Drop In Days Research Articles

Identifying Implementation Determinants and Strategies for Long-Acting Injectable Cabotegravir-Rilpivirine in People With HIV Who Are Virally Unsuppressed.

Early evidence suggests long-acting injectable cabotegravir and rilpivirine (LA-CAB/RPV) may be beneficial for people with HIV (PWH) who are unable to attain viral suppression (VS) on oral therapy. Limited guidance exists on implementation strategies for this population. Ward 86, a clinic serving publicly insured PWH in San Francisco. We describe multilevel determinants of and strategies for LA-CAB/RPV implementation for PWH without VS, using the Consolidated Framework for Implementation Research. To assess patient and provider-level determinants, we drew on pre-implementation qualitative data. To assess inner and outer context determinants, we undertook a structured mapping process. Key patient-level determinants included perceived ability to adhere to injections despite oral adherence difficulties and care engagement challenges posed by unmet subsistence needs; strategies to address these determinants included a direct-to-inject approach, small financial incentives, and designated drop-in days. Provider-level determinants included lack of time to obtain LA-CAB/RPV, assess injection response, and follow-up late injections; strategies included centralizing eligibility review with the clinic pharmacist, a pharmacy technician to handle procurement and monitoring, regular multidisciplinary review of patients, and development of a clinic protocol. Ward 86 did not experience many outer context barriers because of rapid and unconstrained inclusion of LA-CAB/RPV on local formularies and ability of its affiliated hospital pharmacy to stock the medication. Multilevel strategies to support LA-CAB/RPV implementation for PWH without VS are required, which may necessitate additional resources in some settings to implement safely and effectively. Advocacy to eliminate outer-context barriers, including prior authorizations and specialty pharmacy restrictions, is needed.

Greater Hamilton Health Network: Women’s Health Drop-In Days: a community approach to integrated care for women, trans and gender diverse persons experiencing homelessness

The International Journal of Integrated Care (IJIC) is an online, open-access, peer-reviewed scientific journal that publishes original articles in the field of integrated care on a continuous basis.IJIC has an Impact Factor of 2.913 (2021 JCR, received in June 2022)The IJIC 20th Anniversary Issue was published in 2021.

Day 1 to day 4 serum hCG change in predicting single-dose methotrexate treatment failure for tubal ectopic pregnancies

ObjectiveTo determine if changes in Day 1 to Day 4 serum human chorionic gonadotropin (hCG) levels can predict treatment failure of single-dose methotrexate (MTX) in medical management of tubal ectopic pregnancies (EP). Study DesignThis retrospective cohort study was conducted at a tertiary level hospital. Files were reviewed for all women who received at least one dose of 50 mg/m2 intramuscular MTX for treatment of ultrasound-confirmed tubal EPs between 2013 and 2018. “Treatment failure” is defined as needing additional MTX or surgery to manage the EP. The primary purpose is to establish a threshold percentage change in Day 1 to Day 4 (Day 1/4) hCG that best predicts treatment failure, with clinically and statistically significant sensitivity and specificity, based on receiver-operator characteristic (ROC) analysis. Results252 files were reviewed, with 108 included for final analysis. 17% of cases required a second dose of MTX and 12% required surgery to manage the EP. Women in the treatment failure group had significantly higher median hCG levels on Day 1, 4 and 7, but were otherwise similar to women who were successful in age, parity, history of previous EP, and EP size. ROC curve analysis of Day 1/4 hCG demonstrates that ≥5% rise best predicts treatment failure with sensitivity 68% (95% confidence interval [CI] 49–83%), specificity 69% (95%CI 56–78%), and AUC 0.77 (95%CI 0.68–0.86, p < 0.001). The positive predictive value is 46% (95%CI 36–56%) and negative predictive value is 84% (95%CI 75–90%). In comparison, ROC analysis of Day 4 to Day 7 hCG demonstrates that a drop of ≤17% best predicted failure, with sensitivity 83% (95%CI 64–94%), specificity 82% (95%CI 71–90%), and AUC 0.90 (95%CI 0.84–0.96), p < 0.001. ConclusionThis study suggests that ≥5% rise in Day 1/4 serum hCG levels could potentially predict treatment failure of single-dose MTX for tubal EPs, and that conversely, <5% rise or any drop in Day 1/4 hCG levels can reliably predict treatment success. Clinicians could consider factoring-in Day 1/4 hCG changes during the course of medically managing patients. They must bear in mind, however, that acting on the Day 1/4 hCG change would lead to increased interventions.

