Douglas Shire Water Quality Monitoring Strategy: Final Report: a Report to Douglas Shire Council and the Department of the Environment and Heritage

This report describes results and conclusions from the monitoring component of the Douglas Shire Council (DSC) water quality project. The components of this project that this report addresses are: • Site selection and installation of in-stream and off-paddock automatic water quality monitoring equipment in the Douglas Shire. • Design of appropriate sampling strategies for automatic stations. • Estimation of loads of suspended sediment, total nitrogen and total phosphorus in rivers and also estimation of the changes in nutrient loads from sugar cane under different fertilizer application rates. • Development of a community-based water quality sampling program to complement the automatic sampling efforts. • Design of an optimised, long-term water quality monitoring strategy.

The increasing impact of human immunodeficiency virus infections, sexually transmitted diseases, and viral hepatitis in Durham County, North Carolina: a call for coordinated and integrated services.

BACKGROUND: Durham County, North Carolina, faces high rates of human immunodeficiency virus (HIV) infection (with or without progression to AIDS) and sexually transmitted diseases (STDs). We explored the use of health care services and the prevalence of coinfections, among HIV-infected residents, and we recorded community perspectives on HIV-related issues. METHODS: We evaluated data on diagnostic codes, outpatient visits, and hospitalizations for individuals with HIV infection, STDs, and/or hepatitis B or C who visited Duke University Hospital System (DUHS). Viral loads for HIV-infected patients receiving care were estimated for 2009. We conducted geospatial mapping to determine disease trends and used focus groups and key informant interviews to identify barriers and solutions to improving testing and care. RESULTS: We identified substantial increases in HIV/STDs in the southern regions of the county. During the 5-year period, 1,291 adults with HIV infection, 4,245 with STDs, and 2,182 with hepatitis B or C were evaluated at DUHS. Among HIV-infected persons, 13.9% and 21.8% were coinfected with an STD or hepatitis B or C, respectively. In 2009, 65.7% of HIV-infected persons receiving care had undetectable viral loads. Barriers to testing included stigma, fear, and denial of risk, while treatment barriers included costs, transportation, and low medical literacy. LIMITATIONS: Data for health care utilization and HIV load were available from different periods. Focus groups were conducted among a convenience sample, but they represented a diverse population. CONCLUSIONS: Durham County has experienced an increase in the number of HIV-infected persons in the county, and coinfections with STDs and hepatitis B or C are common. Multiple barriers to testing/treatment exist in the community. Coordinated care models are needed to improve access to HIV care and to reduce testing and treatment barriers.

Voucher #2 from the Engineer Department of Port Dalhousie and Thorold Railway Extension paid to Daniel Plumsteel, Dec. 31, 1856

Voucher #2 from the Engineer Department of Port Dalhousie and Thorold Railway Extension for surveys, paid to Daniel Plumsteel, Dec. 31, 1856.

Voucher #3 from the Engineer Department of Port Dalhousie and Thorold Railway Extension paid to Thomas Woods, Dec. 31, 1856

Voucher #3 from the Engineer Department of Port Dalhousie and Thorold Railway Extension for sinking test pits, paid to Thomas Woods, Dec. 31, 1856.

Pay roll voucher #4 from the Engineer Department of Port Dalhousie and Thorold Railway for the month of January, Jan. 1857

Pay roll voucher #4 from the Engineer Department of Port Dalhousie and Thorold Railway Extension for surveying for the month of January, Jan. 1857.

Voucher #5 from the Engineer Department of Port Dalhousie and Thorold Railway Extension to George Forbes for surveys, Jan. 31, 1857

Voucher #5 from the Engineer Department of Port Dalhousie and Thorold Railway Extension to George Forbes for surveys, Jan. 31, 1857.

Voucher #6 from the Engineer Department of Port Dalhousie and Thorold Railway Extension to Thomas Woods for surveys, Jan. 31, 1857

Voucher #6 from the Engineer Department of Port Dalhousie and Thorold Railway Extension to Thomas Woods for surveys, Jan. 31, 1857.

Voucher #7 from the Engineer Department of Port Dalhousie and Thorold Railway Extension to W.G. Thompson accompanied by an abstract of vouchers and summaries of account paid by W.G. Thompson for surveys, Jan. 31, 1857

Voucher #7 from the Engineer Department of Port Dalhousie and Thorold Railway Extension to W.G. Thompson accompanied by an abstract of vouchers and summaries of account paid by W.G. Thompson for surveys, Jan. 31, 1857.

Pay roll voucher #8 from the Engineer Department of Port Dalhousie and Thorold Railway Extension for surveys in the month of February, Feb. 28, 1857

Pay roll voucher #8 from the Engineer Department of Port Dalhousie and Thorold Railway Extension for surveys in the month of February, Feb. 28, 1857.

Voucher #9 from the Engineer Department of Port Dalhousie and Thorold Railway Extension to W. G. Thompson accompanied by an abstract of vouchers for surveys, Feb. 28, 1857

Voucher #9 from the Engineer Department of Port Dalhousie and Thorold Railway Extension to W. G. Thompson accompanied by an abstract of vouchers for surveys, Feb. 28, 1857

Pay roll voucher #10 from the Engineer Department of Port Dalhousie and Thorold Railway Extension for the engineer corps. , Mar. 31, 1857

Pay roll voucher #10 from the Engineer Department of Port Dalhousie and Thorold Railway Extension for the engineer corps. , Mar. 31, 1857.