Early Discharge to Clinic-Based Therapy of Patients Presenting With Decompensated Heart Failure (EDICT-HF): Study Protocol for a Multi-Centre Randomised Controlled Trial.

BACKGROUND: Acute decompensated heart failure involves a high rate of mortality and complications. Management typically involves a multi-day hospital admission. However, patients often lose part of their function with each successive admission, and are at a high risk for hospital-associated complications such as nosocomial infection. This study aims to determine the safety and efficacy of the management of patients presenting with acute decompensated heart failure to clinic-based therapy vs usual inpatient care using a reproducible management pathway. METHOD: An investigator-initiated, prospective, non-inferiority, 1:1 randomised-controlled trial, stratified by left ventricular ejection fraction including 460 patients with a minimum follow-up of 7 days. This is a multi-centre study to be performed in centres across Victoria, Australia. Participants will be patients with either heart failure with reduced ejection fraction (HFrEF) or heart failure with preserved ejection fraction (HFpEF), admitted for acute decompensation of heart failure. INTERVENTION: Early discharge to an outpatient-based Heart Failure Rapid Access Clinical Review (RACER) in addition to frequent medical/nursing at-home review for patients admitted with decompensated heart failure. RESULTS: The primary endpoint will be a non-inferiority assessment of re-hospitalisation at 30 days. Secondary outcomes include superiority assessment of hospitalisation at 30 days, a composite clinical endpoint of major adverse cardiac and cerebrovascular event (MACCE), hospital re-admission or mortality at 3 months, achievement of guideline-directed medical therapy, patient assessment of symptoms (visual-analogue scale quantified as area under curve and Kansas City Cardiomyopathy Questionnaire-12 [KCCQ-12]), attendance at 3-month outpatient follow-up, number of bed stays/clinics attended, proportion of patients free from congestion, change in serum creatinine level, treatment for electrolyte disturbances, time to transition from intravenous to oral diuretics, and health economics analysis (cost-benefit analysis, cost-utility analysis, incremental cost-effectiveness ratio). CONCLUSIONS: The Early Discharge to Clinic-Based Therapy of Patients Presenting with Decompensated Heart Failure (EDICT-HF) trial will help determine whether earlier discharge to out-of-hospital care is non-inferior to the usual practice of inpatient care, in patients with heart failure admitted to hospital for acute decompensation, as an alternative model of care.

Getting men in the room: perceptions of effective strategies to initiate men's involvement in gender-based violence prevention in a global sample.

As engaging men in gender-based violence prevention efforts becomes an increasingly institutionalised component of gender equity work globally, clarity is needed about the strategies that best initiate male-identified individuals' involvement in these efforts. The purpose of this study was to examine the perceived relevance and effectiveness of men's engagement strategies from the perspective of men around the world who have organised or attended gender-based violence prevention events. Participants responded to an online survey (available in English, French and Spanish) and rated the effectiveness of 15 discrete engagement strategies derived from earlier qualitative work. Participants also provided suggestions regarding strategies in open-ended comments. Listed strategies cut across the social ecological spectrum and represented both venues in which to reach men, and the content of violence prevention messaging. Results suggest that all strategies, on average, were perceived as effective across regions of the world, with strategies that tailor messaging to topics of particular concern to men (such as fatherhood and healthy relationships) rated most highly. Open-ended comments also surfaced tensions, particularly related to the role of a gender analysis in initial men's engagement efforts. Findings suggest the promise of cross-regional adaptation and information sharing regarding successful approaches to initiating men's anti-violence involvement.

A Latent Class Analysis of Heterosexual Young Men's Masculinities.

