Sharing success - understanding barriers and enablers to secondary prophylaxis delivery for rheumatic fever and rheumatic heart disease

Background: Rheumatic fever (RF) and rheumatic heart disease (RHD) cause considerable morbidity and mortality amongst Australian Aboriginal and Torres Strait Islander populations. Secondary antibiotic prophylaxis in the form of 4-weekly benzathine penicillin injections is the mainstay of control programs. Evidence suggests, however, that delivery rates of such prophylaxis are poor. Methods: This qualitative study used semi-structured interviews with patients, parents/care givers and health professionals, to explore the enablers of and barriers to the uptake of secondary prophylaxis. Data from participant interviews (with 11 patients/carers and 11 health practitioners) conducted in four far north Queensland sites were analyzed using the method of constant comparative analysis. Results: Deficits in registration and recall systems and pain attributed to injections were identified as barriers to secondary prophylaxis uptake. There were also varying perceptions regarding responsibility for ensuring injection delivery. Enablers of secondary prophylaxis uptake included positive patient-healthcare provider relationships, supporting patient autonomy, education of patients, care givers and healthcare providers, and community-based service delivery. Conclusion: The study findings provide insights that may facilitate enhancement of secondary prophylaxis delivery systems and thereby improve uptake of secondary prophylaxis for RF/RHD

Origins of the Ambient Solar Wind: Implications for Space Weather

The Sun's outer atmosphere is heated to temperatures of millions of degrees, and solar plasma flows out into interplanetary space at supersonic speeds. This paper reviews our current understanding of these interrelated problems: coronal heating and the acceleration of the ambient solar wind. We also discuss where the community stands in its ability to forecast how variations in the solar wind (i.e., fast and slow wind streams) impact the Earth. Although the last few decades have seen significant progress in observations and modeling, we still do not have a complete understanding of the relevant physical processes, nor do we have a quantitatively precise census of which coronal structures contribute to specific types of solar wind. Fast streams are known to be connected to the central regions of large coronal holes. Slow streams, however, appear to come from a wide range of sources, including streamers, pseudostreamers, coronal loops, active regions, and coronal hole boundaries. Complicating our understanding even more is the fact that processes such as turbulence, stream-stream interactions, and Coulomb collisions can make it difficult to unambiguously map a parcel measured at 1 AU back down to its coronal source. We also review recent progress -- in theoretical modeling, observational data analysis, and forecasting techniques that sit at the interface between data and theory -- that gives us hope that the above problems are indeed solvable.Comment: Accepted for publication in Space Science Reviews. Special issue connected with a 2016 ISSI workshop on "The Scientific Foundations of Space Weather." 44 pages, 9 figure

Submerged cage culture of fish in supersaturated thermal effluent. 8 Annual Meeting of World Mariculture Society. San Jose (Costa Rica) Jan. 9, 1977.

p. 625-645.A primary drawback for cage culture in heated effluent has been extensive mortalities due to gas bubble disease. This malady, endemic to power plant effluent, is caused by supersaturation of atmospheric gases in water. The objective of this research was to determine the effect of hydrostatic pressure as a possible remedy for gas bubble disease in the discharge canal of a Galveston Bay, Texas, steam-electric plant. Seven estuarine fishes, pinfish (Lagodon rhomboides), spot (Leiostomus xanthurus), Atlantic croaker (Micropogon undulatus), black drum (Pogonias cromis), red drum (Sciaenops ocellata), Atlantic spade-fish (Chaetodipterus faber), and striped mullet (Mugil cephalus), were caged at the surface and bottom of the 3 m-deep discharge canal where total gas saturation frequently exceeded 120% during winter months. Survival in surface cages averaged 1% after 2 weeks, while survival in bottom cages averaged 81% after 12 weeks. No supplemental food was allotted, but an abundance of small organisms was continually sluiced down the discharge canal through the cages. Winter growth rates generally surpassed those of comparable species cultured elsewhere in the cooling water system at ambient temperature and fed a prepared ration. As discharge water temperature approached 35 degrees C, growth rates declined. Other factors affecting growth were cage mesh size, species type, and size of individuals. All fish were maintained in the heated effluent until thermal death to determine the upper lethal temperature limits. These results indicate that submerged cage culture in power plant effluent might offer a significant savings to the culturist by increasing winter growth rates without the expense of feeding.http://gbic.tamug.edu/request.ht