“EXCHANGE NORTHERN KY”: AN EVIDENCE-BASED NEEDLE & SYRINGE EXCHANGE PROGRAM SERVING THE NORTHERN KENTUCKY AREA DEVELOPMENT DISTRICT

Intravenous drug users (IDUs) account for nearly 16% of new HIV infections in the United States and almost one half (48%) of newly reported acute hepatitis C virus (HCV) infections have been found to be IDU related.1 Within the Northern Kentucky Area Development District, hepatitis C infections have soared with an incidence of more than 1,000 newly reported cases during 2015 alone.4 Rigorous scientific evidence complied by the U.S. Department of Health & Human Services has indicated that one of the most unique and effective strategies for the curtailing HIV incidence among IDUs is by ensuring users’ access to sterile injection equipment, as part of a well-designed and implemented HIV prevention strategy.8 The intervention adapted and proposed by the Northern Kentucky Health Department (NKHD) aims to provide IDUs within the Northern Kentucky Area Development District with a mobile needle exchange program entitled “Exchange Northern KY,” designed to provide the safe disposal of used needles and syringes for IDUs, supply clean needles to lessen the possibility of HCV infection through shared needles, and assist IDUs with finding treatment and social services with which they may not be currently familiar, as part of a larger community HCV prevention and substance abuse strategy. Resulting health impacts are aimed to primarily include an increase in public knowledge about the services provided by “Exchange Northern KY” to the community, and in long-term outcome goals, a 5% reduction in hepatitis C incidence after three years of program implementation

Improving Door-to-Balloon Times in Adult Patients with ST-Elevation Myocardial Infarction by Utilizing a STEMI-RN

Background: Heart disease is the leading cause of death in Alabama. The national estimated annual incidence of myocardial infarction (MI) is 605,000 new and 200,000 recurrent attacks, of which approximately 170,000 are silent (Tsao et al., 2022). Roughly every 40 seconds, an American will have an MI (Tsao et al., 2022). An ST-elevation myocardial infarction (STEMI) occurs when one or more of the coronary arteries supplying the heart with blood occlude, leading to myocardial injury (Akbar et al., 2021). Clinical practice guidelines for STEMI recommend Door to Balloon (D2B) intervention in 90 minutes or less (O\u27Gara et al., 2013), while the European Society of Cardiology STEMI guidelines recommend reperfusion occur within 60 minutes (Ibanez et al., 2017). Early reperfusion is associated with favorable outcomes, including improved morbidity and mortality (Tsao et al., 2022). Purpose: The Doctor of Nursing Practice (DNP) quality improvement project aims to decrease D2B times to within 60 minutes for patients arriving at the emergency department (ED) with STEMI. The project\u27s goal is to meet the target timeframe at least 90% of the time. Methods: This single-center quality improvement project was held at a regional hospital in Northeast Alabama, utilizing concurrent secondary data from all STEMI patients who underwent percutaneous coronary intervention (PCI). The project compared baseline data (12 weeks during the same implementation period in the previous year) to post-implementation data (12 weeks after implementation). Variables analyzed include door-to-electrocardiogram (ECG) time, door-to-activation of STEMI code, activation-to-arrival in the catheterization laboratory (cath lab), door-to-balloon (D2B) time, location of the lesion, and intervention received. Results: After implementing a STEMI-RN, 60% of cases met the D2B goal of fewer than 60 minutes. In the previous year, 33% of patients met the target of 60 minutes or less. Sample sizes were too small to show statistical significance in the baseline and post-implementation groups. The metric presenting improvement opportunity includes the activation-to-arrival in the cath lab time. More research is needed to determine the cause of the delay. Conclusion: Further study is needed to directly correlate the effect of a STEMI-RN on D2B times

Investigation of water repellency and critical water content in undisturbed and reclaimed soils from the Athabasca Oil Sands Region of Alberta, Canada