Parallel bodies of research have described the diverse and complex ways that men understand and construct their masculine identities (often termed "masculinities") and, separately, how adherence to traditional notions of masculinity places men at risk for negative sexual and health outcomes. The goal of this analysis was to bring together these two streams of inquiry. Using data from a national, online sample of 555 heterosexually active young men, we employed latent class analysis (LCA) to detect patterns of masculine identities based on men's endorsement of behavioral and attitudinal indicators of "dominant" masculinity, including sexual attitudes and behaviors. LCA identified four conceptually distinct masculine identity profiles. Two groups, termed the Normative and Normative/Male Activities groups, respectively, constituted 88 % of the sample and were characterized by low levels of adherence to attitudes, sexual scripts, and behaviors consistent with "dominant" masculinity, but differed in their levels of engagement in male-oriented activities (e.g., sports teams). Only eight percent of the sample comprised a masculinity profile consistent with "traditional" ideas about masculinity; this group was labeled Misogynistic because of high levels of sexual assault and violence toward female partners. The remaining four percent constituted a Sex-Focused group, characterized by high numbers of sexual partners, but relatively low endorsement of other indicators of traditional masculinity. Follow-up analyses showed a small number of differences across groups on sexual and substance use health indicators. Findings have implications for sexual and behavioral health interventions and suggest that very few young men embody or endorse rigidly traditional forms of masculinity.

A roadmap for research on crassulacean acid metabolism (CAM) to enhance sustainable food and bioenergy production in a hotter, drier world.

Crassulacean acid metabolism (CAM) is a specialized mode of photosynthesis that features nocturnal CO2 uptake, facilitates increased water-use efficiency (WUE), and enables CAM plants to inhabit water-limited environments such as semi-arid deserts or seasonally dry forests. Human population growth and global climate change now present challenges for agricultural production systems to increase food, feed, forage, fiber, and fuel production. One approach to meet these challenges is to increase reliance on CAM crops, such as Agave and Opuntia, for biomass production on semi-arid, abandoned, marginal, or degraded agricultural lands. Major research efforts are now underway to assess the productivity of CAM crop species and to harness the WUE of CAM by engineering this pathway into existing food, feed, and bioenergy crops. An improved understanding of CAM has potential for high returns on research investment. To exploit the potential of CAM crops and CAM bioengineering, it will be necessary to elucidate the evolution, genomic features, and regulatory mechanisms of CAM. Field trials and predictive models will be required to assess the productivity of CAM crops, while new synthetic biology approaches need to be developed for CAM engineering. Infrastructure will be needed for CAM model systems, field trials, mutant collections, and data management.

"He enjoys giving her pleasure": diversity and complexity in young men's sexual scripts.

Research on heterosexual men's sexual expectations has focused on self-described personal traits and culturally dominant models of masculinity. In a pair of studies, we used a sexual scripts perspective to explore the range and diversity of young men's thoughts about sex and relationships with women and to develop measures for assessing these scripts. In the first study, we conducted semi-structured interviews to elicit young men's accounts of their sexual relationships. We used these narratives to produce brief sexual script scenarios describing typical sexual situations, as well as conventional survey items assessing sexual behavior themes. In the second study, we administered the scenarios and theme items to an ethnically diverse, national sample of 648 heterosexually active young men in an online survey. Using exploratory factor analysis, we delineated sets of sexual scripts and sexual behavior themes. In the scenarios, we found both a traditional masculine "player" script and a script that emphasized mutual sexual pleasure. Analysis of theme items produced scales of Drinking and Courtship, Monogamy and Emotion, and Sexual Focus and Variety. We discuss the implications of these findings for understanding heterosexual men's thinking about sexuality and how cultural change in sexual thinking may arise. We also discuss the need for measures of sexual thinking that better integrate perceptions and expectations about the partner as well as the self in relation to the partner, rather than solely self-assessed traits.

Emergency department patient knowledge, opinions, and risk tolerance regarding computed tomography scan radiation.

