A cross-site, comparative effectiveness study of an integrated HIV and substance use treatment program.

Co-occurrence of HIV and substance abuse is associated with poor outcomes for HIV-related health and substance use. Integration of substance use and medical care holds promise for HIV patients, yet few integrated treatment models have been reported. Most of the reported models lack data on treatment outcomes in diverse settings. This study examined the substance use outcomes of an integrated treatment model for patients with both HIV and substance use at three different clinics. Sites differed by type and degree of integration, with one integrated academic medical center, one co-located academic medical center, and one co-located community health center. Participants (n=286) received integrated substance use and HIV treatment for 12 months and were interviewed at 6-month intervals. We used linear generalized estimating equation regression analysis to examine changes in Addiction Severity Index (ASI) alcohol and drug severity scores. To test whether our treatment was differentially effective across sites, we compared a full model including site by time point interaction terms to a reduced model including only site fixed effects. Alcohol severity scores decreased significantly at 6 and 12 months. Drug severity scores decreased significantly at 12 months. Once baseline severity variation was incorporated into the model, there was no evidence of variation in alcohol or drug score changes by site. Substance use outcomes did not differ by age, gender, income, or race. This integrated treatment model offers an option for treating diverse patients with HIV and substance use in a variety of clinic settings. Studies with control groups are needed to confirm these findings.

The implementation of a translational study involving a primary care based behavioral program to improve blood pressure control: The HTN-IMPROVE study protocol (01295).

BACKGROUND: Despite the impact of hypertension and widely accepted target values for blood pressure (BP), interventions to improve BP control have had limited success. OBJECTIVES: We describe the design of a 'translational' study that examines the implementation, impact, sustainability, and cost of an evidence-based nurse-delivered tailored behavioral self-management intervention to improve BP control as it moves from a research context to healthcare delivery. The study addresses four specific aims: assess the implementation of an evidence-based behavioral self-management intervention to improve BP levels; evaluate the clinical impact of the intervention as it is implemented; assess organizational factors associated with the sustainability of the intervention; and assess the cost of implementing and sustaining the intervention. METHODS: The project involves three geographically diverse VA intervention facilities and nine control sites. We first conduct an evaluation of barriers and facilitators for implementing the intervention at intervention sites. We examine the impact of the intervention by comparing 12-month pre/post changes in BP control between patients in intervention sites versus patients in the matched control sites. Next, we examine the sustainability of the intervention and organizational factors facilitating or hindering the sustained implementation. Finally, we examine the costs of intervention implementation. Key outcomes are acceptability and costs of the program, as well as changes in BP. Outcomes will be assessed using mixed methods (e.g., qualitative analyses--pattern matching; quantitative methods--linear mixed models). DISCUSSION: The study results will provide information about the challenges and costs to implement and sustain the intervention, and what clinical impact can be expected.

Identification and assessment of potential wind energy project sites in the State of Maryland

Gemstone Team Renewables

Legacy Resource Management Program Archaeological Reconnaissance Survey, United States Naval Academy, Annapolis, MD.

The Archaeological Reconnaissance Survey of United States Naval Academy will provide the Navy with a rich understanding of the history of this property. A National Register of Historic Places District, such as the Academy, deserves a thorough analysis of its past, in order to preserve what exists and to plan for the future. The goal of this project is to investigate the history of the Academy through traditional historic research, innovative computer analysis of historic maps, oral history interviews, and tract histories. This information has been synthesized to provide the Navy with a planning tool for Public Works, a concise look at the cartographic history of the Academy, and reference manual of the vast amounts of information which have been gathered during the course of this project. This information can serve as a reference tool to help the Public Works department comply with Section 106 regulations of the Historic Sites Preservation Act, with regard to construction. It can also serve as a source of cartographic history for those interested in the Academy's physical development, and as a way of preserving the culture of residents in Annapolis. This program and archaeological survey will ultimately serve to add to the rich history of the United States Naval Academy while preserving an important part of our nation's heritage.

