Estimating the contribution of stimulant injection to HIV and HCV epidemics among people who inject drugs and implications for harm reduction:A modeling analysis

BACKGROUND: Stimulants, such as amphetamines and cocaine, are widely injected among people who inject drugs (PWID). Systematic reviews indicate stimulant injection is associated with HIV and HCV among PWID. Using these associations, we estimated the contribution of stimulant injection to HIV and HCV transmission among PWID. METHODS: We modeled HIV and HCV transmission among PWID, incorporating excess injecting and sexual risk among PWID who inject stimulants. We simulated three illustrative settings with different stimulants injected, prevalence of stimulant injecting, and HIV/HCV epidemiology. We estimated one-year population attributable fractions of stimulant injection on new HIV and HCV infections, and impact of scaling up needle-syringe programs (NSP). RESULTS: In low prevalence settings of stimulant injection (St. Petersburg-like, where 13% inject amphetamine), 9% (2.5-97.5% interval [95%I]: 6-15%) and 7% (95%I 4-11%) of incident HIV and HCV cases, respectively, could be associated with stimulant injection in the next year. With moderate stimulant injection (Montreal-like, where 34% inject cocaine), 29% (95%I: 19–37%) and 19% (95%I: 16-21%) of incident HIV and HCV cases, respectively, could be associated with stimulant injection. In high-burden settings like Bangkok where 65% inject methamphetamine, 23% (95%I:10–34%) and 20% (95%I: 9-27%) of incident HIV and HCV cases could be due to stimulant injection. High-coverage NSP (60%) among PWID who inject stimulants could reduce HIV (by 22-65%) and HCV incidence (by 7-11%) in a decade. DISCUSSION: Stimulant injection contributes substantially to HIV and HCV among PWID. NSP scale-up and development of novel interventions among PWID who inject stimulants are warranted

The Self stepping into the shoes of the Other: Understanding and developing self-perceptions of empathy among prospective physical education teachers through a special school placement

Teachers who demonstrate a high degree of empathy are said to have more positive attitudes towards pupils with disabilities. Therefore, this article sought to explore the influence of a special school placement on prospective teachers’ self-perceptions of empathy. Thirty-two final year undergraduate students participated in focus group interviews and were selected because they aspired to be a physical education teacher and had attended a placement in a special school. Interview transcripts were analysed and the following themes constructed: Stepping into the shoes of the Other; Frustrated ‘for’ not ‘with’ pupils with disabilities; Empathy for planning inclusive lessons and ‘reading’ pupil body language; and Knowing when not to show empathy. All prospective teachers felt that: (a) they could empathise with pupils with disabilities; (b) situated learning experiences within the placement enabled them to reflect on the ways in which their empathy influences their teaching now and could continue to do so in the future; and (c) it was important that teachers demonstrated empathy. Thus, it is recommended that all prospective teachers gain some experience teaching in special schools. Our research also warns against teachers claiming the last, conclusive word about who children with disabilities are, what they think, how they feel and what they want, in myriad contexts and situations

Supporting reasonable adjustments for learners with disabilities in physical education: An investigation into teacher’s perceptions of one online tool

This study sets out to investigate physical education (PE) teachers’ perceptions of the use of an online professional development resource to support making reasonable adjustment for learners with disability. The Equality Act (2010) called on all UK schools to ensure access to PE was equitable for all learners. This means schools have to adopt strategies for making reasonable adjustments so as not to disadvantage learners with any special educational need and disability. Teachers report that they are working towards an inclusive classroom; however, parents of learners with disabilities report that there remains a lack of opportunities for their children to engage with activity. Using purposive sampling, participants were selected for the study after which they were asked to complete a continuing professional development online training course on the subject of making reasonable adjustments for learning with disabilities. Through one-to-one interviews, qualitative data were collected and analysed through thematic analysis. The findings indicated that the online resource was greeted positively by staff and not only supported the PE teachers but also increased their awareness of different approaches to making reasonable adjustments. The findings also indicated that the issue of making reasonable adjustments and the use of the online development tool need to be driven from the school senior leadership team if it is to have value for the whole school community

