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Objective To determine whether a nurse-led model of care for patients with hepatitis C virus (HCV) infections can provide safe and effective diagnosis and treatment in a resource-poor setting in rural Cambodia. Methods The nurse-led initiation pilot project was implemented by MedecinsSans Frontieres in collaboration with the Cambodian health ministry in two operational districts in Battambang Province between 1 June and 30 September 2020. Nursing staff at 27 rural health centres were trained to identify signs of decompensated liver cirrhosis and to provide HCV treatment. Patients without decompensated cirrhosis or another comorbidity were initiated at health centres onto combined treatment with sofosbuvir, 400 mg/day, and daclatasvir, 60 mg/day, orally for 12 weeks. Treatment adherence and effectiveness were assessed during follow-up. Findings Of 10 960 individuals screened, 547 had HCV viraemia (i.e. viral load [greater than or equal to] 1000 IU/mL). Of the 547, 329 were eligible for treatment initiation at health centres through the pilot project. All 329 (100%) completed treatment and 310 (94%; 95% confidence interval: 91-96) achieved a sustained virological response 12 weeks post-treatment. Depending on patient subgroups, this response varied from 89% to 100%. Only two adverse events were recorded; both were determined as unrelated to treatment. Conclusion The safety and effectiveness of direct-acting antiviral medication has previously been demonstrated. Models of HCV care now need to enable greater access for patients. The nurse-led initiation pilot project provides a model for use in other resource-poor settings to scale up national programmes. Objectif Determiner si un modele de soins dirige par le personnel infirmier pour les patients infectes par le virus de l'hepatite C (VHC) offrirait un niveau de fiabilite et d'efficacite suffisant pour le depistage et le traitement de la maladie dans les regions rurales du Cambodge, ou les ressources sont limitees. Methodes Le projet pilote de prise en charge initiale par le personnel infirmier a ete deploye par Medecins Sans Frontieres en collaboration avec le Ministere cambodgien de la Sante dans deux districts operationnels dans la province de Battambang entre le 1er juin et le 30 septembre 2020. Le personnel infirmier de 27 centres de sante ruraux a ete forme afin d'identifier les symptomes d'une cirrhose decompensee et fournir un traitement contre le VHC. Les patients ne presentant pas de cirrhose decompensee ni d'autre comorbidite ont entame, dans des centres de sante, un traitement combine au sofosbuvir (400 mg/jour) et au daclatasvir (60 mg/jour) par voie orale pendant 12 semaines. Ladhesion au traitement ainsi que son efficacite ont ete evaluees durant le suivi. Resultats Sur 10 960 individus depistes, 547 affichaient une viremie VHC (c'est-a-dire une charge virale [greater than or equal to] 1000 UI/mL). Sur ces 547 personnes, 329 etaient eligibles pour une mise sous traitement au sein d'un centre de sante dans le cadre du projet pilote. La totalite de ces 329 patients (100%) a suivi le traitement complet et 310 d'entre eux (94%; intervalle de confiance de 95%: 91-96) ont obtenu une reponse virologique durable apres 12 semaines de traitement. En fonction des sous-groupes de patients, cette reponse etait comprise entre 89% et 100%. Seuls deux effets indesirables ont ete constates; tous deux se sont reveles sans aucun lien avec le traitement. Conclusion La fiabilite et l'efficacite des medicaments antiviraux a action directe ont deja ete demontrees par le passe. Les modeles de prise en charge du VHC doivent desormais garantir un meilleur acces aux patients. Le projet pilote de prise en charge initiale par le personnel infirmier offre une solution applicable a d'autres endroits ou les ressources sont limitees, afin de renforcer les programmes nationaux. Objetivo Determinar si un modelo de atencion dirigido por el personal de enfermeria para pacientes con infecciones por el virus de la hepatitis C (VHC) puede proporcionar un diagnostico y un tratamiento seguros y eficaces en una poblacion con pocos recursos de las zonas rurales de Camboya. Metodos Medicos Sin Fronteras, en colaboracion con el Ministerio de Sanidad de Camboya, ejecuto el proyecto piloto de tratamiento inicial dirigido por el personal de enfermeria en dos distritos operativos de la provincia de Battambang entre el 1 de junio y el 30 de septiembre de 2020. El personal de enfermeria de 27 centros sanitarios rurales recibio formacion para identificar los signos de cirrosis descompensada y proporcionar tratamiento contra el VHC. Los pacientes sin cirrosis descompensada u otra comorbilidad iniciaron en los centros sanitarios un tratamiento combinado con sofosbuvir, 400 mg/dia, y daclatasvir, 60 mg/dia, por via oral durante 12 semanas. Durante el seguimiento se evaluo la adherencia al tratamiento y su eficacia. Resultados De las 10 960 personas examinadas, 547 presentaban viremia por VHC (es decir, una concentracion virica [greater than or equal to] 1000 UI/ml). De los 547, 329 cumplian los requisitos para iniciar el tratamiento en los centros sanitarios a traves del proyecto piloto. Los 329 (100 %) completaron el tratamiento y 310 (94 %; intervalo de confianza del 95 %: 91-96) lograron una respuesta virologica sostenida 12 semanas despues del tratamiento. Dependiendo de los subgrupos de pacientes, esta respuesta vario entre el 89 % y el 100 %. Solo se registraron dos acontecimientos adversos; en ambos casos se determino que no estaban relacionados con el tratamiento. Conclusion La seguridad y eficacia de los antiviricos de accion directa ya ha quedado demostrada. Ahora es necesario que los modelos de atencion al VHC permitan un mayor acceso a los pacientes. El proyecto piloto de tratamiento inicial dirigido por el personal de enfermeria ofrece un modelo que se puede utilizar en otras poblaciones con pocos recursos para ampliar los programas nacionales., Introduction Given the demonstrated safety and effectiveness of current, direct-acting antiviral treatments for hepatitis C virus (HCV) infection and the validity of rapid, point-of-care tests, (1,2) international discussions and investigations [...]

