Pre-Exposure Prophylaxis for HIV Infection as a Public Health Tool

The efficacy of pre-exposure prophylaxis, PrEP, with antiviral agents for prevention of HIV infection has been demonstrated in multiple randomized controlled trials and demonstration projects. These trials have studied prevention at the individual level. The effectiveness of PrEP as a public health intervention to reduce HIV incidence at community and population levels is being actively evaluated but is less well described. In reviewing the available data on PrEP as a public health intervention, three significant examples have demonstrated success, and all have been among communities of gay, bisexual and other men who have sex with men (MSM)

Simulation in the time of COVID 19

© 2020 The Author(s). This an open access work distributed under the terms of the Creative Commons Attribution Licence (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.The Corona virus disease 2019 (COVID-19), FFP3 (filtering face piece-3), COVID, shielding, powered air-purifying respirator (PAPR), donning, doffing... are aA plethora of words and acronyms little known to the simulation community which have been added to our lexicon. A year ago the pre-conference editorial referred to the challenges of an ageing population, complex treatments, limited resources, and out of hospital care. To those we must now add a pandemic which continues to have a colossal impact on society. The world has momentarily been paralysed in order to find strategies to minimise and control the spread of the virus. The economy of every country has suffered as our way of living, working, travelling, and doing business changed. The aims were to minimise the loss of life and not overwhelm the healthcare system. While many “routine” simulation sessions have decreased or even ceased, simulation- based education (SBE) which is directly relevant to dealing with the particulars of an infectious agent has greatly increased. In one of the author’s own hospital, simulation was used to prepare healthcare staff for doffing and donning personal protective equipment (PPE), proning ventilated patients, optimising patient pathways and much more. The pandemic has, in many ways, forced the simulation community to put its money where its mouth is. Years of extolling the benefits of simulation in terms of upskilling, rapid cycle learning and resilience was now put to the test. Even people who were slightly skeptical about SBE became advocates of “trying things out in a safe environment” and encouraged the delivery of training sessions during which clinicians could practise to ensure their own safety and that of their colleagues.Peer reviewe

National Survey of Stroke Survivors: Documenting the Experiences and Levels of Self-Reported Long-Term Need in Stroke Survivors in the First 5 years.Systematic Review:Factors Associated with Community Re-integration in the First 12 months Post Stroke: A Qualitative Synthesis.

Introduction In Ireland it is estimated that there are 30,000 persons living with residual effects of stroke.1 The Irish National Audit of Stroke Care, carried out in 2007, identified substantial deficits in a number of areas including discharge planning, rehabilitation, on-going secondary prevention, and communication with patients and families.2 The present study builds on the findings of the audit. It explores in detail the current needs of people post stroke in Ireland who are living in the community. It also provides a profile of many possible problems that stroke can cause. In addition it provides a comprehensive review of the literature. Aim This report contains two distinct pieces of research: Firstly, a systematic review and qualitative synthesis (metasynthesis) of the literature was conducted. The aim of the systematic review was to identify perceived barriers and facilitators to community re-integration in the first 12 months after stroke, from the perspective of persons with stroke Secondly, a national survey of stroke survivors who experienced their stroke up to 5 years previously was carried out. The aim of the survey was to document the experiences and levels of self-reported long-term need among community-dwelling stroke survivors in Ireland Methods of the National Survey Stroke survivors were recruited to take part in the survey primarily though the Irish Heart Foundation National Stroke Support Group Network and non-statutory organisations that provide support after acquired brain injury. The survey was also advertised online to a broader stroke population. A questionnaire was developed to assess respondents’ own perceptions of their recovery, community re-integration and on-going needs from existing validated questionnaires with the permission of the original authors.3 Data collection took place between June and October 2013. Main findings: Systematic Review Eighteen articles, using qualitative methodology, were included in the final review. Four primary themes that were perceived to act as barriers or facilitators to community re-integration for individuals in the first year after stroke were identified from the included studies: Primary effects of stroke Personal factors Social factors Relationships with professionals National Survey A total of 196 stroke survivors, aged between 24 and 89 years, responded to the surve Mobility difficulties were reported by eighty-three per cent of respondents. Emotional problems, fatigue, concentration and arm dysfunction were reported almost as commonly Of the 150 individuals with emotional difficulties only eleven per cent received psychological services Sixty per cent of respondents felt that their household finances were affected by their stroke. Thirty-six per cent of respondents reported paying privately for rehabilitation. Thirty-four per cent of respondents had to pay privately to adapt their home Over half of respondents needed help with personal care and two thirds needed help with household tasks since their stroke. Family provided most of this help Forty-two per cent of respondents who were in a relationship at the time of the survey felt that it has been significantly affected by their stroke Less than a quarter of respondents under the age of 66 have worked in a full or part-time capacity since their stroke, while sixty per cent of drivers have returned to driving Conclusions Stroke had a personal, social and economical impact on the lives of many respondents. Successful return to work levels after stroke, as reported, were particularly low. Emotional distress and fatigue were common and were barriers to many activities. Satisfaction with the level of help available for these problems was poor

