The use of antilibidinal medications in the treatment of sexual offenders

Antilibidinal medications can be used to reduce a sexual offender’s deviant sexual fantasies and arousal. We briefly review what these medications are and what effects they have, how commonly they are used or should be used, how effective they actually are, and finally in our clinical opinion which sex offenders would benefit from the taking these medications. We also raise briefly some of the ethical, legal, and medical implications of their use

Population genetic structure of serotine bats (Eptesicus serotinus) across Europe and implications for the potential spread of bat rabies (European bat lyssavirus EBLV-1)

This is the author accepted manuscript. The final version is available from the publisher via the DOI in this record.Understanding of the movements of species at multiple scales is essential to appreciate patterns of population connectivity and in some cases, the potential for pathogen transmission. The serotine bat (Eptesicus serotinus) is a common and widely distributed species in Europe where it frequently harbours European bat lyssavirus type 1 (EBLV-1), a virus causing rabies and transmissible to humans. In the United Kingdom, it is rare, with a distribution restricted to south of the country and so far the virus has never been found there. We investigated the genetic structure and gene flow of E. serotinus across the England and continental Europe. Greater genetic structuring was found in England compared with continental Europe. Nuclear data suggest a single population on the continent, although further work with more intensive sampling is required to confirm this, while mitochondrial sequences indicate an east-west substructure. In contrast, three distinct populations were found in England using microsatellite markers, and mitochondrial diversity was very low. Evidence of nuclear admixture indicated strong male-mediated gene flow among populations. Differences in connectivity could contribute to the high viral prevalence on the continent in contrast with the United Kingdom. Although the English Channel was previously thought to restrict gene flow, our data indicate relatively frequent movement from the continent to England highlighting the potential for movement of EBLV-1 into the United Kingdom.We acknowledge DEFRA and University of Exeter for funding this stud

Solution generating with perfect fluids

We apply a technique, due to Stephani, for generating solutions of the Einstein-perfect fluid equations. This technique is similar to the vacuum solution generating techniques of Ehlers, Harrison, Geroch and others. We start with a ``seed'' solution of the Einstein-perfect fluid equations with a Killing vector. The seed solution must either have (i) a spacelike Killing vector and equation of state P=rho or (ii) a timelike Killing vector and equation of state rho+3P=0. The new solution generated by this technique then has the same Killing vector and the same equation of state. We choose several simple seed solutions with these equations of state and where the Killing vector has no twist. The new solutions are twisting versions of the seed solutions

Phylogeography of the Patagonian otter Lontra provocax: adaptive divergence to marine habitat or signature of southern glacial refugia?

<p>Abstract</p> <p>Background</p> <p>A number of studies have described the extension of ice cover in western Patagonia during the Last Glacial Maximum, providing evidence of a complete cover of terrestrial habitat from 41°S to 56°S and two main refugia, one in south-eastern Tierra del Fuego and the other north of the Chiloé Island. However, recent evidence of high genetic diversity in Patagonian river species suggests the existence of aquatic refugia in this region. Here, we further test this hypothesis based on phylogeographic inferences from a semi-aquatic species that is a top predator of river and marine fauna, the huillín or Southern river otter (<it>Lontra provocax</it>).</p> <p>Results</p> <p>We examined mtDNA sequences of the control region, ND5 and Cytochrome-b (2151 bp in total) in 75 samples of <it>L. provocax </it>from 21 locations in river and marine habitats. Phylogenetic analysis illustrates two main divergent clades for <it>L. provocax </it>in continental freshwater habitat. A highly diverse clade was represented by haplotypes from the marine habitat of the Southern Fjords and Channels (SFC) region (43°38' to 53°08'S), whereas only one of these haplotypes was paraphyletic and associated with northern river haplotypes.</p> <p>Conclusions</p> <p>Our data support the hypothesis of the persistence of <it>L. provocax </it>in western Patagonia, south of the ice sheet limit, during last glacial maximum (41°S latitude). This limit also corresponds to a strong environmental change, which might have spurred <it>L. provocax </it>differentiation between the two environments.</p

Comparison of Marine Spatial Planning Methods in Madagascar Demonstrates Value of Alternative Approaches

The Government of Madagascar plans to increase marine protected area coverage by over one million hectares. To assist this process, we compare four methods for marine spatial planning of Madagascar's west coast. Input data for each method was drawn from the same variables: fishing pressure, exposure to climate change, and biodiversity (habitats, species distributions, biological richness, and biodiversity value). The first method compares visual color classifications of primary variables, the second uses binary combinations of these variables to produce a categorical classification of management actions, the third is a target-based optimization using Marxan, and the fourth is conservation ranking with Zonation. We present results from each method, and compare the latter three approaches for spatial coverage, biodiversity representation, fishing cost and persistence probability. All results included large areas in the north, central, and southern parts of western Madagascar. Achieving 30% representation targets with Marxan required twice the fish catch loss than the categorical method. The categorical classification and Zonation do not consider targets for conservation features. However, when we reduced Marxan targets to 16.3%, matching the representation level of the “strict protection” class of the categorical result, the methods show similar catch losses. The management category portfolio has complete coverage, and presents several management recommendations including strict protection. Zonation produces rapid conservation rankings across large, diverse datasets. Marxan is useful for identifying strict protected areas that meet representation targets, and minimize exposure probabilities for conservation features at low economic cost. We show that methods based on Zonation and a simple combination of variables can produce results comparable to Marxan for species representation and catch losses, demonstrating the value of comparing alternative approaches during initial stages of the planning process. Choosing an appropriate approach ultimately depends on scientific and political factors including representation targets, likelihood of adoption, and persistence goals

Treatments for people who use anabolic androgenic steroids: a scoping review.

