Hepatitis C Screening Practices in a Local County Health Department: A Gap Analysis

Hepatitis C virus (HCV) infection is a growing problem in the United States and most patients remain undiagnosed. CDC guidelines from 2012 recommend one-time screening of everyone born from 1945-1965. The penetration of this guideline is relatively unknown and the literature reveals that most efforts for improvement are poorly sustained. The purpose of this study was to compare a Florida county health department’s screening practices to national guidelines. In addition, provider-level barriers to screening were assessed in order to develop tailored recommendations for improvement. Using a serial cross-sectional design, data was examined to determine HCV screening prevalence for patients born from 1945-1965. Providers were also interviewed to identify barriers to screening. Results indicated HCV screening prevalence improved from 14.3% in 2011 to 25.9% in 2014 but remained well below the 100% birth cohort guideline. Notable barriers included provider confusion over and lack of familiarity with the guideline, an attitude that current practices were adequate, treatment cost concerns, and a perceived lack of referral sources. Other clinics likely have similar suboptimal screening. Health care clinics should assess their HCV screening rates, then evaluate provider-level knowledge, attitude, and external barriers in order to choose locally relevant strategies for sustainable improvement

Selective cooling of the brain in reindeer

Selective cooling of the brain during hyper-thermia has been demonstrated in several species of mammals (Baker 1979, 1982). Such cooling is achieved by heat exchange between the cooled venous blood returning from the nasal mucosa and the warmer arterial blood entering the brain via the carotid rete. Spot measurements of brain temperature (Tbr) and carotid blood temperature (TCar) were made within 1 min. of death in 40 wild reindeer (Rangifer tarandus tarandus). At Tear lower than 40.5°C Tbr was higher than T c a r. With increasing Tear above 40.5°C Tbr remained at approxima-tely 40.5°C, indicating that selective cooling of the brain had occurred

Introducing an Interdisciplinary Frontier to Judging, Emotion and Emotion Work

This special issue of Oñati Socio-Legal Series, titled Judging, Emotion and Emotion Work, is the result of presentations and discussions during an interdisciplinary workshop at the International Institute for the Sociology of Law (IISL) held in May 2018. This issue builds on the growing critique of the dispassionate ideal of judicial work, combining original theoretical insights with imaginative empirical analyses to extend the understanding of emotion in judging. Fifteen articles are presented in four themes: Theoretical, cultural and historical perspectives; Tensions of the dispassionate ideal; Social dynamics of emotion in judging; and Research methods, empirical insights and [changing] judicial practice. The international diversity of contributions recognises similarities and differences in the structure and organization of courts and the judiciary, and socio-cultural variations in emotional experience and expression

An intra ruminal heat exchanger for use in large concious animals

A method is described whereby it is possible to alter total body core temperature independently of environmetal temperature and/or exercise in conscious reindeer. The method employs the use of a simple heat exchanger introduced through a permanent rumen fistula. The heat exchanger consists of a 7 m long coil of flexible plastic tubing (OD, 10.0 mm, ID, 8.0 mm). By perfusing the tubing with thermostatically controlled water, heat can be added to or subtracted from the body core at rates equalling several times resting heat production. It is suggested that the method could be used in any large ruminant species.En intra-rumenal varmeveksler til bruk i større, uanesteserte dyr.Abstract in Norwegian / Sammendrag: Vi har i denne undersøkelsen beskrevet en metode for hvordan kroppstemperatur hos uanesteserte reinsdyr kan endres uavhengig av omgivelsestemperatur og om dyret løper eller ikke. Metoden innebærer bruk av en enkel varmeveksler som plasseres i dyrets vom gjennom en permanent vom-fistel. Varmeveksleren består av en 7 m lang kveil av fleksibel plastslange (ytre diameter 10.0 mm, indre diameter 8.0 mm). Ved å perfundere slangen med vann av en bestemt temperatur er det mulig å fjerne eller tilføre kroppen en varmemengde som tilsvarer flere ganger dyrets varmeproduksjon. Vi mener at denne metoden kan tilpasses alle store drøvtyggere.Potsiin asetettavan låmpotilan muuttajan kåytto suurilla nukkumattomilla elåimillå.Abstract in Finnish / Yhteenveto: Tutkimuksessa olemme kuvanneet menetelman, jolla voidaan muuttaa nukuttamattoman poron ruumiinlåmpotilaa riippumatta ulkolampotilasta tai siita juokseeko elåin vai ei. Menetelmassa kåytaan yksinkertaista låmpotilan muuttajaa, joka asetetaan elaimeen pysyyan potsifistulan kautta. Låmpotilan muuttaja kasittåa 7 m pitkan muoviletkurullan (letkun halkaisija 10.6 mm, reian halkaisija" 8.0 mmJTTayttåmålla letku tietyn lampoisellå vedella on mahdollista joko laskea tai nostaa ruumiin lampomååråa niin, etta se vastaa moninkertaisesti elaimen omaa låmmontuottoa. Oletamme, etta menetelmåa voidaan kayttaå kaikille suurille mårehtijoille

How much synthetic oxytocin is infused during labour? A review and analysis of regimens used in 12 countries.

