High Rate of Hepatitis C Virus Reinfection Among Recently Injecting Drug Users: : Results From the TraP Hep C Program-A Prospective Nationwide, Population-Based Study

© The Author(s) 2022. Published by Oxford University Press on behalf of the Infectious Diseases Society of America.BACKGROUND: The Treatment as Prevention for Hepatitis C program started in 2016 in Iceland, offering treatment with direct-acting antivirals to hepatitis C virus (HCV)-infected individuals. Reinfections through injection drug use (IDU) can hamper elimination efforts. We determined reinfection rates (RIR) of HCV among patients in the program. METHODS: Clinical data were gathered prospectively. The study cohort consisted of HCV-cured patients with an estimated sustained virologic response between February 1st 2016 and November 20th 2018, with follow-up until November 20th 2019. The observation period and time until reinfection was estimated using a single random point imputation method coupled with Monte Carlo simulation. The RIR was expressed as reinfections/100 person-years (PYs). RESULTS: 640 treatments of 614 patients (417 males, mean age 44.3 years) resulted in cure, with 52 reinfections subsequently confirmed in 50 patients (37 males). Follow-up was 672.1 PYs with median time to reinfection of 231.7 days. History of IDU was reported by 523 patients (84.8%) and recent IDU with 220 (34.4%) treatments. Stimulants were the preferred injected drug in 85.5% of patients with history of IDU. The RIR was 7.7/100 PYs. Using multivariate Cox proportional hazards models for interval-censored data, age (HR 0.96, 95% CI 0.94-0.99) and recent IDU (HR 2.91, 95% CI 1.48-5.76) were significantly associated with reinfection risk. CONCLUSIONS: The RIR is high in a setting of widespread stimulant use, particularly in young people with recent IDU. Regular follow up is important among high-risk populations to diagnose reinfections early and reduce transmission.Peer reviewe

Simultaneous Multi-Wavelength Observations of Sgr A* during 2007 April 1-11

We report the detection of variable emission from Sgr A* in almost all wavelength bands (i.e. centimeter, millimeter, submillimeter, near-IR and X-rays) during a multi-wavelength observing campaign. Three new moderate flares are detected simultaneously in both near-IR and X-ray bands. The ratio of X-ray to near-IR flux in the flares is consistent with inverse Compton scattering of near-IR photons by submillimeter emitting relativistic particles which follow scaling relations obtained from size measurements of Sgr A*. We also find that the flare statistics in near-IR wavelengths is consistent with the probability of flare emission being inversely proportional to the flux. At millimeter wavelengths, the presence of flare emission at 43 GHz (7mm) using VLBA with milli-arcsecond spatial resolution indicates the first direct evidence that hourly time scale flares are localized within the inner 30$\times$70 Schwarzschild radii of Sgr A*. We also show several cross correlation plots between near-IR, millimeter and submillimeter light curves that collectively demonstrate the presence of time delays between the peaks of emission up to three hours. The evidence for time delays at millimeter and submillimeter wavelengths are consistent with the source of emission being optically thick initially followed by a transition to an optically thin regime. In particular, there is an intriguing correlation between the optically thin near-IR and X-ray flare and optically thick radio flare at 43 GHz that occurred on 2007 April 4. This would be the first evidence of a radio flare emission at 43 GHz delayed with respect to the near-IR and X-ray flare emission.Comment: replaced with revised version 57 pages, 28 figures, ApJ (in press

INTEGRAL, Swift, and RXTE observations of the 518 Hz accreting transient pulsar Swift J1749.4-2807

