Estimating national-level syringe availability to injecting drug users and injection coverage: Switzerland, 1996-2006.

BACKGROUND: Measuring syringe availability and coverage is essential in the assessment of HIV/AIDS risk reduction policies. Estimates of syringe availability and coverage were produced for the years 1996 and 2006, based on all relevant available national-level aggregated data from published sources. METHODS: We defined availability as the total monthly number of syringes provided by harm reduction system divided by the estimated number of injecting drug users (IDU), and defined coverage as the proportion of injections performed with a new syringe, at national level (total supply over total demand). Estimates of supply of syringes were derived from the national monitoring system, including needle and syringe programmes (NSP), pharmacies, and medically prescribed heroin programmes. Estimates of syringe demand were based on the number of injections performed by IDU derived from surveys of low threshold facilities for drug users (LTF) with NSP combined with the number of IDU. This number was estimated by two methods combining estimates of heroin users (multiple estimation method) and (a) the number of IDU in methadone treatment (MT) (non-injectors) or (b) the proportion of injectors amongst LTF attendees. Central estimates and ranges were obtained for availability and coverage. RESULTS: The estimated number of IDU decreased markedly according to both methods. The MT-based method (from 14,818 to 4809) showed a much greater decrease and smaller size of the IDU population compared to the LTF-based method (from 24,510 to 12,320). Availability and coverage estimates are higher with the MT-based method. For 1996, central estimates of syringe availability were 30.5 and 18.4 per IDU per month; for 2006, they were 76.5 and 29.9. There were 4 central estimates of coverage. For 1996 they ranged from 24.3% to 43.3%, and for 2006, from 50.5% to 134.3%. CONCLUSION: Although 2006 estimates overlap 1996 estimates, the results suggest a shift to improved syringe availability and coverage over time.

Non-invasive and non-occlusive blood pressure estimation via a chest sensor.

The clinical demand for a device to monitor Blood Pressure (BP) in ambulatory scenarios with minimal use of inflation cuffs is increasing. Based on the so-called Pulse Wave Velocity (PWV) principle, this paper introduces and evaluates a novel concept of BP monitor that can be fully integrated within a chest sensor. After a preliminary calibration, the sensor provides non-occlusive beat-by-beat estimations of Mean Arterial Pressure (MAP) by measuring the Pulse Transit Time (PTT) of arterial pressure pulses travelling from the ascending aorta towards the subcutaneous vasculature of the chest. In a cohort of 15 healthy male subjects, a total of 462 simultaneous readings consisting of reference MAP and chest PTT were acquired. Each subject was recorded at three different days: D, D+3 and D+14. Overall, the implemented protocol induced MAP values to range from 80 ± 6 mmHg in baseline, to 107 ± 9 mmHg during isometric handgrip maneuvers. Agreement between reference and chest-sensor MAP values was tested by using intraclass correlation coefficient (ICC = 0.78) and Bland-Altman analysis (mean error = 0.7 mmHg, standard deviation = 5.1 mmHg). The cumulative percentage of MAP values provided by the chest sensor falling within a range of ±5 mmHg compared to reference MAP readings was of 70%, within ±10 mmHg was of 91%, and within ±15mmHg was of 98%. These results point at the fact that the chest sensor complies with the British Hypertension Society (BHS) requirements of Grade A BP monitors, when applied to MAP readings. Grade A performance was maintained even two weeks after having performed the initial subject-dependent calibration. In conclusion, this paper introduces a sensor and a calibration strategy to perform MAP measurements at the chest. The encouraging performance of the presented technique paves the way towards an ambulatory-compliant, continuous and non-occlusive BP monitoring system.

Health problems of nursing workers in a public educational institution

Objective: To identify the issues occurred with nursing workers through a Health Monitoring System for Nursing Workers (SIMOSTE) and to describe the consequences of those problems. Method: This is a quantitative, exploratory and descriptive study realized in a teaching hospital in the west region of the city of São Paulo. Results: From the SIMOSTE, 1.847 occurrences were registered in a six month period. Within the main occurrences, medical licenses, work related accidents with and without removals; psychiatric consultations and psychotherapy were highlighted. Conclusion: The data points out to the need for the development of new health vigilance actions to notify accidents and illness related to work, besides the prevention of issues. 