REMA: A computer-based mapping tool for analysis of restriction sites in multiple DNA sequences

REMA is an interactive web-based program which predicts endonuclease cut sites in DNA sequences. It analyses Multiple sequences simultaneously and predicts the number and size of fragments as well as provides restriction maps. The users can select single or paired combinations of all commercially available enzymes. Additionally, REMA permits prediction of multiple sequence terminal fragment sizes and suggests suitable restriction enzymes for maximally discriminatory results. REMA is an easy to use, web based program which will have a wide application in molecular biology research. Availability: REMA is written in Perl and is freely available for non-commercial use. Detailed information on installation can be obtained from Jan Szubert (jan.szubert@gmail.com) and the web based application is accessible on the internet at the URL http://www.macaulay.ac.uk/rema. Contact: b.singh@macaulay.ac.uk. (C) 2007 Elsevier B.V. All rights reserved.

Use and views on social networking sites of pharmacy students in the United Kingdom

Objective. To investigate students' use and views on social networking sites and assess differences in attitudes between genders and years in the program.

Methods. All pharmacy undergraduate students were invited via e-mail to complete an electronic questionnaire consisting of 21 questions relating to social networking.

Results. Most (91.8%) of the 377 respondents reported using social networking Web sites, with 98.6% using Facebook and 33.7% using Twitter. Female students were more likely than male students to agree that they had been made sufficiently aware of the professional behavior expected of them when using social networking sites (76.6% vs 58.1% p=0.002) and to agree that students should have the same professional standards whether on placement or using social networking sites (76.3% vs 61.6%; p<0.001).

Conclusions. A high level of social networking use and potentially inappropriate attitudes towards professionalism were found among pharmacy students. Further training may be useful to ensure pharmacy students are aware of how to apply codes of conduct when using social networking sites.

The androgen receptor induces a distinct transcriptional program in castration-resistant prostate cancer in man

The androgen receptor (AR) regulates prostate cell growth in man, and prostate cancer is the commonest cancer in men in the UK. We present a comprehensive analysis of AR binding sites in human prostate cancer tissues, including castrate-resistant prostate cancer (CRPC). We identified thousands of AR binding sites in CRPC tissue, most of which were not identified in PC cell lines. Many adjacent genes showed AR regulation in xenografts but not in cultured LNCaPs, demonstrating an in-vivo-restricted set of AR-regulated genes. Functional studies support a model of altered signaling in vivo that directs AR binding. We identified a 16 gene signature that outperformed a larger in-vitro-derived signature in clinical data sets, showing the importance of persistent AR signaling in CRPC.

The African Pediatric Fellowship Program: Training in Africa for Africans

Africa has a significant burden of childhood disease, with relatively few skilled health care professionals. The African Paediatric Fellowship Programme was developed by the Department of Pediatrics and Child Health at the University of Cape Town to provide relevant training for African child health professionals, by Africans, within Africa. Trainees identified by partner academic institutions spend 6 months to 2 years training in the Department of Pediatrics and allied disciplines. They then return to their home institution to build practice, training, research, and advocacy. From 2008 to 2015, 73 physicians have completed or are completing training in general pediatrics or a pediatric subspecialty. At 1 year posttraining, 98% to 100% are practicing back in their home institution. The impact of the returning fellows is evident from their practice interventions, research collaborations, and positions as stakeholders who can change health care policies. Thirty-three centers in 13 African countries are partners with the program, and the program template is now followed by other partner sites in Africa. Increasing and retaining the skills pool of African child health specialists is building a network of motivated, highly skilled clinicians who are equipped to advance child health in Africa.