BACKGROUND: A growing body of evidence suggests that anabolic androgenic steroids (AAS) are used globally by a diverse population with varying motivations. Evidence has increased greatly in recent years to support understanding of this form of substance use and the associated health harms, but there remains little evidence regarding interventions to support cessation and treat the consequences of use. In this scoping review, we identify and describe what is known about interventions that aim to support and achieve cessation of AAS, and treat and prevent associated health problems. METHODS: A comprehensive search strategy was developed in four bibliographic databases, supported by an iterative citation searching process to identify eligible studies. Studies of any psychological or medical treatment interventions delivered in response to non-prescribed use of AAS or an associated harm in any setting were eligible. RESULTS: In total, 109 eligible studies were identified, which included case reports representing a diverse range of disciplines and sources. Studies predominantly focussed on treatments for harms associated with AAS use, with scant evidence on interventions to support cessation of AAS use or responding to dependence. The types of conditions requiring treatment included psychiatric, neuroendocrine, hepatic, kidney, cardiovascular, musculoskeletal and infectious. There was limited evidence of engagement with users or delivery of psychosocial interventions as part of treatment for any condition, and of harm reduction interventions initiated alongside, or following, treatment. Findings were limited throughout by the case report study designs and limited information was provided. CONCLUSION: This scoping review indicates that while a range of case reports describe treatments provided to AAS users, there is scarce evidence on treating dependence, managing withdrawal, or initiating behaviour change in users in any settings. Evidence is urgently required to support the development of effective services for users and of evidence-based guidance and interventions to respond to users in a range of healthcare settings. More consistent reporting in articles of whether engagement or assessment relating to AAS was initiated, and publication within broader health- or drug-related journals, will support development of the evidence base

An Exploration of Three New South Wales Nurse Practitioner Services in 2008

Background To control increasing health costs, the Australian government initiated a range of health care reforms in the late 1990s. In 2000, the development of the Nurse Practitioner (NP) Service in New South Wales (NSW) was one strategy implemented to improve health care delivery. Supported by legislation, NPs extended their role beyond other nursing roles. The number of NPs in NSW doubled between 2004 and 2007, and NP Services flourished. With little published evidence, research was vital to justify the contribution of this new and rapidly evolving service model to existing health services and the acceptability of the new service model to patients seeking health care. Through interviewing relevant stakeholders and a medical record audit, this study generated knowledge about both the integration of the NP Service with existing health services and patient perceptions of the NP Service. Aim and Research Objectives Aim: Using an intrinsic case study design, the aim of this study was to gain an understanding of the early implementation of the NSW NP Service in 2008. Specifically, this study sought to answer five research objectives: 1) To understand the physical environment and organisational characteristics of the NP Service. 2) To investigate the patient care provided by the NP Service. 3) To examine NPs’ views about their role and its integration into the existing health care team. 4) To investigate health professionals’ views about the NP Service and its integration into the existing health care team. 5) To examine the patients’ experiences of the NP Service. Methods Using Stake’s (1995) classification, this intrinsic case study design was conducted from November 2008 to April 2009. The case was the NP Service and three services were studied as embedded units. Three NPs from three different health services (a mental health NP working in an emergency department, an emergency NP working in the subacute area of an emergency department and a neonatal NP working in neonatal intensive care), who met the inclusion criteria of being authorised and endorsed nurse practitioners, were sampled by geographical and service diversity. Data sources included participant observation, interviews and medical record audit. Participant observation examined the physical and organisational characteristics of the NP Service. The NPs were interviewed about their role and integration with health care teams using face-to-face semi-structured interviews. Semi-structured interviews were also conducted with 5 health professionals and 5 patients per site, selected using maximum variation sampling, about their views and experiences of the NP Service. A medical record audit of 10 consecutive patients (included those interviewed plus an additional 5 patients per site) was undertaken following consultation with the NP, to identify the elements of care provided by the NP. Qualitative data (interviews and participant observation) were analysed using thematic analysis, triangulation and concept modelling. Medical record audit data were analysed descriptively. Enablers and constrainers to the implementation of the NP Service were identified. Results were compared and contrasted within and between the three sites. Findings: Medical record audit data showed that all three NPs engaged in therapeutic communication (96.7%), prescribed medications (80%) and referred patients for further assessment (73.3%). From thematic analysis, four themes emerged that reflected the concept of evolution: speciation, adaptation, co-operation and succession. Enabling factors that supported the implementation of the NP Service included the legislated protection of the NP title and scope of practice, and the development of standards of practice. The perceived overlapping boundaries between the NP and other colleagues on the health team were identified as constrainers during implementation. Findings were consistent across all three sites. Conclusion: This thesis provides new knowledge on the implementation and evolution of the NP Service in NSW. New knowledge includes support given (or withheld) to the NP Services, the physical environment and organisational characteristics of each service, the diversity of patient care provided, the perceptions of NPs and health professionals regarding integration of the NP Service with existing services, and patients’ understanding of their experience with the NP Service. NPs have worked through the stages of speciation and adaptation to define the scope and work differentiating them from their colleagues. Through co-operation with their colleagues NPs continue to define their specific contribution to the health care team, but they experience ongoing impediments to establishing succession, primarily due to organisational and fiscal constraints within the workplace. Two key recommendations from this study were the need for better communication with patients and health professionals about the role of the NP Service and the need to generate short and long-term workforce strategies to sustain NP Services. If the NP Service is to be viable in the future, health services need to develop comprehensive communication strategies to promote the role of the NP Service and establish strong and formal succession planning programs