Workloads and strain process in Community Health Agents

ABSTRACT OBJECTIVE To identify the workloads present in the work activities of community health agents (CHAs) and the resulting strain processes. METHOD A descriptive, exploratory, cross-sectional and quantitative study conducted with 137 CHAs. Data were collected through a questionnaire and interview guided by the health surveillance software called SIMOSTE (Health Monitoring System of Nursing Workers), following the ethical codes of the current law. RESULTS In total, were identified 140 workloads involved in 122 strain processes, represented by the occurrence of health problems of the CHAs. The mechanical (55.00%) and biological (16.43%) loads stood out. The most common strain processes were the external causes of morbidity and mortality (62.31%) and diseases of the musculoskeletal system and connective tissue (10.66%). CONCLUSION From the identified overloads, it became evident that all workloads are present in the work process of CHAs, highlighting the mechanical load, represented mainly by external causes of morbidity and mortality that are related to occupational accidents.

Pescadores y aves marinas compitiendo por el mismo recurso: estrategias de forrajeo, interacciones y consecuencias

Con el examen conjunto de datos de seguimiento satelital de la flota pesquera y de marcaje electrónico de aves marinas, se analizan las interacciones entre la actividad pesquera y el forrajeo de las aves en periodo de reproducción. Se evidencia que las aves pueden mitigar la competencia con la pesca hasta cierto punto, forrajeando más lejos o quedándose más tiempo en el mar. Sin embargo, las aves en reproducción enfrentan a la vez un alto requerimiento energético para alimentar los pichones, y viajes de forrajeo limitados en distancia y tiempo por la necesidad de atender el nido. Para optimizar el éxito reproductivo de las aves marinas se recomienda: (1) Estimar, con la ayuda de modelos ecotróficos, qué cantidad de anchoveta sería conveniente ‘reservar’ para la alimentación de las aves; (2) Establecer zonas temporalmente cerradas a la pesca, alrededor de las principales colonias en los meses de reproducción de las aves. Los rangos máximos de forrajeo observados en guanayes y piqueros sugieren un radio de 50 a 100 km alrededor de las colonias, lo cual permitiría asegurar el forrajeo de estas especies en periodo de reproducción y así favorecer la sostenibilidad de sus poblaciones.

Exploring the implementation of a medication adherence programme by community pharmacists : a qualitative study

Background Medication adherence has been identified as an important factor for clinical success. Twenty-four Swiss community pharmacists participated in the implementation of an adherence support programme for patients with hypertension, diabetes mellitus and/or dyslipidemia. The programme combined tailored consultations with patients about medication taking (expected at an average of one intervention per month) and the delivery of each drug in an electronic monitoring system (MEMS6?). Objective To explore pharmacists' perceptions and experiences with implementation of the medication adherence programme and to clarify why only seven patients were enrolled in total. Setting Community pharmacies in French-speaking Switzerland. Method Individual in-depth interviews were audio-recorded, with 20 of the pharmacists who participated in the adherence programme. These were transcribed verbatim, coded and thematically analysed. Process quality was ensured by using an audit trail detailing the development of codes and themes; furthermore, each step in the coding and analysis was verified by a second, experienced qualitative researcher. Main outcome measure Community pharmacists' experiences and perceptions of the determining factors influencing the implementation of the adherence programme. Results Four major barriers were identified: (1) poor communication with patients resulting in insufficient promotion of the programme; (2) insufficient collaboration with physicians; (3) difficulty in integrating the programme into pharmacy organisation; and (4) insufficient pharmacist motivation. This was related to the remuneration perceived as insufficient and to the absence of clear strategic thinking about the pharmacist position in the health care system. One major facilitator of the programme's implementation was pre-existing collaboration with physicians. Conclusion A wide range of barriers was identified. The implementation of medication adherence programmes in Swiss community pharmacies would benefit from an extended training aimed at developing communication and change management skills. Individualised onsite support addressing relevant barriers would also be necessary throughout the implementation process.

