Search

The lived experience of HIV for women remains poorly understood. In particular, there has been little attention to the consequences for women living with HIV (WLHIV) of changing social, epidemiological, biomedical and policy contexts, or to the implications of long-term treatment and aging for the current generation of HIV-positive women. We reviewed qualitative research with WLHIV in selected high-income countries (Australia, Canada, New Zealand, the UK and the USA) to identify the most prevalent experiences of HIV for women and trends over time. Our synthesis highlights the relative consistency of experiences of a diverse sample of WLHIV, particularly the enduring prevalence of gendered HIV-related stigma, sociostructural barriers to healthcare and support, and negative encounters with health professionals. We also identified gaps in knowledge. Understanding women's experiences, particularly their changing needs and strategies for coping as they live long-term with HIV, is key to effective support and services for WLHIV.

This article will discuss opportunities to improve the efficiency of cobalt-60 (Co-60) utilization within a gamma irradiator. It will show how redistributing the Co-60 within the source rack may lead to improved throughput or dose uniformity within a product. It presents examples of modifications to the equipment within the source pass; these include reduction in the carrier wall thickness and changes to the product stack size. It will discuss the process of scheduling and present ideas of how to optimize both the order of the products and transitions between the products to maximize process efficiencies.

For populations at risk of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG), regular testing of multiple anatomical sites is recommended. Pooling methods that combine one patient’s anatomical site specimens can reduce cost and workflow burdens.1 2 The feasibility of such methods within a community setting is well established3 4; however, sensitivities of pooling are inferior to methodologies that test anatomical sites separately.1 5 Our group sought to improve pooling performance near the point of care within a peer-led, community-based STI testing service. Adapting a protocol described by Speers et al ,5 we previously reported3 sensitivities of 90% (95% CI 77.4% to 96.3%) and 89.7% (95% CI 74.8% to 96.7%) for the pooled detection of CT and NG, respectively, when using the Xpert CT/NG assay (Cepheid, Sunnyvale, California, USA). The Xpert CT/NG assay has not been listed by any regulatory body …

Abstract Background The advent of fully automated nucleic acid amplification test (NAAT) technology brings new public health opportunities to provide Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) point-of-care testing (POCT) in non-traditional settings. Methods: This pilot study evaluated the integration of the CT/NG Xpert diagnostic assay into an urban peer-led community setting providing HIV and syphilis POCT. A comprehensive protocol of testing, result notification, referral and follow up, managed by peer test facilitators, was undertaken. Results: Over 67 weeks, there were 4523 occasions of CT/NG testing using urine, oropharyngeal and anorectal samples with 25.7% (803) of the 3123 unique participants returning for repeat testing. The prevalence of CT and NG was 9.5% and 5.4% respectively. Where CT and or NG infection was detected, 98.4% (604/614) of participants were successfully notified of detected infection and referred for treatment. Evaluation Survey responses (11.4%, 516/4523) indicated a substantial proportion of respondents (27.1%, 140/516) ‘would not have tested anywhere else’. Of note, 17.8% (92/516) of participants reported no previous CT/NG test and an additional 17.8% (92/516) reported testing more than 12 months ago. A total of 95.9% (495/516) of participants ‘Strongly agreed’ or ‘Agreed’ to being satisfied with the service. Conclusion: The project successfully demonstrated an acceptable and feasible model for a peer-delivered community-led service to provide targeted molecular CT/NG POCT. This model offers capacity to move beyond the traditional pathology and STI testing services and establish community-led models that build trust and increase testing rates for key populations of epidemiological significance.

The emergence of treatment-as-prevention has made early initiation of antiretroviral treatment (ART) a "universal" policy. This review synthesizes qualitative research findings on barriers and facilitators of ART initiation in Organization for Economic Co-operation and Development (OECD) countries published since 2010. Ten articles describing seven research studies were included in the review. Findings confirmed ART initiation as a complicated process involving careful deliberation of the personal risks and benefits of treatment within the broader contexts of everyday life for people living with HIV (PLHIV). They also highlight interpersonal dynamics and concern for the public as increasingly important factors in shaping the decision to initiate treatment. The review provides valuable information for understanding treatment behaviour and maximizing treatment options brought forth by new biomedical advances.