The Long Run Earnings Effects of a Credit Market Disruption

This paper studies the long term consequences on workers' labour earnings of the credit crunch induced by the 2007-2008 financial crisis. We study the evolution of both employment and wages in a large sample of Italian workers followed for nine years after the start of the crisis. We rely on a unique matched bank-employer-employee administrative dataset to construct a firm-specific shock to credit supply, which identifies firms that, because of the collapse of the interbank market during the financial crisis, were unexpectedly affected by credit restrictions. We find that workers who were employed before the crisis in firms more exposed to the credit crunch experience persistent and sizable earnings losses, mainly due to a permanent drop in days worked. These effects are heterogeneous across workers, with high-type workers being more affected in the long run. Moreover, firms operating in areas with favourable labour market conditions react to the credit shock by hoarding high-type workers and displacing low-type ones. Under unfavourable labour market conditions instead, firms select to displace also high-type (and therefore more expensive) workers, even though wages do react to the slack. All in all, our results document persistent effects on the earnings distribution.

Effectiveness of brief alcohol interventions in primary care populations.

Effectiveness of brief alcohol interventions in primary care populations.

Trends in serum human chorionic gonadotropin levels 0-4days after methotrexate administration for predicting tubal ectopic pregnancy treatment success.

To evaluate serum human chorionic gonadotropin (HCG) levels 0-4days after single-dose methotrexate administration for tubal ectopic pregnancy. The present retrospective study included women with tubal ectopic pregnancy treated by methotrexate at a tertiary hospital in Hong Kong, China, between January 1, 2007, and December 31, 2016. Patients were stratified serum HCG levels rose or fell from day 0-4 post-administration. Trends in day 0-4 serum HCG to predict treatment success were compared with that of day 4-7 serum HCG. The optimal drop in HCG was identified by receiver operating characteristic curve analysis. There were 102 patients included. The positive predictive value (PPV) of day 0-4 serum HCG for treatment success was 91% (95% confidence interval [CI] 82-96), which is comparable to the current criterion of a 15% drop in day 4-7 serum HCG (PPV 91%, 95% CI 84-95). A 6% drop in day 0-4 serum HCG was the best predictor of treatment success (PPV 96%, 95% CI 86-99). A drop in day 0-4 serum HCG provided earlier prognostic information and was not inferior to the current criterion.

Significance of provisioning ecosystem services from moist temperate forest ecosystems: lessons from upper Kedarnath valley, Garhwal, India

Forests have been very important natural resource for rural subsistence lifestyle providing variety of and provisioning ecosystem services. Study was carried out in six villages of upper Kedarnath valley at an altitudinal gradient of 1400–2800. Paper examines the nature and extent of provisioning services from forests to hill locals living in nearby villages. Frequent field survey of 151 households from five villages in proximity to forest was conducted using semi-structured questionnaires followed by field surveys. Primary data were collected for basic household’s attributes, fuelwood, fodder, leaf litter and NTFP collection pattern. Simple descriptive methods were used for data analysis. The result shows that fuelwood contributes more than 95 % of total domestic fuel requirement in the study area with more collection during summers but more consumption during winter months due to extensive drop in day and night temperatures. Fodder collection is a major practice adding a lot to women drudgery, and winter fodder deficit is a major issue that leads to dry fodder collection from remote locations. Similarly the average seasonal collection figures were also high for leaf litter ranging from 120 to 89 kg/household/day. Collection of wild edibles is moderate, while for medicinal plants is low in the study area. Resource availability, collection and consumption depend on the family size, distance from forest area and economic condition of the household. More than 95 % of the household’s biomass demands and requirement in the study area are fulfilled completely from forests, while rest are procured from various sources such as agroforests and agriculture.