Identificación de puntos de pesca en los viajes pesqueros de anchoveta monitoreados por satélites mediante redes neuronales artificiales

La sostenibilidad de los recursos marinos y de su ecosistema hace necesario un manejo responsable de las pesquerías. Conocer la distribución espacial del esfuerzo pesquero y en particular de las operaciones de pesca es indispensable para mejorar el monitoreo pesquero y el análisis de la vulnerabilidad de las especies frente a la pesca. Actualmente en la pesquería de anchoveta peruana, se recoge información del esfuerzo y capturas mediante un programa de observadores a bordo, pero esta solo representa una muestra de 2% del total de viajes pesqueros. Por otro lado, se dispone de información por cada hora (en promedio) de la posición de cada barco de la flota gracias al sistema de seguimiento satelital de las embarcaciones (VMS), aunque en estos no se señala cuándo ni dónde ocurrieron las calas. Las redes neuronales artificiales (ANN) podrían ser un método estadístico capaz de inferir esa información, entrenándose en una muestra para la cual sí conocemos las posiciones de calas (el 2% anteriormente referido), estableciendo relaciones analíticas entre las calas y ciertas características geométricas de las trayectorias observadas por el VMS y así, a partir de las últimas, identificar la posición de las operaciones de pesca. La aplicación de la red neuronal requiere un análisis previo que examine la sensibilidad de la red a variaciones en sus parámetros y bases de datos de entrenamiento, y que nos permita desarrollar criterios para definir la estructura de la red e interpretar sus resultados de manera adecuada. La problemática descrita en el párrafo anterior, aplicada específicamente a la anchoveta (Engraulis ringens) es detalllada en el primer capítulo, mientras que en el segundo se hace una revisión teórica de las redes neuronales. Luego se describe el proceso de construcción y pre-tratamiento de la base de datos, y definición de la estructura de la red previa al análisis de sensibilidad. A continuación se presentan los resultados para el análisis en los que obtenemos una estimación del 100% de calas, de las cuales aproximadamente 80% están correctamente ubicadas y 20% poseen un error de ubicación. Finalmente se discuten las fortalezas y debilidades de la técnica empleada, de métodos alternativos potenciales y de las perspectivas abiertas por este trabajo.

Escala de madurez gonadal de anchoveta peruana Engraulis ringens (Jenyns, 1842

En este trabajo, se describe la escala de madurez gonadal macroscópica, validada microscópicamente, de anchoveta peruana Engraulis ringens. Se analizó 1970 gónadas (1251 ovarios, 719 testículos), procedentes del seguimiento de la pesquería pelágica del 2006, 2008, 2009 y 2012 y de cruceros de Evaluación Hidroacústica de Recursos Pelágicos del 2006, 2009 y 2012. La escala establece seis estadios de madurez para hembras y machos: 0 (virginal), I (reposo), II (en maduración), III (maduro), IV (desovante/expulsante), V (recuperación/post expulsante).

Escala de madurez gonadal de bonito Sarda chiliensis chiliensis (Cuvier, 1832)

El objetivo fue elaborar la escala de madurez gonadal macroscópica de Sarda chiliensis chiliensis con una validación basada en análisis histológicos. Se analizaron 591 muestras de gónadas provenientes del plan de seguimiento de la pesquería pelágica en el año 2014. A cada gónada se asignó un estadio de madurez macroscópico luego de la observación del desarrollo ovocitario y espermatogénico en los cortes histológicos. Se describieron seis estadios de maduración que van desde 0 (virginal) hasta el estadio 5 (recuperación en hembras, post expulsante en machos). Se compara la descripción de esta escala con trabajos anteriormente realizados, se discuten los criterios de catalogación y se dan recomendaciones para el seguimiento de la pesquería.

Escala de madurez gonadal de cabrilla Paralabrax humeralis (Valenciennes, 1828)

Se realiza la validación de la escala de madurez gonadal macroscópica de la cabrilla Paralabrax humeralis. Se analizaron 197 ovarios y 188 testículos provenientes del seguimiento de la pesquería demersal y cruceros de investigación de recursos demersales en el 2005 (Enero-febrero y mayo-junio). Sobre la base del análisis histológico se asignó a cada individuo un estadio de madurez macroscópico. Se realizó la descripción de los estadios de madurez que van desde el estadio 0 (virginal) hasta el 5 (recuperación en hembras, post expulsante en machos). Se realizó una comparación con escalas anteriormente realizadas, discutiendo además los beneficios de su uso.

Reliable tidal volume estimates at the airway opening with an infant monitor during high-frequency oscillatory ventilation.