The burst-only Swift J1749.4-2807 source was discovered in a high X-ray-active state, while during an {INTEGRAL observations of the Galactic bulge on 2010 April 10. Pulsations at 518 Hz were discovered in the RXTE data, confirming previous suggestions of possible associations between burst-only sources and accreting millisecond X-ray pulsars. The subsequent discovery of X-ray eclipses made Swift J1749.4$-$2807 the first eclipsing accreting millisecond X-ray pulsar. We obtain additional information on Swift J1749.4-2807 and other burst-only sources. We report on the results of a monitoring campaign on the source, carried out for about two weeks with the Swift, INTEGRAL, and RXTE satellites. The observations showed that the X-ray spectrum (energy range 0.5-40 keV) of Swift J1749.4-2807 during the entire event was accurately modeled by an absorbed power-law model (N_H~3e2 cm^-2, Gamma~1.7). X-ray eclipses were also detected in the Swift data and provides a clear evidence of a dust-scattering halo located along the line of sight to the source. Only one type-I X-ray burst was observed throughout the two-weeks long monitoring. The X-ray flux of Swift J1749.4-2807 decayed below the detection threshold of Swift/XRT about 11 days after the discovery, in a exponential fashion (e-folding time of tau=12^+7_-3 days). We compare the properties of the outburst observed from Swift J1749.4-2807 with those of the previously known millisecond X-ray pulsars and other transient low mass X-ray binaries.Comment: Accepted for publication on A&

The COSPIX mission: focusing on the energetic and obscured Universe

Tracing the formation and evolution of all supermassive black holes, including the obscured ones, understanding how black holes influence their surroundings and how matter behaves under extreme conditions, are recognized as key science objectives to be addressed by the next generation of instruments. These are the main goals of the COSPIX proposal, made to ESA in December 2010 in the context of its call for selection of the M3 mission. In addition, COSPIX, will also provide key measurements on the non thermal Universe, particularly in relation to the question of the acceleration of particles, as well as on many other fundamental questions as for example the energetic particle content of clusters of galaxies. COSPIX is proposed as an observatory operating from 0.3 to more than 100 keV. The payload features a single long focal length focusing telescope offering an effective area close to ten times larger than any scheduled focusing mission at 30 keV, an angular resolution better than 20 arcseconds in hard X-rays, and polarimetric capabilities within the same focal plane instrumentation. In this paper, we describe the science objectives of the mission, its baseline design, and its performances, as proposed to ESA.Comment: 7 pages, accepted for publication in Proceedings of Science, for the 25th Texas Symposium on Relativistic Astrophysics (eds. F. Rieger & C. van Eldik), PoS(Texas 2010)25

The match between motivation and performance management of health sector workers in Mali

Human resources for health (HRH) play a central role in improving accessibility to services and quality of care. Their motivation influences this. In Mali, operational research was conducted to identify the match between motivation and the range and use of performance management activities. OBJECTIVES: To describe the factors motivating and demotivating health workers in Mali and match the motivators with the implementation of performance management. METHODS: First an exploratory qualitative study was conducted: 28 interviews and eight group discussions were held. This was followed by a cross-sectional survey, during which 370 health workers were interviewed. The study population consisted of health workers of eight professional groups. The following issues were investigated: • motivating and demotivating factors; • experiences with performance management, including: job descriptions, continuous education, supervision, performance appraisal and career development. FINDINGS: The study showed that the main motivators of health workers were related to responsibility, training and recognition, next to salary. These can be influenced by performance management (job descriptions, supervisions, continuous education and performance appraisal). Performance management is not optimally implemented in Mali, as job descriptions were not present or were inappropriate; only 13% of interviewees received 4× per year supervision, and training needs were not analysed. Some 48% of the interviewees knew their performance had been appraised in the last two years; the appraisals were perceived as subjective. No other methods were in place to show recognition. The results enabled the research team to propose adaptations or improvements upon existing performance management. CONCLUSION: The results showed the importance of adapting or improving upon performance management strategies to influence staff motivation. This can be done by matching performance management activities to motivators identified by operational research

Benzodiazepine prescribing behaviour and attitudes: a survey among general practitioners practicing in northern Thailand

