Local Health Department Interest in Implementation of a Jail-Based Human Papillomavirus Vaccination Program in Kansas, Iowa, Missouri, and Nebraska.

CONTEXT: Local health departments (LHDs) play a vital role in community vaccination programs for human papillomavirus (HPV) infection, but little research has been done to assess LHD interest in cross-sectoral partnerships to vaccinate high-risk groups, specifically incarcerated persons. OBJECTIVE: To describe factors associated with interest in a novel implementation strategy linking LHDs with jails in 4 Midwestern states to deliver HPV vaccine. DESIGN: Survey based on the Consolidated Framework for Implementation Research (CFIR) model given to LHD administrators. A modified Poisson relative risk regression was used to assess the relationship between independent variables and LHD interest in implementation of a jail-based HPV vaccination program. SETTING: LHDs in Kansas, Missouri, Iowa, and Nebraska. PARTICIPANTS: From September 2017 to April 2018, two-thirds (237/344) of invited LHD administrators from the 4 states responded to the survey. MAIN OUTCOME MEASURE: LHD interest in implementation of a jail-based HPV vaccination program. RESULTS: Forty-five percent of LHDs were interested in learning more about implementing a jail-based HPV vaccination program, and 2% already offered or had plans to offer HPV vaccine in their jails. Barriers to implementation were cost (66%), inmates' short incarcerations (47%), and availability of medical staffing (43%). LHD characteristics associated with interest in implementation of a jail-based HPV vaccination program included "inner setting" CFIR variables, which capture the structural and cultural context for program implementation: 7 or more employees (odds ratio [OR] = 2.22; 95% confidence interval [CI], 1.24-3.95), perception of importance to provide HPV vaccine in jails (OR = 3.70; 95% CI, 2.00-6.84), and already providing any vaccines in jails (OR = 2.62; 95% CI, 1.18-5.80). CONCLUSIONS: Nearly half of LHDs in the region expressed interest in partnering with local entities to meet HPV vaccination needs of high-risk groups. Research on cross-sectoral partnerships and what these collaborations look like in practice is needed for public health impact.

Multiscale Nature of Thixotropy and Rheological Hysteresis in Attractive Colloidal Suspensions under Shear.

Colloids with short range attractions self-assemble into sample-spanning structures, whose dynamic nature results in a thermokinematic memory of the deformation history, also referred to as "thixotropy." Here, we study the origins of the thixotropic effect in these time- and rate-dependent materials by investigating hysteresis across different length scales: from particle-level local measurements of coordination number (microscale), to the appearance of density and velocity fluctuations (mesoscale), and up to the shear stress response to an imposed deformation (macroscale). The characteristic time constants at each scale become progressively shorter, and hysteretic effects become more significant as we increase the strength of the interparticle attraction. There are also strong correlations between the thixotropic effects we observe at each scale.

The Role of Copper Speciation in the Low Temperature Oxidative Upgrading of Short Chain Alkanes over Cu/ZSM-5 Catalysts.

Partial oxidative upgrading of C1 -C3 alkanes over Cu/ZSM-5 catalysts prepared by chemical vapour impregnation (CVI) has been studied. The undoped ZSM-5 support is itself able to catalyse selective oxidations, for example, methane to methanol, using mild reaction conditions and the green oxidant H2 O2 . Addition of Cu suppresses secondary oxidation reactions, affording methanol selectivities of up to 97 %. Characterisation studies attribute this ability to population of specific Cu sites below the level of total exchange (Cu/Al<0.5). These species also show activity for radical-based methane oxidation, with productivities exceeding those of the parent zeolite supports. When tested for ethane and propane oxidation reactions, comparable trends are observed.

A Kinetic Study of Methane Partial Oxidation over Fe-ZSM-5 Using N2 O as an Oxidant.

Catalytic methane oxidation using N2 O was investigated at 300 °C over Fe-ZSM-5. This reaction rapidly produces coke (retained organic species), and causes catalyst fouling. The introduction of water into the feed-stream resulted in a significant decrease in the coke selectivity and an increase in the selectivity to the desired product, methanol, from ca. 1 % up to 16 %. A detailed investigation was carried out to determine the fundamental effect of water on the reaction pathway and catalyst stability. The delplot technique was utilised to identify primary and secondary reaction products. This kinetic study suggests that observed gas phase products (CO, CO2 , CH3 OH, C2 H4 and C2 H6 ) form as primary products whilst coke is a secondary product. Dimethyl ether was not detected, however we consider that the formation of C2 products are likely to be due to an initial condensation of methanol within the pores of the zeolite and hence considered pseudo-primary products. According to a second order delplot analysis, coke is considered a secondary product and its formation correlates with CH3 OH formation. Control experiments in the absence of methane revealed that the rate of N2 O decomposition is similar to that of the full reaction mixture, indicating that the loss of active alpha-oxygen sites is the likely cause of the decrease in activity observed and water does not inhibit this process.

