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HIV clinicians are uniquely positioned to treat their patients with opioid use disorder using buprenorphine to prevent overdose death. The Prescribe to Save Lives (PtSL) study aimed to increase HIV clinicians' buprenorphine prescribing via an overdose prevention intervention.The quasi-experimental stepped-wedge study enrolled 22 Ryan White-funded HIV clinics and delivered a peer-to-peer training to clinicians with follow-up academic detailing that included overdose prevention education and introduced buprenorphine prescribing. Site-aggregated electronic medical record (EMR) data measured with the change in X-waivered clinicians and patients prescribed buprenorphine. Clinicians completed surveys preintervention and at 6- and 12-month postintervention that assessed buprenorphine training, prescribing, and attitudes. Analyses applied generalized estimating equation models, adjusting for time and clustering of repeated measures among individuals and sites.Nineteen sites provided EMR prescribing data, and 122 clinicians returned surveys. Of the total patients with HIV across all sites, EMR data showed 0.38% were prescribed buprenorphine pre-intervention and 0.52% were prescribed buprenorphine postintervention. The intervention increased completion of a buprenorphine training course (adjusted odds ratio 2.54, 95% confidence interval: 1.38 to 4.68, P = 0.003) and obtaining an X-waiver (adjusted odds ratio 2.11, 95% confidence interval: 1.12 to 3.95, P = 0.02). There were nonsignificant increases at the clinic level, as well.Although the PtSL intervention resulted in increases in buprenorphine training and prescriber certification, there was no meaningful increase in buprenorphine prescribing. Engaging and teaching HIV clinicians about overdose and naloxone rescue may facilitate training in buprenorphine prescribing but will not result in more treatment with buprenorphine without additional interventions.

PURPOSE: Assess systemic vascular endothelial growth factor-A (VEGF) levels after treatment with intravitreous aflibercept, bevacizumab or ranibizumab. DESIGN: Comparative-effectiveness trial with participants randomly assigned to 2-mg aflibercept, 1.25-mg bevacizumab, or 0.3-mg ranibizumab following a retreatment algorithm. PARTICIPANTS: Participants with available plasma samples (N=436) METHODS: Plasma samples were collected before injections at baseline, 4-week, 52-week and 104-week visits. In a pre-planned secondary analysis, systemic free-VEGF levels from an ELISA immunoassay were compared across anti-VEGF agents and correlated with systemic side effects. MAIN OUTCOME MEASURES: Changes in the natural log (ln) of plasma VEGF levels. RESULTS: Baseline free-VEGF levels were similar across all 3 groups. At 4 weeks, mean ln(VEGF) changes were −0.30±0.61, −0.31±0.54, −0.02±0.44 pg/ml for the aflibercept, bevacizumab, and ranibizumab groups, respectively. The adjusted differences between treatment groups (adjusted CI; P-value) were −0.01 (−0.12, +0.10; P=0.89), −0.31 (−0.44, −0.18; P

BACKGROUND Adherence to antiretroviral therapy (ART) is essential for allowing persons living with HIV to live longer, healthier lives. However, a large portion of this population has suboptimal adherence and are not virally suppressed. Conventional interventions aimed at improving ART adherence lack portability and scalability, and improvements in adherence are not often sustained. Mobile health (mHealth) ART interventions offer a low-cost and accessible method of improving adherence, but many have limited functionality and do not offer comprehensive support. The combination of an mHealth intervention with a face-to-face adherence intervention and interactive health coaching feature may offer sufficient support in a manner that is sensitive to resource limitations that are often found in HIV treatment settings. This paper details the protocol of a study designed to evaluate the potential of an enhanced mHealth intervention for improving ART adherence. OBJECTIVE The primary objective of this study is to assess the feasibility and acceptability of the Fitbit Plus app enhanced with a face-to-face LifeSteps session (Fitbit Plus condition) for improving ART adherence. In addition, we will determine the preliminary efficacy of the intervention by calculating treatment effect sizes. METHODS This study will be conducted in 2 phases. The intervention will be developed and piloted with a small group of participants during phase 1. Pilot participants will provide feedback that will be used to refine the intervention for phase 2. In phase 2, a preliminary randomized controlled trial (RCT) comparing Fitbit Plus with a condition that approximates the standard of care (SOC) will be conducted with 60 persons living with HIV. Interviews will be conducted with RCT participants at baseline, and follow-up interviews will be conducted at 1, 3, 6, and 12 months. ART adherence is the primary outcome and will be monitored throughout the study via electronic pill boxes. Effect sizes will be generated using a fractional logit model estimated by generalized estimating equations. RESULTS Phase 1 of this trial is complete; data collection for phase 2 is ongoing. Follow-ups with enrolled participants will conclude in January 2020. CONCLUSIONS This study will contribute to the literature on ART adherence and may produce an efficacious intervention. Owing to a small sample size, there may be insufficient power to detect statistically significant differences between Fitbit Plus and SOC. However, if Fitbit Plus is found to be acceptable and feasible and yields promising effect size estimates, this pilot study could serve as the foundation for a larger, fully powered trial of Fitbit Plus. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/15356

