Detection of Somatic and Male Specific Coliphages in Fecally Contaminated Shellfish and Harvest Waters

Coliphages are rapidly (<12hrs) and easily detectable candidate indicators of human enteric viruses in seawater and shellfish. Furthermore male-specific (F+) RNA coliphages may be useful in differentiating human and animal fecal contamination by classification into one of their four serogroups. Despite their indicator potential, there has been only limited field evaluation of coliphages as indicator viruses of shellfish quality. We studied the concentrations and types of coliphages in six well characterized estuarine field sites impacted by fecal pollution. At each site, there were three stations designated as either open, transitional or closed to shellfish harvesting according to current classification criteria. Samples of water, oysters, and clams were analyzed for concentrations of somatic coliphages , WG49 bacteriophages and male-specific coliphages seasonally for two years. WG49 bacteriophages and F+ coliphages were enumerated on host Salmonella typhimurium WG49 and somatic coliphages were detected on host E. coli C. Coliphages in water were concentrated by adsorption to and elution from membrane filters followed by double agar layer (DAL) plaque assay. Coliphages were extracted from shellfish by homogenizing in nutrient broth, centrifuging, and recovering the supernatant, and the extract was assayed by DAL. WG49 bacteriophages and F+ and somatic coliphages were more prevalent in shellfish than in water by 1 to 3 orders of magnitude. Bacteriophage concentrations in shellfish were higher at sites of known human fecal pollution. Both types of coliphages varied seasonally, with highest levels in winter, lowest levels in summer and intermediate levels in spring and fall. The results of this study indicate that although all three groups of bacteriophages are more prevalent in shellfish than in water, the WG49 bacteriophages and F+ coliphages may be more reliable indicators of fecal contamination. F+ coliphages are easy to detect and quantify and they offer the potential to detect and distinguish between human and animal fecal pollution. For routine monitoring though, total WG49 bacteriophages may be adequate indicators of fecal contamination in shellfish because they are rapidly detected and give information similar to F+ coliphages.Master of Science in Public Healt

Pharmacists\u27 Role in Harm Reduction: A Survey Assessment of Kentucky Community Pharmacists\u27 Willingness to Participate in Syringe/Needle Exchange

Background: Pharmacists\u27 role in harm reduction is expanding in many states, yet there are limited data on pharmacists\u27 willingness to participate in harm reduction activities. This study assessed community pharmacists\u27 willingness to participate in one harm reduction initiative: syringe/needle exchange. Methods: In 2015, all Kentucky pharmacists with active licenses were emailed a survey that examined attitudes towards participation in syringe/needle exchange. Response frequencies were calculated for community pharmacist respondents. Ordinal logistic regression estimated the impact of community pharmacist characteristics and attitudes on willingness to provide clean needles/syringes to people who inject drugs and to dispose of used syringes/needles, where both dependent variables were defined as Likert-type questions on a scale of 1 (not at all willing) to 6 (very willing). Results: Of 4699 practicing Kentucky pharmacists, 1282 pharmacists responded (response rate = 27.3%); the majority (n = 827) were community pharmacists. Community pharmacists were divided on willingness to provide clean needles/syringes, with 39.1% not willing (score 1 or 2 of 6) and 30% very willing (score 5 or 6 of 6). Few were willing to dispose of used needles/syringes, with only 18.7% willing. Community pharmacists who agreed that pharmacists could have significant public health impact by providing access to clean needles expressed 3.56 times more willingness to provide clean needles (95% CI 3.06-4.15), and 2.04 times more willingness to dispose of used needles (95% CI 1.77-2.35). Chain/supermarket pharmacists (n = 485, 58.6% of community pharmacies) were 39% less likely to express willingness to dispose of used needles (95% CI 0.43-0.87) when compared with independent community pharmacists (n = 342, 41.4% of community pharmacies). Independent pharmacists reported different barriers (workflow) than their chain/supermarket pharmacist colleagues (concerns of clientele). Conclusions: Kentucky community pharmacists were more willing to provide clean needles than to dispose of used needles. Strategies to mitigate barriers to participation in syringe/needle exchange are warranted