This paper explores the willingness to use and pay for HIV Self-testing (HIVST) among Australian gay and bisexual men (GBM). Bivariate and univariate multinominal logistic regression of data from an online survey was performed. Thirty-one (13%) had never HIV tested and 41.9% (88) were testing sub-optimally by Australian guidelines. Half (58.4%, 136) had never heard of HIVST, however, 56.2% (131) reported willingness to use HIVST, with sub-optimal (OR=2.13; p

Background The success of ‘treatment as prevention’ (TasP) to control HIV relies on the uptake of testing across priority population groups. Innovative strategies including; rapid HIV testing (RHT) in community and outreach settings, engaging peer service providers, and not requiring disclosure of sexual history have been designed to increase access. This paper reports on the implementation of ‘RAPID’, a community-based testing program in Queensland, Australia that employs these strategies to increase access to testing. Methods Service data, including client registration forms and a satisfaction survey from all clients attending RAPID between August 2014 and July 2015 were analysed. Results In 2014/2015 1,199 people attended RAPID to receive a free HIV test. The majority were urban-based gay men. 17.1% were first-time testers and 20.1% of participants were not eligible to access Medicare, Australia’s universal health care scheme. Conclusions RAPID’s evidence-based strategies appear to facilitate access to HIV testing, particularly among those who have never tested before; however the implications for the ongoing treatment and care of people ineligible for Medicare, who test positive to HIV warrants careful consideration. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2249-5) contains supplementary material, which is available to authorized users.

People living with HIV (PLHIV) have high rates of tobacco smoking, and smoking is a leading cause of premature mortality and morbidity. It is important to understand HIV healthcare providers' practices and attitudes towards addressing smoking with their patients. An online survey that measured: (i) use of the 5A framework for addressing smoking (Ask, Assess, Advise, Assist, Arrange) and (ii) attitudes and barriers to addressing smoking cessation was distributed by relevant professional bodies. Eligible participants were Australian health practitioners providing healthcare to PLHIV. Of the 179 respondents, most reported practising at least one of the 5As: Ask (94%); Assess (78%); Advise (82%); Assist (89%); and Arrange (73%). Practising the full 5A framework (completing at least one activity from each A) was less common (62%) and associated with having undertaken smoking cessation training (OR 2.1, CI 1.1-3.9), being a medical practitioner (OR 6.0, CI 3.1-11.6), having greater perceived knowledge and resources (OR 1.7, CI 1.3-2.4) and more positive attitudes (OR 1.5, CI 1.1-2.0). Common barriers to delivering cessation assistance related to knowledge and availability of resources. Development and greater dissemination of effective smoking cessation training and resources may be required to ensure healthcare practitioners have the capacity to complete all aspects of the 5A framework for smoking cessation and support their patients with HIV who smoke.

FuelCell Energy is developing a Hybrid Solid Oxide Fuel Cell (SOFC)-Battery Power System for Large Displacement Unmanned Underwater Vehicle (LDUUV) propulsion as part of the Office of Naval Research’s LDUUV Innovative Naval Prototype (INP) Energy Program. The project objective is the development of an air-independent refuelable power system with high energy density suitable for long duration underwater missions. The Hybrid SOFC-Battery system will be capable of generating 1800 kW-hr of electricity over a 70-day mission with no discharge outside of the vehicle at any time. The power system is fueled by JP-10 logistic fuel, utilizes liquid O2 for air-independent operation, and is compact enough to fit within a 42 inch x 42 inch (square) x 120 inch space within the LDUUV. Phase I of the project includes process design and cost analysis, development of a 3-D CAD model of the power system, breadboard level testing of components and the integrated system, as well as completion of a Preliminary Hazard Analysis (PHA).

Integrated Gasification Fuel Cell (IGFC) power plants, incorporating solid oxide fuel cell (SOFC), are an attractive alternative to traditional pulverized coal-fired steam cycle and Integrated Gasification Combined Cycle power plants, for central power generation. Key features of the IGFC plants are: high efficiency, near-zero emissions of SOx and NOx, low water consumption, and amenability to carbon dioxide (CO2) capture. FuelCell Energy is developing SOFC systems and technology for very efficient, economically viable, coal-based power plants through a cooperative agreement with the U.S. Department of Energy. A key project objective is implementation of an innovative system concept in design of a Baseline Power Plant (>100 MW) to achieve an electrical efficiency of >55% based on coal higher heating value, exclusive of power requirements for CO2 compression. The Baseline system is designed to remove at least 90% of carbon in the syngas for sequestration as CO2. The coal-based power plant is targeted to have a cost of $700/kW (2007 US dollars) for the SOFC power block.