BACKGROUND: Computed tomography (CT) scanning use for emergency department (ED) patients has increased exponentially since its inception. STUDY OBJECTIVES: This study aimed to determine what patients view as the risk of radiation from CT scans, their risk tolerance and preference for alternative testing, and their opinions about informed consent and malpractice regarding CT scans. METHODS: A 25-question survey was administered to a random convenience sample of ED patients aged ≥ 18 years by trained research associates. RESULTS: There were 487 patients approached to be surveyed; 78 patients were excluded, leaving 409 patients (84.0%) responding. Mean patient age was 40.5 (standard deviation [SD] 16.8) years, and 51.5% were female. Three hundred ninety of 409 (95.4%) believed doctors should explain the risks and benefits of CT, and 316/409 (77.3%) thought an informed consent form should be signed. One hundred seventy-nine of 409 (43.8%) patients recognized that there was more radiation from a CT scan than a single chest x-ray study. Three hundred twenty-four of 409 (79.2%) preferred CT angiography over lumbar puncture to exclude subarachnoid hemorrhage. To diagnose appendicitis, 199/409 (48.7%) preferred an ultrasound first even if it meant needing a subsequent confirmatory CT, and 193/409 (47.2%) preferred a CT right away. One hundred sixty-nine of 409 (41.3%) patients would still like to have a CT scan of the head after head trauma even if their physician did not believe the test was indicated. CONCLUSION: This study elucidates patient preference and knowledge regarding CT scans. Overall, patients have a poor understanding of CT scan radiation, and desire to have risks explained to them as informed consent prior to the scan.

Help-Seeking Patterns Among Students Experiencing Sexual Harassment: A Latent Class Analysis.

Sexual harassment continues to be a pervasive problem in institutes of higher education. Despite this, there are significant gaps in research and our understanding related to students' help-seeking associated with sexual harassment. Understanding students' help-seeking patterns is critical in improving and streamlining campus-wide resources. The following study uses a latent class analysis to examine whether unique patterns of help-seeking exist among students experiencing sexual harassment and whether there are meaningful differences between help-seeking groups with respect to incident characteristics, campus climate, and demographic profiles. Data used in this analysis are from an anonymous, web-based campus climate survey across a university system that included 7,318 undergraduate and 3,484 graduate students. Of these, 704 undergraduates and 229 graduate students reported experiencing sexual harassment. Our results indicated four help-seeking groups: Comprehensive help-seeking group (engaged in multiple types of formal and informal help-seeking), Informal help-seeking group (relied exclusively on friends as sources of support), Low help-seeking group (individuals in this group told virtually no one about their experience, including friends or family), and Unsure group (reached out to friends in large numbers but universally characterized themselves as not knowing what to do). Across classes, findings highlight significant differences related to incident characteristics (offender identity and incident location), student status, and racial identity. Our results point to the heterogeneity of patterns and responses in help-seeking for students experiencing sexual harassment. Variations in help-seeking across different classes highlight that students' perceptions and preferences for formal and informal support depend on their specific type. Our study is a reminder that survivors access support through diverse ways; understanding these distinct patterns in help-seeking behaviors based on specific subgroups will help universities tailor programs that better align with students' contextual needs and realities.

Context, Challenges, and Tensions in Global Efforts to Engage Men in the Prevention of Violence against Women: An Ecological Analysis.

As gender-based violence prevention programs around the world increasingly include efforts to engage men and boys as antiviolence allies, both the profound benefits and the inherent complexities of these efforts are emerging. Acknowledging and exploring tensions associated with engaging men is an important element of thoughtfully fostering men's antiviolence ally movements so as to both respectfully invite men into anti-violence work and create effective, gender-equitable prevention programming. To this end, this study presents descriptive findings regarding challenges associated with men's engagement programming from in-depth interviews with twenty-nine representatives of organizations that engage men and boys in preventing violence against women and girls in Africa, Asia, Europe, Oceania, and North and South America. Programs reported negotiating complex issues related to gender, the intersectional nature of men's identities, and establishing legitimacy and sustainability within communities while maintaining ideological focus and consistency. Additionally, programs reported that these tensions manifest across ecological layers of analysis, and impact both the participation of individual men and the programs' experiences in community and national contexts.