Microstructural Rearrangements and their Rheological Implications in a Model Thixotropic Elastoviscoplastic Fluid.

We identify the sequence of microstructural changes that characterize the evolution of an attractive particulate gel under flow and discuss their implications on macroscopic rheology. Dissipative particle dynamics is used to monitor shear-driven evolution of a fabric tensor constructed from the ensemble spatial configuration of individual attractive constituents within the gel. By decomposing this tensor into isotropic and nonisotropic components we show that the average coordination number correlates directly with the flow curve of the shear stress versus shear rate, consistent with theoretical predictions for attractive systems. We show that the evolution in nonisotropic local particle rearrangements are primarily responsible for stress overshoots (strain-hardening) at the inception of steady shear flow and also lead, at larger times and longer scales, to microstructural localization phenomena such as shear banding flow-induced structure formation in the vorticity direction.

How to Synthesise High Purity, Crystalline d-Glucaric Acid Selectively.

Glucaric acid has potential applications in food, pharmaceutical and polymer industries yet no methodology exists within the public domain for isolation of this key bio-derived platform molecule as a pure, crystalline solid. Here we demonstrate the difficulties, which arise in doing so and report development of a process for derivation of free-glucaric acid from its Ca2+/K+ glucarate salts, which are both commercially available. Employing Amberlyst-15 (H+) exchange resin and azeotrope drying, powdered glucaric acid is prepared at > 99.96 % purity in 98.7 % dry yield.

The preparation of large surface area lanthanum based perovskite supports for AuPt nanoparticles: tuning the glycerol oxidation reaction pathway by switching the perovskite B site.

Gold and gold alloys, in the form of supported nanoparticles, have been shown over the last three decades to be highly effective oxidation catalysts. Mixed metal oxide perovskites, with their high structural tolerance, are ideal for investigating how changes in the chemical composition of supports affect the catalysts' properties, while retaining similar surface areas, morphologies and metal co-ordinations. However, a significant disadvantage of using perovskites as supports is their high crystallinity and small surface area. We report the use of a supercritical carbon dioxide anti-solvent precipitation methodology to prepare large surface area lanthanum based perovskites, making the deposition of 1 wt% AuPt nanoparticles feasible. These catalysts were used for the selective oxidation of glycerol. By changing the elemental composition of the perovskite B site, we dramatically altered the reaction pathway between a sequential oxidation route to glyceric or tartronic acid and a dehydration reaction pathway to lactic acid. Selectivity profiles were correlated to reported oxygen adsorption capacities of the perovskite supports and also to changes in the AuPt nanoparticle morphologies. Extended time on line analysis using the best oxidation catalyst (AuPt/LaMnO3) produced an exceptionally high tartronic acid yield. LaMnO3 produced from alternative preparation methods was found to have lower activities, but gave comparable selectivity profiles to that produced using the supercritical carbon dioxide anti-solvent precipitation methodology.

Effect of provision of an integrated neonatal survival kit and early cognitive stimulation package by community health workers on developmental outcomes of infants in Kwale County, Kenya: study protocol for a cluster randomized trial.

BACKGROUND: Each year, more than 200 million children under the age of 5 years, almost all in low- and middle-income countries (LMICs), fail to achieve their developmental potential. Risk factors for compromised development often coexist and include inadequate cognitive stimulation, poverty, nutritional deficiencies, infection and complications of being born low birthweight and/or premature. Moreover, many of these risk factors are closely associated with newborn morbidity and mortality. As compromised development has significant implications on human capital, inexpensive and scalable interventions are urgently needed to promote neurodevelopment and reduce risk factors for impaired development. METHOD/DESIGN: This cluster randomized trial aims at evaluating the impact of volunteer community health workers delivering either an integrated neonatal survival kit, an early stimulation package, or a combination of both interventions, to pregnant women during their third trimester of pregnancy, compared to the current standard of care in Kwale County, Kenya. The neonatal survival kit comprises a clean delivery kit (sterile blade, cord clamp, clean plastic sheet, surgical gloves and hand soap), sunflower oil emollient, chlorhexidine, ThermoSpot(TM), Mylar infant sleeve, and a reusable instant heater. Community health workers are also equipped with a portable hand-held electric scale. The early cognitive stimulation package focuses on enhancing caregiver practices by teaching caregivers three key messages that comprise combining a gentle touch with making eye contact and talking to children, responsive feeding and caregiving, and singing. The primary outcome measure is child development at 12 months of age assessed with the Protocol for Child Monitoring (Infant and Toddler version). The main secondary outcome is newborn mortality. DISCUSSION: This study will provide evidence on effectiveness of delivering an innovative neonatal survival kit and/or early stimulation package to pregnant women in Kwale County, Kenya. Study findings will help inform policy on the most appropriate interventions for promoting healthy brain development and reduction of newborn morbidity and mortality in Kenya and other similar settings. TRIAL REGISTRATION: ClinicalTrial.gov NCT02208960 (August 1, 2014).

