Association of Primary Care providers Health Habits with Lifestyle Counseling to Hypertensive Elderly Patient: Results of a National Survey

We were interested in studying the association between personal health habits of healthcare providers and their beliefs and practices of lifestyle counseling to elderly hypertensive patients. We conducted a national anonymous cross sectional survey of physicians and nurse practitioners providing primary care. The survey was developed to assess providers’ beliefs and practices of lifestyle counseling as well as personal habits. Beliefs about counseling were assessed by (a) perceived available time, (b) perceived skill, and (c) perceived effectiveness of lifestyle counseling. Reported lifestyle counseling practice were assessed by reported frequency of (a) obtaining lifestyle habits and (b) providing lifestyle counseling to elderly hypertensive patients. We mailed 7,500 mailed surveys and received 774. Providers who reported healthier lifestyle habits reported that they more frequently obtain lifestyle history (p=.004) and provide lifestyle counseling (

Linked symptom monitoring and depression treatment programmes for specialist cancer services: protocol for a mixed-methods implementation study.

INTRODUCTION: There is growing awareness that cancer services need to address patients' well-being as well as treating their cancer. We developed systematic approaches to (1) monitoring patients' symptoms including depression using a 'Symptom Monitoring Service' and (2) providing treatment for those with major depression using a programme called 'Depression Care for People with Cancer'. Used together, these two programmes were found to be highly effective and cost-effective in clinical trials. The overall aims of this project are to: (1) study the process of introducing these programmes into routine clinical care in a large cancer service, (2) identify the challenges associated with implementation and how these are overcome, (3) determine their effectiveness in a routine non-research setting and (4) describe patients' and clinicians' experience of the programmes. METHODS AND ANALYSIS: This is a mixed-methods longitudinal implementation study. We will study the process of implementation in three phases (April 2016-December 2018): 'Pre-implementation' (setting up of the new programmes), 'Early Implementation' (implementation of the programmes in a small number of clinics) and 'Implementation and Maintenance' (implementation in the majority of clinics). We will use the following methods of data collection: (1) contemporaneous logs of the implementation process, (2) interviews with healthcare professionals and managers, (3) interviews with patients and (4) routinely collected clinical data. ETHICS AND DISSEMINATION: The study has been reviewed by a joint committee of Oxford University Hospitals National Health Service Foundation Trust Research and Development Department and the University of Oxford's Clinical Trials and Research Governance Department and judged to be service evaluation, not requiring ethics committee approval. The findings of this study will guide the scaling up implementation of the programmes across the UK and will enable us to construct an implementation toolkit. We will disseminate our findings in publications and at relevant national and international conferences

A portable neutron spectroscope (NSPECT) for detection, imaging and identification of nuclear material

We have developed, fabricated and tested a prototype imaging neutron spectrometer designed for real-time neutron source location and identification. Real-time detection and identification is important for locating materials. These materials, specifically uranium and transuranics, emit neutrons via spontaneous or induced fission. Unlike other forms of radiation (e.g. gamma rays), penetrating neutron emission is very uncommon. The instrument detects these neutrons, constructs images of the emission pattern, and reports the neutron spectrum. The device will be useful for security and proliferation deterrence, as well as for nuclear waste characterization and monitoring. The instrument is optimized for imaging and spectroscopy in the 1-20 MeV range. The detection principle is based upon multiple elastic neutron-proton scatters in organic scintillator. Two detector panel layers are utilized. By measuring the recoil proton and scattered neutron locations and energies, the direction and energy spectrum of the incident neutrons can be determined and discrete and extended sources identified. Event reconstruction yields an image of the source and its location. The hardware is low power, low mass, and rugged. Its modular design allows the user to combine multiple units for increased sensitivity. We will report the results of laboratory testing of the instrument, including exposure to a calibrated Cf-252 source. Instrument parameters include energy and angular resolution, gamma rejection, minimum source identification distances and times, and projected effective area for a fully populated instrument

Press Reports of Animal Hoarding

This article explores how the press reports nonhuman animal hoarding and hoarders. It discusses how 100 articles from 1995 to the present were content analyzed. Analysis revealed five emotional themes that include drama, revulsion, sympathy, indignation, and humor. While these themes draw readers\u27 attention and make disparate facts behind cases understandable by packaging them in familiar formats, they also present an inconsistent picture of animal hoarding that can confuse readers about the nature and significance of this behavior as well as animal abuse, more generally

HIV seroprevalence, self-reported STIs and associated risk factors among men who have sex with men: a cross-sectional study in Rwanda, 2015.