SmaggIce Version 1.8

SmaggIce version 1.8 is a set of software tools for geometrical modeling of, and generation of grids that conform to, both clean and iced airfoils. Ice shapes, especially those that include rough surfaces, pose difficulty in generating high-quality grids that are essential for predicting airflows by use of computational fluid dynamics. SmaggIce version 1.8 contains software tools needed to overcome this difficulty. For a given airfoil, it allows the user to define the flow domain, decompose the domain into blocks, generate grids, merge gridded blocks, and control the density and smoothness of each grid. Among the unique features of version 1.8 is a thin C-shaped block, called a "viscous sublayer block," which is wrapped around an iced airfoil and its wake line and serves as a means to generate highly controlled grids near the rough ice surface. Users can modify block boundary shapes using control points of non-uniform rational B-spline (NURBS) curves. Concave ice regions can be smoothed during geometrical modeling or creation of the viscous sublayer block

Physically fit or physically literate? Children with special educational needs understanding of physical education

The role of physical literacy within physical education (PE) has become a widely debated topic in recent years. Its role in educating children about physicality through embodiment, skill acquisition and reading the environment is argued to be of great benefit to children. However, whether children understand the role of PE in the development of these competencies is not clear, and this is even truer for children who have special educational needs (SEN). Drawing on qualitative phenomenological data from 30 children in key stages 2 and three (7 to 14 years of age) who have SEN, this paper explores notions of physical fitness and physical literacy as understood by children in PE lessons. It aims to gain insight into the ways that children understand the purpose of PE, and places these perceptions within a physical literacy framework, using the National Curriculum for PE (NCPE) as a foundation. Findings demonstrate that children with SEN perceive PE as a means for improving physical fitness, whereas concepts surrounding physical literacy appear to be lost. The paper concludes by making recommendations for factoring physical literacy components more forcibly into the PE curriculum, and through initial teacher training and continued professional development

Teaching inclusively: are secondary physical education teachers sufficiently prepared to teach in inclusive environments?

Background: Contemporary British educational guidelines, such as the National Curriculum (NC) have adopted inclusivity in the way children with special educational needs (SEN) are taught. Therefore, inclusion has risen up the political agenda, resulting in more children with SEN being taught in mainstream environments. Empirical research has attempted to examine PE teacher's perceptions of inclusion. However, it is evident that PE teachers perceive the training they receive during initial teacher training (ITT) as a constraint on their practice with specific regard to teaching children with SEN. Purpose: This study aimed to determine if student secondary PE teachers are sufficiently prepared to teach children with SEN inclusively, by examining their training at ITT as well as their perceived preparedness and confidence to teach inclusively. Participants and setting: 107 students from a four-year BA (Hons) and a PGCE secondary PE ITT course attending a North West England ITT institution participated in the study. Research design: Survey research was implemented to examine if student secondary PE teachers attending two different ITT courses were sufficiently prepared to teach in inclusive environments. Data collection: A 31-item semi-structured questionnaire comprising predominantly of closed questioning, was used for this study. Open-ended questions were included to collect qualitative data, intended to add richness to the data and explore students' perceptions. Questions focused upon respondents' inclusion training at ITT, the perceived effectiveness of this training, students' preferences in teaching, experience of teaching children with SEN, as well as their perceived preparedness and confidence to teach inclusively

Model projections on the impact of HCV treatment in the prevention of HCV transmission among people who inject drugs in Europe"

