Stakeholders' perceptions of rehabilitation services for individuals living with disability:A survey study

Background: The World Health Organization (WHO) was tasked with developing health system guidelines for the implementation of rehabilitation services. Stakeholders' perceptions are an essential factor to take into account in the guideline development process. The aim of this study was to assess stakeholders' perceived feasibility and acceptability of eighteen rehabilitation services and the values they attach to ten rehabilitation outcomes.   Methods: We disseminated an online self-administered questionnaire through a number of international and regional organizations from the different WHO regions. Eligible individuals included persons with disability, caregivers of persons with disability, health professionals, administrators and policy makers. The answer options consisted of a 9-point Likert scale.   Results: Two hundred fifty three stakeholders participated. The majority of participants were health professional (64 %). In terms of outcomes, 'Increasing access' and 'Optimizing utilization' were the top service outcomes rated as critical (i.e., 7, 8 or 9 on the Likert scale) by >70 % of respondents. 'Fewer hospital admissions', 'Decreased burden of care' and 'Increasing longevity' were the services rated as least critical (57 %, 63 % and 58 % respectively). In terms of services, 'Community based rehabilitation' and 'Home based rehabilitation' were found to be both definitely feasible and acceptable (75 % and 74 % respectively). 'Integrated and decentralized rehabilitation services' was found to be less feasible than acceptable according to stakeholders (61 % and 71 % respectively). As for 'Task shifting', most stakeholders did not appear to find task shifting as either definitely feasible or definitely acceptable (63 % and 64 % respectively).   Conclusion: The majority of stakeholder's perceived 'Increasing access' and 'Optimizing utilization' as most critical amongst rehabilitation outcomes. The feasibility of the 'Integrated and decentralized rehabilitation services' was perceived to be less than their acceptability. The majority of stakeholders found 'Task shifting' as neither feasible nor acceptable

Sexual Differentiation of Circadian Clock Function in the Adrenal Gland

Sex differences in glucocorticoid production are associated with increased responsiveness of the adrenal gland in females. However, the adrenal-intrinsic mechanisms that establish sexual dimorphic function remain ill defined. Glucocorticoid production is gated at the molecular level by the circadian clock, which may contribute to sexual dimorphic adrenal function. Here we examine sex differences in the adrenal gland using an optical reporter of circadian clock function. Adrenal glands were cultured from male and female Period2::Luciferase (PER2::LUC) mice to assess clock function in vitro in real time. We confirm that there is a pronounced sex difference in the intrinsic capacity to sustain PER2::LUC rhythms in vitro, with higher amplitude rhythms in adrenal glands collected from males than from females. Changes in adrenal PER2::LUC rhythms over the reproductive life span implicate T as an important factor in driving sex differences in adrenal clock function. By directly manipulating hormone levels in adult mice in vivo, we demonstrate that T increases the amplitude of PER2::LUC rhythms in adrenal glands of both male and female mice. In contrast, we find little evidence that ovarian hormones modify adrenal clock function. Lastly, we find that T in vitro can increase the amplitude of PER2::LUC rhythms in male adrenals but not female adrenals, which suggests the existence of sex differences in the mechanisms of T action in vivo. Collectively these results reveal that activational effects of T alter circadian timekeeping in the adrenal gland, which may have implications for sex differences in stress reactivity and stress-related disorders

The Wealth Effects of Merger Activities: Further Evidence from Real Estate Investment Trusts

This paper examines the effect of merger announcements on target firm shareholder wealth. The sample is limited to Real Estate Investment Trust (REIT) targets. Previous corporate acquisition studies report strong pre-announcement and announcement day price appreciation for target firms. Significant positive abnormal returns are detected for the REIT targets at announcement but not during the pre-announcement period.

Atmospheric velocity fields in tepid main sequence stars

The line profiles of the stars with v sin i below a few km/s can reveal direct signatures of local velocity fields (e.g. convection) in stellar atmospheres. This effect is well established in cool main sequence stars, and has been detected and studied in three A stars. This paper reports observations of main sequence B, A and F stars with two goals: (1) to identify additional stars having sufficiently low values of v sin i to search for spectral line profile signatures of local velocity fields, and (2) to explore how the signatures of the local velocity fields in the atmosphere depend on stellar parameters such as effective temperature T_eff and peculiarity type. For stars having T_eff below about 10000 K, we always detect local atmospheric velocity fields indirectly through a non-zero microturbulence parameter, but not for hotter stars. Among the A and F stars in our sample having the sharpest lines, direct tracers of atmospheric velocity fields are found in six new stars. The velocity field signatures identified include asymmetric excess line wing absorption, deeper in the blue line wing than in the red; line profiles of strong lines that are poorly fit by computed profiles; and strong lines that are broader than they should be for the v sin i values deduced from weak lines. These effects are found in both normal and Am stars, but seem stronger in Am stars. These data still have not been satisfactorily explained by models of atmospheric convection, including numerical simulations.Comment: Acepted for publication by Astronomy and Astrophysic

Testing for sexually transmitted infections in general practice: cross-sectional study

