Early Discharge to Clinic-Based Therapy of Patients Presenting With Decompensated Heart Failure (EDICT-HF): Study Protocol for a Multi-Centre Randomised Controlled Trial

BACKGROUND

Acute decompensated heart failure involves a high rate of mortality and complications. Management typically involves a multi-day hospital admission. However, patients often lose part of their function with each successive admission, and are at a high risk for hospital-associated complications such as nosocomial infection. This study aims to determine the safety and efficacy of the management of patients presenting with acute decompensated heart failure to clinic-based therapy vs usual inpatient care using a reproducible management pathway.

METHOD

An investigator-initiated, prospective, non-inferiority, 1:1 randomised-controlled trial, stratified by left ventricular ejection fraction including 460 patients with a minimum follow-up of 7 days. This is a multi-centre study to be performed in centres across Victoria, Australia. Participants will be patients with either heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF), admitted for acute decompensation of heart failure.

INTERVENTION

Early discharge to an outpatient-based Heart Failure Rapid Access Clinical Review (RACER) in addition to frequent medical/nursing at-home review for patients admitted with decompensated heart failure.

RESULTS

The primary endpoint will be a non-inferiority assessment of re-hospitalisation at 30 days. Secondary outcomes include superiority assessment of hospitalisation at 30 days, a composite clinical endpoint of major adverse cardiac and cerebrovascular event (MACCE), hospital re-admission or mortality at 3 months, achievement of guideline-directed medical therapy, patient assessment of symptoms (visual-analogue scale quantified as area under curve and Kansas City Cardiomyopathy Questionnaire-12 [KCCQ-12]), attendance at 3-month outpatient follow-up, number of bed stays/clinics attended, proportion of patients free from congestion, change in serum creatinine level, treatment for electrolyte disturbances, time to transition from intravenous to oral diuretics, and health economics analysis (cost-benefit analysis, cost-utility analysis, incremental cost-effectiveness ratio).

CONCLUSIONS

The Early Discharge to Clinic-Based Therapy of Patients Presenting with Decompensated Heart Failure (EDICT-HF) trial will help determine whether earlier discharge to out-of-hospital care is non-inferior to the usual practice of inpatient care, in patients with heart failure admitted to hospital for acute decompensation, as an alternative model of care.

A Longitudinal Exploration of How Connections to Staff Facilitate Efficacy and Service Use in Drop-in Centers Serving Youth Experiencing Homelessness

INTRODUCTION

Youth experiencing homelessness (YEH) benefit from a variety of services to meet their immediate and long-term needs. Drop-in centers are a popular service venue used by YEH. However, the mechanisms responsible for engaging youth in drop-in services are not clear. The current study uses longitudinal data to explore the role of positive staff relationships in increasing youths' knowledge and efficacy to access and subsequently use drop-in center services.

METHODS

731 youth (M_age = 21.8, SD = 2.2, 25.1% female) accessing services at three drop-in centers in Los Angeles, California participated in the study. Surveys were completed at baseline, 1-month, and 3-months later. Path models examined the direct effect of positive relationships with adult staff on service use at the 3-month follow-up, and the indirect effect of service knowledge (assessed at the 1-month follow-up).

RESULTS

The direct effect model showed that positive staff relationships at baseline were significantly associated with number of services used at the 3-month follow-up (aIRR = 1.24, 95% CI: 1.00, 1.54). Positive staff relationships were also associated with greater service knowledge at 1-month (b = 0.93, p < 0.001), which in turn was associated with greater service use at 3-months (IRR = 1.15, 95% CI: 1.04, 1.28). The indirect effect of service knowledge was significant (b = 0.13, p = 0.02), suggesting that the association between positive staff relationships and service use was completely mediated by service knowledge.

CONCLUSIONS

The current study adds to the literature by demonstrating that positive relationships with staff lead to increased service use by increasing youths' knowledge and efficacy to access services. Efforts should be made to develop positive relationships with YEH in order to engage them in essential services needed to exit homelessness.

Sexual assault and harassment victimization and post-assault help-seeking among undergraduate students: Comparing residential and nonresidential campuses

In the United States, campus sexual violence research has mostly focused on 4-year residential campuses. The experiences of students on nonresidential campuses are less well understood. Using data from a Web-based campus climate survey, this study explores sexual assault and sexual harassment victimization rates, victimization characteristics, and post-assault help-seeking across nonresidential and residential students in a campus system that contains both residential and nonresidential campuses. Our analyses highlight that sexual victimization rates, characteristics, and post-assault help-seeking patterns vary by campus type. Interestingly, while nonresidential students on nonresidential campuses reported lower rates of victimization, they accessed formal support resources at higher rates than students on a residential campus. Findings underscore the importance of accounting for campus type in campus sexual violence research and programming and to center nonresidential campuses to learn more about the strategies they adopt to address their students' unique victimization needs and experiences.

The use, perceptions and knowledge of safety of over-the-counter medications during pregnancy in a Canadian population

BACKGROUND

The prevalence of prenatal over-the-counter medication use in Canadian women is unknown.

METHODS

A cross-sectional study of prenatal over-the-counter medication use and safety knowledge was conducted among pregnant and post-partum women attending an academic hospital obstetrics clinic.

RESULTS

Seventy-two women participated; 90.3% were Caucasian, 69.4% had a college/university degree, and 61.1% lived in an urban area. Of the 72 women, 87.5% used over-the-counter medications prenatally, first (55.6%), second (65.3%), and third (47.2%) trimesters, with prenatal acetaminophen use most common (72.2%). Women who used over-the-counter medications 1-0onths before conception were more likely to use over-the-counter medications during pregnancy, and 18% of women initiated over-the-counter medications in pregnancy. Women self-reported a medium level of over-the-counter medication safety knowledge (73.6%) and responded that not all over-the-counter medications are safe during pregnancy (95.8%).

