Advanced Nurses\u27 Perspectives on the Drug Addiction Treatment Act, 13 Years Later

The United States experiences opioid addiction at epidemic levels. In 2012, the National Institute of Drug Abuse reported that 23.1 million Americans were in need of addiction treatment services, although only 2.5 million were enrolled in treatment. Following an amendment to the Drug Addiction Treatment Act of 2000 (Public Law 106-310), advanced practice nurses were qualified as providers who could bridge the healthcare gap in treatment access. The purpose of this project was to determine the interest of advanced practice nurses in (a) prescribing buprenorphine and (b) establishing guidelines that would allow them to do so. This quantitative project used a 10-question Internet-based survey with a convenience sample of 95 nurses (recruited online) who were currently practicing in advanced nursing roles. Social media platforms, including Facebook, were used to recruit participants. The survey included questions about expanding the scope of practice in addiction treatment and establishing guidelines that would allow nursing knowledge and expertise to be used in outpatient opiate addiction treatment. Critical social theory and Kingdon\u27s theory of policy analysis were applied to support the project. The Survey Monkey data analysis tool was used to generate descriptive statistics, which demonstrated respondents\u27 support for an expanded scope of practice. If the recommendations of this project are adopted by national legislation, increased accessibility to addiction treatment services will save millions of dollars in justice system, healthcare system, employment, and societal costs. Nursing policy advocates nationally can apply these results to support efforts to expand scope of practice to include prescribing buprenorphine

Analysis of effective resistance calculation methods and their effect on modelling evapotranspiration in two different patches of vegetation in semi-arid SE Spain

International audienceEffective parameters are of major importance in modelling surface fluxes at different scales of spatial heterogeneity. Different ways to obtain these effective parameters for their use in meso-scale and GCM models have been studied. This paper deals with patch-scale heterogeneity, where effective resistances were calculated in two patches with different vegetation (Retama sphaerocarpa (L.) Boiss shrubs, and herbaceous plants) using different methods: aggregating soil and plant resistances in parallel, in series or by an average of both. Effective aerodynamic resistance was also calculated directly from patch fluxes. To assess the validity of the different methods used, the Penman-Monteith equation was used with effective resistances to estimate the total ?E for each patch. The ?E estimates found for each patch were compared to Eddy Covariance system measurements. Results showed that for effective surface resistances, parallel aggregation of soil and plant resistances led to ?E estimates closer to the measured ?E in both patches (differences of around 10%). Results for effective aerodynamic resistances differed depending on the patch considered and the method used to calculate them. The use of effective aerodynamic resistances calculated from fluxes provided less accurate estimates of ?E compared to the measured values, than the use of effective aerodynamic resistances aggregated from soil and plant resistances. The results reported in this paper show that the best way of aggregating soil and plant resistances depends on the type of resistance, and the type of vegetation in the patch

Kawasaki disease in Kenya and review of the African literature

Background: Kawasaki disease has been described across the globe, although publications from Africa are limited. To our knowledge, there are no publications on Kawasaki disease from Kenya, which triggered this report. Methods: A retrospective cross-sectional study was undertaken to identify in-patients with a discharge diagnosis of Kawasaki disease, over 2 different 5-year periods, at two pediatric hospitals in Nairobi, Kenya. We reviewed the medical records of all patients and report their clinical findings, diagnostic workup and treatment. In addition, we undertook a detailed review of the literature. Results: Twenty-three patients with Kawasaki disease were identified, of those 12 (52.2%) had incomplete disease. The mean age was 2.3 years (SD+/-2.2) (range 0.3–10.3) with a male to female ratio of 1:1. The mean duration of fever at diagnosis was 8.3 days (SD+/-4.7) (range 2–20). Oral changes were the most common clinical feature and conjunctivitis the least common. Thrombocytosis at diagnosis was seen in 52% (12/23). Twenty-one patients (91.3%) were treated with intravenous immunoglobulin and all except 1 received aspirin. Baseline echocardiograms were performed in 95.7% (22/23) and found to be abnormal in 3 (13.6%). Follow-up data was limited. Our literature review identified 79 publications with documented cases of Kawasaki disease in children from 22 countries across the African continent with a total of 1115 patients including those from this report. Only 153 reported cases, or 13.7%, are from sub-Saharan Africa. Conclusions: This is the first publication on Kawasaki disease from Kenya and one of the largest reports from sub-Saharan Africa. It is the first to have a complete review of the number of published cases from the African continent. Challenges in the diagnosis and management of Kawasaki disease in many African countries include disease awareness, infectious confounders, access and cost of intravenous immunoglobulin, access to pediatric echocardiography and follow-up. Increasing awareness and health care resources are important for improving outcomes of Kawasaki disease in Africa

Analysis of effective resistance calculation methods and their effect on modelling evapotranspiration in two different patches of vegetation in semi-arid SE Spain