Background: Primary care is an important provider of sexual health care in England. We sought to explore the extent of testing for chlamydia and HIV in general practice and its relation to associated measures of sexual health in two contrasting geographical settings.Methods: We analysed chlamydia and HIV testing data from 64 general practices and one genitourinary medicine (GUM) clinic in Brent (from mid-2003 to mid-2006) and 143 general practices and two GUM clinics in Avon (2004). We examined associations between practice testing status, practice characteristics and hypothesised markers of population need (area level teenage conception rates and Index of Multiple Deprivation, IMD scores).Results: No HIV or chlamydia testing was done in 19% (12/64) of general practices in Brent, compared to 2.1% (3/143) in Avon. In Brent, the mean age of general practitioners (GPs) in Brent practices that tested for chlamydia or HIV was lower than in those that had not conducted testing. Practices where no HIV testing was done had slightly higher local teenage conception rates (median 23.5 vs. 17.4/1000 women aged 15-44, p = 0.07) and served more deprived areas (median IMD score 27.1 vs. 21.8, p = 0.05). Mean yearly chlamydia and HIV testing rates, in practices that did test were 33.2 and 0.6 (per 1000 patients aged 15-44 years) in Brent, and 34.1 and 10.3 in Avon, respectively. In Brent practices only 20% of chlamydia tests were conducted in patients aged under 25 years, compared with 39% in Avon.Conclusions: There are substantial geographical differences in the intensity of chlamydia and HIV testing in general practice. Interventions to facilitate sexually transmitted infection and HIV testing in general practice are needed to improve access to effective sexual health care. The use of routinely-collected laboratory, practice-level and demographic data for monitoring sexual health service provision and informing service planning should be more widely evaluated

Harvest strategy evaluation to optimise the sustainability and value of the Queensland scallop fishery. Queensland scallop fishery - FRDC Project No 2006/024 Final Report

Objective 1. Measure spatial and temporal trawl frequency of scallop grounds using VMS data. This will provide a relative measure of how often individual undersized scallops are caught and put through a tumbler 2. Estimate discard mortality and growth rates for saucer scallops using cage experiments. 3. Evaluate the current management measures, in particular the seasonal closure, rotational closure and seasonally varying minimum legal sizes using stock assessment and management modeling models. Recommend optimal range of management measures to ensure long-term viability and value of the Scallop fishery based on a formal management strategy evaluation. Outcomes acheived to date: 1. Improved understanding of the survival rates of discarded sub-legal scallops; 2. Preliminary von Bertalanffy growth parameters using data from tagged-and-released scallops; 3. Changing trends in vessels and fishing gear used in the Queensland scallop fishery and their effect on scallop catch rates over time using standardised catch rates quantified; 4. Increases in fishing power of vessels operating in the Queensland scallop fishery quantified; 5. Trawl intensity mapped and quantified for all Scallop Replenishment Areas; 6. Harvest Strategy Evaluations completed

Improved performance of porphyrin-based dye sensitised solar cells by phosphinic acid surface treatment

Chemical surface treatment of porphyrin-sensitised titania films using bis-(4-methoxyphenyl) phosphinic acid after dye adsorption, results in large improvements in DSSC efficiencies which originate primarily from higher short circuit currents. The result was attributed to a positive shift in the TiO2 quasi-Fermi level with simultaneous retardation of charge recombination. High device performances have been achieved even using simplified electrolyte matrices devoid of the common additives, LiI and t-butylpyridine

Prevalence of Malaria and Anaemia among HIV Infected Pregnant women Receiving Co-trimoxazole Prophylaxis in Tanzania: A Cross Sectional Study in Kinondoni Municipality.

HIV-infected pregnant women are particularly more susceptible to the deleterious effects of malaria infection particularly anaemia. In order to prevent opportunistic infections and malaria, a policy of daily co-trimoxazole prophylaxis without the standard Suphadoxine-Pyrimethamine intermittent preventive treatment (SP-IPT) was introduced to all HIV infected pregnant women in the year 2011. However, there is limited information about the effectiveness of this policy. This was a cross sectional study conducted among HIV-infected pregnant women receiving co-trimoxazole prophylaxis in eight public health facilities in Kinondoni Municipality from February to April 2013. Blood was tested for malaria infection and anaemia (haemoglobin <11 g/dl). Data were collected on the adherence to co-trimoxazole prophylaxis and other risk factors for malaria infection and anaemia. Pearson chi-square test, Fischer's exact test and multivariate logistic regression were used in the statistical analysis. This study enrolled 420 HIV infected pregnant women. The prevalence of malaria infection was 4.5%, while that of anaemia was 54%. The proportion of subjects with poor adherence to co-trimoxazole was 50.5%. As compared to HIV infected pregnant women with good adherence to co-trimoxazole prophylaxis, the poor adherents were more likely to have a malaria infection (Adjusted Odds Ratio, AOR = 6.81, 95%CI = 1.35-34.43, P = 0.02) or anaemia (AOR = 1.75, 95%CI = 1.03-2.98, P = 0.039). Other risk factors associated with anaemia were advanced WHO clinical stages, current malaria infection and history of episodes of malaria illness during the index pregnancy. The prevalence of malaria was low; however, a significant proportion of subjects had anaemia. Good adherence to co-trimoxazole prophylaxis was associated with reduction of both malaria infection and anaemia among HIV infected pregnant women

The Wilderness Expedition: An effective life course intervention to improve young peoples well-being and connectedness to nature

It is well understood that wilderness expeditions improve well-being; however, there is little supporting quantitative data. The aim of this study was to measure the impact of wilderness expeditions on self-esteem (SE) and connectedness to nature (CN) and assess whether benefits varied according to participant and expedition characteristics. SE and CN were assessed pre– and post–wilderness expeditions in 130 adolescents using Rosenberg’s SE scale and the state CN scale. Two-way ANOVA revealed significant increases in SE and CN (p < .001) as a result of single expeditions. There was also an interaction effect of expedition and gender on SE (p < .05). Males had a higher SE at the start but female SE increased most. Linear regression revealed that living environment, gender, and the length and location of the expedition did not contribute to changes in SE and CN. Regular contact with natural environments will improve adolescent well-being, with the largest improvements in females