rock interaction among which the protogranular harzburgites are the least metasomatised xenoliths and dunites are the ultimate stage of metasomatism. Olivine LPO is characterized by high concentration of [010] axes perpendicular to the foliation and [100] axes close to the lineation or distributed in the foliation plane in harzburgites, whereas the high concentration of [100] axes is parallel to the lineation and [010] axes is perpendicular to the assumed foliation in dunites. Olivine LPO in harzburgites is interpreted as being due to a deformation regime in axial compression or transpression. The fabric strength of olivine decreases progressively from protogranular to poikilitic harzburgites and finally to dunites, for which it remains nevertheless significant (J index 3.8). Seismic properties calculated from LPO of minerals indicate that metasomatism at higher melt/rock ratio lowers the P wave velocities. The most significant difference between harzburgites and dunites corresponds to the distribution of S wave anisotropy. Harzburgites display the maximum of anisotropy within the foliation plane and the minimum of anisotropy perpendicular to the foliation plane, whereas the lowest anisotropy is parallel to the lineation for dunites. These modifications of seismic properties as a result of metasomatic processes may induce seismic heterogeneities in the mantle above the Kerguelen plume. In addition, assuming a lithospheric mantle primarily harzburgitic and structured with a horizontal foliation, the seismic properties calculated for the Kerguelen xenoliths reconcile the rather high anisotropy evidenced by the horizontally propagating surface waves with the apparent isotropy revealed by the absence of splitting of vertically propagating teleseismic SKS waves recorded by the GEOSCOPE Kerguelen station