OBJECTIVES: In many populations, men who have sex with men (MSM) are at a high risk of HIV infection. This study aimed to estimate the burden of HIV, other STIs and risk behaviours among Rwandan MSM. METHODS: In this cross-sectional study, we recruited through peer referral men aged between 18 and 60 years, who reported sex with men at least once in the 12 months prior to the survey. Representativeness was increased using 'seeds' from a variety of sources. Signed informed consent was obtained from all participants. Data on demographics, risk behaviours and self-reported STIs were collected through an interviewer-administered questionnaire. We screened all eligible participants for HIV using the Rwanda-approved protocol for rapid HIV detection. RESULTS: 504 MSM were recruited from five major cities in Rwanda. Participants were mostly young (median age 23 years, range 18-55 years) and unmarried (484/504, 96.0%). Thirteen per cent (65/504) of the participants reported past gonorrhoea and/or syphilis infection. Of 504 MSM, 53 (10.5%) reported they were diagnosed and treated for gonorrhoea in the past 12 months and 24 (4.8%) tested positive for HIV. A high proportion (232/504, 46%) reported receiving payment for sex by a man, with almost half of these reporting on more than three occasions (107/232, 46%). Many reported having had an HIV test within the past 12 months (385/504, 76.4%). In multivariate logistic regression models controlling for age, being paid for sex was associated with higher odds of past STI (OR 3.36 (1.82-6.43]; P<0.001) and testing HIV positive (OR 3.13, P<0.05). CONCLUSION: Further research is needed to understand the high rate of payment for sex in this population, which appears to be a major risk factor for STI including HIV

Mapping post-diagnostic dementia care in England: an e-survey

Purpose: Post-diagnostic dementia care is often fragmented in the United Kingdom, with great variation in provision. Recent policies suggest moving towards better community-based care for dementia; however, little is known on how this care is delivered. This study aimed to map the post-diagnostic dementia support provided in England a decade after the introduction of a National Dementia Strategy. Design/methodology/approach: A mixed-methods e-survey (open Nov 2018–Mar 2019) of dementia commissioners in England recruited through mailing lists of relevant organisations was conducted. The authors descriptively summarised quantitative data and carried out thematic analysis of open-ended survey responses. Findings: 52 completed responses were received, which covered 82 commissioning bodies, with representation from each region in England. Respondents reported great variation in the types of services provided. Information, caregiver assessments and dementia navigation were commonly reported and usually delivered by the voluntary sector or local authorities. Integrated pathways of care were seen as important to avoid overlap or gaps in service coverage. Despite an increasingly diverse population, few areas reported providing dementia health services specifically for BME populations. Over half of providers planned to change services further within five years. Practical implications: There is a need for greater availability of and consistency in services in post-diagnostic dementia care across England. Originality/value: Post-diagnostic dementia care remains fragmented and provided by a wide range of providers in England

Development of a research-based classification of approaches to paediatric palliative medicine service provision within children's and young adults' hospices: A mixed methods study.

BACKGROUND: Globally, pioneers in children's palliative care influenced this speciality's development through individual initiatives leading to diverse models of care. Children's and young adults' hospices have now been established around the world. However, service provision varies widely leading to inequities both within countries and internationally. AIM: To describe and classify existing approaches to paediatric palliative medicine in children's and young adults' hospices across the UK. DESIGN: A mixed methods study conducted by telephone interview. SETTING/PARTICIPANTS: Thirty-one leaders of children's hospice care, representing 28 services, 66% of UK children's and young adults' hospice organisations. RESULTS: A geographic-specialist classification was developed through integration of findings, enabling hospices to be classified as Regional specialist, Regional non-specialist, Local specialist and Local non-specialist. Both qualitative and quantitative data demonstrated diversity and inequity in paediatric palliative medicine provision. Of 159 doctors (63.5% of whom were general practitioners) working in participating hospices only 27.5% had specialist training in paediatric palliative medicine. The majority of participating hospices (67.9%) did not have involvement from a paediatric palliative medicine consultant. CONCLUSIONS: Internationally, the integration of specialist children's palliative care teams with existing services is a current challenge. Despite differing approaches to children's palliative care world-wide, models of care which facilitate integration of specialist children's palliative care could benefit a range of countries and contexts. The geographic-specialist classification could be used to inform recommendations for a networked approach to paediatric palliative medicine within children's and young adults' hospices to promote equity for children with life-limiting and life-threatening conditions