In many developed countries around the world residential care interventions for children and adolescents have come under increasing scrutiny. Against this background an international summit was organised in England (spring 2016) with experts from 13 countries to reflect on therapeutic residential care (TRC). The following working definition of TRC was leading: "Therapeutic residential care involves the planful use of a purposefully constructed, multi-dimensional living environment designed to enhance or provide treatment, education, socialization, support, and protection to children and youth with identified mental health or behavioural needs in partnership with their families and in collaboration with a full spectrum of community based formal and informal helping resources". The meeting was characterised by exchange of information and evidence, and by preparing an international research agenda. In addition, the outlines of a consensus statement on TRC were discussed. This statement, originally published in English and now reproduced in a Dutch translation, comprises inter alia five basic principles of care that according to the Work Group on Therapeutic Residential Care should be guiding for residential youth care provided at any time.

Excavations at Ravelrig Quarry, City of Edinburgh revealed activity from the Late Neolithic, and late Bronze Age, although the main phase of activity was the construction of a palisaded homestead during the early Iron Age. Inside an oval shaped palisade was a circular ring-groove roundhouse and a possible second circular structure comprising ditches and post-holes. The roundhouse contained a central hearth with associated post-holes, two large pits and features that appear to represent the early formation of a ring-ditch. This phase has been radiocarbon dated to 600–400 cal BC