Ecosystems are disturbed to extract synthetic crude oil from the Athabasca Oil Sands Region (AOSR) in northern Alberta, Canada. Successful reclamation of mined oil sands sites depends on maximizing water storage and minimizing the potential for erosion. Soil water repellency in the AOSR affects undisturbed sites and consequently reclamation materials. Extreme water repellency may lead to low infiltration rates and hinder reclamation. There is a lack of information about the naturally occurring and pre-existing levels of soil water repellency in the AOSR. Thus, questions arise about the degree of naturally occurring water repellency and the potential for severe water repellency in reclamation soils. Studies were conducted on nine sites in the AOSR in the summers of 2008 and 2009. A range of undisturbed and reclaimed sites, as well as mineral and organic reclamation materials were examined. Five undisturbed Jack Pine stands (classified as A ecosites), four reclaimed sites and reclamation materials including mineral soil, peat and leaf and lichen covering the forest floor (LFH) were studied. For a comparison of methods, one grasslands site in central Saskatchewan was included. Mini and standard tension infiltrometers were compared as a means of measuring soil water repellency index (RI). There was strong variability in RI values between the infiltrometer methods. The mean RI values from the mini infiltrometers were higher than from the standard infiltrometer (9.61 and 3.46, respectively). The variability within sites dominated the variability in RI for the two methods. Despite these obvious trends, RI values between infiltrometer sizes were statistically different for only two individual sites. Increasing the number of sampling points in the second field season did not reduce the variability. The simpler, less expensive mini infiltrometer is as effective as the standard infiltrometer in measuring soil water repellency. This will enable more efficient and extensive monitoring of soil water repellency in reclaimed and undisturbed sites in the AOSR. Soil water repellency of reclaimed and undisturbed sites was investigated in situ using RI, the water droplet penetration time (WDPT) test, and the molarity of ethanol droplet (MED) test. These measures showed similar trends. Variability in soil water repellency was high at both reclaimed and undisturbed sites. The average RI value for the surface of reclaimed sites was higher than that of the subsurface at reclaimed sites; however, there were no statistical differences between RI values of surface reclaimed and undisturbed sites (P =0.213) due to high spatial variability. The critical water content (CWC) of reclamation materials was determined by measuring the contact angle (CA) and WDPT. Generally, CA and WDPT were inversely related to water content, though variability was high and the relationship between water content was weak. The clearest relationship between water repellency and water content was present for the mineral soil samples. Reclaimed mineral soil was generally wettable above gravimetric water contents of 5-10 %, while the coarse textured tarball affected materials were only subcritically water repellent. There was no relationship between water repellency and water content for peat and LFH. The degree of water repellency was statistically higher for peat materials with increasing decomposition levels. The average WDPT was 44, 128 and 217 s for fibric, mesic, and humic peat, respectively. With careful management and monitoring, water repellency may not be a major limitation to reclamation success. The mini tension infiltrometer is an effective method for monitoring soil water repellency in the AOSR

What (actually) matters in literacy education: Contributions from community psychology

This paper describes the critical role community psychology theories played in reframing literacy research involving mainly Māori and Pacific peoples’ extended families and communities. Within a critical social constructionist paradigm, ecological systems theory and holistic, integrative theories of wellbeing brought much-needed new thinking to how family-focused adult literacy education might be theorised and practiced. This reframing marks a challenge to and movement away from still-dominant Western individualistic, behavioural orientated, skills-based and formal economy-focused ways of thinking about people’s literacy abilities. It highlights the important role of community psychology in developing theory, informing policy and enhancing practices in culturally diverse education settings to achieve both educational and quality of life aims. Improving quality of life is not possible through literacy education in and of itself, but rather through the inculcation in programme design and delivery of those things which are fundamental and critical to the participants’ overall wellbeing and welfare

Intraskeletal variation in human cortical osteocyte lacunar density: Implications for bone quality assessment

