Training the Next Generation of Family Medicine Providers through Group Buprenorphine-Naloxone Visits

Introduction: The rise in opioid use disorders (OUD) and fatal overdoses highlight the need to expand access to and capacity for treating OUD. Medication Assisted Treatment (MAT), a medication/group visit model, done in the office setting, is an effective remedy for treating OUD. Understanding residents’ perspectives on their clinical training in MAT can inform the design of a more effective and responsive curriculum. Methods: A qualitative study using group semi-structured interviews with residents in an urban family medicine residency rotating through a federally qualified health center. Interviews centered on strengths and weaknesses of the MAT program, resident likeliness to prescribe MAT, and potential training that would boost confidence were conducted. Grounded theory was utilized to identify themes among transcripts. Results: Four interrelated themes emerged: modeling and mentorship, harm reduction, skills, and intent. Residents’ desire to treat and views on harm reduction, combined with their skills and mentorship, give them the confidence and intent to utilize MAT post-residency. Discussion: Residents have the desire to prescribe MAT post-residency but lack confidence to do so. This can be attributed to a lack of modeling, mentorship, and skills developed within residency. Addition of this into programs, combined with exposure to harm-reduction as a principle and practice, must be incorporated into programs and could play an important role in closing the “treatment gap” by training the next generation of providers in providing MAT

Characterizing Mathematics Graduate Student Teaching Assistants’ Opportunities to Learn from Teaching

Exemplary models to inform novice instruction and the development of graduate teaching assistants (TAs) exist. What is missing from the literature is the process of how graduate students in model professional development programs make sense of and enact the experiences offered. A first step to understanding TAs’ learning to teach is to characterize how and whether they link observations of student work to hypotheses about student thinking and then connect those hypotheses to future teaching actions. A reason to be interested in these connections is that their strength and coherence determine how well TAs can learn from experiences. We found TAs can connect observations and future teaching, but that the connections vary in quality. Our analysis suggests future revisions to TA development programs, which we discuss in the conclusion

User-centric analytic approach to evaluate the performance of sports facilities: A study of swimming pools

While the performance of sports facilities such as swimming pools is crucial to the health, safety and enjoyment of pool users, little research has been conducted to explore how to analytically evaluate the holistic performance of such facilities from the users' perspective. Even an evaluation framework portraying the key performance attributes of swimming pools is yet to be available. Recognising this research gap, this study aims to adopt a user-centric approach to evaluate the performance of swimming pools and a multi-stage study was initiated. After a thorough literature review, a performance attribute hierarchy for swimming pools was established through a focus group study and then two surveys, covering four swimming pools and 103 pool users interviewed, were conducted in Hong Kong. Analysing the responses using the Analytic Hierarchy Process (AHP) method illustrates that the building services (i.e. utilitarian) aspect of swimming pools is more important than the architectural counterpart, and survey participants cared more about the performance attributes inside water than those outside. This study's novelty lies in that it adopted the user-centric approach, which can differentiate between the relative importance of different swimming pool components and prioritize resources for their maintenance and management. The evaluation framework as well as the findings of the study provides facilities managers with important benchmark criteria for optimising the performance of these sports facilities. In the long run, this study contributes to enabling the project stakeholders to conduct evidence-based decision making over the life cycle of sport facilities development and management

Cross-National Differences in Victimization : Disentangling the Impact of Composition and Context

Varying rates of criminal victimization across countries are assumed to be the outcome of countrylevel structural constraints that determine the supply ofmotivated o¡enders, as well as the differential composition within countries of suitable targets and capable guardianship. However, previous empirical tests of these ‘compositional’ and ‘contextual’ explanations of cross-national di¡erences have been performed upon macro-level crime data due to the unavailability of comparable individual-level data across countries. This limitation has had two important consequences for cross-national crime research. First, micro-/meso-level mechanisms underlying cross-national differences cannot be truly inferred from macro-level data. Secondly, the e¡ects of contextual measures (e.g. income inequality) on crime are uncontrolled for compositional heterogeneity. In this paper, these limitations are overcome by analysing individual-level victimization data across 18 countries from the International CrimeVictims Survey. Results from multi-level analyses on theft and violent victimization indicate that the national level of income inequality is positively related to risk, independent of compositional (i.e. micro- and meso-level) di¡erences. Furthermore, crossnational variation in victimization rates is not only shaped by di¡erences in national context, but also by varying composition. More speci¢cally, countries had higher crime rates the more they consisted of urban residents and regions with lowaverage social cohesion.