Halo Star Streams in the Solar Neighborhood

We have assembled a sample of halo stars in the solar neighborhood to look for halo substructure in velocity and angular momentum space. Our sample includes red giants, RR Lyrae, and red horizontal branch stars within 2.5 kpc of the Sun with [Fe/H] less than -1.0. It was chosen to include stars with accurate distances, space velocities, and metallicities as well as well-quantified errors. We confirm the existence of the streams found by Helmi and coworkers, which we refer to as the H99 streams. These streams have a double-peaked velocity distribution in the z direction. We use the results of modeling of the H99 streams by Helmi and collaborators to test how one might use v_z velocity information and radial velocity information to detect kinematic substructure in the halo. We find that detecting the H99 streams with radial velocities alone would require a large sample. We use the velocity distribution of the H99 streams to estimate their age. From our model of the progenitor of the H99 streams, we determine that it was accreted between 6 and 9 Gyr ago. The H99 streams have [alpha/Fe] abundances similar to other halo stars in the solar neighborhood, suggesting that the gas that formed these stars were enriched mostly by Type II SNe. We have also discovered in angular momentum space two other possible substructures, which we refer to as the retrograde and prograde outliers. The retrograde outliers are likely to be halo substructure, but the prograde outliers are most likely part of the smooth halo. The retrograde outliers have significant structure in the v_phi direction and show a range of [alpha/Fe]. The methods presented in this paper can be used to exploit the kinematic information present in future large databases like RAVE, SDSSII/SEGUE, and Gaia.Comment: 46 pages, 13 figures, and 9 tables. Minor changes to text to match proofed version of the paper. Low resolution figures. High resolution version at http://www.astro.wisc.edu/~kepley/solar_streams.p

Weaving Academic Grace into the Fabric of Online Courses and Faculty Training: First-Year Engineering Student Advice for Online Faculty During the COVID-19 Pandemic and Faculty Responses

Background: In the spring of 2020, COVID-19 forced the majority of higher education online, resulting in a wave of new online students uniquely positioned to offer fresh perspectives and advice to faculty. Purpose: This study investigated the advice offered to online faculty by first-year engineering (FYE) students who were forced online during the pandemic and faculty ideas to address the student advice. Methods: This multi-methods study included qualitative data from 233 FYE students (in 67 teams across four class offerings) who provided advice for online faculty through an end-of-year team assignment, leveraging analytic induction methods for analysis. The Quality Matters Online Instructor Skill Set was used as the theoretical framework for viewing the student results (Quality Matters, 2016). After being presented with the student results, 41 faculty participants within two workshops brainstormed ways to respond to FYEs’ advice. Faculty workshop participants organized their own brainstorming/discussion results by themes within community documents. Results: Students forced online expressed the following needs/desires: instructional design practices appropriate for the online environment; understanding, flexibility, and patience from their faculty (which we defined as Academic Grace); instructor social presence; appropriate pedagogy for online learning environments; effective assessment; technologically capable instructors; and instructor understanding of their institutional context. Faculty advised responding to online students with more Academic Grace. Conclusions: This work reveals a new competency missing from traditional online instructor skills, that of Academic Grace. To embed Academic Grace within online courses, we propose that faculty consider a flexible bichronous model for online courses, in which students can choose to attend synchronous live lectures/classes or cover the material asynchronously at their own convenience. In this model, lecture/class recordings and supplemental asynchronous materials should be provided to foster fluid student movement between the learning modes. We also recommend online faculty training efforts include the components of Academic Grace: understanding, flexibility, and patience

Isometric handgrip (IHG) training-induced reductions in resting blood pressure: Reactivity to a 2-minute handgrip task identifies responders and non-responders in young normotensive individuals

In people with hypertension, systolic blood pressure (SBP) reactivity to an isometric handgrip task (IHGT), but not a cold pressure task (CPT), is predictive of IHG training-induced reductions in resting SBP. To investigate whether these findings could be extended to include young normotensives, resting BP and BP reactivity to an IHGT (2-minute sustained contraction at 30% maximal voluntary contraction, MVC) and a CPT (2-minute hand immersion in a cold water bath) were measured prior to and following 10 weeks of IHG training (4, 2-minute IHG contractions at 30% MVC, using alternating hands, interspersed with 1-minute rest periods, 3X/week) in 7 normotensive individuals (3 females, 4 males; age=25 ± 5.7 years). BP reactivity was derived by calculating the difference between peak stress BP and mean baseline resting BP. Significant training-induced reductions in resting SBP (p<0.001) were strongly correlated with pre-training SBP reactivity to the IHGT (r=-0.8, p=0.03), but not the CPT (r= 0.2, p=0.6). These preliminary findings suggest that SBP reactivity to a short and simple handgrip task can be used as a predictive tool to identify who will respond best to IHG training. It might be possible to further explore how the IHG training stimulus could be optimized in non-responders, to ensure that they too, experience reductions in resting BP