CONCLUSION

Despite limited safety profiles of some over-the-counter medications, pre-conception and prenatal over-the-counter medication use was high. Further research on the risk of over-the-counter medications and combinations in pregnancy is needed to help women to make safe choices during pregnancy.

Psychosocial Impacts of the COVID-19 Pandemic

Background and objective: Globally, men are at greater risk of mortality and serious physical consequences from COVID-19 infection than women, but are less impacted by the pandemic’s impact on labor force participation and increased childcare responsibilities. Outside of gender identity, however, it is unclear whether men’s beliefs about gender may be related to the kinds of COVID-19-related impacts they report. This study sought to describe the employment, income, and household responsibility-related impacts of the pandemic on a sample of young men in the U.S. and to examine relationships between the men’s gender ideologies andattitudes toward gender equity with self-reported stress impacts of the pandemic. Methods: The data are from an online survey of 481 young men from across the U.S. Measures included scales assessing masculinity ideology, modern sexism, support for traditional divisions of labor by gender, and attitudes toward gender equity. New items developed for this study assessed COVID-19-related changes in employment, household responsibilities, and childcare duties as well as levels of stress. Hierarchical regression examined the relative roles of demographic characteristics, changes in employment and household work, and gender-related attitudes on COVID-related stress. Results: Descriptive findings showed that under 50% of the men in the sample experienced negative COVID-related impacts on employment, but that a majority of the men reported at least some COVID-related stress. Results of the hierarchical regression suggest that higher levels of stress were predicted by having a minori-tized sexual identity, less religiosity, experiencing employment or household responsibility-related changes, and not endorsing modern sexism or a traditional, gendered division of labor. Conclusions: Experiencing COVID-19-related stress was normative in this sample of young men. However, endorsing traditional notions of a gendered division of labor was slightly protective against higher levels of COVID-related stress. These findings add to existing evidence that gender analysis must be a central compo-nent of ongoing COVID-related policy and programming development.

A Quality Improvement Project to Delay Umbilical Cord Clamping Time

Delayed cord clamping (DCC) has numerous benefits to the neonate, including increased hemoglobin levels, decreased need for red blood cell transfusions, and decreased incidence of necrotizing enterocolitis and intraventricular hemorrhage. A preliminary observational study at our institution demonstrated 12% of the observed deliveries met the DCC standard, defined as umbilical cord clamping at least 30-60 seconds after birth. Therefore, we designed a quality improvement project to increase the percentage of deliveries using DCC.

METHODS

We planned a quality improvement project aiming to increase DCC rates on the university obstetrics service. Our interventions included provider education, installation of timers in the delivery suites, and modification to documentation in the electronic health record. We measured our results through the documented status of cord clamping, either: (1) greater than or equal to 30 seconds or (2) less than 30 seconds. We analyzed the DCC rates weekly and compared those results to the DCC goal of 80% of all deliveries.

RESULTS

Postintervention DCC rates were 96% overall. Rates of DCC met our aim of 80% or greater each of the 6 weeks we collected data.

CONCLUSION

Simple and inexpensive interventions quickly led to improvements in DCC rates on our university obstetrics service. Our interventions including, provider education, installation of timers in delivery suites, and modification to cord clamping documentation in the electronic health record can be easily instituted at other hospitals. Additionally, the simplicity of this system can produce long-term sustainability of DCC.

POS1089 ASSOCIATION BETWEEN PAIN SEVERITY AND HEALTHCARE UTILIZATION IN AN OSTEOARTHRITIS POPULATION: AN 18-YEAR RETROSPECTIVE COHORT STUDY

Background:

Osteoarthritis (OA) is a common disease that varies in severity among patients. A standardized definition to classify patients into different severity levels is lacking, however, due to the disease’s complex pathogenesis and presentation. Prior studies have shown associations between pain severity and higher healthcare resource utilization (HRU) and costs. We investigated an association between pain severity and higher healthcare resource utilization by examining the use of specific OA-related treatments across pain intensity levels in a large, integrated health system’s OA population over an 18-year period.

Objectives:

Our aim was to compare use of medications and other treatments among OA patients experiencing mild, moderate, or severe pain.

Methods:

This was a retrospective study of electronic health records from 2001 to 2018 at Geisinger, an integrated health system in Pennsylvania. Patients were included with a diagnosis code for OA (ICD-9: 715.*, ICD-10 M15-19) on a problem list or encounter or an OA-specific procedure (hip or knee replacement, arthroscopy or injection). We examined pain scores (0-10 scale, with 10 being worst pain) taken after the first OA diagnosis date and defined pain episodes starting on the pain score’s date and lasting for 90 days. If a new pain score was measured before 90 days elapsed, the episode was extended for an additional 90 days, with this process repeated as necessary. Each episode was categorized as mild (pain score 0-3), moderate (4-6), or severe (7-10) based on initial score, and patients could contribute multiple episodes to the analysis. Descriptive statistics were used to quantify treatment utilization during each patients’ mild, moderate and severe episodes. Percentages of patients who had any use of 10 medication types (tramadol, non-tramadol opioids, nonsteroidal anti-inflammatory drugs (NSAIDs), injectable corticosteroids, acetaminophen, salicylates, duloxetine, homeopathic medications, other topical medications, and other over-the-counter (OTC) medications were compared across pain episode types. Percentages of patients with knee or hip surgeries, spine or joint imaging procedures (x-ray, computed tomography or magnetic resonance) and consults to OA-related care (pain management, orthopedics or physical medicine and rehabilitation) were also compared. All analyses used logistic regression with p-values <0.05 considered significant.