A student-centred approach to teaching has been conceptualized as a key driver in higher education to facilitate understanding of concepts and improve attainment. The occurrence of student study team behaviours is diagnostic of this approach to teaching. However, the extent to which team behaviours are performed outside the parameters of formal teacher-learner environments remains under-researched. This is problematic as it is unclear whether study teams are maintained outside the confines of lectures, and the extent to which they impact on individual student grades. A naturalistic observational study was carried out that utilized short message text service communication as a means to record the frequency of team behaviours within informal environments. The findings suggest the frequency of team behaviours: 1) were positively associated with student grades; 2) increased after lectures independently rated as low in employing a student-centred focus; and 3) were facilitated by students' trait emotional intelligence.

Recent policy in England has advocated the introduction of fast-track degrees to provide an alternative, shorter route to a bachelor’s degree. It has been argued that this will widen participation in higher education and increase labour market flexibility by providing an option in which undergraduates spend one fewer years out of the labour market. Critics have suggested that the outcomes from this new undergraduate option will be worse than those for students following the standard length of undergraduate degree (which is three years for most subjects studied at universities in England). This criticism is based on a belief that students on the shorter degrees will be encouraged to ‘cram’, having less opportunity for reflection that will foster a deep understanding. These arguments are evaluated using data which compare students following two and three year degrees in the same subjects at the same university.

There has been a considerable shift in the higher education literature from a focus on the characteristics and traits of individual students to the role of the learning environment. More than ever, the context in which learning takes place has come to the fore and the role of lecturers in helping to facilitate learning and to engage students across a wide diversity of learning contexts is of upmost importance. To this end, learning is relational, which involves the development and quality of relationships between students and lecturers but also the relationships between students themselves (see Gergen, 2011). The empirical evidence is encouraging as it demonstrates that students who learn collaboratively achieve higher grades than students working independently. The challenge for programme managers is to move beyond the prescriptive view that learning only takes place at an individual level within the lecture theater, seminar or tutorial room and explore the wider sets of relationships and communities in which students are situated within (Singh, 2003; Garrison and Vaughan, 2008). Students come to higher education institutions already engaged in a wider set of relationships (e.g., family, employment, and organizations) and will develop new ones through their studies which need to be understood in order to engage students with innovative program design and delivery. This research topic was born out of this need and collects together a range of perspectives that converge on one salient question i.e., by what means can we further engage students in their studies? This research topic is both innovative and ambitious and highlights as well as consolidates the current understanding of the role that student based engagement behaviors may serve in effective pedagogy. Of the nine papers submitted six were platform articles that highlighted an existing agenda or set a further direction for new lines of work. The very fact that so many opinion articles were submitted to this topic perhaps highlight the need for more empirical work in this area. In a highly original article, Irving (2015) describes her work on the use of dance to engage students with the development of statistical literacy. Research methods and statistics are traditionally viewed as difficult topics by undergraduate psychology students and many fail to engage due to the (miss) perceived difficulty that they may encounter (Onwuegbuzie and Wilson, 2010). However, by communicating statistical concepts via the medium of dance Irving argues that students can be more readily engaged within this topic. A similar process is advocated with the work of McGivern and Coxon (2015) as well Rich et al. (2014) who respectively describe the possible role that student polling software and student focused assessments have in driving engagement and retention. While Orosz et al. (2015) found that teacher enthusiam drove a reduction of cheating behaviors in subsequent assessments. These articles each highlight the need for student-focused activities in the classroom as facilitators of engagement. However, such student-focused activities need not be purely designed around the manner in which students engage with their respective programme. Indeed, Senior et al. (2014b) argue that the unique experience of maintaining gainful employment at the same time as studying full time should be considered as a central part of programme design. Not only will this ensure that subsequent programmes are flexible enough to support the real world needs of the incoming student cohort but they will also be designed to facilitate effective learning with students who often have to balance the needs of full time study with work and sometimes even family commitments (see also Senior and Cubbidge, 2010). Such student-facing commitments are significant and as Gill et al. (2015) describe sometimes they are simply essential to consider in the delivery of programmes that maximize student retention. While, Senior et al. (2014a) make an interesting observation and bring in organizational theory to highlight the importance of differences in the style of academic leadership and how a more open and relationship focused style of leadership may have a significant benefit in driving student retention. Taken together these opinion papers describe the importance of various factors that when considered may increase student retention and maximize engagement—these are the gold standards of effective programme design. The work by Hammar-Chiriac (2014), Orosz and colleagues (2015) as well as Senior and Howard (2014) examine the possible social mechanisms that are in play in driving such engagement. Hammer-Chiriac first examines the social processes that are experienced during the act of engaging with group work. In a study that spanned across two institutes involving several programmes and analysis was carried out to examine the student experiences of group work. Three key factors were uncovered to play a significant role in student engagement these being the organization of the group, its effective role in facilitating learning and also its function in the facilitating and an affiliation to a particular discipline based group. Here the students use group work to develop and enforce their emerging professional identity. This goes beyond subscribing to a professional identity merely by enrolling on a particular programme here the act of working together on a group project actively drives the formation of such a professional identity. The social psychological mechanism behind such a process was examined further in the work by Senior and Howard (2014). In a series of focus group carried out with students who enrolled on Psychology programmes it was revealed that students used their immediate friendship groups not only to reinforce their professional identity but to also reinforce their own understanding of the topics that had been discussed in their lectures. However, perhaps more interestingly was the fact that those student who used their friendship groups to reinforce their understanding of lecture topics were also unaware they were doing so. The authors of this paper highlight the fact that the students were using their engagement within a so called community of learners as an effective learning mechanism but also coined the phrase the “implicit community of learners” to describe the manner in which the students were engaging with their social groups to reinforce their professional identity as well as develop a stronger understanding of the disciplinary concepts. All of the work described above is a snap shot of the current state of the art in student engagement highlights the various means by which future work can make an impact. We would like to express our sincere thanks to all of the reviewers for the papers submitted to this Research Topic and to Professors Jesus De La Fuentes and Jason Osborne who agreed to act as action editors for the papers that we submitted—without them the work you are currently reading will not have happened.