OBJECTIVE: To assess the suitability of a hot-wire anemometer infant monitoring system (Florian, Acutronic Medical Systems AG, Hirzel, Switzerland) for measuring flow and tidal volume (Vt) proximal to the endotracheal tube during high-frequency oscillatory ventilation. DESIGN: In vitro model study. SETTING: Respiratory research laboratory. SUBJECT: In vitro lung model simulating moderate to severe respiratory distress. INTERVENTION: The lung model was ventilated with a SensorMedics 3100A ventilator. Vt was recorded from the monitor display (Vt-disp) and compared with the gold standard (Vt-adiab), which was calculated using the adiabatic gas equation from pressure changes inside the model. MEASUREMENTS AND MAIN RESULTS: A range of Vt (1-10 mL), frequencies (5-15 Hz), pressure amplitudes (10-90 cm H2O), inspiratory times (30% to 50%), and Fio2 (0.21-1.0) was used. Accuracy was determined by using modified Bland-Altman plots (95% limits of agreement). An exponential decrease in Vt was observed with increasing oscillatory frequency. Mean DeltaVt-disp was 0.6 mL (limits of agreement, -1.0 to 2.1) with a linear frequency dependence. Mean DeltaVt-disp was -0.2 mL (limits of agreement, -0.5 to 0.1) with increasing pressure amplitude and -0.2 mL (limits of agreement, -0.3 to -0.1) with increasing inspiratory time. Humidity and heating did not affect error, whereas increasing Fio2 from 0.21 to 1.0 increased mean error by 6.3% (+/-2.5%). CONCLUSIONS: The Florian infant hot-wire flowmeter and monitoring system provides reliable measurements of Vt at the airway opening during high-frequency oscillatory ventilation when employed at frequencies of 8-13 Hz. The bedside application could improve monitoring of patients receiving high-frequency oscillatory ventilation, favor a better understanding of the physiologic consequences of different high-frequency oscillatory ventilation strategies, and therefore optimize treatment.

Adhésion thérapeutique en oncologie : persistance, qualité d'exécution et satisfaction des patients sous traitement oral et MEMS®

Introduction: en oncologie apparaissent sur le marché depuis quelques années de nouveaux traitements en formulation orale facilitant l'administration et améliorant la qualité de vie du patient mais augmentant le risque de non adhésion et d'erreurs de posologie. L'observation par MEMS® (Medication Event Monitoring System) permet le suivi et l'encadrement du traitement oral et par le biais d'entretiens semi structurés menés par le pharmacien, ouvre la discussion sur les problèmes révélés par cette prise en charge. Méthode: étude non randomisée prospective uni centrique regroupant 50 patients inclus dans 3 groupes de traitements oncologiques oraux courants (capecitabine, letrozole/exemestane, imatinib/sunitinib) bénéficiant d'un suivi oncologique classique et équipés d'un MEMS® pour un an maximum. La persistance et la qualité d'exécution sont les deux paramètres mesurés grâce aux données récoltées électroniquement. Les entretiens sont dédiés à la prévention de la non adhésion et à la gestion des effets secondaires médicamenteux. La satisfaction est évaluée par un questionnaire à la fin du suivi. Résultats: à ce jour 38 patients ont été inclus dans l'étude. Les données complètes sont disponibles pour les 19 premiers patients dont 10 sous capecitabine et 9 sous letrozole/exemestane. Dans ce collectif l'âge médian est de 66 ans avec une majorité de femmes (11:8). La persistance à 10 jours est de 85% et la qualité d'exécution de 99%. Les toxicités observées supérieures à grade 1 sont 1 syndrome mains-pieds (G3) et 1 syndrome coronarien aigu (G3). Le questionnaire de fin de suivi relève une satisfaction de 85% des patients pour les entretiens proposés (57% utiles, 28% très utiles, 15% inutiles) et le succès quant à l'intégration du MEMS® dans leur quotidien (57% très facile, 43% facile). Conclusion: la persistance et la qualité d'exécution observées dans notre collectif sont excellentes. La satisfaction retrouvée auprès des patients reflète le besoin d'un soutien complémentaire face à la complexité de la maladie oncologique. La gestion pluridisciplinaire profite tant aux patients qu'au binôme médecin-pharmacien par l'amélioration de la communication globale entre les divers acteurs et par l'identification précoce des risques de non adhésion. La poursuite de cette étude et l'analyse des futures données permettra de mesurer le réel impact de notre intervention et de justifier le bénéfice pour des patients sous traitement similaire.