Results:

We identified 290,897 patients with OA, representing 34% of the health system population in 2018; 58% were female with mean age of 49 years and mean BMI of 30.5 kg/m2. A total of 801,144 pain episodes were defined, with 75% of patients having at least one pain score. The two most frequently occurring pain scores were 0 (17%) and 5 (13%), and pain episodes were classified as 43% mild, 32% moderate and 25% severe. Significantly higher percentages of patients used certain medication types (NSAIDs, injectable corticosteroids, non-tramadol opioid, duloxetine) in both moderate and severe pain episodes as compared to mild episodes, but other medication types were less likely to be used as pain severity increased (acetaminophen, salicylates, homeopathic medications, other OTC medications). Knee or hip surgeries, imaging, and consults to OA-related specialists were all consistently significantly more likely to occur in patients during moderate or severe pain episodes versus mild episodes (relative risk ratios of 1.76, 1.25 and 1.35 for moderate vs mild, respectively, and 2.00, 1.44 and 1.46 for severe vs mild, all p-values <0.05).

Conclusion:

While pain is generally recognized to be a subjective measure that could be influenced by other unmeasured factors and can be confounded with treatment effectiveness, it is nevertheless the primary symptom of OA. It is important to understand the relationship between pain intensity and treatment utilization, and our results support an overall association between pain and utilization but provide new details on the extent to which it depends on specific utilization type.

Acknowledgements:

Pfizer and Eli Lilly and Company for sponsoring this study.

Disclosure of Interests:

Jove Graham Grant/research support from: I am an employee of Geisinger which received financial support from Pfizer and Eli Lilly and Company in connection with the development of this abstract, Tonia Novosat Grant/research support from: I am an employee of Geisinger which received financial support from Pfizer and Eli Lilly and Company in connection with the development of this abstract, Haiyan Sun Grant/research support from: I am an employee of Geisinger which received financial support from Pfizer and Eli Lilly and Company in connection with the development of this abstract, Brian Piper Grant/research support from: I am an employee of Geisinger which received financial support from Pfizer and Eli Lilly and Company in connection with the development of this abstract, Joseph Boscarino Grant/research support from: I am an employee of Geisinger which received financial support from Pfizer and Eli Lilly and Company in connection with the development of this abstract, Vanessa Duboski Grant/research support from: I am an employee of Geisinger which received financial support from Pfizer and Eli Lilly and Company in connection with the development of this abstract, Melissa Kern Grant/research support from: I am an employee of Geisinger which received financial support from Pfizer and Eli Lilly and Company in connection with the development of this abstract, Eric Wright Grant/research support from: I am an employee of Geisinger which received financial support from Pfizer and Eli Lilly and Company in connection with the development of this abstract, Rebecca Robinson Shareholder of: Eli Lilly & Co., Employee of: Eli Lilly & Co., Edward Casey Shareholder of: Pfizer, Inc., Paid instructor for: As an employee of Pfizer, Inc. this is part of my role., Employee of: Pfizer, Inc., Craig Beck Shareholder of: Pfizer, Inc., Employee of: Pfizer, Inc., Jerry Hall Shareholder of: Eli Lilly & Co., Employee of: Eli Lilly & Co., Patricia Schepman Shareholder of: Pfizer, Inc., Employee of: Pfizer, Inc.

Disjunctures in Experiences of Support During the Transition to Fatherhood of Men Who Have Used Intimate Partner Violence

The transition to fatherhood has been shown to be a stressful time for men, and their experiences of identifying and accessing formal and informal support are mixed. However, research on the experience of men who use intimate partner violence (IPV) during the transition to fatherhood is limited. The evidence documenting the prevalence and short- and long-term impact of violence perpetrated by men against women during pregnancy and postpartum demonstrates the seriousness of this public health issue. To understand the mechanisms of interrupting IPV by engaging men, the gap between what is known about experiences of identifying the need for and access to support during the transition to fatherhood of men with past and current histories of using IPV must be bridged. The study described explores experiences of support during the transition to fatherhood of men who have used IPV. Descriptive findings revealed that men had a range of types of supports from multiple sources; however, most also identified crucial unmet instrumental and socioemotional needs. Four themes surfaced disjunctures in how participants described resources they needed, accessed, and desired. Specifically, these disjunctures were related to men's adherence to a self-reliant identity, a lack of male-specific peer or role model support, the tendency for childbirth classes to be geared toward mothers and not seen by fathers as sources of support, and a gap between men's goals for themselves as fathers, and the actual tools, resources, and modeling that were accessible and "acceptable." The implications include suggestions for group-based programmatic efforts, and three initial steps for organizations to assess and build current capacity to engage-with safety and accountability at the forefront-fathers who use IPV.

Gender Transformative Approaches to Engaging Men in Gender-Based Violence Prevention: A Review and Conceptual Model

Engaging men and boys as participants and stakeholders in gender-based violence (GBV) prevention initiatives is an increasingly institutionalized component of global efforts to end GBV. Accordingly, evidence of the impact of men's engagement endeavors is beginning to emerge, particularly regarding interventions aimed at fostering gender equitable and nonviolent attitudes and behaviors among men. This developing evidence base suggests that prevention programs with a "gender transformative" approach, or an explicit focus on questioning gender norms and expectations, show particular promise in achieving GBV prevention outcomes. Interventions targeting attitude and behavior change, however, represent just one kind of approach within a heterogeneous collection of prevention efforts around the globe, which can also include community mobilization, policy change, and social activism. The degree to which gender transformative principles inform this broader spectrum of men's engagement work is unclear. The goals of this article are twofold. First, we offer a conceptual model that captures and organizes a broader array of men's antiviolence activities in three distinct but interrelated domains: (1) initial outreach and recruitment of previously unengaged males, (2) interventions intended to promote gender-equitable attitudes and behavior among men, and (3) gender equity-related social action aimed at eradicating GBV, inclusive of all genders' contributions. Second, we review empirical literature in each of these domains. Across these two goals, we critically assess the degree to which gender transformative principles inform efforts within each domain, and we offer implications for the continuing conceptualization and assessment of efforts to increase men's participation in ending GBV.