The Effectiveness of the precision fluency shaping program controlling stuttering behaviour in adults

This study was done to test the effectiveness of the Precision Fluency Shaping Program in controlling stuttering behaviour in adults. Two sites were chosen, each using the Precision Fluency Shaping Program to treat stuttering. At each clinic, a Speech Patbologist made a random selection of the subjects' pre- and post-therapy video-taped interviews, totalling 20 in all. During the interviews, the clients were asked questions and re~d a short passage to determine the frequency of stuttering in natural conversation and in reading. Perceptions of Stuttering Inventory questionnaires vvere also filled in before and after therapy. Two judges were trained to identify stuttering behaviour, and were given an inter-rater reliability test at selected intervals throughout the study. Protocols",:m.a;d;6 of each interview tape, were scored for (a) stuttering behaviour and (b) words spoken or read. An Analysis of Variance Repeated Measures Test was used to compare before and after scores of conversations, readings, and Perceptions of Stuttering Inventory to determine whether the Precision Fluency Shaping Program controlled stuttering behaviour significantly. A Pearson R Correlation Test was also administered to determine if a relationship existed bet\veen Perceptions of Stuttering Inventory and (i) conversation and (ii) reading scores.

Examining and describing professional development and continuing education in the personal training and fitness industry : sites and issues of disconnect

The following phenomenologically oriented study examines and describes the relevance and effectiveness of professional development and continuing education programs for real-world situations of personal trainers. The participants were personal trainers, facility managers, and persons involved in the accreditation process. Data collection took place in 3 phases. The first phase consisted of the participants completing the PUMP Questionnaire, followed by focus groups with personal trainers and interviews with managers. The study's 3 data sets required reduction via a content analysis by question, content analysis by existential categories, and further thematic analysis using the lived relation existential dimension. The discussion contains the salient sites and issues of disconnect between clients, personal trainers, and facility managers and how they might affect the personal training experience. The intergenerational disconnect emphasized between Boomers as clients and Millennials as personal trainers requires further exploration and dialogue and underscores the need for different approaches to content and delivery of professional development and continuing education experiences for personal trainers and managers of fitness facilities.

Combating homophobia : preliminary results of a school-based program to reduce discrimination against same-sex attracted youth

Two key determinants of mental health are (a) freedom from discrimination and (b) social connectedness. Same-sex attracted youth who are subjected to violence and discrimination, or who experience homophobia in their everyday lives are at greater risk of mental health problems, including suicidal thoughts and behaviours. As one of the most significant sites of homophobia is the school, a 6-week school-based program designed to help students explore their attitudes to gays and lesbians was developed, called “Pride & Prejudice”. In order to evaluate the usefulness of the program, students’ attitudes were measured before and after their participation. Variables assessed were: beliefs about gender roles, social desirability, attitudes to gay men and lesbians, social connectedness, self-esteem, and attitudes to race. Attitudes towards gay men held by students were significantly more positive after the program, and the level of attendance during the program significantly predicted > this change. A significant positive change also occurred in attitudes towards lesbians. Process evaluation showed that students generally viewed the program positively. From this preliminary data, it can be concluded that school-based programs delivered to individual classes in which students are given the opportunity to explore their attitudes towards lesbians and gay men are likely to lead to a significant reduction in homophobia. Health-promoting schools now have available to them an effective tool for promoting opportunities for students to reflect on their attitudes towards gay men and lesbians, and other aspects of “social diversity”. It is hoped that school-wide implementation of such a program will eventually lead to a reduction in the discrimination same-sex attracted youth often experience (either directly, or indirectly), and improve the social-connectedness of all students.

Video streaming: Implementation and evaluation in an undergraduate nursing program

Video streaming technology enables video content, held on the web sites, to be streamed via the web. We report the implementation and evaluation of video streaming in an undergraduate nursing program in a metropolitan university in Australia. Students (n = 703) were emailed a survey with a 15% response rate. We found that 91% (n = 74) of respondents stated that video streaming assisted their learning. Forty-six percent(n = 50) of students had difficulty accessing video streaming (particularly at the beginning of the study period). Over a 97-day period there were 8440 “hits” to the site from 1039 different internet protocol (IP) addresses. There were 4475 video streaming sessions undertaken by users. Video streaming was used for reviewing previously attended lectures (52%, n = 56), examination preparation (34%, n = 37), viewing missed lectures (27%, n = 29) and class preparation (9%, n = 10). Our experience with the introduction of video streaming has met with general enthusiasm from both students and teaching staff. Video streaming has particular relevance for rural students.

