"New Choices" for women with addictions: perceptions of program participants

BACKGROUND: Substance use in pregnancy is a major public health problem. It can have profound effects on pregnancy outcomes, and childhood health and development. Additionally, women who use substances have their own health-related issues. Although intervention is important, these women often have difficulty using traditional systems of care. The New Choices program is a centralized, multi-sector approach to service delivery that has attempted to overcome barriers to care by offering one-stop shopping in a supportive environment. As part of an evaluation of this program designed for women who are pregnant and/or parenting young children, interviews were conducted with participants to gain insight into their experiences in New Choices and perceptions of any changes attributed to program involvement. METHODS: A qualitative, exploratory design was used to guide data collection and analysis. Four women participated in a focus group interview and seven women agreed to individual interviews over the course of the program evaluation (N = 11). A semi-structured interview guide was used to explore women's experiences in New Choices and their perceptions of the program and its impact. The interview data were analyzed using NVivo software and an inductive approach to data analysis. RESULTS: The emergent themes captured women's motivations for attending New Choices, benefits of participation, and overall quality of the program. Children were the primary motivating factor for program enrollment. Perceived benefits included decreased substance use, improved maternal health, enhanced opportunity for employment, increased access to other resources, enhanced parenting skills, and improved child behaviour and development. Women highly valued the comprehensive and centralized approach to service delivery that provided a range of informal and formal supports. CONCLUSIONS: Interview findings endorse the appropriateness and potential efficacy of a collaborative, centralized approach to service provision for women with substance use issues. Although the findings provide insight into an alternative model of service delivery for women with addictions, future research is needed to evaluate the effectiveness of the intervention. Research also is needed to determine which program components or constellation of components contribute to desired outcomes, and to learn more about processes that underlie changes in behaviour

Family Physician attitudes about prescribing using a drug formulary

<p>Abstract</p> <p>Background</p> <p>Drug formularies have been created by third party payers to control prescription drug usage and manage costs. Physicians try to provide the best care for their patients. This research examines family physicians' attitudes regarding prescription reimbursement criteria, prescribing and advocacy for patients experiencing reimbursement barriers.</p> <p>Methods</p> <p>Focus groups were used to collect qualitative data on family physicians' prescribing decisions related to drug reimbursement guidelines. Forty-eight family physicians from four Ontario cities participated. Ethics approval for this study was received from the Hamilton Health Sciences/Faculty of Health Sciences Research Ethics Board at McMaster University. Four clinical scenarios were used to situate and initiate focus group discussions about prescribing decisions. Open-ended questions were used to probe physicians' experiences and attitudes and responses were audio recorded. NVivo software was used to assist in data analysis.</p> <p>Results</p> <p>Most physicians reported that drug reimbursement guidelines complicated their prescribing process and can require lengthy interpretation and advocacy for patients who require medication that is subject to reimbursement restrictions.</p> <p>Conclusion</p> <p>Physicians do not generally see their role as being cost-containment monitors and observed that cumbersome reimbursement guidelines influence medication choice beyond the clinical needs of the patient, and produce unequal access to medication. They observed that frustration, discouragement, fatigue, and lack of appreciation can often contribute to family physicians' failure to advocate more for patients. Physicians argue cumbersome reimbursement regulations contribute to lower quality care and misuse of physicians' time increasing overall health care costs by adding unnecessary visits to family physicians, specialists, and emergency rooms.</p

The relationship between daytime napping and glycemic control in people with type 2 diabetes

AimTo examine the association between napping characteristics and glycemic control in people with type 2 diabetes.DesignThis study used a cross-sectional design.MethodsA convenience sample of people with type 2 diabetes (N=226) were included. Glycemic control was indicated by HbA1c which was measured by A1C Now®+. Napping characteristics including napping frequency, duration, timing, and type were measured by validated questionnaires. Other variables, such as insomnia, cognitive impairment, and depression were measured by the Insomnia Severity Index, Montreal Cognitive Assessment, and Patient Health Questionnaire-9, respectively. Multivariate linear regression analyses were performed.ResultsThe sample consisted of 122 women (54.0%), with a median age of 67 years. Their median HbA1c was 6.8%. No significant relationship was found between napping frequency and HbA1c. Among nappers, after controlling for covariates, long napping duration (≥60 min) and morning napping were both associated with poorer glycemic control. Compared with appetitive napping, restorative napping was associated with better glycemic control.ConclusionDaytime napping (e.g., duration and type) is an important modifiable factor for glycemic control in people with type 2 diabetes. This study provides new insights into the relationship between napping and glucose management among people with diabetes

Well-dispersed Pd–Sn nanocatalyst anchored on TiO 2 nanosheets with enhanced activity and durability for ethanol electarooxidation