OBJECTIVE: To compare synthetic oxytocin infusion regimens used during labour, calculate the International Units (IU) escalation rate and total amount of IU infused over eight hours. DESIGN: Observational study. SETTING: Twelve countries, eleven European and South Africa. SAMPLE: National, regional or institutional-level regimens on oxytocin for induction and augmentation labour. METHODS: Data on oxytocin IU dose, infusion fluid amount, start dose, escalation rate and maximum dose were collected. Values for each regimen were converted to IU in 1000ml diluent. One IU corresponded to 1.67μg for doses provided in grams/micrograms. IU hourly dose increase rates were based on escalation frequency. Cumulative doses and total IU amount infused were calculated by adding the dose administered for each previous hour. Main Outcome Measures Oxytocin IU dose infused. RESULTS: Data were obtained on 21 regimens used in 12 countries. Details on the start dose, escalation interval, escalation rate and maximum dose infused were available from 16 regimens. Starting rates varied from 0.06 IU/hour to 0.90 IU/hour, and the maximum dose rate varied from 0.90 IU/hour to 3.60 IU/hour. The total amount of IU oxytocin infused, estimated over eight hours, ranged from 2.38 IU to 27.00 IU, a variation of 24.62 IU and an 11-fold difference. CONCLUSION: Current variations in oxytocin regimens for induction and augmentation of labour are inexplicable. It is crucial that the appropriate minimum infusion regimen is administered because synthetic oxytocin is a potentially harmful medication with serious consequences for women and babies when inappropriately used. Estimating the total amount of oxytocin IU received by labouring women, alongside the institution's mode of birth and neonatal outcomes, may deepen our understanding and be the way forward to identifying the optimal infusion regimen

Experiences of non-progressive and augmented labour among nulliparous women: a qualitative interview study in a Grounded Theory approach

<p>Abstract</p> <p>Background</p> <p>Non-progressive labour is the most common complication in nulliparas and is primarily treated by augmentation. Augmented labour is often terminated by instrumental delivery. Little qualitative research has addressed experiences of non-progressive and augmented deliveries. The aim of this study was to gain a deeper understanding of the experience of non-progressive and augmented labour among nulliparas and their experience of the care they received.</p> <p>Methods</p> <p>A qualitative study was conducted using individual interviews. Data was collected and analysed according to the Grounded Theory method. The participants were a purposive sample of ten women. The interviews were conducted 4–15 weeks after delivery.</p> <p>Results</p> <p>The women had contrasting experiences during the birth process. During labour there was a conflict between the expectation of having a natural delivery and actually having a medical delivery. The women experienced a feeling of separation between mind and body. Interacting with the midwife had a major influence on feelings of losing and regaining control. Reconciliation between the contrasting feelings during labour was achieved. The core category was named Dialectical Birth Process and comprised three categories: Balancing natural and medical delivery, Interacting, Losing and regaining control.</p> <p>Conclusion</p> <p>A dialectical process was identified in these women's experiences of non-progressive labour. The process is susceptible to interaction with the midwife; especially her support to the woman's feeling of being in control. Midwives should secure that the woman's recognition of the fact that the labour is non-progressive and augmentation is required is handled with respect for the dialectical process. Augmentation of labour should be managed as close to the course of natural labour and delivery as possible.</p

The CRCbiome study : a large prospective cohort study examining the role of lifestyle and the gut microbiome in colorectal cancer screening participants