How Childhood Maltreatment Profiles of Male Victims Predict Adult Perpetration and Psychosocial Functioning

This study used latent class analysis to empirically identify subgroups of men based on their exposure to childhood maltreatment (i.e., emotional neglect and abuse, physical neglect and abuse, and sexual abuse). It then examined subgroups' differential perpetration of adult intimate partner violence (IPV; both psychological and physical), violence against peers, and sexual assault. Finally, we compared sociodemographic variables and psychosocial functioning across profiles to characterize the adult experiences of men in different maltreatment groups. The community sample consisted of 626 heterosexually active 21- to 30-year-old men. We identified four subgroups: Low Maltreatment (80% of the sample), Emotional and Physical Maltreatment (12%), Emotional and Sexual Maltreatment (4%), and Poly-Victimized (4%). The Low Maltreatment group had significantly lower IPV perpetration rates than the Emotional and Physical Maltreatment group, but groups did not significantly differ on peer violence or sexual assault perpetration rates. Overall, Poly-Victimized men were significantly worse off than the Low Maltreatment group regarding income, education level, and incarceration history. Their rates of recent anxiety and depression symptoms were also higher than those of Low Maltreatment men. Findings support the use of person-oriented techniques for deriving patterns of childhood maltreatment and how these patterns relate to psychological, behavioral, and social factors in adulthood.

Quality Improvement Initiative to Increase the Use of Nasogastric Hydration in Infants With Bronchiolitis

BACKGROUND AND OBJECTIVES

Intravenous (IV) hydration is used primarily in children with bronchiolitis at our institution. Because nasogastric (NG) hydration can provide better nutrition, the goal of our quality improvement (QI) initiative was to increase the rate of NG hydration in eligible children 1 to 23 months old with bronchiolitis by 20% over 6 months.

METHODS

We used Plan-Do-Study-Act cycles to increase the use of NG hydration in eligible children. Interventions included educational and system-based changes and sharing parental feedback with providers. Chart reviews were performed to identify the rates of NG hydration, which were plotted over time in a statistical process control p chart. The balancing measure was the rate of complications in children with NG versus IV hydration.

RESULTS

Two hundred and ninety-three children who were hospitalized with bronchiolitis needed supplemental hydration during the QI initiative (January 2016-April 2016). Ninety-one children were candidates for NG hydration, and 53 (58%) received NG hydration. The rates of NG hydration increased from a baseline of 0% pre-QI bronchiolitis season (January 2015-April 2015) to 58% during the initiative. There was no aspiration and no accidental placement of the NG tube into a child's airway. Nine patients (17%) in the NG group had a progression of disease requiring nil per os status, and 6 of these were transferred to the PICU whereas none of those in the IV group were transferred to the PICU. Post-QI initiative, the majority of nurses (63%) and physicians (95%) stated that they are more likely to consider NG hydration in children with bronchiolitis.

CONCLUSIONS

We successfully increased the rates of NG hydration in eligible children with bronchiolitis by using educational and system-based interventions.

Dynamics of silver elution from functionalised antimicrobial nanofiltration membranes

In an effort to mitigate biofouling on thin film composite membranes such as nanofiltration and reverse osmosis, a myriad of different surface modification strategies has been published. The use of silver nanoparticles (Ag-NPs) has emerged as being particularly promising. Nevertheless, the stability of these surface modifications is still poorly understood, particularly under permeate flux conditions. Leaching or elution of Ag-NPs from the membrane surface can not only affect the antimicrobial characteristics of the membrane, but could also potentially present an environmental liability when applied in industrial-scale systems. This study sought to investigate the dynamics of silver elution and the bactericidal effect of an Ag-NP functionalised NF270 membrane. Inductively coupled plasma-atomic emission spectroscopy was used to show that the bulk of leached silver occurred at the start of experimental runs, and was found to be independent of salt or permeate conditions used. Cumulative amounts of leached silver did, however, stabilise following the initial release, and were shown to have maintained the biocidal characteristics of the modified membrane, as observed by a higher fraction of structurally damaged Pseudomonas fluorescens cells. These results highlight the need to comprehensively assess the time-dependent nature of bactericidal membranes.

Inducible ablation of dopamine D2 receptors in adult mice impairs locomotion, motor skill learning and leads to severe parkinsonism

Motor execution and planning are tightly regulated by dopamine D1 and D2 receptors present in basal ganglia circuits. Although stimulation of D1 receptors is known to enhance motor function, the global effect of D2 receptor (D2R) stimulation or blockade remains highly controversial, with studies showing increasing, decreasing or no changes in motor activity. Moreover, pharmacological and genetic attempts to block or eliminate D2R have led to controversial results that questioned the importance of D2R in motor function. In this study, we generated an inducible Drd2 null-allele mouse strain that circumvented developmental compensations found in constitutive Drd2^-/- mice and allowed us to directly evaluate the participation of D2R in spontaneous locomotor activity and motor learning. We have found that loss of D2R during adulthood causes severe motor impairments, including hypolocomotion, deficits in motor coordination, impaired learning of new motor routines and spontaneous catatonia. Moreover, severe motor impairment, resting tremor and abnormal gait and posture, phenotypes reminiscent of Parkinson's disease, were evident when the mutation was induced in aged mice. Altogether, the conditional Drd2 knockout model studied here revealed the overall fundamental contribution of D2R in motor functions and explains some of the side effects elicited by D2R blockers when used in neurological and psychiatric conditions, including schizophrenia, bipolar disorder, Tourette's syndrome, dementia, alcohol-induced delusions and obsessive-compulsive disorder.

Towards understanding clinical campylobacter infection and its transmission: time for a different approach?