none 32 si The International Work Group for Therapeutic Residential Care convened an International Summit on ‘Pathways to Evidence-Based Practice’ at Loughborough University (GBR), Centre for Child and Family Research on 27-29 April, 2016 with generous support from the Sir Halley Stewart Trust and in partnership with The European Scientific Association on Residential and Family Care for Children and Adolescents (NLD) (EUSARF), the International Association for Outcome-Based Evaluation and Research on Family and Children’s Services (ITA) (IAOBER) and the Association of Children’s Residential Centers (USA) and with the additional support of Action for Children (GBR) and the National Implementation Service (NIS) (GBR). Membership includes: Lisa Holmes (Chair), Director, Centre for Child and Family Research, Loughborough University (GBR); James K. Whittaker (Co-Chair), Charles O. Cressey Endowed Professor Emeritus, University of Washington, School of Social Work, Seattle (USA); Jorge Fernandez del Valle, Professor of Psychology and Director, Child and Family Research Group, University of Oviedo (ESP); Frank Ainsworth, Senior Principal Research Fellow (Adjunct), James Cook University, School of Social Work and Human Services, Townsville, Queensland (AUS); Tore Andreassen, Psychologist, The Norwegian Directorate for Children, Youth and Family Affairs (NOR); James P. Anglin, Professor, Faculty of the School of Child and Youth Care, University of Victoria (CAN); Christopher Bellonci, Board-Certified Child/Adolescent and Adult Psychiatrist; Associate Professor, Psychiatry Department, Tufts University School of Medicine, Boston, MA (USA); David Berridge, Professor of Child and Family Welfare, School for Policy Studies, University of Bristol (GBR); Amaia Bravo, Lecturer, Department of Psychology, University of Oviedo (ESP); Cinzia Canali, Senior Researcher, Fondazione Emanuela Zancan, Padova (ITA) and President, International Association of Outcome-Based Evaluation and Research in Family and Children’s Services (IAOBER); Mark Courtney, Professor, School of Social Service Administration, University of Chicago (USA); Laurah Currey, Chief Operating Officer, Pressley Ridge, Pittsburgh, PA (USA) and President, Association for Children’s Residential Centers, (USA); Daniel. L. Daly, Executive Vice President and Director of Youth Care, Father Flanagan’s Boys’ Home, Boys Town, NE (USA); Robbie Gilligan, Professor of Social Work and Social Policy, Trinity College Dublin IRE), Hans Grietens, Professor, Centre for Special Needs Education & Youth Care, University of Groningen (NLD) and President, European Scientific Association on Residential and Family Care for Children and Adolescents (EUSARF); Annemiek T. Harder, Assistant professor, Department of Special Needs Education and Youth Care, University of Groningen (NLD); Martha J. Holden, Senior Extension Associate with the Bronfenbrenner Center for Translational Research and the Principal Investigator and Director of the Residential Child Care Project at Cornell University, Ithaca, NY (USA); Sigrid James, Professor, Department of Social Work & Social Ecology, School of Behavioral Health, Loma Linda University, CA (USA); Andrew Kendrick, Professor of Residential Child Care, School of Social Work and Social Policy at the University of Strathclyde (GBR) and Consultant at the Centre of Excellence for Looked After Children in Scotland (CELCIS) and the Centre for Youth and Criminal Justice (CYCJ) (UK); Erik J. Knorth, Professor, Department of Special Needs Education and Youth Care, University of Groningen (NLD); Mette Lausten, Senior Researcher at SFI - The Danish National Centre for Social Research, Copenhagen (DNK), John S. Lyons, Senior Policy Fellow at Chapin Hall, University of Chicago, IL (USA); Eduardo Martin, Lecturer at the Department of Developmental and Educational Psychology, University of La Laguna, Tenerife (ESP); Samantha McDermid, Research Fellow, Centre for Child and Family Research, Loughborough University (GBR); Patricia McNamara, Senior Fellow (Honorary), Department of Social Work, University of Melbourne (AUS); Laura Palareti, Assistant Professor in Social Psychology, Department of Education Studies, University of Bologna (ITA); Susan Ramsey, Parent and Former Children’s Mental Health Advocate, The Walker School, Needham, MA (USA); Kari M. Sisson, Executive Director, Association of Children’s Residential Centers (USA); Richard W. Small, Walker Executive Director Emeritus, The Walker School, Needham, MA (USA); June Thoburn, Emeritus Professor of Social Work, University of East Anglia (GBR); Ronald Thompson, Senior Director, Boys Town National Research Institute for Child and Family Studies, Boys Town, NE (USA); Anat Zeira, Professor, School of Social Work and Social Welfare, Hebrew University of Jerusalem, and Head of Research and Evaluation at the Haruv Institute (ISR). Our work group wishes to thank CFRC staffer Laura Dale at Loughborough for extraordinary efforts in producing this statement in record time and for her care and assistance with all phases of our Summit activity. Whittaker, James K; Holmes, Lisa; del Valle, Jorge F.; Ainsworth, Frank; Andreassen, Tore; Anglin, James; Bellonci, Christopher; Berridge, David; Bravo, Amaia; Canali, Cinzia; Courtney, Mark; Currey, Laurah; Daly, Daniel; Gilligan, Robbie; Grietens, Hans; Harder, Annemiek; Holden, Martha; James, Sigrid; Kendrick, Andrew; Knorth, Erik; Lausten, Mette; Lyons, John; Martin, Eduardo; Mcdermid, Samantha; Mcnamara, Patricia; Palareti, Laura; Ramsey, Susan; Sisson, Kari; Small, Richard; Thoburn, June; Thompson, Ronald; Zeira, Anat Whittaker, James K; Holmes, Lisa; del Valle, Jorge F.; Ainsworth, Frank; Andreassen, Tore; Anglin, James; Bellonci, Christopher; Berridge, David; Bravo, Amaia; Canali, Cinzia; Courtney, Mark; Currey, Laurah; Daly, Daniel; Gilligan, Robbie; Grietens, Hans; Harder, Annemiek; Holden, Martha; James, Sigrid; Kendrick, Andrew; Knorth, Erik; Lausten, Mette; Lyons, John; Martin, Eduardo; Mcdermid, Samantha; Mcnamara, Patricia; Palareti, Laura; Ramsey, Susan; Sisson, Kari; Small, Richard; Thoburn, June; Thompson, Ronald; Zeira, Anat