Prevention of hepatitis C virus (HCV) transmission among people who inject drugs (PWID) is critical for eliminating HCV in Europe. We estimated the impact of current and scaled-up HCV treatment with and without scaling up opioid substitution therapy (OST) and needle and syringe programmes (NSPs) across Europe over the next 10 years. We collected data on PWID HCV treatment rates, PWID prevalence, HCV prevalence, OST, and NSP coverage from 11 European settings. We parameterised an HCV transmission model to setting-specific data that project chronic HCV prevalence and incidence among PWID. At baseline, chronic HCV prevalence varied from <25% (Slovenia/Czech Republic) to >55% (Finland/Sweden), and <2% (Amsterdam/Hamburg/Norway/Denmark/Sweden) to 5% (Slovenia/Czech Republic) of chronically infected PWID were treated annually. The current treatment rates using new direct-acting antivirals (DAAs) may achieve observable reductions in chronic prevalence (38-63%) in 10 years in Czech Republic, Slovenia, and Amsterdam. Doubling the HCV treatment rates will reduce prevalence in other sites (12-24%; Belgium/Denmark/Hamburg/Norway/Scotland), but is unlikely to reduce prevalence in Sweden and Finland. Scaling-up OST and NSP to 80% coverage with current treatment rates using DAAs could achieve observable reductions in HCV prevalence (18-79%) in all sites. Using DAAs, Slovenia and Amsterdam are projected to reduce incidence to 2 per 100 person years or less in 10 years. Moderate to substantial increases in the current treatment rates are required to achieve the same impact elsewhere, from 1.4 to 3 times (Czech Republic and France), 5-17 times (France, Scotland, Hamburg, Norway, Denmark, Belgium, and Sweden), to 200 times (Finland). Scaling-up OST and NSP coverage to 80% in all sites reduces treatment scale-up needed by 20-80%. The scale-up of HCV treatment and other interventions is needed in most settings to minimise HCV transmission among PWID in Europe. Measuring the amount of HCV in the population of PWID is uncertain. To reduce HCV infection to minimal levels in Europe will require scale-up of both HCV treatment and other interventions that reduce injecting risk (especially OST and provision of sterile injecting equipment

A cost-effectiveness analysis of shortened direct-acting antiviral treatment in genotype 1 noncirrhotic treatment-naive patients with chronic hepatitis C virus

BACKGROUND:Direct-acting antivirals are successful in curing hepatitis C virus infection in more than 95% of patients treated for 12 weeks, but they are expensive. Shortened treatment durations, which may have lower cure rates, have been proposed to reduce costs. OBJECTIVES:To evaluate the lifetime cost-effectiveness of different shortened treatment durations for genotype 1 noncirrhotic treatment-naive patients. METHODS:Assuming a UK National Health Service perspective, we used a probabilistic decision tree and Markov model to compare 3 unstratified shortened treatment durations (8, 6, and 4 weeks) against a standard 12-week treatment duration. Patients failing shortened first-line treatment were re-treated with a 12-week treatment regimen. Parameter inputs were taken from published studies. RESULTS:The 8-week treatment duration had an expected incremental net monetary benefit of £7737 (95% confidence interval £3242-£11 819) versus the standard 12-week treatment, per 1000 patients. The 6-week treatment had a positive incremental net monetary benefit, although some uncertainty was observed. The probability that the 8- and 6-week treatments were the most cost-effective was 56% and 25%, respectively, whereas that for the 4-week treatment was 17%. Results were generally robust to sensitivity analyses, including a threshold analysis that showed that the 8-week treatment was the most cost-effective at all drug prices lower than £40 000 per 12-week course. CONCLUSIONS:Shortening treatments licensed for 12 weeks to 8 weeks is cost-effective in genotype 1 noncirrhotic treatment-naive patients. There was considerable uncertainty in the estimates for 6- and 4-week treatments, with some indication that the 6-week treatment may be cost-effective

High-Speed Rail Versus Air Transportation: Case Study of Madrid–Barcelona, Spain.

Travel time savings, better quality of the supplied services, greater comfort for the users, and improved accessibility are the main factors of success of High Speed Rail(HSR)links. This paper presents the results from a revealed and stated preference survey conducted to both HSR and air transport users in the Madrid Barcelona corridor. The data gathered from the stated preference survey was used to calibrate a modal choice model aiming at explaining competition between HSR and air transportation in the corridor. From the model, the authors obtain that prices and service frequency are the most important variables to compete with the other mode. In addition, they found that check-in and security controls at the airport are a crucial variable for the users in their modal choice. Other policies, such as the improvement of parking facilities at the train stations, play a secondary role