Campylobacter spp. are among the most commonly diagnosed causes of human infection. Methods for detection of the 29 campylobacter species have mainly focused on cultivation of the thermophilic species. More than 99% of clinical campylobacter isolates notified in the UK in the recent past have been from faecal samples and associated with gastroenteritis. Campylobacter enteritis notifications in temperate zones show a seasonal increase during the summer months with a sharp decrease in the winter months, a pattern which remains incompletely understood. The striking seasonality in the expression of many human genes, some concerned with inflammation and immunity, suggests a need for further study of the host regarding the temporal distribution of many human infections, including campylobacteriosis. A tendency for campylobacter to enter a non-cultivable state under adverse conditions effects a reduction in the number of isolations. A Polymerase Chain Reaction (PCR)-based screening approach for the presence of the Campylobacter genus and followed by speciation has provided some insight into the limitations of cultivation for campylobacter, also allowing the discovery of new species. The increased sensitivity of the PCR-based approach over culture-based methods may make it difficult for the laboratory to differentiate asymptomatic campylobacter carriage from clinical campylobacter infection in non-sterile body sites. Campylobacter infection depends on a combination of host factors, and on acquisition of a suitably virulent strain with a tropism for human epithelium. The possibility of persistence of campylobacter in a viable but non-culturable latent form in the human body may also require further investigation. The scope of this review includes a discussion of current methods for diagnosing acute campylobacter infection and for detecting campylobacter in water and foodstuffs. The review also questions the prevailing view that poultry is the most common source of campylobacteriosis.

Efficacy of Bystander Programs to Prevent Dating Abuse Among Youth and Young Adults: A Review of the Literature

Estimates suggest that between 10% and 25% of adolescents have experienced some form of physical violence within a dating relationship, and one in four college-age women experiences attempted or completed sexual violence on campus. Bystander programs focus on equipping young adults with the skills to safely intervene when they witness behaviors that can result in dating abuse. This approach is promoted for its capacity both to transform community norms that contribute to dating abuse and to foster more positive social interactions among youth, however, there has been limited review of the literature on the outcomes of bystander programs. Therefore, this article provides an in-depth systematic literature review, which describes the content and program components of bystander programs and summarizes what is currently known about the impact of bystander interventions on participants' behaviors and attitudes. Results indicate that bystander programs are promising from the standpoint of increasing young adults' willingness to intervene and confidence in their ability to intervene when they witness dating or sexual violence, however, the utilization of actual bystander behaviors was less straightforward. Implications for prevention practice and for future research are presented.

Efficacy of Bystander Programs to Prevent Dating Abuse Among Youth and Young Adults: A Review of the Literature

Estimates suggest that between 10% and 25% of adolescents have experienced some form of physical violence within a dating relationship, and one in four college-age women experiences attempted or completed sexual violence on campus. Bystander programs focus on equipping young adults with the skills to safely intervene when they witness behaviors that can result in dating abuse. This approach is promoted for its capacity both to transform community norms that contribute to dating abuse and to foster more positive social interactions among youth, however, there has been limited review of the literature on the outcomes of bystander programs. Therefore, this article provides an in-depth systematic literature review, which describes the content and program components of bystander programs and summarizes what is currently known about the impact of bystander interventions on participants' behaviors and attitudes. Results indicate that bystander programs are promising from the standpoint of increasing young adults' willingness to intervene and confidence in their ability to intervene when they witness dating or sexual violence, however, the utilization of actual bystander behaviors was less straightforward. Implications for prevention practice and for future research are presented.

Cicada Wing Surface Topography: An Investigation into the Bactericidal Properties of Nanostructural Features

Recently, the surface of the wings of the Psaltoda claripennis cicada species has been shown to possess bactericidal properties and it has been suggested that the nanostructure present on the wings was responsible for the bacterial death. We have studied the surface-based nanostructure and bactericidal activity of the wings of three different cicadas (Megapomponia intermedia, Ayuthia spectabile and Cryptotympana aguila) in order to correlate the relationship between the observed surface topographical features and their bactericidal properties. Atomic force microscopy and scanning electron microscopy performed in this study revealed that the tested wing species contained a highly uniform, nanopillar structure on the surface. The bactericidal properties of the cicada wings were investigated by assessing the viability of autofluorescent Pseudomonas fluorescens cells following static adhesion assays and targeted dead/live fluorescence staining through direct microscopic counting methods. These experiments revealed a 20-25% bacterial surface coverage on all tested wing species; however, significant bactericidal properties were observed in the M. intermedia and C. aguila species as revealed by the high dead:live cell ratio on their surfaces. The combined results suggest a strong correlation between the bactericidal properties of the wings and the scale of the nanotopography present on the different wing surfaces.

A roadmap for research on crassulacean acid metabolism (CAM) to enhance sustainable food and bioenergy production in a hotter, drier world

Crassulacean acid metabolism (CAM) is a specialized mode of photosynthesis that features nocturnal CO2 uptake, facilitates increased water-use efficiency (WUE), and enables CAM plants to inhabit water-limited environments such as semi-arid deserts or seasonally dry forests. Human population growth and global climate change now present challenges for agricultural production systems to increase food, feed, forage, fiber, and fuel production. One approach to meet these challenges is to increase reliance on CAM crops, such as Agave and Opuntia, for biomass production on semi-arid, abandoned, marginal, or degraded agricultural lands. Major research efforts are now underway to assess the productivity of CAM crop species and to harness the WUE of CAM by engineering this pathway into existing food, feed, and bioenergy crops. An improved understanding of CAM has potential for high returns on research investment. To exploit the potential of CAM crops and CAM bioengineering, it will be necessary to elucidate the evolution, genomic features, and regulatory mechanisms of CAM. Field trials and predictive models will be required to assess the productivity of CAM crops, while new synthetic biology approaches need to be developed for CAM engineering. Infrastructure will be needed for CAM model systems, field trials, mutant collections, and data management.

Strategies to Engage Men and Boys in Violence Prevention: A Global Organizational Perspective

This study presents descriptive findings from in-depth interviews with 29 representatives of organizations in Africa, Asia, Europe, Oceania, and North and South America that engage men and boys in preventing gender-based violence. In particular, the findings suggest that strategies are responsive to the specific cultural, economic, and contextual concerns of the local community, with nuanced messages and appropriate messengers. In addition, respondents reported key principles informing their organizational strategies to deepen men and boys' engagement. Attention is also paid to respondents' caution about the risks of framing of engagement practices as separate from both women's organizations and women and girls themselves.