SUMMARY * INTEGRATING PHYSICIANS INTO the Healthfirst administration through employment sowed seeds of mutual understanding among these two groups that would benefit the system immeasurably over the next several years. The immediate future, however, saw only cultural upheaval between our hospitals and newly employed physicians, hospitals and nonemployed physicians, employed and nonemployed physicians, as well as specialists and primary care providers. Traditional physician-relationship-building efforts became difficult, if not impossible, to maintain. Essentially, administration was forced to scrap ten years of physician-development plans in order to reconfigure a relations effort that would maintain hospital support from all sides while restructuring the employed medical group. This article describes the evolution of Healthfirst's approach to maintaining effective physician relationships within our healthcare system and its affiliated entities over the past decade. Specifically, the article details the manner in which our system has evolved physician-relations activity to maintain an effective strategy during times of significant change in the healthcare industry. HISTORICAL PERSPECTIVE Healthfirst Physician Management Services, Inc., was originally formed in 1993 as an Oklahoma for-profit corporation residing under the corporate umbrella of SSM Health Care of Oklahoma (SSMHCO), a not-for-profit Oklahoma corporation. SSMHCO operates as a subsidiary corporation to the SSM Health Care System, a multistate healthcare system based in St. Louis, Missouri. Healthfirst was originally created to provide managed care network formation, practice management support, and physician development/ relations for St. Anthony Hospital, a 644-bed not-for-profit tertiary-care facility located in downtown Oklahoma City, Oklahoma; and Bone & Joint Hospital, a national leader in the provision of inpatient orthopedic services. As was the case with many hospitals in the early 1990s, SSMHCO aspired to solidify our market position by developing a primary care and subspecialty network to use in protecting our market and managed care position. Healthfirst was utilized to manage this network. From 1993 to 2003 the network has grown from 10 employed or managed physicians to a network that includes 70 employed or managed physicians and an additional 350 network-contracted physicians who use SSMHCO facilities. BACKGROUND For Healthfirst and St. Anthony Hospital, the 1990s ushered in a new era of hospital-physician relationships. SSMHCO followed the trend of most multihospital systems aspiring to provide efficient services in a world thought to be soon dominated by capitated medicine. Resources were heavily invested in developing components of integrated healthcare delivery systems, including the acquisition and development of a primary/specialty care physician network. Healthfirst, on behalf of our parent hospital system, set about to construct a large physician network capable of sustaining SSMHCO. Our acquisition and development department worked diligently from 1993 to 1996 to acquire physician practices that would serve as the core medical group for our system. Physicians became employees of our system, and Healthfirst eventually employed, managed, and operated more than 80 physician practices. Developing a large physician-employment model required significant investment of both monetary and operational resources. SSMHCO, through Healthfirst, developed a management company to provide operational support for our newly employed physician group. Administrative resources were allocated to the group, including traditional physician-relations activity originally designed to build relationships with our general medical staff. Hospital management that had previously rounded to staff physicians now placed much of their time and attention on the newly employed and managed physicians. Special time and attention was paid to primary care physicians who at that time were thought to be the most critical component of medical groups in the new era of capitated medicine. …