Sexual assault and harassment victimization and post-assault help-seeking among undergraduate students: Comparing residential and nonresidential campuses.

In the United States, campus sexual violence research has mostly focused on 4-year residential campuses. The experiences of students on nonresidential campuses are less well understood. Using data from a Web-based campus climate survey, this study explores sexual assault and sexual harassment victimization rates, victimization characteristics, and post-assault help-seeking across nonresidential and residential students in a campus system that contains both residential and nonresidential campuses. Our analyses highlight that sexual victimization rates, characteristics, and post-assault help-seeking patterns vary by campus type. Interestingly, while nonresidential students on nonresidential campuses reported lower rates of victimization, they accessed formal support resources at higher rates than students on a residential campus. Findings underscore the importance of accounting for campus type in campus sexual violence research and programming and to center nonresidential campuses to learn more about the strategies they adopt to address their students' unique victimization needs and experiences.

Patterns of Intimate Partner Violence and the Harsh Parenting of Children.

While research shows that adult intimate partner violence (IPV) and harsh parenting of children co-occur, less information is available about whether specific types or patterns of IPV create greater risk for harsh parenting, and whether these patterns vary by gender. This study used latent class analysis (LCA) to examine unique patterns of IPV perpetration and victimization among men and women, and variation across patterns by gender, parenting status, and harsh parenting of children. Data are from the Lehigh Longitudinal study (n = 332). LCA produced four classes of IPV perpetration and victimization (Minor Psychological; None; Moderate; and Severe), which were invariant by gender. Although any level of IPV was associated with an increase in harsh parenting, patterns of IPV characterized by a greater number of and more severe types, were particularly associated with the use of harsh parenting toward their children for both mothers and fathers. Parents were overrepresented in all IPV classes compared to the No-IPV class. Results suggest the need for more broad screening and increased supports for parents that are tailored to different levels of need.

Patterns of Gender Equitable Attitudes and Behaviors Among Young Men: Relationships With Violence Perpetration and Masculinity Ideologies.

This study used latent profile analysis with data from 481 U.S. men to examine patterns of men's attitudes toward gender equity and their engagement in gender-equitable (GE) behaviors. Five resulting profiles included groups with (a) high endorsement of both GE attitudes and behaviors, (b) low endorsement of both, (c) mid-range endorsement of both, (d) strong endorsement of GE attitudes, but low engagement in action, and (e) low endorsement of GE attitudes but high participation in GE behavior. Worryingly, this last group reported higher rates of violence perpetration than other groups, while simultaneously reporting higher rates of participation in gender-based violence prevention actions.

A Longitudinal Exploration of How Connections to Staff Facilitate Efficacy and Service Use in Drop-in Centers Serving Youth Experiencing Homelessness.

INTRODUCTION: Youth experiencing homelessness (YEH) benefit from a variety of services to meet their immediate and long-term needs. Drop-in centers are a popular service venue used by YEH. However, the mechanisms responsible for engaging youth in drop-in services are not clear. The current study uses longitudinal data to explore the role of positive staff relationships in increasing youths' knowledge and efficacy to access and subsequently use drop-in center services. METHODS: 731 youth (Mage = 21.8, SD = 2.2, 25.1% female) accessing services at three drop-in centers in Los Angeles, California participated in the study. Surveys were completed at baseline, 1-month, and 3-months later. Path models examined the direct effect of positive relationships with adult staff on service use at the 3-month follow-up, and the indirect effect of service knowledge (assessed at the 1-month follow-up). RESULTS: The direct effect model showed that positive staff relationships at baseline were significantly associated with number of services used at the 3-month follow-up (aIRR = 1.24, 95% CI: 1.00, 1.54). Positive staff relationships were also associated with greater service knowledge at 1-month (b = 0.93, p < 0.001), which in turn was associated with greater service use at 3-months (IRR = 1.15, 95% CI: 1.04, 1.28). The indirect effect of service knowledge was significant (b = 0.13, p = 0.02), suggesting that the association between positive staff relationships and service use was completely mediated by service knowledge. CONCLUSIONS: The current study adds to the literature by demonstrating that positive relationships with staff lead to increased service use by increasing youths' knowledge and efficacy to access services. Efforts should be made to develop positive relationships with YEH in order to engage them in essential services needed to exit homelessness.