"He enjoys giving her pleasure": diversity and complexity in young men's sexual scripts

Research on heterosexual men's sexual expectations has focused on self-described personal traits and culturally dominant models of masculinity. In a pair of studies, we used a sexual scripts perspective to explore the range and diversity of young men's thoughts about sex and relationships with women and to develop measures for assessing these scripts. In the first study, we conducted semi-structured interviews to elicit young men's accounts of their sexual relationships. We used these narratives to produce brief sexual script scenarios describing typical sexual situations, as well as conventional survey items assessing sexual behavior themes. In the second study, we administered the scenarios and theme items to an ethnically diverse, national sample of 648 heterosexually active young men in an online survey. Using exploratory factor analysis, we delineated sets of sexual scripts and sexual behavior themes. In the scenarios, we found both a traditional masculine "player" script and a script that emphasized mutual sexual pleasure. Analysis of theme items produced scales of Drinking and Courtship, Monogamy and Emotion, and Sexual Focus and Variety. We discuss the implications of these findings for understanding heterosexual men's thinking about sexuality and how cultural change in sexual thinking may arise. We also discuss the need for measures of sexual thinking that better integrate perceptions and expectations about the partner as well as the self in relation to the partner, rather than solely self-assessed traits.

Condoms and Contexts: Profiles of Sexual Risk and Safety Among Young Heterosexually Active Men

Heterosexual men's sexual safety behavior is important to controlling the U.S. epidemic of sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). While sexual safety is often treated as a single behavior, such as condom use, it can also be conceptualized as resulting from multiple factors. Doing so can help us achieve more nuanced understandings of sexual risk and safety within partner-related contexts. We used latent class analysis with data collected online from 18- to 25-year-old heterosexually active U.S. men (n = 432) to empirically derive a typology of the patterns of sexual safety strategies they employed. Indicators were sexual risk-reduction strategies used in the past year with the most recent female sex partner: condom use, discussing sexual histories, STI testing, agreeing to be monogamous, and discussing birth control. We identified four subgroups: Risk Takers (12%), Condom Reliers (25%), Multistrategists (28%), and Relationship Reliers (35%). Partner-related context factors--number of past-year sex partners, relationship commitment, and sexual concurrency--predicted subgroup membership. Findings support tailoring STI prevention to men's sexual risk-safety subgroups. Interventions should certainly continue to encourage condom use but should also include information on how partner-related context factors and alternate sexual safety strategies can help men reduce risk for themselves and their partners.

A physical impact of organic fouling layers on bacterial adhesion during nanofiltration

Organic conditioning films have been shown to alter properties of surfaces, such as hydrophobicity and surface free energy. Furthermore, initial bacterial adhesion has been shown to depend on the conditioning film surface properties as opposed to the properties of the virgin surface. For the particular case of nanofiltration membranes under permeate flux conditions, however, the conditioning film thickens to form a thin fouling layer. This study hence sought to determine if a thin fouling layer deposited on a nanofiltration membrane under permeate flux conditions governed bacterial adhesion in the same manner as a conditioning film on a surface. Thin fouling layers (less than 50 μm thick) of humic acid or alginic acid were formed on Dow Filmtec NF90 membranes and analysed using Atomic Force Microscopy (AFM), confocal microscopy and surface energy techniques. Fluorescent microscopy was then used to quantify adhesion of Pseudomonas fluorescens bacterial cells onto virgin or fouled membranes under filtration conditions. It was found that instead of adhering on or into the organic fouling layer, the bacterial cells penetrated the thin fouling layer and adhered directly to the membrane surface underneath. Contrary to what surface energy measurements of the fouling layer would indicate, bacteria adhered to a greater extent onto clean membranes (24 ± 3% surface coverage) than onto those fouled with humic acid (9.8 ± 4%) or alginic acid (7.5 ± 4%). These results were confirmed by AFM measurements which indicated that a considerable amount of energy (10(-7) J/μm) was dissipated when attempting to penetrate the fouling layers compared to adhering onto clean NF90 membranes (10(-15) J/μm). The added resistance of this fouling layer was thusly seen to reduce the number of bacterial cells which could reach the membrane surface under permeate conditions. This research has highlighted an important difference between fouling layers for the particular case of nanofiltration membranes under permeate flux conditions and surface conditioning films which should be considered when conducting adhesion experiments under filtration conditions. It has also shown AFM to be an integral tool for such experiments.

Peak plasma anti-Xa levels after first and third doses of enoxaparin in women receiving weight-based thromboprophylaxis following caesarean section: a prospective cohort study

BACKGROUND

Women undergoing caesarean section are at higher risk for thromboembolic complications following delivery than other parturients. The aim of this study was to determine whether higher doses of enoxaparin based on body weight are safe and more likely to achieve plasma anti-Xa levels within the accepted thromboprophylactic range.

METHODS

We undertook a prospective cohort study of 80 women undergoing caesarean section in a tertiary obstetric hospital with >6000 deliveries per year. Enoxaparin was administered after caesarean section using the Royal College of Obstetricians and Gynaecologists weight-adjusted dosing guidelines. Plasma anti-Xa levels were measured at baseline and 3-4 h after enoxaparin administration on days one and three postoperatively. The main outcomes of interest were plasma anti-Xa levels and the proportion of patients with plasma anti-Xa levels in the range of 0.2-0.4 IU/mL.

RESULTS

The proportion of women with anti-Xa levels between 0.2 and 0.4 IU/mL was 72% (95% CI 60-81%). Unadjusted mean anti-Xa levels were 0.26 ± 0.09 IU/mL and 0.28 ± 0.08 IU/mL on day one and day three respectively. No woman had levels >0.48 IU/mL.