An Importance-Performance Analysis of Local and Destination Visitors to Monocacy National Battlefield

The purpose of this study was to understand the evolving visitor experience at Monocacy National Battlefield (MONO) in Fredrick, Maryland and, specifically, the way this National Park Service site serves both its’ destination and local visitors. Using an Importance-Performance Analysis, segmented by visitors’ county of residence, we demonstrate key differences in the visitor experience across visitor type. Following survey design with MONO managers and approval from the U.S. Office of Management and Budget, onsite sampling occurred over 21 visitor contact days, stratified by day of the week and time of day, in summer and fall of 2021. 469 visitors were contacted across five high-use sites of interest identified by the park (Best Farm, Gambrill Mill, Thomas House, Worthington House, and the MONO Visitors Center). 445 visitors agreed to participate in an online survey, yielding an acceptance rate of 94.9 percent. Surveys were conducted online and completed by visitors following their visit. 287 visitors completed more than 50 percent of the survey yielding a 61.2 percent response rate. Emerging results suggest key differences in the visitor experience across visitor type, as well as potential areas importance shared by diverse visitors to MONO. Results allow the park to use data-driven decision making to plan and manage across visitor type and add to the evolving understanding of how recent recreational trends impact park and historic area managemen

An Importance-Performance Analysis of Local and Destination Visitors to Monocacy National Battlefield

The purpose of this study was to understand the evolving visitor experience at Monocacy National Battlefield (MONO) in Fredrick, Maryland and, specifically, the way this National Park Service site serves both its’ tourist and local visitors. MONO has two main demographics who utilize it: individuals seeking to learn about historical importance of the site in the Civil War and local recreational visitors from Frederick and surrounding communities. Due to MONO’s proximity to the more densely populated area of Fredrick and Civil War roots, it appeals to both of these populations, who find different uses in the park. Accordingly, we were asked to assist the Park, in better understanding the similarities or differences between visitors desired amenities, opportunities, and experiences at the Park to guide future investment, planning and management. To gauge visitors’ perceived importance and performance across different characteristics, an Importance-Performance questionnaire was developed. This process “provides businesses and organizations with a fairly clear assessment of where they are performing well and where improvements are required” (Draper, 2016; Martilla & James, 1977). Following survey design and approval, onsite sampling occurred over 21 visitor contact days in summer and fall of 2021. 469 visitors were contacted across five sites of interest identified by the park. 445 visitors agreed to participate, yielding an acceptance rate of 94.9 percent. Surveys were conducted online and completed by visitors following their visit. 287 visitors completed more than half of the survey yielding a 61.2 percent response rate. Emerging results suggest key differences and similarities across visitor types. References Draper, J. (2016). Applying importance-performance analysis to services of a visitor information center. Tourism and Hospitality Research, 18(1), 84–95. doi: 10.1177/1467358415627300 Martilla, J., & James, J. (1977). Importance-Performance Analysis. Journal of Marketing, 41(1), 77-79. doi:10.2307/1250495https://digitalcommons.odu.edu/gradposters2022_education/1007/thumbnail.jp