Effective parameters are of major importance in modelling surface fluxes at different scales of spatial heterogeneity. Different ways to obtain these effective parameters for their use in meso-scale and GCM models have been studied. This paper deals with patch-scale heterogeneity, where effective resistances were calculated in two patches with different vegetation (Retama sphaerocarpa (L.) Boiss shrubs, and herbaceous plants) using different methods: aggregating soil and plant resistances in parallel, in series or by an average of both. Effective aerodynamic resistance was also calculated directly from patch fluxes. To assess the validity of the different methods used, the Penman-Monteith equation was used with effective resistances to estimate the total λE for each patch. The λE estimates found for each patch were compared to Eddy Covariance system measurements. Results showed that for effective surface resistances, parallel aggregation of soil and plant resistances led to λE estimates closer to the measured λE in both patches (differences of around 10%). Results for effective aerodynamic resistances differed depending on the patch considered and the method used to calculate them. The use of effective aerodynamic resistances calculated from fluxes provided less accurate estimates of λE compared to the measured values, than the use of effective aerodynamic resistances aggregated from soil and plant resistances. The results reported in this paper show that the best way of aggregating soil and plant resistances depends on the type of resistance, and the type of vegetation in the patch.This work received financial support from several different research projects: the PROBASE (ref.: CGL2006-11619/HID) and CANOA (ref.: CGL2004-04919-C02-01/HID) projects funded by the Spanish Ministry of Education and Science; and the BACAEMA (“Balance de carbono y de agua en ecosistemas de matorral mediterráneo en Andalucía: Efecto del cambio climático”, RNM-332) and CAMBIO (“Efectos del cambio global sobre la biodiversidad y el funcionamiento ecosistémico mediante la identificación de áreas sensibles y de referencia en el SE ibérico”, RNM 1280) projects funded by the regional government Junta de Andalucía. The first author enjoyed a pre-doctoral grant from the Spanish Ministry of Science and Technology

Prevention and management of malaria during pregnancy: findings from qualitative studies in Ghana and Malawi

BACKGROUND: In endemic regions of sub-Saharan Africa, malaria during pregnancy (MiP) is a major preventable cause of maternal and infant morbidity and mortality. Current recommended MiP prevention and control includes intermittent preventive treatment (IPTp), distribution of insecticide-treated bed nets (ITNs) and appropriate case management. This article explores the social and cultural context to the uptake of these interventions at four sites across Africa. METHODS: A comparative qualitative study was conducted at four sites in three countries: Ghana, Malawi and Kenya. Individual and group interviews were conducted with pregnant women, their relatives, opinion leaders, other community members and health providers. Observations, which focused on behaviours linked to MiP prevention and treatment, were also undertaken at health facilities and in local communities. RESULTS: ITNs were generally recognized as important for malaria prevention. However, their availability and use differed across the sites. In Malawi and Kenya, ITNs were sought-after items, but there were complaints about availability. In central Ghana, women saved ITNs until the birth of the child and they were used seasonally in northern Ghana. In Kenya and central Ghana, pregnant women did not associate IPTp with malaria, whereas, in Malawi and northern Ghana, IPTp was linked to malaria, but not always with prevention. Although IPTp adherence was common at all sites, whether delivered with directly observed treatment or not, a few women did not comply with IPTp often citing previous side effects. Although generally viewed as positive, experiences of malaria testing varied across the four sites: treatment was sometimes administered in spite of a negative diagnosis in Ghana (observed) and Malawi (reported). Despite generally following the advice of healthcare staff, particularly in Kenya, personal experience, and the availability and accessibility of medication – including anti-malarials – influenced MiP treatment. CONCLUSION: Although ITNs were valued as malaria prevention, health messages could address issues that reduce their use during pregnancy in particular contexts. The impact of previous side effects on adherence to IPTp and anti-malarial treatment regimens during pregnancy also requires attention. Overtreatment of MiP highlights the need to monitor the implementation of MiP case management guidelines

Local illness concepts and their relevance for the prevention and control of malaria during pregnancy in Ghana, Kenya and Malawi: findings from a comparative qualitative study

BACKGROUND: In sub-Saharan Africa, the burden of morbidity and mortality linked to malaria during pregnancy (MiP) is significant and compounded by its unclear symptoms and links with other health problems during pregnancy. Mindful of the biomedical and social complexity of MiP, this article explores and compares local understandings of MiP and their links with other pregnancy-related health problems. METHODS: A comparative qualitative study was undertaken at four sites in three countries: Ghana, Malawi and Kenya. Individual and group interviews were conducted with pregnant women, their relatives, opinion leaders, other community members and health providers. MiP-related behaviours were also observed at health facilities and in local communities. RESULTS: Across the four sites, local malaria concepts overlapped with biomedically defined malaria. In terms of symptoms, at-risk groups, outcomes and aetiology of malaria during pregnancy, this overlap was however both site-specific and partial. Moreover, the local malaria concepts were not monolithic and their descriptions varied amongst respondents. The symptoms of pregnancy and malaria also overlapped but, for respondents, symptom severity was the distinguishing factor. Malaria was generally, though not universally, perceived as serious for pregnant women. Miscarriage was the most widely known outcome, and links with anaemia, low birth weight and congenital malaria were mentioned. Nonetheless, amongst many potential causes of miscarriage, malaria was not recognized as the most important, but rather interacted with other pregnancy-related problems. CONCLUSIONS: Given the overlap of common pregnancy problems with the symptoms of malaria, and the limited association of malaria with its main outcomes, a comprehensive antenatal care programme is the most appropriate strategy for the provision of health education, prevention and treatment for MiP. Variations in locally shared understandings of MiP must however be taken into account when designing and promoting MiP intervention strategies