CONCLUSION

The majority of women receiving weight-based enoxaparin thromboprophylaxis following caesarean section achieved plasma anti-Xa levels within the putative thromboprophylactic range. No woman achieved levels associated with an increased risk of bleeding (>0.8 IU/mL). These findings provide a safety basis for a large prospective study using this regimen.

The importance of laboratory water quality for studying initial bacterial adhesion during NF filtration processes

Biofouling of nanofiltration (NF) and reverse osmosis (RO) membranes for water treatment has been the subject of increased research effort in recent years. A prerequisite for undertaking fundamental experimental investigation on NF and RO processes is a procedure called compaction. This involves an initial phase of clean water permeation at high pressures until a stable permeate flux is reached. However water quality used during the compaction process may vary from one laboratory to another. The aim of this study was to investigate the impact of laboratory water quality during compaction of NF membranes. A second objective was to investigate if the water quality used during compaction influences initial bacterial adhesion. Experiments were undertaken with NF 270 membranes at 15 bar for permeate volumes of 0.5 L, 2 L, and 5 L using MilliQ, deionized or tap water. Membrane autopsies were performed at each permeation point for membrane surface characterisation by contact angle measurements, profilometry, and scanning electron microscopy. The biological content of compacted membranes was assessed by direct epi-fluorescence observation following nucleic acid staining. The compacted membranes were also employed as substrata for monitoring the initial adhesion of Ps. fluorescens under dynamic flow conditions for 30 min at 5 min intervals. Compared to MilliQ water, membrane compaction using deionized and tap water led to decreases in permeate flux, increase in surface hydrophobicity and led to significant build-up of a homogeneous fouling layer composed of both living and dead organisms (>10(6) cells cm(-2)). Subsequent measurements of bacterial adhesion resulted in cell loadings of 0.2 × 10(5), 1.0 × 10(5) cells cm(-2) and 2.6 × 10(5) cells cm(-2) for deionized, tap water and MilliQ water, respectively. These differences in initial cell adhesion rates demonstrate that choice of laboratory water can significantly impact the results of bacterial adhesion on NF membranes. Standardized protocols are therefore needed for the fundamental studies of bacterial adhesion and biofouling formation on NF and RO membrane. This can be implemented by first employing pure water during all membrane compaction procedures and for the modelled feed solutions used in the experiment.

Sexual scripts among young heterosexually active men and women: continuity and change

Whereas gendered sexual scripts are hegemonic at the cultural level, research suggests they may be less so at dyadic and individual levels. Understanding "disjunctures" between sexual scripts at different levels holds promise for illuminating mechanisms through which sexual scripts can change. Through interviews with 44 heterosexually active men and women aged 18 to 25, the ways young people grappled with culture-level scripts for sexuality and relationships were delineated. Findings suggest that, although most participants' culture-level gender scripts for behavior in sexual relationships were congruent with descriptions of traditional masculine and feminine sexuality, there was heterogeneity in how or whether these scripts were incorporated into individual relationships. Specifically, three styles of working with sexual scripts were found: conforming, in which personal gender scripts for sexual behavior overlapped with traditional scripts; exception-finding, in which interviewees accepted culture-level gender scripts as a reality, but created exceptions to gender rules for themselves; and transforming, in which participants either attempted to remake culture-level gender scripts or interpreted their own nontraditional styles as equally normative. Changing sexual scripts can potentially contribute to decreased gender inequity in the sexual realm and to increased opportunities for sexual satisfaction, safety, and well-being, particularly for women, but for men as well.

The role of a movement disorders clinic

Ireland's ageing population will result in a substantial increase in neurodegenerative disease with a projected increase in prevalence of Idiopathic Parkinson's disease (IPD) to 9,000 by 2021. There are few published audits of neurology services to assist care planning. As a first step towards evaluating future service needs for this group of patients, we audited a single tertiary referral IPD and Other Movement Disorders clinic for 2006. A total of 497 patients from all counties in Ireland were seen; 225 (59%) of patients had IPD, 32 (8.2%) had atypical parkinsonism, and 22 (5.8%) dystonia. In a subset of 275 patients, 151 (55%) were referred by GPs, 74 (27%) by other consultants, and 49 (18%) by other consultant neurologists. Diagnosis was changed in 22 (38%) and medication was adjusted in 203 (74%). A telephone survey of 50 patients demonstrated 100% satisfaction with the improved access to the clinical nurse specialist, telephone support and improved continuity of care. The IPD and Other Movement Disorders clinic provides an important local, regional, and national diagnostic and therapeutic service for complex movement disorders. It is proposed that a national registry of IPD and audit of the delivery of care to patients with movement disorders is needed.

"How can I not?": men's pathways to involvement in anti-violence against women work

Despite growing male participation in ending violence against women, little is known about the factors that precipitate men's engagement as antiviolence "allies." This study presents findings from a qualitative analysis of interviews with 27 men who recently initiated involvement in an organization or event dedicated to ending sexual or domestic violence. Findings suggest that men's engagement is a process that occurs over time, that happens largely through existing social networks, and that is influenced by exposure to sensitizing experiences, tangible involvement opportunities and specific types of meaning making related to violence. Implications for models of ally development and for efforts to engage men in antiviolence work are discussed.

Frontline worker responses to domestic violence disclosure in public welfare offices

Although substantial numbers of women seeking Temporary Assistance for Needy Families (TANF) report domestic violence, few receive mandated services through the Family Violence Option (FVO). This study used transcripts ofinterviews between welfare caseworkers and their clients to identify and classify the responses made by workers to client disclosures of abuse and to assess the match or mismatch of these responses with FVO policy requirements. Only 22 of 782 client interviews involved the disclosure of abuse to the welfare caseworker. A typology of worker responses was created, from least to most engaged. This typology shows that only half of those who disclosed abuse received assistance from the welfare worker, despite policy mandates that clients receive information on TANF waivers and community resources. This study suggests that problems with implementation of the FVO reflect a systemic reluctance to address issues of violence with women rather than problems of individual workers.