A preliminary analysis of the cost-effectiveness of the National Bowel Cancer Screening Program – demonstrating the potential value of comprehensive real world data

Background The complexity and cost of treating cancer patients is escalating rapidly and increasingly difficult decisions are being made regarding which interventions provide value for money. BioGrid Australia supports collection and analysis of comprehensive treatment and outcome data across multiple sites. Here we use preliminary data regarding the National Bowel Cancer Screening Program (NBCSP) and stage-specific treatment costs for colorectal cancer (CRC) to demonstrate the potential value of real world data for cost-effectiveness analyses (CEA).

Methods Data regarding the impact of NBCSP on stage at diagnosis was combined with stage-specific CRC treatment costs and existing literature. An incremental CEA was undertaken from a government healthcare perspective, comparing NBCSP to no-screening. The 2008 invited population (n=681,915) was modelled in both scenarios. Effectiveness was expressed as CRC-related life years saved (LYS). Costs and benefits were discounted at 3% per annum.

Results Over the lifetime and relative to no-screening, NBCSP was predicted to save 1,265 life-years, prevent 225 CRC cases and cost an additional $48.3 million, equivalent to a cost-effectiveness ratio of $38,217 per LYS. A scenario analysis assuming full participation improved this to $23,395.

Conclusions This preliminary CEA based largely on contemporary real world data suggests population-based FOBT screening for CRC is attractive. Planned ongoing data collection will enable repeated analyses over time, using the same methodology in the same patient populations, permitting an accurate analysis of the impact of new therapies and changing practice. Similar CEA using real world data related to other disease types and interventions appears desirable.

Facilitating best practice : transferring the lessons of the Clinical Support Systems program

The Clinical Support Systems Program (CSSP) includes the management of clinical practice using clinical and consumer pathways, outcome and performance indicators, clinical measurement and review in a continuous improvement cycle using the best available extant evidence. The Royal Australasian College of Physicians is testing the CSSP model through four consortia around Australia. There are 17 project sites in three States. The funded projects address major clinical problems including congestive heart failure and acute coronary syndromes, acute stroke management, and colorectal cancer care. There is some early evidence of the CSSP influencing change in areas beyond the bounds of the project settings and the College has developed a plan to promote wider adoption of best practice. This approach recognises the College’s role in providing Fellows with the practical tools of quality improvement, the means to collect data and compare their practice to other clinicians, while traversing the appropriate educational framework.

Using strategic philanthropy to improve heritage tourist sites on the Gallipoli Peninsula, Turkey : community perceptions of changing quality of life and of the sponsoring organization

This paper examines the “Respect for History” project on Turkey's Gallipoli Peninsula sponsored by a Turkish oil company, OPET. The project sought to enhance and protect the cultural and historical experiences of tourists visiting Gallipoli, and to bring direct and indirect benefits to local communities through enhancing tourism-related business opportunities and improving community infrastructure. This research investigates the project's impact on residents’ perceived social and economic wellbeing, using a quality of life framework, and also ascertains residents’ views of the sponsoring firm. The context illustrates key differences between pure philanthropy and strategic philanthropy; the latter defined as doing good by purposefully achieving corporate and civic benefits. The role of strategic philanthropy as a sustainable tourism development tool, and its impact on tourism governance, are considered. Data were collected from 674 residents on the Turkish Gallipoli Peninsula in areas impacted by OPET's investment program. The results, using structural equation modelling (SEM), identify that respondents generally believe that both their economic and social quality of life have improved. This, in turn, has positively influenced respondents’ views of the sponsoring organization. The concept of strategic philanthropy appears valuable as a private sector, non-tourism, sustainable tourism development tool in some circumstances.