514 research outputs found
Improving HIV pre-exposure prophylaxis (PrEP) adherence and retention in care: Process evaluation and recommendation development from a nationally implemented PrEP programme
Introduction HIV pre-exposure prophylaxis (PrEP), in which people take HIV medication to prevent HIV acquisition, underpins global HIV transmission elimination strategies. Effective prevention needs people to adhere to PrEP and remain in care during periods of risk, but this is difficult to achieve. We undertook a process evaluation of Scotland’s PrEP programme to explore barriers and facilitators to PrEP adherence and retention in care and to systematically develop evidence-based, theoretically-informed recommendations to address them. Methods We conducted semi-structured interviews and focus groups (09/2018-07/2019) with patients who identified as gay or bisexual men and were either using PrEP, had declined the offer of PrEP, had stopped PrEP, or had been assessed as ineligible for PrEP (n = 39 of whom n = 5 (13%) identified as trans, median age 31 years and interquartile range 14 years), healthcare professionals involved in PrEP provision (n = 54 including specialist sexual health doctors and nurses of various grades, PrEP prescribing general practitioners, health promotion officers, midwifes, and a PrEP clinical secretary), and clients (n = 9) and staff (n = 15) of nongovernmental organisations with an HIV prevention remit across Scotland. We used thematic analysis to map key barriers and facilitators to priority areas that could enhance adherence and retention in care. We used implementation science analytic tools (Theoretical Domains Framework, Intervention Functions, Behaviour Change Technique Taxonomy, APEASE criteria) and expert opinion to systematically generate recommendations. Results Barriers included perceived complexity of on-demand dosing, tendency for users to stop PrEP before seeking professional support, troublesome side-effects, limited flexibility in the settings/timings/nature of review appointments, PrEP-related stigma and emerging stigmas around not using PrEP. Facilitators included flexible appointment scheduling, reminders, and processes to follow up non-attenders. Examples of the 25 recommendations include: emphasising benefits of PrEP reviews and providing appointments flexibly within individualised PrEP care; using clinic systems to remind/recall PrEP users; supporting PrEP conversations among sexual partners; clear on-demand dosing guidance; encouraging good PrEP citizenship; detailed discussion on managing side-effects and care/coping planning activities. Conclusions PrEP adherence and retention in care is challenging, reducing the effectiveness of PrEP at individual and population levels. We identify and provide solutions to where and how collaborative interventions across public health, clinical, and community practice could address these challenges
Helicoidal surfaces rotating/translating under the mean curvature flow
We describe all possible self-similar motions of immersed hypersurfaces in
Euclidean space under the mean curvature flow and derive the corresponding
hypersurface equations. Then we present a new two-parameter family of immersed
helicoidal surfaces that rotate/translate with constant velocity under the
flow. We look at their limiting behaviour as the pitch of the helicoidal motion
goes to 0 and compare it with the limiting behaviour of the classical
helicoidal minimal surfaces. Finally, we give a classification of the immersed
cylinders in the family of constant mean curvature helicoidal surfaces.Comment: 21 pages, 22 figures, final versio
Evaluating the effectiveness and cost effectiveness of the ‘strengthening families, strengthening communities’ group-based parenting programme: study protocol and initial insights
Background: Up to 20% of UK children experience socio-emotional difficulties which can have serious implications for themselves, their families and society. Stark socioeconomic and ethnic inequalities in children’s well-being exist. Supporting parents to develop effective parenting skills is an important preventive strategy in reducing inequalities. Parenting interventions have been developed, which aim to reduce the severity and impact of these difficulties. However, most parenting interventions in the UK focus on early childhood (0–10 years) and often fail to engage families from ethnic minority groups and those living in poverty. Strengthening Families, Strengthening Communities (SFSC) is a parenting programme designed by the Race Equality Foundation, which aims to address this gap. Evidence from preliminary studies is encouraging, but no randomised controlled trials have been undertaken so far.
Methods/design: The TOGETHER study is a multi-centre, waiting list controlled, randomised trial, which aims to test the effectiveness of SFSC in families with children aged 3–18 across seven urban areas in England with ethnically and socially diverse populations. The primary outcome is parental mental well-being (assessed by the Warwick-Edinburgh Mental Well-Being Scale). Secondary outcomes include child socio-emotional well-being, parenting practices, family relationships, self-efficacy, quality of life, and community engagement. Outcomes are assessed at baseline, post intervention, three- and six-months post intervention. Cost effectiveness will be estimated using a cost-utility analysis and cost-consequences analysis. The study is conducted in two stages. Stage 1 comprised a 6-month internal pilot to determine the feasibility of the trial. A set of progression criteria were developed to determine whether the stage 2 main trial should proceed. An embedded process evaluation will assess the fidelity and acceptability of the intervention.
Discussion: In this paper we provide details of the study protocol for this trial. We also describe challenges to implementing the protocol and how these were addressed. Once completed, if beneficial effects on both parental and child outcomes are found, the impact, both immediate and longer term, are potentially significant. As the intervention focuses on supporting families living in poverty and those from minority ethnic communities, the intervention should also ultimately have a beneficial impact on reducing health inequalities.