Sexual and Relationship Violence Prevention Programming on Commuter Campuses: Wisdom From Students and Campus Personnel.

Responding to the dearth of literature regarding sexual and relationship violence prevention programming on nonresidential university campuses, this study investigates how students and staff conceptualize prevention on commuter campuses. We use qualitative analysis of data from interviews with personnel, and focus groups with students on three commuter campuses and describe (a) the unique considerations associated with implementing prevention in commuter contexts and (b) core elements of comprehensive prevention approaches on these campuses. Results suggest that comprehensive prevention programming is desired by commuter campus stakeholders, but requires policy revision, creative delivery strategies, and student involvement, among other factors, to be realized.

How Research Evidence is Defined, Acquired, and Shared Across Systems That Address Intimate Partner Violence.

This exploratory study examined the flow of research evidence through systems that address intimate partner violence (IPV), including victim services, law enforcement, and criminal justice organizations. Qualitative interviews with representatives of these disciplines assessed how respondents define, acquire, and share research evidence. Findings suggest that research evidence is defined more broadly in the field than in academic settings, and is accessed primarily from trusted intermediaries within professional networks. State IPV coalitions and victim service providers are key intermediaries across sectors. Findings suggest the need for more tangible supports to support sharing of research information within and across service sectors.

Life Course and Socioecological Influences on Gender-Equitable Attitudes Among Men: A Scoping Review.

Emerging research suggests that holding gender-equitable attitudes (GEA) is associated with decreased risk of gender-based violence perpetration and increased willingness to engage in violence preventative actions among men. GEA, defined here as support for political, economic, and social equity across gender in both public and private spheres, may therefore constitute a protective factor against perpetration and a promotive factor in fostering healthy relationships and communities. Forces that shape GEA throughout boys' and young men's lives are less well articulated. The purpose of this exploratory, scoping review was to synthesize cross-disciplinary research to distill life-course influences on the development of GEA among men. Three databases and Google Scholar were searched to locate peer-reviewed studies that empirically examined GEA as an outcome of childhood, adolescent, or young adulthood factors. Sixty-nine articles were located that, collectively, used data from 97 different countries and identified 22 potential life-course influences on men's GEA. Across studies, facilitators of equitable attitudes included higher levels of education, exposure to gender transformative prevention programming, and having parents who held, modeled, and communicated gender-equitable beliefs. Hindrances to equitable attitudes included but were not limited to religiosity, the transition to fatherhood, and having mostly male peer groups. Findings suggest that opportunities to foster equitable attitudes exist across the life course and both inside and outside of formal prevention or education interventions.

Disjunctures in Experiences of Support During the Transition to Fatherhood of Men Who Have Used Intimate Partner Violence.

The transition to fatherhood has been shown to be a stressful time for men, and their experiences of identifying and accessing formal and informal support are mixed. However, research on the experience of men who use intimate partner violence (IPV) during the transition to fatherhood is limited. The evidence documenting the prevalence and short- and long-term impact of violence perpetrated by men against women during pregnancy and postpartum demonstrates the seriousness of this public health issue. To understand the mechanisms of interrupting IPV by engaging men, the gap between what is known about experiences of identifying the need for and access to support during the transition to fatherhood of men with past and current histories of using IPV must be bridged. The study described explores experiences of support during the transition to fatherhood of men who have used IPV. Descriptive findings revealed that men had a range of types of supports from multiple sources; however, most also identified crucial unmet instrumental and socioemotional needs. Four themes surfaced disjunctures in how participants described resources they needed, accessed, and desired. Specifically, these disjunctures were related to men's adherence to a self-reliant identity, a lack of male-specific peer or role model support, the tendency for childbirth classes to be geared toward mothers and not seen by fathers as sources of support, and a gap between men's goals for themselves as fathers, and the actual tools, resources, and modeling that were accessible and "acceptable." The implications include suggestions for group-based programmatic efforts, and three initial steps for organizations to assess and build current capacity to engage-with safety and accountability at the forefront-fathers who use IPV.