AbstractOsteocytes and their lacunocanalicular network have been identified as the regulator of bone quality and function by exerting extensive influence over metabolic processes, mechanical adaptation, and mineral homeostasis. Recent research has shown that osteocyte apoptosis leads to a decrease in bone quality and increase in bone fragility mediated through its effects on remodeling. The purpose of this study is to investigate variation in cortical bone osteocyte lacunar density with respect to major factors including sex, age, and intracortical porosity to establish both regional and systemic trends. Samples from the midshaft femur, midshaft rib and distal one-third diaphysis of the radius were recovered from 30 modern cadaveric individuals (15 males and 15 females) ranging from 49 to 100years old. Thick ground undecalcified histological (80μm) cross-sections were made and imaged under bright field microscopy. Osteocyte lacunar density (Ot.Lc.N/B.Ar) and intracortical porosity (%Po.Ar) were quantified. No significant sex differences in Ot.Lc.N/B.Ar or %Po.Ar were found in any element. Linear regressions demonstrated a significant decrease in osteocyte lacunar density (Ot.Lc.N/B.Ar) and increase in intracortical porosity (%Po.Ar) with age for the sex-pooled sample in the femur (R2=0.208, 0.297 respectively) and radius (R2=0.108, 0.545 respectively). Age was unable to significantly predict osteocyte lacunar density or intracortical porosity in the rib (R2=0.058, 0.114 respectively). Comparisons of regression coefficients demonstrated a systemic trend in the decrease in osteocyte lacunar density (Ot.Lc.N/B.Ar) and increase in intracortical porosity (%Po.Ar) with age. In each element, intracortical porosity was significantly negatively correlated with lacunar density for which the radius demonstrated the strongest relationship (r=−0.746). Using pore number (Po.N) as a proxy for available vascularity to support the osteocyte population, Po.N was able to predict 61.8% of variation in osteocyte lacunar number (Ot.Lc.N) in the rib. The femur and radius also demonstrated significant relationships between these variables (R2=0.560 and 0.397 respectively). The results from this study indicate that although the femur, radius and rib may be experiencing systemically influenced declines in osteocyte lacunar density, there may be differential effects at each anatomical site potentially due to age related changes in mechanical loading. With decreasing osteocyte lacunar density in each element, intracortical porosity increased with likely direct impacts on gross bone strength. This study provides a foundation upon which to build interpretations of osteocyte lacunar density values and their effect on differential fracture risk for aging individuals

What do working menopausal women want? A qualitative investigation into women’s perspectives on employer and line manager support

Objectives: To explore women’s perspectives on what employers and managers should, and should not do in relation to women going through the menopause at work. Methods: An online questionnaire was used to collect qualitative data in a cross-sectional study of working women. Three open-ended questions asked peri- and post-menopausal women, aged 45-65 years: (i) what they thought employers could do, or should do, to help menopausal women who may be experiencing difficult menopausal symptoms at work; (ii) how managers should behave, and (iii) how managers should not behave towards women going through the menopause. Results: 137 women responded to the open questions in the survey. An inductive thematic analysis was conducted and three overarching themes emerged. Theme 1 related to employer/manager awareness, specifically to knowledge about the menopause and awareness of how the physical work environment might impact on menopausal women. Theme 2 related to employer/ manager communication skills and behaviors, specifically, those considered helpful and desired and those unhelpful and undesired. Theme 3 described employer actions, involving staff training and raising awareness, and supportive policies such as those relating to sickness absence and flexible working hours. Conclusions: The menopause can be difficult for some women to deal with at work partly due to the working environment. To our knowledge, this is the first study to explore women’s descriptions of how they would like to be treated by employers/managers, and what would be helpful and unhelpful. The results have clear implications for communication about menopause at work and for employer-level policy and practice

A Role for YouTube in Telerehabilitation

YouTube is a free video sharing website that allows users to post and view videos. Although there are definite limitations in the applicability of this website to telerehabilitation, there are possible uses that should not be overlooked. Certain types of therapy, such as errorless learning therapy for certain language and cognitive deficits can be provided remotely via YouTube. In addition, negative emotional reactions to deficits are known to delay or halt recovery. The social networking capability YouTube provides enables individuals with health problems that may be unable to leave their houses an opportunity to gain valuable emotional support by meeting and communicating with others with similar problems. This article address the benefits and limitations of YouTube in the context of telerehabilitation and reports patient feedback on errorless learning therapy for aphasia delivered via videos posted on YouTube.