Background There is a significant global health burden associated with acute rheumatic fever (ARF) and rheumatic heart disease (RHD), especially in developing countries. ARF and RHD most often strike children and young adults living in impoverished settings, where unhygienic conditions and lack of awareness and knowledge of streptococcal infection progression are common. Secondary prophylactic measures have been recommended in the past, but primary prevention measures have been gaining more attention from researchers frustrated by the perpetual prevalence of ARF and RHD in developing countries. Health education aims to empower people to take responsibility for their own well-being by gaining control over the underlying factors that influence health. We therefore conducted a review of the current best evidence for the use of health education interventions to increase awareness and knowledge of streptococcal pharyngitis and ARF. Methods and design This article describes the protocol for a systematic review of the effectiveness of health education interventions aimed at increasing awareness and knowledge of the symptoms, causes and consequences of streptococcal pharyngitis, rheumatic fever and/or rheumatic heart disease. Studies will be selected in which the effect of an intervention is compared with either a pre-intervention or a control, targeting all possible audience types. Primary and secondary outcomes of interest are pre-specified. Randomized controlled trials, quasi-randomized trials, controlled before–after studies and controlled clinical trials will be considered. We will search several bibliographic databases (for example, PubMed, EMBASE, World Health Organization Library databases, Google Scholar) and search sources for gray literature. We will meta-analyze included studies. We will conduct subgroup analyses according to intervention subtypes: printed versus audiovisual and mass media versus training workshops. Discussion This review will provide evidence for the effectiveness of educational components in health promotion interventions in raising public awareness in regard to the symptoms, causes and consequences of streptococcal pharyngitis, ARF and/or RHD. Our results may provide guidance in the development of future intervention studies and programs.

Washington state used the Multistate Learning Collaborative grants to address improvement opportunities identified through the results of the Standards Performance Review cycles and county-specific local public health indicators. State and local health departments initiated statewide collaboratives to address the high priorities for system and individual health department improvements. Two individual agency quality improvement efforts are highlighted, one in a large local health department and the other in the State Department of Health, with emphasis on the results in establishing an agency quality improvement infrastructure and Rapid Cycle Improvement teams.

An archaeological excavation was carried out at Gearraidh na h'Aibhne near Calanais on the Isle of Lewis by Northamptonshire Archaeology, working for Glasgow University Archaeological Research Division (GUARD) as part of the Historic Scotland Human Remains Call Off Contract. The site, initially interpreted as a cist potentially containing a bog body, was identified during annual peat cutting. Excavation demonstrated that the feature was in fact an oval pit containing a quantity of hazel branches, capped with a number of flat slabs of Lewisian Gneiss. Several similar stones had been placed in the base of the feature, overlying more hazel branches.The observation of several branches placed vertically at the edges of the cut suggests that the wood remains may have originally constituted a wicker structure or basket. Further evidence of anthropogenic activity was identified in the form of bent and/or twisted hazel rods and cut marks on a larger piece of wood. Growth-ring analysis of the hazel pieces identified two distinct age clusters: a large group of pieces between five and seven years old and a smaller group between ten and 13 years old, indicating the hazel branches had been deliberately selected for size. Analysis of preserved botanical macrofossil remains indicated that heather type stems and Sphagnum moss might have been incorporated or deposited into the structure. Two radiocarbon dates of 1080-830 BC (SUERC-2086) and 1000-830 BC (SUERC-2087) at 2-sigma probability were obtained from two discrete samples of hazel, suggesting the structure was constructed and deposited during the Late Bronze Age.