Sexual and Relationship Violence Prevention and Response: What Drives the Commuter Campus Student Experience?

This exploratory study brings together two lines of inquiry on (a) college campus-based responses to sexual and intimate partner violence among students, and (b) the characteristics, experiences, and challenges unique to commuter students and commuter institutions of higher education. Using qualitative analysis of 14 in-depth interviews with campus personnel and focus groups with a total of 71 students on three commuter campuses in the Pacific Northwest, we offer a detailed description of the experiences and characteristics of commuter students as they pertain to sexual and relationship violence programming and prevention, the associated nature of commuter campus communities, and the resulting lack of visibility of the issue of sexual and relationship violence on commuter campuses. We conclude that creative, tailored approaches to prevention and response services on commuter campuses are needed to address the unique circumstances and challenges facing commuter campus students.

A Quality Improvement Project to Delay Umbilical Cord Clamping Time.

Delayed cord clamping (DCC) has numerous benefits to the neonate, including increased hemoglobin levels, decreased need for red blood cell transfusions, and decreased incidence of necrotizing enterocolitis and intraventricular hemorrhage. A preliminary observational study at our institution demonstrated 12% of the observed deliveries met the DCC standard, defined as umbilical cord clamping at least 30-60 seconds after birth. Therefore, we designed a quality improvement project to increase the percentage of deliveries using DCC. METHODS: We planned a quality improvement project aiming to increase DCC rates on the university obstetrics service. Our interventions included provider education, installation of timers in the delivery suites, and modification to documentation in the electronic health record. We measured our results through the documented status of cord clamping, either: (1) greater than or equal to 30 seconds or (2) less than 30 seconds. We analyzed the DCC rates weekly and compared those results to the DCC goal of 80% of all deliveries. RESULTS: Postintervention DCC rates were 96% overall. Rates of DCC met our aim of 80% or greater each of the 6 weeks we collected data. CONCLUSION: Simple and inexpensive interventions quickly led to improvements in DCC rates on our university obstetrics service. Our interventions including, provider education, installation of timers in delivery suites, and modification to cord clamping documentation in the electronic health record can be easily instituted at other hospitals. Additionally, the simplicity of this system can produce long-term sustainability of DCC.

The structure of male adolescent peer networks and risk for intimate partner violence perpetration: findings from a national sample.

Although peer networks have been implicated as influential in a range of adolescent behaviors, little is known about relationships between peer network structures and risk for intimate partner violence (IPV) among youth. This study is a descriptive analysis of how peer network "types" may be related to subsequent risk for IPV perpetration among adolescents using data from 3,030 male respondents to the National Longitudinal Study of Adolescent Health. Sampled youth were a mean of 16 years of age when surveyed about the nature of their peer networks, and 21.9 when asked to report about IPV perpetration in their adolescent and early adulthood relationships. A latent class analysis of the size, structure, gender composition and delinquency level of friendship groups identified four unique profiles of peer network structures. Men in the group type characterized by small, dense, mostly male peer networks with higher levels of delinquent behavior reported higher rates of subsequent IPV perpetration than men whose adolescent network type was characterized by large, loosely connected groups of less delinquent male and female friends. Other factors known to be antecedents and correlates of IPV perpetration varied in their distribution across the peer group types, suggesting that different configurations of risk for relationship aggression can be found across peer networks. Implications for prevention programming and future research are addressed.