Introduction: Various types of sedation can be used for the reduction of a dislocated total hip arthroplasty. Traditionally, an Opiate/Benzodiazepine combination has been employed. The use of other pharmacologic agents, such as Etomidate and Propofol, has more recently gained popularity. Currently no studies directly comparing these sedation agents have been carried out.  The purpose of this study is to compare differences in reduction and sedation outcomes including recovery times of these three different sedation agents.Methods: A retrospective chart review was performed examining 198 patient’s charts who presented with dislocated total hip arthroplasty at two academic affiliated medical centers. The patients were organized into groups according to the type of sedation agent used during their reduction. The percentages of reduction and sedation complications were calculated along with overall recovery times. Reduction complications included fracture, skin or neurovascular injury, and failure of reduction requiring general anesthesia. Sedation complications included use of bag-valve mask and artificial airway, intubation, prolonged recovery, use of a reversal agent, and inability to achieve sedation. The data were then compared for each sedation agent.Results: The reduction complications rates found were 8.7% in the Propofol group, 24.68% in the Etomidate, and 28.85% in the Opiate/Benzodiazepine groups. The reduction complication rate in the Propofol group was significantly different than those of the other two agents (p≤0.01). Sedation complications were found to happen 7.25% of the time in the Propofol group, 11.69% in the Etomidate group, and 21.25% in the Opiate/ Benzodiazepine group with Propofol having complication rates significantly different than that of the Opiate/Benzodiazepine group (p=0.02). Average lengths of recovery were 25.17 minutes for Propofol, 30.83 minutes for Etomidate, and 44.35 minutes for Opiate/ Benzodiazepine with Propofol averaging a significantly less recovery time than the Opiate/Benzodiazepine group (p=0.05).Conclusions: For the purpose of reducing a dislocated total hip arthroplasty under conscious sedation, Propofol appears to have fewer complications and a trend of more rapid recovery than both Etomidate and Opiate/Benzodiazepine. Etomidate does appear to have some advantages over Opiate/Benzodiazepine regarding sedation complications and recovery time; however its rate of reduction complications was similar. This preliminary data supports the use of Propofol as the first line agent for procedural sedation of dislocated total hip arthroplasty as it may lead to few complications and shorter stays in the emergency department.