Abstract(#br)Novel Pd 1 -Sn x /TiO 2 nanosheets catalyst with higher activity and durability for ethanol oxidation (EOR) was obtained by NaBH 4 co-reduction method in direct ethanol fuel cells (DEFCs). The electrochemical performance tested under alkaline conditions illustrates that the prepared Pd 1 –Sn 0.6 /TiO 2 NSs catalyst presents outstanding activity (3381 mA mg Pd − 1 ) and excellent CO anti-poisoning ability for EOR. Meanwhile, the residual current density of Pd 1 –Sn 0.6 /TiO 2 NSs nanocatalyst (1207 mA mg Pd − 1 ) is 8.5 times of the Pd/C (JM) catalyst (142 mA mg Pd − 1 ) after the durability test of 5000 s for EOR. Additionally, the Pd 1 -Sn x /TiO 2 nanosheets show prominent electrocatalytic activity in EOR comparison with Pd/TiO 2 nanosheets and Pd–Sn nanocatalysts. Thus, Pd and Sn doped in TiO 2 nanosheets not only display excellent electrocatalytic, but also reduce the cost of Pd, which have some reference value for DEFCs

Insight-HXMT on-orbit thermal control status and thermal deformation impact analysis

Purpose: The Hard X-ray Modulation Telescope is China's first X-ray astronomy satellite launched on June 15th, 2017, dubbed Insight-HXMT. Active and passive thermal control measures are employed to keep devices at suitable temperatures. In this paper, we analyzed the on-orbit thermal monitoring data of the first 5 years and investigated the effect of thermal deformation on the point spread function (PSF) of the telescopes. Methods: We examined the data of the on-orbit temperatures measured using 157 thermistors placed on the collimators, detectors and their support structures and compared the results with the thermal control requirements. The thermal deformation was evaluated by the relative orientation of the two star sensors installed on the main support structure. its effect was estimated with evolution of the PSF obtained with calibration scanning observations of the Crab nebula. Conclusion: The on-orbit temperatures met the thermal control requirements thus far, and the effect of thermal deformation on the PSF was negligible after the on-orbit pointing calibration.Comment: 25 pages, 35 figures, submitte

Pemetrexed plus Platinum as the First-Line Treatment Option for Advanced Non-Small Cell Lung Cancer: A Meta-Analysis of Randomized Controlled Trials

To compare the efficacy and toxicities of pemetrexed plus platinum with other platinum regimens in patients with previously untreated advanced non-small cell lung cancer (NSCLC). Methods: A meta-analysis was performed using trials identified through PubMed, EMBASE, and Cochrane databases. Two investigators independently assessed the quality of the trials and extracted data. The outcomes included overall survival (OS), progression-free survival (PFS), response rate (RR), and different types of toxicity. Hazard ratios (HRs), odds ratios (ORs) and their 95% confidence intervals (CIs) were pooled using RevMan software. Results: Four trials involving 2,518 patients with previously untreated advanced NSCLC met the inclusion criteria. Pemetrexed plus platinum chemotherapy (PPC) improved survival compared with other platinum-based regimens (PBR) in patients with advanced NSCLC (HR = 0.91, 95% CI: 0.83–1.00, p = 0.04), especially in those with non-squamous histology (HR = 0.87, 95% CI: 0.77–0.98, p = 0.02). No statistically significant improvement in either PFS or RR was found in PPC group as compared with PBR group (HR = 1.03, 95% CI: 0.94–1.13, p = 0.57; OR = 1.15, 95% CI: 0.95–1.39, p = 0.15, respectively). Compared with PBR, PPC led to less grade 3–4 neutropenia and leukopenia but more grade 3–4 nausea. However, hematological toxicity analysis revealed significant heterogeneities. Conclusion: Our results suggest that PPC in the first-line setting leads to a significant survival advantage with acceptable toxicities for advanced NSCLC patients, especially those with non-squamous histology, as compared with other PRB. PPC could be considered as the first-line treatment option for advanced NSCLC patients, especially those with non-squamous histology

Insight-HXMT observations of Swift J0243.6+6124 during its 2017-2018 outburst

The recently discovered neutron star transient Swift J0243.6+6124 has been monitored by {\it the Hard X-ray Modulation Telescope} ({\it Insight-\rm HXMT). Based on the obtained data, we investigate the broadband spectrum of the source throughout the outburst. We estimate the broadband flux of the source and search for possible cyclotron line in the broadband spectrum. No evidence of line-like features is, however, found up to $\rm 150~keV$. In the absence of any cyclotron line in its energy spectrum, we estimate the magnetic field of the source based on the observed spin evolution of the neutron star by applying two accretion torque models. In both cases, we get consistent results with $B\rm \sim 10^{13}~G$, $D\rm \sim 6~kpc$ and peak luminosity of $\rm >10^{39}~erg~s^{-1}$ which makes the source the first Galactic ultraluminous X-ray source hosting a neutron star.Comment: publishe