Background: Colorectal cancer (CRC) screening reduces CRC incidence and mortality. However, current screening methods are either hampered by invasiveness or suboptimal performance, limiting their effectiveness as primary screening methods. To aid in the development of a non-invasive screening test with improved sensitivity and specificity, we have initiated a prospective biomarker study (CRCbiome), nested within a large randomized CRC screening trial in Norway. We aim to develop a microbiome-based classification algorithm to identify advanced colorectal lesions in screening participants testing positive for an immunochemical fecal occult blood test (FIT). We will also examine interactions with host factors, diet, lifestyle and prescription drugs. The prospective nature of the study also enables the analysis of changes in the gut microbiome following the removal of precancerous lesions. Methods: The CRCbiome study recruits participants enrolled in the Bowel Cancer Screening in Norway (BCSN) study, a randomized trial initiated in 2012 comparing once-only sigmoidoscopy to repeated biennial FIT, where women and men aged 50-74 years at study entry are invited to participate. Since 2017, participants randomized to FIT screening with a positive test result have been invited to join the CRCbiome study. Self-reported diet, lifestyle and demographic data are collected prior to colonoscopy after the positive FIT-test (baseline). Screening data, including colonoscopy findings are obtained from the BCSN database. Fecal samples for gut microbiome analyses are collected both before and 2 and 12 months after colonoscopy. Samples are analyzed using metagenome sequencing, with taxonomy profiles, and gene and pathway content as primary measures. CRCbiome data will also be linked to national registries to obtain information on prescription histories and cancer relevant outcomes occurring during the 10 year follow-up period. Discussion: The CRCbiome study will increase our understanding of how the gut microbiome, in combination with lifestyle and environmental factors, influences the early stages of colorectal carcinogenesis. This knowledge will be crucial to develop microbiome-based screening tools for CRC. By evaluating biomarker performance in a screening setting, using samples from the target population, the generalizability of the findings to future screening cohorts is likely to be high.Peer reviewe

Comparing the effect of STan (cardiotocographic electronic fetal monitoring (CTG) plus analysis of the ST segment of the fetal electrocardiogram) with CTG alone on emergency caesarean section rates: study protocol for the STan Australian Randomised controlled Trial (START).

BACKGROUND: Cardiotocography is almost ubiquitous in its use in intrapartum care. Although it has been demonstrated that there is some benefit from continuous intrapartum fetal monitoring using cardiotocography, there is also an increased risk of caesarean section which is accompanied by short-term and long-term risks to the mother and child. There is considerable potential to reduce unnecessary operative delivery with up to a 60% false positive diagnosis of fetal distress using cardiotocography alone. ST analysis of the fetal electrocardiogram is a promising adjunct to cardiotocography alone, and permits detection of metabolic acidosis of the fetus, potentially reducing false positive diagnosis of fetal distress. METHODS: This study will be a single-centre, parallel-group, randomised controlled trial, conducted over 3 years. The primary hypothesis will be that the proportion of women with an emergency caesarean section on ST analysis will not equal that for women on cardiotocography monitoring alone. Participants will be recruited at the Women's and Children's Hospital, a high-risk specialty facility with approximately 5000 deliveries per annum. A total of 1818 women will be randomised to the treatment or conventional arm with an allocation ratio of 1:1, stratified by parity. The primary outcome is emergency caesarean section (yes/no). Statistical analysis will follow standard methods for randomised trials and will be performed on an intention-to-treat basis. Secondary maternal and neonatal outcomes will also be analysed. Additional study outcomes include psychosocial outcomes, patient preferences and cost-effectiveness. DISCUSSION: Approximately 20% of Australian babies are delivered by emergency caesarean section. This will be the first Australian trial to examine ST analysis of the fetal electrocardiogram as an adjunct to cardiotocography as a potential method for reducing this proportion. The trial will be among the first to comprehensively examine ST analysis, taking into account the impact on psychosocial well-being as well as cost-effectiveness. This research will provide Australian evidence for clinical practice and guideline development as well as for policy-makers and consumers to make informed, evidence-based choices about care in labour. TRIAL REGISTRATION: ANZCTR, ACTRN1261800006268 . Registered on 19 January 2018

Relevance of the light signaling machinery for cellulase expression in trichoderma reesei (hypocrea jecorina)

<p>Abstract</p> <p>Background</p> <p>In nature, light is one of the most important environmental cues that fungi perceive and interpret. It is known not only to influence growth and conidiation, but also cellulase gene expression. We therefore studied the relevance of the main components of the light perception machinery of <it>Trichoderma reesei </it>(<it>Hypocrea jecorina</it>), ENV1, BLR1 and BLR2, for production of plant cell wall degrading enzymes in fermentations aimed at efficient biosynthesis of enzyme mixtures for biofuel production.</p> <p>Findings</p> <p>Our results indicate that despite cultivation in mostly dark conditions, all three components show an influence on cellulase expression. While we found the performance of the enzyme mixture secreted by a deletion mutant in <it>env1 </it>to be enhanced, the higher cellulolytic activity observed for <it>Δblr2 </it>is mainly due to an increased secretion capacity of this strain. <it>Δblr1 </it>showed enhanced biomass accumulation, but due to its obviously lower secretion capacity still was the least efficient strain in this study.</p> <p>Conclusions</p> <p>We conclude that with respect to regulation of plant cell wall degrading enzymes, the blue light regulator proteins are unlikely to act as a complex. Their regulatory influence on cellulase biosynthesis involves an alteration of protein secretion, which may be due to adjustment of transcription or posttranscriptional regulation of upstream factors. In contrast, the regulatory function of ENV1 seems to involve adjustment of enzyme proportions to environmental conditions.</p