Water percolation estimated with time domain reflectometry (TDR) in drainage lysimeters

Due to the difficulty of estimating water percolation in unsaturated soils, the purpose of this study was to estimate water percolation based on time-domain reflectometry (TDR). In two drainage lysimeters with different soil textures TDR probes were installed, forming a water monitoring system consisting of different numbers of probes. The soils were saturated and covered with plastic to prevent evaporation. Tests of internal drainage were carried out using a TDR 100 unit with constant dielectric readings (every 15 min). To test the consistency of TDR-estimated percolation levels in comparison with the observed leachate levels in the drainage lysimeters, the combined null hypothesis was tested at 5 % probability. A higher number of probes in the water monitoring system resulted in an approximation of the percolation levels estimated from TDR - based moisture data to the levels measured by lysimeters. The definition of the number of probes required for water monitoring to estimate water percolation by TDR depends on the soil physical properties. For sandy clay soils, three batteries with four probes installed at depths of 0.20, 0.40, 0.60, and 0.80 m, at a distance of 0.20, 0.40 and 0.6 m from the center of lysimeters were sufficient to estimate percolation levels equivalent to the observed. In the sandy loam soils, the observed and predicted percolation levels were not equivalent even when using four batteries with four probes each, at depths of 0.20, 0.40, 0.60, and 0.80 m.

Comprehensive Bridge Deck Deterioration Mapping of Nine Bridges by Nondestructive Evaluation Technologies Final Report, January 2011

The primary objective of this research was to demonstrate the benefits of NDT technologies for effectively detecting and characterizing deterioration in bridge decks. In particular, the objectives were to demonstrate the capabilities of ground-penetrating radar (GPR) and impact echo (IE), and to evaluate and describe the condition of nine bridge decks proposed by Iowa DOT. The first part of the report provides a detailed review of the most important deterioration processes in concrete decks, followed by a discussion of the five NDT technologies utilized in this project. In addition to GPR and IE methods, three other technologies were utilized, namely: half-cell (HC) potential, electrical resistivity (ER), and ultrasonic surface waves (USW) method. The review includes a description of the principles of operation, field implementation, data analysis, and interpretation; information regarding their advantages and limitations in bridge deck evaluations and condition monitoring are also implicitly provided.. The second part of the report provides descriptions and bridge deck evaluation results from the nine bridges. The results of the NDT surveys are described in terms of condition assessment maps and are compared with the observations obtained from the recovered cores or conducted bridge deck rehabilitation. Results from this study confirm that the used technologies can provide detailed and accurate information about a certain type of deterioration, electrochemical environment, or defect. However, they also show that a comprehensive condition assessment of bridge decks can be achieved only through a complementary use of multiple technologies at this stage,. Recommendations are provided for the optimum implementation of NDT technologies for the condition assessment and monitoring of bridge decks.

Integral Bridge Abutment-to-Approach Slab Connection Final Report, June 2008

The Iowa Department of Transportation has long recognized that approach slab pavements of integral abutment bridges are prone to settlement and cracking, which manifests as the “bump at the end of the bridge”. A commonly recommended solution is to integrally attach the approach slab to the bridge abutment. Two different approach slabs, one being precast concrete and the other being cast-inplace concrete, were integrally connected to side-by-side bridges and investigated. The primary objective of this investigation was to evaluate the approach slab performance and the impacts the approach slabs have on the bridge. To satisfy the research needs, the project scope involved a literature review, survey of Midwest Department of Transportation current practices, implementing a health monitoring system on the bridge and approach slab, interpreting the data obtained during the evaluation, and conducting periodic visual inspections. Based on the information obtained from the testing the following general conclusions were made: The integral connection between the approach slabs and the bridges appear to function well with no observed distress at this location and no relative longitudinal movement measured between the two components; Tying the approach slab to the bridge appears to impact the bridge; The two different approach slabs, the longer precast slab and the shorter cast-in-place slab, appear to impact the bridge differently; The measured strains in the approach slabs indicate a force exists at the expansion joint and should be taken into consideration when designing both the approach slab and the bridge; The observed responses generally followed an annual cyclic and/or short term cyclic pattern over time.