The role that student friendship groups play in learning was investigated here. Employing a critical realist design, two focus groups on undergraduates were conducted to explore their experience of studying. Data from the “case-by-case” analysis suggested student-to-student friendships produced social contexts which facilitated conceptual understanding through discussion, explanation, and application to “real life” contemporary issues. However, the students did not conceive this as a learning experience or suggest the function of their friendships involved learning. These data therefore challenge the perspective that student groups in higher education are formed and regulated for the primary function of learning. Given these findings, further research is needed to assess the role student friendships play in developing disciplinary conceptual understanding.

Objective To determine whether variants of the mitochondrial genome influence the risk of developing age-related hearing loss (ARHL). Design Cross-sectional study. Setting Eligible participants were noninstitutionalized permanent residents 49 years or older identified in a door-to-door census of 2 suburban postcode areas, west of Sydney, Australia. Participants The Blue Mountains Hearing Study (BMHS) was a population-based survey of hearing loss, conducted during 1997 to 1999, among the participants of the Blue Mountains Eye Study cohort. Main Outcome Measures We defined hearing impairment as the pure-tone average of audiometric hearing thresholds at 500, 1000, 2000, and 4000 Hz (> 25- but ≤ 40-dB hearing level [HL] [mild hearing loss], > 40- but ≤ 60-dB HL [moderate hearing loss], or > 60-dB HL [severe hearing loss]) in the better of the 2 ears. Results Of the 2765 BMHS participants, 912 (33%) were found to have ARHL. After adjusting for other hearing loss risk factors, mitochondrial DNA (mtDNA) haplogroups U and K were independently associated with a higher prevalence of ARHL compared with subjects with other haplogroups. Haplogroup U was significantly associated with moderate to severe ARHL (multivariable-adjusted odds ratio, 1.63; 95% confidence interval, 1.10-2.41). Haplogroup K was associated with severity types of ARHL in persons aged 50 to 59 years (odds ratio, 3.02; 95% confidence interval, 1.30-6.99). There was also a joint effect between mtDNA haplogroups U and K and other known hearing loss risk factors such as diabetes and past noise exposure. Conclusion Findings from this older Australian population demonstrate an association between certain mtDNA haplogroups and ARHL, as well as a link to the susceptibility of other known risk factors for ARHL.

Chris Howard Bailey, B.Ed., M.A. is teacher of drama at Avon High School and is consultant for the Health Education programme at Avon Public School (CT). She has taught and directed drama extensively and is currently preparing a book on Drama and Health.

With the realisation of the Internet of Things (IoT) paradigm, the analysis of the Activities of Daily Living (ADLs), in a smart home environment, is becoming an active research domain. The existence of representative datasets is a key requirement to advance the research in smart home design. Such datasets are an integral part of the visualisation of new smart home concepts as well as the validation and evaluation of emerging machine learning models. Machine learning techniques that can learn ADLs from sensor readings are used to classify, predict and detect anomalous patterns. Such techniques require data that represent relevant smart home scenarios, for training, testing and validation. However, the development of such machine learning techniques is limited by the lack of real smart home datasets, due to the excessive cost of building real smart homes. This paper provides two datasets for classification and anomaly detection. The datasets are generated using OpenSHS, (Open Smart Home Simulator), which is a simulation software for dataset generation. OpenSHS records the daily activities of a participant within a virtual environment. Seven participants simulated their ADLs for different contexts, e.g., weekdays, weekends, mornings and evenings. Eighty-four files in total were generated, representing approximately 63 days worth of activities. Forty-two files of classification of ADLs were simulated in the classification dataset and the other forty-two files are for anomaly detection problems in which anomalous patterns were simulated and injected into the anomaly detection dataset.