Prospective longitudinal studies of salmonid alphavirus infections on two Atlantic salmon farms in Ireland; evidence for viral persistence

Prospective longitudinal studies of two outbreaks of pancreas disease in Atlantic salmon (AS), Salmo salar L., in Ireland were conducted. Both outbreaks occurred during the marine phase of production, with one caused by salmonid alphavirus subtype 1 (SAV1) and the other by SAV4. In addition to screening a range of tissues by real-time reverse transcriptase polymerase chain reaction (RRT-PCR), virological, serological and histopathological examinations were performed along with partial genome sequencing and results were related to environmental and production data and farm history. On Farm 1 (marine sampling only), infection was detected within 3 weeks of smolts being placed on the farm, while on Farm 2 (freshwater and marine sampling), infection was first detected 315 days after transfer to sea. In both outbreaks, RRT-PCR signals were detected in a range of tissues including gill, heart, kidney, pancreas/pyloric caeca, brain and serum. Persistence of signal was longest in gill and heart (> or =265 days on both farms) and shortest in serum. Mortalities on the two farms varied from 10.9% to 30%. In both cases, partial genome sequence of the causative viruses were identical to SAV strains detected in previous populations of AS on each of the study farms, including populations with which the study populations overlapped in time and space.

Inhibitory effects of polyunsaturated fatty acids on Kv4/KChIP potassium channels

Kv4/K channel interacting protein (KChIP) potassium channels are a major class of rapidly inactivating K(+) channels in neurons and cardiac muscle. Modulation of Kv4/KChIP channels by polyunsaturated fatty acids (PUFAs) is important in the regulation of cellular excitability and the induction of activity-dependent synaptic plasticity. Using the Xenopus laevis oocyte expression system, we studied the inhibition by PUFAs of the peak outward K(+) current and the accompanying increase in the rate of current inactivation of rKv4.2/rKChIP1b. Inhibitory effects do not depend on KChIP coexpression since Kv4.2 channels lacking an NH(2)-terminal KChIP association region were substantially inhibited by PUFAs and showed strong kinetic modulation. PUFAs accelerated both the fast and slow time constants that describe the kinetics of Kv4/KChIP inactivation. The time course of entry into closed inactivated states was facilitated by PUFAs, but steady-state inactivation and recovery from inactivation were unaltered. PUFA inhibition of Kv4/KChIP current was not use dependent. The concentration-response relationship for arachidonic acid (AA) inhibition of Kv4/KChIP channels mimicked that for activation of TRAAK channels. Internal serum albumin largely prevents the inhibitory effects of externally applied AA, and the membrane-impermeant AA-CoA is inactive when applied externally. Overall, our data suggest that PUFAs inhibit Kv4/KChIP channels by facilitating inactivation from open and closed gating states and that access of the fatty acid to the internal leaflet of the membrane is important. These results improve our understanding of the mechanisms for the inhibitory effects of PUFAs on Kv4/KChIP channel function.

Patient portals: survey of nursing informaticists

As the US moves toward a more patient centered health care system, an integrated Electronic Health Record with a Patient Portal is one way that providers and patients can more actively collaborate in the health care process. A patient portal is an Internet-based interactive website for patients to communicate with their healthcare provider and with varied functions that gives them access to portions of their medical record and other services [1,2,3,4]. Many hospitals and health centers in the USA have developed patient portals while others are still in the planning stage. From a review of the literature it is evident that there is no standard of the scope of functions that are essential in the Patient Portals and to date most are only accessible in English. If we are truly moving towards a patient centered focus in health care in a diverse society, we need to design patient portals that tailor these resources to the needs of this diverse population. This paper reports on the results of an online survey that was distributed between August and October 2007 to nursing informaticists who subscribe to the CARING e-mail list and nursing informaticists working in the Greater New York City area. The goal of the survey was to see how many of the institutions where nursing informaticists work had patient portals, what functions were embedded in these portals, what research was being conduct., and what plans each institution had for future directions.

Screening for domestic violence in public welfare offices: an analysis of case manager and client interactions

Despite a high prevalence of domestic violence among welfare clients, most studies of the implementation of the Family Violence Option (FVO) under welfare reform find that women rarely receive domestic violence services in welfare offices. This study reviews findings from current research on the factors that improve the likelihood that women will reveal their domestic violence experiences to service personnel, and uses the guidelines drawn from this review to evaluate domestic violence screening practices in welfare offices using 782 transcribed interviews between welfare workers and clients from 11 sites in four states. The analysis found that only 9.3% of case encounters involved screening for domestic violence. Screening rates differed by state, interview type, and length of worker employment. Qualitative analysis of the interviews showed that the majority of screening by workers was routine or consisted of informing clients of the domestic violence policy without asking about abuse. Only 1.2% of the interviews incorporated at least two of the procedures that increase the likelihood of disclosure among domestic violence survivors, suggesting deeply inadequate approaches to screening for abuse within the context of welfare offices, and a need for improved training, protocol, and monitoring of FVO implementation.

Engineering aspects of a mixed methanotrophic culture in a membrane-aerated biofilm reactor

Methanotrophic biodegradation using the membrane-aerated biofilm reactor (MABR) is a technology offering several advantages over both conventional biofilm reactors and suspended-cell processes. In this study the oxidation efficiency of a methanotrophic biofilm in a 1.5 litre MABR was investigated. Measurements of oxygen and methane uptake rates together with biofilm thickness were taken for developing biofilms. It was found that the specific rate of metabolic activity of the biofilm was unusually high as determined by the methane and oxygen uptake rates. Microbial activity stratification was evident and the location of stratified layers of oxygen consuming components of the consortium could be manipulated via the intra-membrane oxygen pressure.