Direct-acting antivirals and hepatocellular carcinoma in chronic hepatitis C: A few lights and many shadows

With the introduction of direct-acting antiviral agents (DAA), the rate of sustained virological response (SVR) in the treatment of hepatitis C virus (HCV) has radically improved to over 95%. Robust scientific evidence supports a beneficial role of SVR after interferon therapy in the progression of cirrhosis, resulting in a decreased incidence of hepatocellular carcinoma (HCC). However, a debate on the impact of DAAs on the development of HCC is ongoing. This review aimed to analyse the scientific literature regarding the risk of HCC in terms of its recurrence and occurrence after the use of DAAs to eradicate HCV infection. Among 11 studies examining HCC occurrence, the de novo incidence rate ranged from 0 to 7.4% (maximum follow-up: 18 mo). Among 18 studies regarding HCC recurrence, the rate ranged from 0 to 54.4% (maximum "not well-defined" followup: 32 mo). This review highlights the major difficulties in interpreting data and reconciling the results of the included studies. These difficulties include heterogeneous cohorts, potential misclassifications of HCC prior to DAA therapy, the absence of an adequate control group, short follow-up times and different kinds of follow-up. Moreover, no clinical feature-based scoring system accounts for the molecular characteristics and pathobiology of the tumours. Nonetheless, this review does not suggest that there is a higher rate of de novo HCC occurrence or recurrence after DAA therapy in patients with previous HCV infection. \ua9 2018 The Author(s). Published by Baishideng Publishing Group Inc. All rights reserved

Making Waves:Collaboration in the time of SARS-CoV-2 - rapid development of an international co-operation and wastewater surveillance database to support public health decision-making

The presence of SARS-CoV-2 RNA in wastewater was first reported in March 2020. Over the subsequent months, the potential for wastewater surveillance to contribute to COVID-19 mitigation programmes has been the focus of intense national and international research activities, gaining the attention of policy makers and the public. As a new application of an established methodology, focused collaboration between public health practitioners and wastewater researchers is essential to developing a common understanding on how, when and where the outputs of this non-invasive community-level approach can deliver actionable outcomes for public health authorities. Within this context, the NORMAN SCORE “SARS-CoV-2 in sewage” database provides a platform for rapid, open access data sharing, validated by the uploading of 276 data sets from nine countries to-date. Through offering direct access to underpinning meta-data sets (and describing its use in data interpretation), the NORMAN SCORE database is a resource for the development of recommendations on minimum data requirements for wastewater pathogen surveillance. It is also a tool to engage public health practitioners in discussions on use of the approach, providing an opportunity to build mutual understanding of the demand and supply for data and facilitate the translation of this promising research application into public health practice.</p

Making Waves : Collaboration in the time of SARS-CoV-2-rapid development of an international co-operation and wastewater surveillance database to support public health decision-making

The presence of SARS-CoV-2 RNA in wastewater was first reported in March 2020. Over the subsequent months, the potential for wastewater surveillance to contribute to COVID-19 mitigation programmes has been the focus of intense national and international research activities, gaining the attention of policy makers and the public. As a new application of an established methodology, focused collaboration between public health practitioners and wastewater researchers is essential to developing a common understanding on how, when and where the outputs of this non-invasive community-level approach can deliver actionable outcomes for public health authorities. Within this context, the NORMAN SCORE "SARS-CoV-2 in sewage" database provides a platform for rapid, open access data sharing, validated by the uploading of 276 data sets from nine countries to-date. Through offering direct access to underpinning meta-data sets (and describing its use in data interpretation), the NORMAN SCORE database is a resource for the development of recommendations on minimum data requirements for wastewater pathogen surveillance. It is also a tool to engage public health practitioners in discussions on use of the approach, providing an opportunity to build mutual understanding of the demand and supply for data and facilitate the translation of this promising research application into public health practice. (C) 2021 Elsevier Ltd. All rights reserved.Peer reviewe

Cardiovascular Effects of Unilateral Nephrectomy in Living Kidney Donors

ABSTRACT—: There is a robust inverse graded association between glomerular filtration rate (GFR) and cardiovascular risk, but proof of causality is lacking. Emerging data suggest living kidney donation may be associated with increased cardiovascular mortality although the mechanisms are unclear. We hypothesized that the reduction in GFR in living kidney donors is associated with increased left ventricular mass, impaired left ventricular function, and increased aortic stiffness. This was a multicenter, parallel group, blinded end point study of living kidney donors and healthy controls (n=124), conducted from March 2011 to August 2014. The primary outcome was a change in left ventricular mass assessed by magnetic resonance imaging (baseline to 12 months). At 12 months, the decrease in isotopic GFR in donors was −30±12 mL/min/1.73m(2). In donors compared with controls, there were significant increases in left ventricular mass (+7±10 versus −3±8 g; P<0.001) and mass:volume ratio (+0.06±0.12 versus −0.01±0.09 g/mL; P<0.01), whereas aortic distensibility (−0.29±1.38 versus +0.28±0.79×10(−3) mm Hg(−1); P=0.03) and global circumferential strain decreased (−1.1±3.8 versus +0.4±2.4%; P=0.04). Donors had greater risks of developing detectable highly sensitive troponin T (odds ratio, 16.2 [95% confidence interval, 2.6–100.1]; P<0.01) and microalbuminuria (odds ratio, 3.8 [95% confidence interval, 1.1–12.8]; P=0.04). Serum uric acid, parathyroid hormone, fibroblast growth factor-23, and high-sensitivity C-reactive protein all increased significantly. There were no changes in ambulatory blood pressure. Change in GFR was independently associated with change in left ventricular mass (R(2)=0.28; P=0.01). These findings suggest that reduced GFR should be regarded as an independent causative cardiovascular risk factor. CLINICAL TRIAL REGISTRATION—: URL: http://www.clinicaltrials.gov. Unique identifier: NCT01028703