BACKGROUND: Over-prescribing of benzodiazepines appears common in many countries, a better understanding of prescribing practices and attitudes may help develop strategies to reduce prescribing. This study aimed to evaluate benzodiazepine prescribing behaviour and attitudes in general practitioners practising in Chiang Mai and Lampoon, Thailand. METHODS: Questionnaire survey of general practitioners in community hospitals, to estimate: i) use of benzodiazepines for anxiety/insomnia, panic disorder, depression, essential hypertension, and uncomplicated low back pain and ii) views on the optimal duration of benzodiazepine use. RESULTS: Fifty-five of 100 general practitioners returned the completed questionnaires. They reported use of benzodiazepines for anxiety/insomnia (n = 51, 93%), panic disorder (n = 43, 78%), depression (n = 26, 43%), essential hypertension (n = 15, 27 %) and uncomplicated low back pain (n = 10, 18%). Twenty-eight general practitioners would prescribe benzodiazepines for non-psychiatric conditions, 17 for use as muscle relaxants. Seventy-five per cent, 62% and 29% of the general practitioners agreed or totally agreed with the use of benzodiazepines for insomnia, anxiety and depression, respectively. Practitioners agreed that prescribing should be less than one week (80%); or from 1 week to 1 month (47%); or 1 to 4 months (16%); or 4 to 6 months (5%) or more than 6 months (2%). Twenty-five general practitioners (45%) accepted that they used benzodiazepines excessively in the past year. CONCLUSION: A considerable proportion of general practitioners in Chiang Mai and Lampoon, Thailand inappropriately use benzodiazepines for physical illnesses, especially essential hypertension and uncomplicated low back pain. However, almost half of them thought that they overused benzodiazepines. General practitioner's lack of time, knowledge and skills should be taken into account in improving prescribing behaviour and attitudes

The role of supportive supervision on immunization program outcome - a randomized field trial from Georgia

<p>Abstract</p> <p>Background</p> <p>One of the most common barriers to improving immunization coverage rates is human resources and its management. In the Republic of Georgia, a country where widespread health care reforms have taken place over the last decade, an intervention was recently implemented to strengthen performance of immunization programs. A range of measures were taken to ensure that immunization managers carry out their activities effectively through direct, personal contact on a regular basis to guide, support and assist designated health care facility staff to become more competent in their immunization work. The aim of this study was to document the effects of "supportive" supervision on the performance of the immunization program at the district(s) level in Georgia.</p> <p>Methods</p> <p>A pre-post experimental research design is used for the quantitative evaluation. Data come from baseline and follow-up surveys of health care providers and immunization managers in 15 intervention and 15 control districts. These data were supplemented by focus group discussions amongst Centre of Public Health and health facility staff.</p> <p>Results</p> <p>The results of the study suggest that the intervention package resulted in a number of expected improvements. Among immunization managers, the intervention independently contributed to improved knowledge of supportive supervision, and helped remove self-perceived barriers to supportive supervision such as availability of resources to supervisors, lack of a clear format for providing supportive supervision, and lack of recognition among providers of the importance of supportive supervision. The intervention independently contributed to relative improvements in district-level service delivery outcomes such as vaccine wastage factors and the DPT-3 immunization coverage rate. The clear positive improvement in all service delivery outcomes across both the intervention and control districts can be attributed to an overall improvement in the Georgian population's access to health care.</p> <p>Conclusion</p> <p>Provider-based interventions such as supportive supervision can have independent positive effects on immunization program indicators. Thus, it is recommended to implement supportive supervision within the framework of national immunization programs in Georgia and other countries in transition with similar institutional arrangements for health services organization.</p> <p>Abstract in Russian</p> <p>See the full article online for a translation of this abstract in Russian.</p

OPEN Introduction: Address as Social Action Across Cultures and Contexts

This is the introductory chapter of Address Practice as Social Action: European Perspectives. It is open access under a CC BY license.How we address one another says a great deal about our social relationships and which groups in society we belong to. This edited volume examines address choices in a range of everyday interactions taking place in Dutch, Finnish, Flemish, French, German, Italian and the two national varieties of Swedish, Finland Swedish and Sweden Swedish