Trial registration: Prospectively registered Randomised Controlled Trial ISRCTN15194500
Evaluating the effectiveness and cost effectiveness of the 'strengthening families, strengthening communities' group-based parenting programme: study protocol and initial insights
BACKGROUND: Up to 20% of UK children experience socio-emotional difficulties which can have serious implications for themselves, their families and society. Stark socioeconomic and ethnic inequalities in children's well-being exist. Supporting parents to develop effective parenting skills is an important preventive strategy in reducing inequalities. Parenting interventions have been developed, which aim to reduce the severity and impact of these difficulties. However, most parenting interventions in the UK focus on early childhood (0-10 years) and often fail to engage families from ethnic minority groups and those living in poverty. Strengthening Families, Strengthening Communities (SFSC) is a parenting programme designed by the Race Equality Foundation, which aims to address this gap. Evidence from preliminary studies is encouraging, but no randomised controlled trials have been undertaken so far. METHODS/DESIGN: The TOGETHER study is a multi-centre, waiting list controlled, randomised trial, which aims to test the effectiveness of SFSC in families with children aged 3-18 across seven urban areas in England with ethnically and socially diverse populations. The primary outcome is parental mental well-being (assessed by the Warwick-Edinburgh Mental Well-Being Scale). Secondary outcomes include child socio-emotional well-being, parenting practices, family relationships, self-efficacy, quality of life, and community engagement. Outcomes are assessed at baseline, post intervention, three- and six-months post intervention. Cost effectiveness will be estimated using a cost-utility analysis and cost-consequences analysis. The study is conducted in two stages. Stage 1 comprised a 6-month internal pilot to determine the feasibility of the trial. A set of progression criteria were developed to determine whether the stage 2 main trial should proceed. An embedded process evaluation will assess the fidelity and acceptability of the intervention. DISCUSSION: In this paper we provide details of the study protocol for this trial. We also describe challenges to implementing the protocol and how these were addressed. Once completed, if beneficial effects on both parental and child outcomes are found, the impact, both immediate and longer term, are potentially significant. As the intervention focuses on supporting families living in poverty and those from minority ethnic communities, the intervention should also ultimately have a beneficial impact on reducing health inequalities. TRIAL REGISTRATION: Prospectively registered Randomised Controlled Trial ISRCTN15194500
Agile software development practices in Egypt SMEs : a grounded theory investigation
Agile information system development methods have been adopted
by most software development organizations due to their proven benefits in terms
of flexibility, reliability, and responsiveness. However, companies face significant
challenges in adopting these approaches. Specifically, this research investigates
challenges faced by software development companies in Egypt while transitioning
to Agile. As little previous research is available targeting their concerns,
we have conducted a grounded theory investigation. Key problem areas were
found including lack of cadence in sprints planning, inadequate use of effort estimation
and product quality issues.
The developed grounded theory reflects on the key problem areas found with
SMEs adopting agile practices and can be used by software development practitioners
adopting agile methods in Egypt or similar developing countries as an
outline for the common problem areas they are expected to find
Towards mentoring as feminist praxis in early childhood education and care in England
Following our contribution to a study of mentoring in seven European countries, we explored epistemological and ontological inconsistencies within mainstream mentoring systems and their regulated practice in England. We considered how feminist mentoring praxis can unsettle conceptualisations of mentoring relationships and challenge inequity in the early education systems and the practice of teaching young children. Predominantly female, early childhood educators suffer from low status in England, and their working lives may be controlled and policed through inequitable systems. On entering the workforce, trainees encounter a reductionist policy milieu where mentoring structures and normative assessment arrangements contribute to inequity. Mentors play pivotal roles in inducting trainees into their worlds of work with young children. Mentoring relationships can determine whether trainees accept the status quo. Principles derived from feminist praxis enable mentors to practise an ‘engaged pedagogy’, co-constructing knowledge, subverting hierarchies and contesting taken-for-granted aspects of policy and practice
British HIV Association/British Association for Sexual Health and HIV/British Infection Association adult HIV testing guidelines 2020
Lesional-targeting of neuroprotection to the inflammatory penumbra in experimental multiple sclerosis
The authors would like to thank the support of the National Multiple Sclerosis Society (USA) and the Multiple Sclerosis Society of Great Britain and Northern Ireland
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Social cohesion and the notion of 'suspect communities': A study of the experiences and impacts of being 'suspect' for Irish communities and Muslim communities in Britain
In this article, we consider how the practice of conceiving of groups within civil society as 'communities' meshes with conceptualisations of certain populations as 'suspect' and consider some of the impacts and consequences of this for particular populations and for social cohesion. We examine how Irish and Muslim people in Britain have become aware of and have experienced themselves to be members of 'suspect communities' in relation to political violence and counterterrorism policies from 1974 to 2007 and investigate the impacts of these experiences on their everyday lives. The study focuses on two eras of political violence. The first coincides with the Irish Republican Army's (IRA) bombing campaigns in England between 1973 and 1996, when the perpetrators were perceived as 'Irish terrorists'; and the second since 2001, when, in Britain and elsewhere, the main threat of political violence has been portrayed as stemming from people who are assumed to be motivated by extreme interpretations of Islam and are often labelled as 'Islamic terrorists'. We outline why the concept of 'suspect communities' continues to be analytically useful for examining: the impact of 'bounded communities' on community cohesion policies; the development of traumatogenic environments and their ramifications; and for examining how lessons might be learnt from one era of political violence to another, especially as regards the negative impacts of practices of suspectification on Irish communities and Muslim communities. The research methods included discussion groups involving Irish and Muslim people. These demonstrated that with the removal of discourses of suspicion the common ground of Britain's urban multiculture was a sufficient basis for sympathetic exchanges. © 2012 Taylor and Francis Group, LLC
The missing spirals of violence:Four waves of movement–countermovement contest in post-war Britain
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