As part of the Historic Scotland Human Remains Call Off Contract, Glasgow University Archaeological Research Division (GUARD) undertook an archaeological excavation of an artificial mound and associated cists containing human remains of mid-Bronze Age date, at Ferndale, Rendall, Orkney. The excavation identified the presence of two cists containing cremation burials (cist 004 and cist 010), and a third that contained a poorly preserved inhumation (cist 003). Cists 004 and 010 would appear to be related to an artificially created mound, and parallel a number of similar 'barrow' sites from Orkney. Cist 004 contained an inhumation and was of differing construction. It would appear to relate to a different phase and tradition of cist burials. Analysis of skeletal material from cist 004 identified the remains of an older adult male, a female of between 18 and 30 years of age and an infant of 15 months. The adult male was found to have suffered from a bone infection of the femur and showed evidence of poor dental health. The female had suffered from iron deficiency anaemia. The preservation of skeletal material in cists 010 and 003 allowed only the identification of a single adult inhumation of unknown age and sex from each cist. The individuals from cists 004 and 010 had been cremated shortly after death, and analysis of associated soil residues suggests that their remains were subsequently picked from the pyre and washed. Radiocarbon dates from the cremated remains from cists 004 and 010 place the use of these two cists and construction of the associated mound in the first quarter of the second millennium BC. These dates are comparable to other dated cist burials in artificial mounds from Orkney, although it would appear to be one of the earlier sites in the currently available list of dates. Regrettably, a date could not be obtained from the poorly preserved inhumation from cist 003.

This paper describes the work intended to supplement a previous study of Extravehicular Mobility Unit (EMU) strength fatigue data, collected from a variety of joints at a fixed velocity (60 degrees/second), by collecting torque data of a single joint (knee) over time, unsuited, under a condition of multiple fixed velocities. Knee flexion and extension torque values were evaluated for 8 subjects at 60, 120, 180, and 240 degrees per second. Subjects were considered “fatigued” when they reached 30% of the maximal voluntary contraction (MVC), or after 5 minutes of testing had elapsed. Results indicated that over the five-minute testing period, subjects’ available torque output decreased to 40% of their MVC, and then reached a plateau at this level. For lower velocities, subjects gradually decreased from their MVC, but their overall decrease in torque over the fiveminute period was high. For higher velocities, subjects experienced a sharp decline in torque output at the beginning of the trial, but quickly reached a plateau and had an overall smaller decrease in torque compared with lower velocities. Subjects were able to maintain a more constant torque at higher velocities at the beginning of a trial. These results will be correlated to the EMU data when it has been collected and processed, and a mathematical fatigue model will be built to aid designers and mission planners in evaluating EVA activities.

In veel ontwikkelde landen wordt in toenemende mate kritiek geleverd op residentiële interventies bij kinderen en jongeren. Tegen de achtergrond hiervan vond in het voorjaar 2016 in Engeland een internationale conferentie plaats van experts uit 13 landen op het gebied van therapeutische residentiële zorg (TRZ). De volgende werkdefinitie van TRZ was leidend: "Therapeutische residentiële zorg omvat het geplande gebruik van een speciaal hiervoor ontwikkelde, multidimensionale leefomgeving, die tot doel heeft behandeling, onderwijs, socialisatie, ondersteuning en bescherming te bieden of te versterken voor kinderen en jongeren met welomschreven psychische en/of gedragsmatige problematiek; dit in samenwerking met hun gezin/familie en een breed scala aan formele en informele hulpbronnen in de samenleving". De bijeenkomst stond in het teken van kennisuitwisseling en het ontwikkelen van een internationale onderzoeksagenda. Tevens werden de contouren van een consensusverklaring over TRZ besproken. Deze verklaring, die hier integraal wordt weergegeven, omvat onder meer vijf basisprincipes van zorg, die in de visie van de Werkgroep TRZ altijd richtinggevend dienen te zijn voor goede residentiële jeugdhulp.