Against a backdrop of widespread global transmission, a number of countries have successfully brought large outbreaks of COVID-19 under control and maintained near-elimination status. A key element of epidemic response is the tracking of disease transmissibility in near real-time. During major outbreaks, the reproduction rate can be estimated from a time-series of case, hospitalisation or death counts. In low or zero incidence settings, knowing the potential for the virus to spread is a response priority. Absence of case data means that this potential cannot be estimated directly.We present a semi-mechanistic modelling framework that draws on time-series of both behavioural data and case data (when disease activity is present) to estimate the transmissibility of SARS-CoV-2 from periods of high to low – or zero – case incidence, with a coherent transition in interpretation across the changing epidemiological situations. Of note, during periods of epidemic activity, our analysis recovers the effective reproduction number, while during periods of low – or zero – case incidence, it provides an estimate of transmission risk. This enables tracking and planning of progress towards the control of large outbreaks, maintenance of virus suppression, and monitoring the risk posed by re-introduction of the virus.We demonstrate the value of our methods by reporting on their use throughout 2020 in Australia, where they have become a central component of the national COVID-19 response.

The study set out to explore how HIV-positive individuals conceptualise and describe depression and its manifestation in their lives, and how this may change over time in the context of antiretroviral therapy (ART) and antidepressant treatment. We conducted in-depth interviews using a semi-structured interview guide with 26 adult HIV-positive clients receiving ART in Uganda. We asked the participants to describe their depression and its impact on their general health, physical functioning and psychological wellbeing, as well as the influences of receiving ART or antidepressant treatment. Although depressive experience among the patients was largely described in terms of criteria in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), some of the symptoms used to describe depression, such as 'thinking too much' or worrisome thoughts, did not fit into the DSM-IV criteria. The participants attributed their depression to news of the HIV diagnosis, a fear of dying, the potential socioeconomic consequences of their HIV infection on their family, ART side-effects and continued bad health. Their subjective reports indicated that the treatment of depression with antidepressants had made a positive impact on their general and psychological health. These findings highlight the need for models of HIV care that integrate mental health services and promote the diagnosis and treatment of depression in culturally sensitive ways so as to improve the quality of life and health outcomes for clients. However, keeping the particular study design in mind, these findings should be interpreted as preliminary.

Dependence on over the counter (OTC) codeine containing analgesics: treatment and recovery with buprenorphine naloxone 1 AbstractMisuse and dependence on prescribed and over the counter (OTC) codeine-combination analgesics is an emerging public health concern. We present a clinical case series of four adult patients dependent on OTC codeine combination analgesics in Ireland. Cases (two males/two females, aged 44-57 years) were consuming between 12 and 72 codeinecontaining tablets/day. In three cases, consumption was linked to pain, with on-going misuse reflecting dependence on codeine. Cases were initiated on buprenorphine-naloxone (Suboxone®), stabilised on doses of between 4 mg/1 mg and 14 mg/ 3.5 mg per day and remain on treatment without additional opioid use, as verified by drug screening reports.Although anecdotal, these cases show the potential of effective opioid agonist treatment (OAT) using buprenorphine-naloxone (Suboxone®) to successfully treat this distinct form of opioid dependence disorder. Optimal service provision should recognise unique patient profiles and needs for this form of opioid dependence and incorporate psycho-social supports.