Mot: A Memoir by Sarah Einstein

Reviewed by: Mot: A Memoir by Sarah Einstein Greta McDonough (bio) Sarah Einstein. Mot: A Memoir. Athens, Ga.: University of Georgia Press, 2015. 168 pages. Hardcover. $24.95. The story of Mot and its author, Sarah Einstein, might be unbelievable as a work of fiction, which makes this memoir all the more remarkable in its telling. Serving the story of an improbable friendship are elements, both big and small, that lend veracity to the storytelling and create in Einstein a reliable narrator. From the memoir’s opening in a KOA campground in a hard-luck part of Amarillo, Texas, the reader is hooked immediately by the lush description and the delicate foreshadowing of an unlikely pair of friends. Mot is a homeless drifter in his mid-sixties, who is waiting—or we think he [End Page 113] is waiting—for Einstein’s visit. She has driven from West Virginia, alone, to spend a platonic week with him, sharing a cabin and seeing the sights, leaving behind her new husband and step-daughter, and a marriage still straining from its brevity and the negotiations of merging several lives into one. We know almost immediately that Mot is suffering from severe mental illness—the voices, the paranoia, and at times the word-salad of the truly disturbed—and that Einstein knows him as a former client from her stint at the Friendship Room, a drop-in day facility for the homeless and mentally ill. We are not sure what to make of Einstein, a woman on the verge of middle age, and Mot, who is in possession of voices and delusions and “The Big Guys Upstairs.” Anyone with a passing understanding of mental health issues will see warnings and red flags, and from time to time the reader may feel a pang or two of discomfort. We wonder about the propriety of such a friendship, all the boundary business that is the cornerstone of working with vulnerable clients, and this wondering is echoed in the descriptions of a relationship that Einstein’s husband has with his own client, Rita. But as the story unfolds, the narrator provides space for our questions while laying her story brick-by-brick in a subtle, elegant way. We are not sure, early on, what motivates the narrator to pursue her friendship with Mot, who has left West Virginia. Einstein has vacated her position at the day center after a traumatic event. She packs up and leaves her husband for a week, something he supports in light of his own enmeshed relationship with a mentally ill client. We can’t imagine how a friendship with Mot can be sustained or sustaining. But they are friends, enjoying each other’s company, cooking together, swimming, and talking, although awkwardly at times, about all sorts of things. She likes his company. He fusses over the health of her car. Their excursions include many trips to [End Page 114] Pep Boys and AutoZone so he can keep her Toyota in prime condition. We think, in this small gesture, that he worries about her, cares for her. That he is her friend. She enjoys her time with him, but wonders, too, about this “fragile faith” she has in him. Is he safe? With her? Around children? Is this foolish, her effort with this man? By the end of this enlightening and engaging read, many of the reader’s questions are answered. Through an economic and tightly structured book, we begin to understand mental illness in a new, more human way—not a clinical discussion, but the day-to-day reality of it, told from a loving and practical point of view. Mot gives the reader a glimpse into the world of the truly disenfranchised, especially the invisible world of the homeless. With an economy of language but sharp detail, Einstein shows us the reality of living “off the grid.” She describes Mot sleeping behind abandoned buildings and in Walmart parking lots after he buys a beat-up car. She gives the reader a glimpse of the homeless person’s day, showing us how Mot, upon rising each morning, gathers his meager belongings and hides them somewhere safe to be retrieved later. He...

Homeless women's experiences of social support from service providers

Purpose – The purpose of this paper is to examine homeless women's interactions with service providers and the degree to which these interactions are perceived as social support. Design/methodology/approach – Using a phenomenological approach, in-depth semistructured interviews were conducted with 15 homeless women recruited through a drop-in day shelter and a winter emergency shelter. Findings – Analysis revealed being “cared for” was experienced within service provider encounters and is commensurate with widely recognized sub-categories of received social support. Participants expressed expanded definitions of service providers and made clear distinctions between routine support expected from a provider and received social support, or being “cared for” by providers. Research limitations/implications – Studies with homeless persons that exclude service providers as a potential source of social support for homeless women or impose predetermined definitions of service provision may not be capturing the full range of participant encounters, relationships, networks, and experiences. Practical implications – Widely used social support measures could serve as a guide for creating education programs for persons who work with homeless people including: professional service providers, students likely to become service providers, paraprofessionals, nonprofessionals, and volunteers. Originality/value – Homeless women's voices have been added to the debate regarding whether social support is within the realm of service provision.