Vaginal progesterone to reduce preterm birth among HIV-infected pregnant women in Zambia: a feasibility study protocol

Abstract Background Women infected with HIV have a risk of preterm birth (PTB) that is twice that among uninfected women, and treatment with antiretroviral therapy (ART) may further increase this risk. Progesterone supplementation reduces the risk of preterm delivery in women who have a shortened cervix in the midtrimester. We propose to study the feasibility of a trial of vaginal progesterone (VP) to prevent PTB among HIV-infected women receiving ART in pregnancy. Given low adherence among women self-administering vaginal study product in recent microbicide trials, we plan to investigate whether adequate adherence to VP can be achieved prior to launching a full-scale efficacy trial. Methods and design One hundred forty HIV-infected pregnant women in Lusaka, Zambia, will be randomly allocated to daily self-administration of either VP or matched placebo, starting between 20 and 24 gestational weeks. The primary outcome will be adherence, defined as the proportion of participants who achieve at least 80% use of study product, assessed objectively with a validated dye stain assay that confirms vaginal insertion of returned single-use applicators. Secondary outcomes will be study uptake, retention, and preliminary efficacy. We will concurrently perform semi-structured interviews with participants enrolled in the study and with women who decline enrollment to assess the acceptability of VP to prevent PTB and of enrollment to a randomized controlled trial. Discussion We hypothesize that VP could prevent PTB among women receiving ART in pregnancy. In preparation for a trial to test this hypothesis, we plan to assess whether participants will be adherent to study product and protocol. Trial registration ClinicalTrial.gov, NCT02970552

Family physicians\u27 responses to personal protective equipment shortages in four regions in Canada: a qualitative study.

BACKGROUND: Despite well-documented increased demands and shortages of personal protective equipment (PPE) during previous disease outbreaks, health systems in Canada were poorly prepared to meet the need for PPE during the COVID-19 pandemic. In the primary care sector, PPE shortages impacted the delivery of health services and contributed to increased workload, fear, and anxiety among primary care providers. This study examines family physicians\u27 (FPs) response to PPE shortages during the first year of the COVID-19 pandemic to inform future pandemic planning. METHODS: As part of a multiple case study, we conducted semi-structured qualitative interviews with FPs across four regions in Canada. During the interviews, FPs were asked to describe the pandemic-related roles they performed over different stages of the pandemic, facilitators and barriers they experienced in performing these roles, and potential roles they could have filled. Interviews were transcribed and a thematic analysis approach was employed to identify recurring themes. For the current study, we examined themes related to PPE. RESULTS: A total of 68 FPs were interviewed across the four regions. Four overarching themes were identified: 1) factors associated with good PPE access, 2) managing PPE shortages, 3) impact of PPE shortages on practice and providers, and 4) symbolism of PPE in primary care. There was a wide discrepancy in access to PPE both within and across regions, and integration with hospital or regional health authorities often resulted in better access than community-based practices. When PPE was limited, FPs described rationing and reusing these resources in an effort to conserve, which often resulted in anxiety and personal safety concerns. Many FPs expressed that PPE shortages had come to symbolize neglect and a lack of concern for the primary care sector in the pandemic response. CONCLUSIONS: During the COVID-19 pandemic response, hospital-centric plans and a lack of prioritization for primary care led to shortages of PPE for family physicians. This study highlights the need to consider primary care in PPE conservation and allocation strategies and to examine the influence of the underlying organization of primary care on PPE distribution during the pandemic

Protocol for: Sheffield Obesity Trial (SHOT): A randomised controlled trial of exercise therapy and mental health outcomes in obese adolescents [ISRCNT83888112]