Current evidence indicates that anxiety responses may be multifaceted. To assess separately cognitive and somatic components of trait anxiety, Schwartz et al. (1978) devised the CSAQ, but provided no psychometric evidence that the CSAQ effectively differentiates between such dimensions. To explore the CSAQs dimensional structure, responses from 100 subjects were factor analysed. Oblique rotation yielded a predominantly somatic, an exclusively cognitive and a minor somatic factor. Specification of two factors for rotation yielded an oblique pattern corresponding predominantly with the somatic and exclusively with most of the cognitive items of the CSAQ. These results are consistent with the Schwartz et al. multiprocess model. (1978) have extensively reviewed the evidence (including the outcome of previous factor analyses) which points to the existence of cognitive and somatic subcomponents of anxiety. Schalling et al. concluded that the intensity and frequency of anxiety is related to susceptibility to high autonomic arousal (i.e. high neuroticism) and that the type of anxiety depends on whether high autonomic arousal tends to occur in combination with low cortical arousal (extraversion) as with somatic anxiety, or with high cortical arousal (introversion) as with psychic anxiety. Their formulation is largely Eysenckian.arousal exist (i.e. electrocortical, autonomic and behavioural) and that these are intimately related but nevertheless dissociated mechanisms. Similarly, Schwartz et al. (1978) with their multiprocess model contend that relaxation consists of a generalized reduction in multiple physiological systems acting in unison, as well as a more specific pattern of changes (e.g. cognitive and somatic) superimposed upon this general reduction -elicited by the particular technique employed.This approach which emphasizes the multidimensionality of arousal is contrasted with an older but still prevalent unidimensional model as propounded by Benson er al. (1974). They hypothesize a bipolar hyper-hypometabolic model of arousal and relaxation, which stems from the physiological arousal theories of Cannon and Hess. Benson et al. contend that Cannon's 'emergency reaction' is the equivalent of Hess's ergotropic response, and that the counterpart of the ergotropic response is Hess's 'trophotropic response' or Benson's 'relaxation response'. Benson et al. suggest that the trophotropic response is mediated by the parasympathetic nervous system whereas the ergotropic response is sympathetically mediated. The Cannon, Hess and Benson models all emphasize an integrated bipolar activation of multiple autonomic response systems in unison as opposed to the Lacey, Schalling and Schwartz et al. models, which emphasize specific multiprocess patterns being superimposed upon a more general bipolar response.These different approaches are also linked with two treatment rationales. Benson el al. contend that the various relaxation techniques all elicit a general relaxation (trophotropic) response involving all subsystems in concert....

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The paper seeks to address the challenges of drilling BHA dysfunction which impacted the drilling performance in Abu Dhabi Offshore. Drilling operations experience vibration and stick-slip which limited the ROP and often led to BHA failure cases. In addition, challenging trip out and casing running were observed which indicated unsatisfactory borehole quality. Enhancement of the drilling BHA is required to reduce vibration and improve borehole quality. In reference to study of Self-Excited Stick-Slip Oscillations of Drag Bits by Thomas Richard in 2001, reducing the amplitude of the vertical oscillations should lessen (if not eliminate) the severity of the coupling between the two modes of vibrations, and therefore, of the self-excited vibrations. This could be achieved by minimizing the upward motion of the BHA, by appropriately increasing the lateral friction between the BHA and the borehole wall. Appropriately means "without affecting too strongly the overall efficiency of the system." Friction Adjustable Stabiliser Technology (FAST) is designed with patented features to achieve the above-mentioned BHA condition. A series of runs with FAST incorporated into RSS drilling BHA were planned. A set of KPIs were put in place to evaluate BHA performance. The drilling BHA was simulated to obtain the optimum tool placement, in collaboration with BHA providers. The drilling results were then analysed and compared with analogue wells to demonstrate the deployment of this technology. The deployment of FAST was conducted in 12-¼″ and 6″ hole sections with a total of 7 runs. FAST was run with various RSS systems with low level of vibration in the majority of the runs and proven to minimize vibration/stick-slip during drilling by acting as the BHA contact point and delivering consistent and sufficient friction. As a result, the drilling BHAs were able to deliver the objective to TD and avoid additional trips due to BHA failure. Borehole quality was evaluated through trip out BHA and casing/tubing RIH performance. There is still room for improvement in trip out performance, as backreaming was still required in most of the runs. However, positive impact to performance of RIH casing or lower completion from good quality borehole drilled by BHA with FAST was confirmed from all runs. The saving from fit-for-purpose BHA design on average is 2 days, considering the average NPT for trip out the BHA. In addition, improvement in trip out performance in 6″ section is 0.4 days. Considering above, total saving from 6″ section is 2.4 rig days. The detailed BHA performance analysis and operation feedback from subsequent wells will be beneficial to assess the suitability of this technology to overcome future drilling challenges.

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