Enhancing the Capabilities of Fluid Bed Granulation through Process Automation and Digitalisation

This paper describes a PAT-enabled, digitalised, and automated fluid bed granulation system. A multichannel Near-Infrared (NIR) spectrophotometer and a direct imaging particle size and shape analyser in constant dialogue with the SmartX no-code/low-code platform provide a ground-breaking process automation toolset now located at the Bernal Institute in the University of Limerick. Two sets of results are presented for this study, from two iterations of the Advance Dynamic Process Control (ADPC) controller application. The results demonstrate the direct measurement and control of the product’s critical quality attributes through digitality enabled feedback control of processing setpoints and parameters. The platform controlled the particle size more tightly compared to non-automated control and a more accurate measurement-driven process endpoint for moisture content was achieved. Implementing a digitally enabled control approach can significantly reduce batch to batch variation and greatly improve process performance and product consistency

Enhancement of Multiwalled Carbon Nanotubes’ Electrical Conductivity Using Metal Nanoscale Copper Contacts and Its Implications for Carbon Nanotube-Enhanced Copper Conductivity

Herein, we present an experimental/computational approach for probing the interaction between metal contacts and carbon nanotubes (CNTs) with regard to creating the most efficient, low resistance junction. Tungsten probes have been coated with copper or chromium and the efficiency of nanocontact transport into multiwalled carbon nanotubes (MWCNTs) has been investigated experimentally, using scanning tunneling spectroscopy and nanoscale two-point probe I-V measurements, and in silico, employing DFT calculations. Experimental I-V measurements suggest the relative conductivity of the metal-CNT interaction to be Cu > W > Cr. It has been found that copper when in contact with MWCNTs results in a high density of states at the Fermi level, which contributes states to the conduction band. It was observed that the density of states also increased when chromium and tungsten probes were in contact with CNTs; however, in these cases the density of states increase would only occur under high voltage/high temperature situations. This is demonstrated by an increase in the experimental electrical resistance when compared to the copper probe. These results suggest that in future copper tips should be used when carrying out all intrinsic conduction measurements on CNTs, and they also provide a rationale for the ultraconductivity of Cu-CNT and Cu-graphene composites

Clinical presentation of eating disorders in young males at a tertiary setting

Abstract Background Young males with eating disorders are a neglected study population in eating disorders. The aim of this study was to provide knowledge about the clinical presentation of eating disorders in young males. Methods The data source was the Helping to Outline Paediatric Eating Disorders (HOPE) Project (N ~ 1000), a prospective, ongoing registry comprising consecutive paediatric (<18 years) tertiary eating disorder referrals. Young males with DSM-5 eating disorders (n = 53) were compared with young females with eating disorders (n = 704). Results There was no significant difference in the prevalence of diagnosis of bulimia nervosa (2 % vs 11 %, p = 0.26) among sexes. Males had comparable duration of illness (9 months; p = 0.28) and a significantly earlier age of onset (M = 12 years; p <0.001). Shape concern (2.39 vs 3.57, p <0.001) and weight concern (1.97 vs 3.09, p <0.001) were lower in males, and body mass index z score (−1.61 vs −1.42, p = 0.29) and medical compromise (odds ratio [OR] = 0.64, 95 % CI: 0.36, 1.12) were comparable. Males had a two-folder higher odds of being diagnosed with unspecified feeding or eating disorders (40 % vs 22 % for females, p = 0.004). Driven exercise to control weight and shape was common and comparable in prevalence among males and females (51 % vs 47 %, p = 0.79) and males were less likely to present with self-induced vomiting (OR = 0.23, 95 % CI: 0.09, 0.59). Conclusion Boys with eating disorders are an understudied group with similarities and differences in clinical presentation from girls with eating disorders. Parents and physicians are encouraged to consider changes in weight, disturbed vital signs, and driven, frequent exercise for the purposes of controlling weight or shape, as possible signs of eating disorders among male children. Diagnostic classification, assessment instruments, conceptualisation, and treatment methods need to be refined to improve application to young males