Background While obesity is known to have many physiological consequences, the psychopathology of this condition has not featured prominently in the literature. Cross-sectional studies have indicated that obese children have increased odds of experiencing poor quality of life and mental health. However, very limited trial evidence has examined the efficacy of exercise therapy for enhancing mental health outcomes in obese children, and the Sheffield Obesity Trial (SHOT) will provide evidence of the efficacy of supervised exercise therapy in obese young people aged 11–16 years versus usual care and an attention-control intervention. Method/design SHOT is a randomised controlled trial where obese young people are randomised to receive; (1) exercise therapy, (2) attention-control intervention (involving body-conditioning exercises and games that do not involve aerobic activity), or (3) usual care. The exercise therapy and attention-control sessions will take place three times per week for eight weeks and a six-week home programme will follow this. Ninety adolescents aged between 11–16 years referred from a children's hospital for evaluation of obesity or via community advertisements will need to complete the study. Participants will be recruited according to the following criteria: (1) clinically obese and aged 11–16 years (Body Mass Index Centile > 98th UK standard) (2) no medical condition that would restrict ability to be active three times per week for eight weeks and (3) not diagnosed with insulin dependent diabetes or receiving oral steroids. Assessments of outcomes will take place at baseline, as well as four (intervention midpoint) and eight weeks (end of intervention) from baseline. Participants will be reassessed on outcome measures five and seven months from baseline. The primary endpoint is physical self-perceptions. Secondary outcomes include physical activity, self-perceptions, depression, affect, aerobic fitness and BMI

A systematic review of strategies to recruit and retain primary care doctors

Background There is a workforce crisis in primary care. Previous research has looked at the reasons underlying recruitment and retention problems, but little research has looked at what works to improve recruitment and retention. The aim of this systematic review is to evaluate interventions and strategies used to recruit and retain primary care doctors internationally. Methods A systematic review was undertaken. MEDLINE, EMBASE, CENTRAL and grey literature were searched from inception to January 2015.Articles assessing interventions aimed at recruiting or retaining doctors in high income countries, applicable to primary care doctors were included. No restrictions on language or year of publication. The first author screened all titles and abstracts and a second author screened 20%. Data extraction was carried out by one author and checked by a second. Meta-analysis was not possible due to heterogeneity. Results 51 studies assessing 42 interventions were retrieved. Interventions were categorised into thirteen groups: financial incentives (n=11), recruiting rural students (n=6), international recruitment (n=4), rural or primary care focused undergraduate placements (n=3), rural or underserved postgraduate training (n=3), well-being or peer support initiatives (n=3), marketing (n=2), mixed interventions (n=5), support for professional development or research (n=5), retainer schemes (n=4), re-entry schemes (n=1), specialised recruiters or case managers (n=2) and delayed partnerships (n=2). Studies were of low methodological quality with no RCTs and only 15 studies with a comparison group. Weak evidence supported the use of postgraduate placements in underserved areas, undergraduate rural placements and recruiting students to medical school from rural areas. There was mixed evidence about financial incentives. A marketing campaign was associated with lower recruitment. Conclusions This is the first systematic review of interventions to improve recruitment and retention of primary care doctors. Although the evidence base for recruiting and care doctors is weak and more high quality research is needed, this review found evidence to support undergraduate and postgraduate placements in underserved areas, and selective recruitment of medical students. Other initiatives covered may have potential to improve recruitment and retention of primary care practitioners, but their effectiveness has not been established

Family physician leadership during the COVID-19 pandemic: roles, functions and key supports.

PURPOSE: Strong leadership in primary care is necessary to coordinate an effective pandemic response; however, descriptions of leadership roles for family physicians are absent from previous pandemic plans. This study aims to describe the leadership roles and functions family physicians played during the COVID-19 pandemic in Canada and identify supports and barriers to formalizing these roles in future pandemic plans. DESIGN/METHODOLOGY/APPROACH: This study conducted semi-structured qualitative interviews with family physicians across four regions in Canada as part of a multiple case study. During the interviews, participants were asked about their roles during each pandemic stage and the facilitators and barriers they experienced. Interviews were transcribed and a thematic analysis approach was used to identify recurring themes. FINDINGS: Sixty-eight family physicians completed interviews. Three key functions of family physician leadership during the pandemic were identified: conveying knowledge, developing and adapting protocols for primary care practices and advocacy. Each function involved curating and synthesizing information, tailoring communications based on individual needs and building upon established relationships. PRACTICAL IMPLICATIONS: Findings demonstrate the need for future pandemic plans to incorporate formal family physician leadership appointments, as well as supports such as training, communication aides and compensation to allow family physicians to enact these key roles. ORIGINALITY/VALUE: The COVID-19 pandemic presents a unique opportunity to examine the leadership roles of family physicians, which have been largely overlooked in past pandemic plans. This study\u27s findings highlight the importance of these roles toward delivering an effective and coordinated pandemic response with uninterrupted and safe access to primary care