Recent guidance from the World Health Organization strongly recommended hepatitis C virus (HCV) self‐testing. We implemented the Vend‐C pilot study to explore the effectiveness and feasibility of distributing rapid HCV antibody self‐test kits to people who inject drugs via needle/syringe dispensing machines (SDMs). Over a 51‐day study period between August and September 2022, we distributed HCV antibody self‐test kits via two SDMs. During the study period, 63 self‐test kits were dispensed, averaging 1.2 self‐test kits per day. Our access methods for evaluation questionnaires failed to attract participants (n = 4). We implemented the Vend‐C pilot study in direct response to recent WHO recommendations. While self‐test kits were effectively distributed from the two SDMs, our evaluation methodology failed. Consequently, we cannot determine the success of linkage to care. Even so, with HCV treatment numbers dropping in Australia, innovative engagement solutions are needed, and considering the number of self‐test kits provided in our pilot, the model could have an important future place in HCV elimination efforts. [ABSTRACT FROM AUTHOR]

We investigated the effects of a major revision of the differential and integral calculus curriculum, the primary goal of which was to improve STEM retention. The revamped curriculum has greater emphasis on the power of computing to help visualize patterns and gain insights to better prepare students for STEM majors, and less emphasis on traditional and theoretical calculus content, such as the limit definition of the derivative. We investigated a comparison between 338 students who had taken the traditional sequence and 328 who had taken the revamped sequence during the Fall 2020 and Spring 2021 semesters. STEM retention, i.e., following through with the initial intent to major in a STEM field, was enhanced by 7% in the revamped group. STEM majors in the traditional group were found to over-perform in their other STEM classes by a 0.18 GPA margin, while non-STEM majors in the revamped group over-performed in their other STEM classes by a 0.17 GPA margin. Both differences are statistically significant. Focus groups were also conducted to gather and synthesize student perceptions. Results may encourage similar innovations to core math curricula in other universities to foster enhanced STEM retention. [ABSTRACT FROM AUTHOR]

Issues: People who inject drugs are at risk of acute infections, such as skin and soft tissue infections, infective endocarditis, bone and joint infections and bloodstream infections. There has been an increase in these infections in people who inject drugs internationally over the past 10 years. However, the local data regarding acute infections in Australia has not been well described. Approach: We review the epidemiology of acute infections and associated morbidity and mortality amongst people who inject drugs in Australia. We summarise risk factors for these infections, including the concurrent social and psychological determinants of health. Key Findings: The proportion of people who report having injected drugs in the prior 12 months in Australia has decreased over the past 18 years. However, there has been an increase in the burden of acute infections in this population. This increase is driven largely by skin and soft tissue infections. People who inject drugs often have multiple conflicting priorities that can delay engagement in care. Implications: Acute infections in people who inject drugs are associated with significant morbidity and mortality. Acute infections contribute to significant bed days, surgical requirements and health‐care costs in Australia. The increase in these infections is likely due to a complex interplay of microbiological, individual, social and environmental factors. Conclusion: Acute infections in people who inject drugs in Australia represent a significant burden to both patients and health‐care systems. Flexible health‐care models, such as low‐threshold wound clinics, would help directly target, and address early interventions, for these infections. [ABSTRACT FROM AUTHOR]

