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We explored the experiences of people in larger bodies seeking fertility and/or pregnancy care through a reproductive justice lens, integrating an understanding of weight stigma with an understanding of who has access to reproductive technologies, who is “allowed” to become pregnant, and the discourses that surround pregnancy. We conducted a thematic analysis of the narratives of 17 participants who had been labelled “overweight” or “obese” while pregnant and/or seeking reproductive healthcare related to fertility and/or pregnancy. Participants’ narratives speak to experiences of being surveilled and controlled in medical settings; this surveillance and control negatively impacted their access to desired care. In order to receive the kinds of care they wanted, many participants had to become self-advocates. This self-advocacy speaks to resistance and “resilience”; we discuss how individualizing “resilience” represents an incomplete solution to navigating the shaming and blaming encounters participants experienced with healthcare providers. We argue for healthcare that is more caring and responsive to the needs of diverse individuals who are or who are seeking to become pregnant. This work was funded by a Canadian Institutes of Health Research (CIHR) operating grant #137019 2021-01-29

Within the hydraulic fracturing domain, automation has begun to play a substantial role in logistics, supply chain, and manufacturing. A review of automation opportunities generally focuses on cost reduction arising from throughput improvements for service delivery. Although cost reduction efforts are important and are delivered in many ways, the automation efforts discussed in this paper take a different approach. Automation now plays a larger role in how stimulation operations are performed from the subsurface perspective. The automation processes reviewed in these studies focus on making more consistent decisions while breaking down the formation to promote an even distribution of fracture fluid placement for all stages. The metric for success is not necessarily focused on cost or time reduction; although these outcomes are occurring, the success metrics focus on the concept that more effective fracturing treatments can be consistently delivered by removing human inconsistency through automation during stimulation operations. This is accomplished is by automatically controlling the pump rate, based on the pressure response from the formation in real time. This paper highlights a series of cases in North American shale basins that include wells that are instrumented with fiber optics and downhole pressure gauges, as well as non-instrumented wells with wellhead pressure and flowrate measurements only. It reviews how automation improves placement consistency in stimulation operations, eliminating some of the risks associated with traditional approaches that can lead to inconsistent outcomes. All of the results communicated are based on the capability to place fracturing fluid and proppant with more uniformity and consistency across the target interval while making real-time automated rate adjustments during pumping operations. The studies include work conducted in all major North American plays. The major findings include a discernable capacity to treat more clusters within a given stage, using automated rate controls, and achieving more even distribution of proppant to the target clusters within a given stage.

Purpose – The purpose of this paper was to identify safeguarding concerns for vulnerable adults, including exploring the implementation of safeguarding policy and procedures into practice. This was achieved by reviewing the content of reflective assignments written by pre-registration student nurses, identifying areas of concerns and proposing action plans. Design/methodology/approach – A qualitative approach was initially utilised to scrutinise a random 10 per cent sample of work, which was thematically analysed. From this, an audit tool was devised and then applied to evaluate a 35 per cent sample of work from the following cohort of students. Approval and consent was gained. Findings – From the initial 10 per cent sample, themes emerged around: practice issues; areas for student's development and marking or assessment issues. The standardised audit tool was devised and applied to a 35 per cent random sample of work. This determined that students identified local safeguarding policies and procedures were being followed in the majority of placement areas, although application of the Mental Capacity Act remained inconsistent. Research limitations/implications – The assessor feedback from the reflective assignments was not available to the reviewers, limiting the reviewers ability to identify if assessors had recognised and corrected any policy or practice issues that the student raised. Only assignments from the adult field of nursing were considered within the scope of this study. The authors recommend further empirical investigation into this area. Practical implications – This paper offers knowledge that can be applied in practice within both academic and health care provider services that deliver and facilitate nursing education. It has generated an audit tool that can be utilised to evaluate the knowledge of pre-registration students and has resulted in the implementation of safeguarding adults policies within an academic institution. Originality/value – Safeguarding adults concerns may be identified through studying pre-registration student assignments and promptly acting upon any concerns raised. Aspects of good practice can be acknowledged within health care provider services.

Nursing staff in a medical/surgical acute care 34-bed hospital unit were challenged by low percentages of patients able to recall nurse leader rounding activity (NLR). NLR occurred daily for all patients, yet many did not recall visits by nursing leaders when surveyed at discharge. Care giver credibility suffered as non-nursing executives questioned if NLR consistently occurred. Several mechanisms were used to facilitate patient NLR recall: scripted NLR verbiage/keywords, nursing uniform leadership insignia and white lab coats, sharing of business cards, handwritten notes on patient communication white boards, multimedia leadership insignia on leader e-tablets, and visits with family members: patient NLR recall did not improve. Nurses designed low effort, active learning, spaced repetition exchanges using the hospital nurse call system in reverse to distinguish NLR from other care-related activity. A pilot study saw NLR recall climb from a baseline measurement of 37.5% (n=88) to 88% (n=93) following implementation. Mann-Whitney U confirmed significant findings (U=2018.5, p

Background Funders now frequently require that sex and gender be considered in research programmes, but provide little guidance about how this can be accomplished, especially in large research programmes. The purpose of this study is to present and evaluate a model for promoting sex- and gender-based analysis (SGBA) in a large health service research programme, the Ontario Pharmacy Evidence Network (OPEN). Methods A mixed method study incorporating (1) team members’ critical reflection, (2) surveys (n = 37) and interviews (n = 23) at programme midpoint, and (3) an end-of-study survey in 2016 with OPEN research project teams (n = 6). Results Incorporating gender and vulnerable populations (GVP) as a cross-cutting theme, with a dedicated team and resources to promote GVP research across the programme, was effective and well received. Team members felt their knowledge was improved, and the programme produced several sex- and gender-related research outputs. Not all resources were well used, however, and better communication of the purposes and roles of the team could increase effectiveness. Conclusions The experience of OPEN suggests that dedicating resources for sex and gender research can be effective in promoting SGBA research, but that research programmes should also focus on communicating the importance of SGBA to their members. Electronic supplementary material The online version of this article (doi:10.1186/s12961-017-0182-z) contains supplementary material, which is available to authorized users.