Mental health service user territories: Enacting ‘safe spaces’ in the community

This article develops a conceptualization of 'space' that enables in-depth analysis of mental health service user 'territories'. Driven by the aim to understand how spaces within the framework of 'community care' are produced, an approach that draws upon Deleuze and Guattari's notion of 'territoriality' is developed. Through this we see how important it can be for service users to produce 'safe spaces' that enable forms of 'normalized' activities to be produced, but, crucially, in settings that exist outside completely mainstream settings. Analysing drop-in day centres and home environments (two key sites in community care), the article demonstrates the value of a micro-analysis of the production of space to understanding some of the ways service user experience operates in a spatially distributed sense. This helps to illuminate the impact on identity of existing within 'community care'.

The Use of Triple Tourniquets for Laparoscopic Myomectomy

Objective: The aim of this study was to assess the feasibility, safety, and effect of vascular occlusion of the uterine and ovarian arteries, on blood loss at laparoscopic myomectomy. Design: This was a pilot study. Setting: A university teaching hospital was the setting for the study. Patients: Ten women with a uterine size less than or equal to a 14-week gravid uterus were studied. Intervention: All patients had a no. 1 polyglactin suture tied around the cervix to occlude the uterine arteries and a further suture tied around the ovarian vessels. Main outcome measures: Operative blood loss, effect on ovarian function, and changes in uterine perfusion. Results: The median ultrasound diameter of the largest fibroid was 6.8 cm (range 3.8–9.8 cm). An average of three fibroids were removed (range 1–10), median total weight 209 g (range 22–318 g). The average intraoperative blood loss was 163 mL (range 33–827 mL). The median drop in day 2 hemoglobin compared to preoperative levels was 2 g/dL (range 0.7–4.5 g/d...

The Homeless Supplement to the Diagnostic Interview Schedule: test-retest analyses.

This study sought to extend previous work on reliability of self-reported residential history in a homeless population with high rates of drug abuse. The latest version of the Homeless Supplement to the Diagnostic Interview Schedule (DIS/HS) was used to achieve reliability on homelessness experience, use of shelters, transience, and recent residential patterns. Homeless study volunteers were recruited for a test-retest study from a drop-in day centre for mentally ill homeless people (N = 25) and a substance abuse day programme (N = 30). They were administered the instrument approximately one to two days apart. Kappa and intraclass correlation analyses were performed to assess reliability. Overall, the reliabilities of most variables were acceptable, ranging from fair to excellent. Six items were reconstructed to achieve reliability and two were dropped. Substance dependence and adult antisocial behaviour patterns did not affect reliability on most items. This study has developed a reliable self report instrument for measuring residential history that can be used with homeless and drug abusing populations. Replication is needed in larger, more representative samples and comparison of reliability with other psychiatric and cognitive characteristics.

Absorbable Cervical Tourniquet at Open Myomectomy: A Pilot Study

Objective: To assess the effects of vascular occlusion of the uterine arteries with an absorbable cervical tourniquet at open myomectomy. Methods: Twelve women with a large fibroid uterus underwent open myomectomy for surgical management of menorrhagia and pelvic pressure symptoms. All patients had a number-1 polyglactin (absorbable) suture tied around the cervix to occlude the uterine vessels and temporary tourniquets tied around the infundibulopelvic ligaments to occlude the ovarian vessels. Intraoperative blood loss was assessed by suction and swabs, and postoperative loss by surgical drains. Results: The mean age of patients was 40 years (standard deviation 2.4). The median uterine size was equivalent to 19 weeks gestation (range 16–28). An average of 17 fibroids were removed from each patient (range 2–84) weighing 608g (range 220–3030). The average intraoperative blood loss was 840 mL (range 400–1540). Postoperatively, the median loss in the drain at 24 hours was 350 mL (range 65–760). The median drop in day 2 Hb compared to preoperative levels was 2.8 g/dL (range 1.5–5.5). Two patients were transfused 2 units and 3 units respectively. Conclusions: The use of a delayed absorbable vascular tourniquet around the cervix to occlude the uterine vessels at open myomectomy appears to be safe. Theoretically, such a tourniquet may reduce not only intraoperative bleeding but also postoperative oozing from the uterine incision(s).