Coverage is an important dimension in measuring the effectiveness of needle and syringe programmes in providing sterile injecting equipment for people who inject drugs. The World Health Organization (WHO), the United Nations Office on Drugs and Crime (UNODC) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) currently recommend methods for measuring coverage at the population level, that is, across an estimated population of people who inject drugs within a given geographical area. However, populationlevel measures of coverage rely on highly uncertain population estimates and cannot capture the different levels of syringe acquisition and injecting episodes among individual users. Consequently, such measures only broadly evaluate the extent of programme service delivery, rather than describe how people who inject drugs as individuals and sub-groups interact with needle and syringe programmes. In response to these limitations, several researchers have proposed measuring coverage at the individual level, by the percentage of injecting episodes in relation to the number of sterile needles and syringes acquired. These measures evaluate coverage according to each individual's needs. Such measures provide enhanced information for planning and monitoring of harm reduction programmes and have now been used in multiple international research studies. We advise that WHO, UNODC and UNAIDS add individual-level coverage measurement methods to their international monitoring guidelines for harm reduction programmes. By doing this, more responsive and effective programmes can be created to better reduce injecting risk behaviours and blood-borne virus transmission among people who inject drugs. La couverture est une dimension importante lorsque I'on veut mesurer l'efficacite des programmes de distribution d'aiguilles et de seringues a fournir du materiel d'injection sterile aux consommateurs de drogues par injection. L'Organisation mondiale de la Sante (OMS), l'Office des Nations Unies contre la drogue et le crime (ONUDC) et le Programme commun des Nations Unies sur le VIH/sida (ONUSIDA) recommandent actuellement des methodes pour mesurer la couverture au niveau de la population, c'est-a-dire sur une population estimee de consommateurs de drogues par injection dans une zone geographique donnee. Or, les mesures de la couverture au niveau de la population se fondent sur des estimations tres incertaines de la population et ne permettent pas de refleter les differents degres d'acquisition de seringues et d'episodes d'injection chez les usagers. Par consequent, ces mesures n'evaluent que globalement la portee des programmes au lieu de decrire la maniere dont les consommateurs de drogues par injection interagissent, individuellement et en sous-groupes, avec les programmes de distribution d'aiguilles et de seringues. En reponse a ces limitations, plusieurs chercheurs ont propose de mesurer la couverture au niveau individuel, en calculant le pourcentage d'episodes d'injection par rapport au nombre d'aiguilles et de seringues steriles acquises. Ces mesures permettent d'evaluer la couverture en fonction des besoins de chaque personne. Ce type de mesures offre des informations plus fiables pour la planification et le suivi des programmes de reduction des risques et il est aujourd'hui utilise dans plusieurs etudes de recherche internationales. Nous suggerons a l'OMS, a l'ONUDC et a l'ONUSIDA d'ajouter des methodes de mesure de la couverture au niveau individuel a leurs directives internationales pour le suivi des programmes de reduction des risques. Cela permettra de mettre au point des programmes plus adaptes et efficaces afin de mieux reduire les comportements a risque lies aux injections ainsi que la transmission de virus par le sang chez les consommateurs de drogues par injection. La cobertura es un factor importante para medir la eficacia de los programas de agujas y jeringas en el suministro de equipo de inyeccion esteril para las personas que se inyectan drogas. La Organizacion Mundial de la Salud (OMS), la Oficina de las Naciones Unidas contra la Droga y el Delito (ONUDD) y el Programa Conjunto de las Naciones Unidas sobre el VIH/SIDA (ONUSIDA) recomiendan actualmente metodos para medir la cobertura a nivel poblacional, es decir, a traves de una poblacion estimada de consumidores de drogas inyectables dentro de una zona geografica determinada. Sin embargo, las medidas de cobertura a nivel poblacional se basan en estimaciones poblacionales altamente inciertas y no pueden captar los diferentes niveles de adquisicion de jeringas y episodios de inyeccion entre los usuarios individuales. En consecuencia, esas medidas solo miden en terminos generales el alcance de la prestacion de servicios de los programas, en lugar de describir la forma en que las personas que se inyectan drogas como individuos y subgrupos interactuan con los programas de suministro de agujas y jeringas. En respuesta a estas limitaciones, varios investigadores han propuesto medir la cobertura a nivel individual, por el porcentaje de episodios de inyeccion en relacion con el numero de agujas y jeringas esteriles adquiridas. Estas medidas miden la cobertura de acuerdo a las necesidades de cada individuo. Estas medidas proporcionan una mejor informacion para la planificacion y el seguimiento de los programas de reduccion de danos y se han utilizado actualmente en multiples estudios de investigacion internacionales. Aconsejamos que la OMS, la ONUDD y el ONUSIDA incorporen metodos de medicion de la cobertura a nivel individual a sus directrices internacionales de vigilancia de los programas de reduccion de danos. De este modo, se pueden crear programas mas receptivos y eficaces para reducir mejor los comportamientos de riesgo en el uso de drogas inyectables y la transmision de virus transmitidos por la sangre entre las personas que se inyectan drogas., Introduction Coverage is an important concept in the evaluation of any public health intervention and coverage has been defined as 'the proportion of the population at risk reached by an [...]

Preventing vaping by adolescents and young adults is unquestionably an important goal. Ma et al.'s meta-analysis invites the conclusion that vaping prevention messages are effective. This commentary discusses two concerns about that conclusion and the affiliated meta-analysis: (1) None of the analyzed effect sizes describes the effectiveness of vaping prevention messages; the effect sizes describe the difference in effectiveness (the difference on an outcome variable) between the two conditions being compared. (2) As the two conditions being compared vary, so do the relevant conclusions–—but the review combines different kinds of comparisons. [ABSTRACT FROM AUTHOR]

In persuasion message effects research, two kinds of research design are common. One compares the persuasiveness of two different advocacy messages on the same topic. The other compares the persuasiveness of an advocacy message against a no-advocacy-message control condition. Because these two designs contain different comparisons they underwrite different claims, but the designs – and their corresponding claims – are prone to misunderstanding and confusion. And when a study combines the two designs, especially complex issues can arise. This article aims to sort out the relevant issues in the service of better alignment between evidence and claims in persuasive message effects research. [ABSTRACT FROM AUTHOR]