Background Data regarding the efficacy of directly administered antiretroviral therapy (DAART) are mixed. Opioid treatment programs (OTPs) provide a convenient framework for DAART. In a randomized controlled trial, we compared DAART and self-administered therapy (SAT) among HIV-infected subjects attending five OTPs in Baltimore, MD. Methods HIV-infected individuals attending OTPs were eligible if they were not taking antiretroviral therapy (ART) or were virologically failing ART at last clinical assessment. In subjects assigned to DAART, we observed one ART dose per weekday at the OTP for up to 12 months. SAT subjects administered ART at home. The primary efficacy comparison was the between-arm difference in the average proportions with HIV RNA

Women’s choice and control impact birthing experiences. This study used a qualitative, descriptive approach to explore how women develop their initial birth plan and how changes made to the plan affect overall birth experiences. Narrative, semistructured interviews were conducted with 15 women who had given birth in Waterloo Region, Ontario, Canada, and data were analyzed using a phenomenological approach. Findings showed that women relied on many resources when planning a birth and that changes made to a woman’s initial birth plan affected her recollection of the birth experience. Conclusions are that women’s positive and negative recollections of their birth experiences are related more to feelings and exertion of choice and control than to specific details of the birth experience.

Background HIV-infected drug users are at higher risk of non-adherence and poor treatment outcomes than HIV-infected non-drug users. Prior work from our group and others suggests that directly administered antiretroviral therapy (DAART) delivered in opioid treatment programs (OTPs) may increase rates of viral suppression. Methods/Design We are conducting a randomized trial comparing DAART to self-administered therapy (SAT) in 5 OTPs in Baltimore, Maryland. Participants and investigators are aware of treatment assignments. The DAART intervention is 12 months. The primary outcome is HIV RNA < 50 copies/mL at 3, 6, and 12 months. To assess persistence of any study arm differences that emerge during the active intervention, we are conducting an 18-month visit (6 months after the intervention concludes). We are collecting electronic adherence data for 2 months in both study arms. Of 457 individuals screened, a total of 107 participants were enrolled, with 56 and 51 randomly assigned to DAART and SAT, respectively. Participants were predominantly African American, approximately half were women, and the median age was 47 years. Active use of cocaine and other drugs was common at baseline. HIV disease stage was advanced in most participants. The median CD4 count at enrollment was 207 cells/mm3, 66 (62%) had a history of an AIDS-defining opportunistic condition, and 21 (20%) were antiretroviral naïve. Conclusions This paper describes the rationale, methods, and baseline characteristics of subjects enrolled in a randomized clinical trial comparing DAART to SAT in opioid treatment programs. Trial Registration ClinicalTrials.gov: NCT00279110

Opioid dependence is common in HIV clinics. Buprenorphine-naloxone (BUP) is an effective treatment of opioid dependence that may be used in routine medical settings.To compare clinic-based treatment with BUP (clinic-based BUP) with case management and referral to an opioid treatment program (referred treatment).Single-center, 12-month randomized trial. Participants and investigators were aware of treatment assignments. (ClinicalTrials.gov registration number: NCT00130819)HIV clinic in Baltimore, Maryland.93 HIV-infected, opioid-dependent participants who were not receiving opioid agonist therapy and were not dependent on alcohol or benzodiazepines.Clinic-based BUP included BUP induction and dose titration, urine drug testing, and individual counseling. Referred treatment included case management and referral to an opioid-treatment program.Initiation and long-term receipt of opioid agonist therapy, urine drug test results, visit attendance with primary HIV care providers, use of antiretroviral therapy, and changes in HIV RNA levels and CD4 cell counts.The average estimated participation in opioid agonist therapy was 74% (95% CI, 61% to 84%) for clinic-based BUP and 41% (CI, 29% to 53%) for referred treatment (P0.001). Positive test results for opioids and cocaine were significantly less frequent in clinic-based BUP than in referred treatment, and study participants receiving clinic-based BUP attended significantly more HIV primary care visits than those receiving referred treatment. Use of antiretroviral therapy and changes in HIV RNA levels and CD4 cell counts did not differ between the 2 groups.This was a small single-center study, follow-up was only moderate, and the study groups were unbalanced in terms of recent drug injections at baseline.Management of HIV-infected, opioid-dependent patients with a clinic-based BUP strategy facilitates access to opioid agonist therapy and improves outcomes of substance abuse treatment.Health Resources and Services Administration Special Projects of National Significance program.

Many students with Autism Spectrum Disorders (ASD) have delays learning to recognize emotions. Social behavior is also challenging, including initiating interactions, responding to others, developing peer relationships, and so forth. In this single case design study we investigated the relationship between use of computer software ( Mind Reading: The Interactive Guide to Emotions) and emotion recognition (ER) and social behavior change. After using Mind Reading for 7 to 10 weeks with a tutor, four boys with ASD improved ER scores and social interactions with peers. However, observed behavior changes were not strong enough to claim a causal relationship between variables. Findings, practice implications, and future research are discussed.