Effect of integrated responsive stimulation and nutrition interventions in the Lady Health Worker programme in Pakistan on child development, growth, and health outcomes: a cluster-randomised factorial effectiveness trial.

BACKGROUND: Stimulation and nutrition delivered through health programmes at a large scale could potentially benefit more than 200 million young children worldwide who are not meeting their developmental potential. We investigated the feasibility and effectiveness of the integration of interventions to enhance child development and growth outcomes in the Lady Health Worker (LHW) programme in Sindh, Pakistan. METHODS: We implemented a community-based cluster-randomised effectiveness trial through the LHW programme in rural Sindh, Pakistan, with a 2 × 2 factorial design. We randomly allocated 80 clusters (LHW catchments) of children to receive routine health and nutrition services (controls; n=368), nutrition education and multiple micronutrient powders (enhanced nutrition; n=364), responsive stimulation (responsive stimulation; n=383), or a combination of both enriched interventions (n=374). The allocation ratio was 1:20 (ie, 20 clusters per intervention group). The data collection team were masked to the allocated intervention. All children born in the study area between April, 2009, and March, 2010, were eligible for enrolment if they were up to 2·5 months old without signs of severe impairments. Interventions were delivered by LHWs to families with children up to 24 months of age in routine monthly group sessions and home visits. The primary endpoints were child development at 12 and 24 months of age (assessed with the Bayley Scales of Infant and Toddler Development, Third Edition) and growth at 24 months of age. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT007159636. FINDINGS: 1489 mother-infant dyads were enrolled into the study, of whom 1411 (93%) were followed up until the children were 24 months old. Children who received responsive stimulation had significantly higher development scores on the cognitive, language, and motor scales at 12 and 24 months of age, and on the social-emotional scale at 12 months of age, than did those who did not receive the intervention. Children who received enhanced nutrition had significantly higher development scores on the cognitive, language, and social-emotional scales at 12 months of age than those who did not receive this intervention, but at 24 months of age only the language scores remained significantly higher. We did not record any additive benefits when responsive stimulation was combined with nutrition interventions. Responsive stimulation effect sizes (Cohen's d) were 0·6 for cognition, 0·7 for language, and 0·5 for motor development at 24 months of age; these effect sizes were slightly smaller for the combined intervention group and were low to moderate for the enhanced nutrition intervention alone. Children exposed to enhanced nutrition had significantly better height-for-age Z scores at 6 months (p<0·0001) and 18 months (p=0·02) than did children not exposed to enhanced nutrition. Longitudinal analysis showed a small benefit to linear growth from enrolment to 24 months (p=0·026) in the children who received the enhanced nutrition intervention. INTERPRETATION: The responsive stimulation intervention can be delivered effectively by LHWs and positively affects development outcomes. The absence of a major effect of the enhanced nutrition intervention on growth shows the need for further analysis of mediating variables (eg, household food security status) that will help to optimise future nutrition implementation design. FUNDING: UNICEF.

Discovery and optimization of a highly efficacious class of 5-aryl-2-aminopyridines as FMS-like tyrosine kinase 3 (FLT3) inhibitors.

Based on a putative binding mode of quizartinib (AC220, 1), a potent FMS-like tyrosine kinase 3 (FLT3) inhibitor in Phase III clinical development, we have designed de novo a simpler aminopyridine-based hinge binding motif. Further optimization focusing on maximizing in vivo efficacy and minimizing CYP3A4 time-dependent inhibition resulted in a highly efficacious compound (6s) in tumor xenograft model for further preclinical development.

Global consensus statement on simulation-based practice in healthcare.

Simulation plays a pivotal role in addressing universal healthcare challenges, reducing education inequities, and improving mortality, morbidity and patient experiences. It enhances healthcare processes and systems, contributing significantly to the development of a safety culture within organizations. It has proven to be cost-effective and successful in enhancing team performance, fostering workforce resilience and improving patient outcomes.Through an international collaborative effort, an iterative consultation process was conducted with 50 societies operating across 67 countries within six continents. This process revealed common healthcare challenges and simulation practices worldwide. The intended audience for this statement includes policymakers, healthcare organization leaders, health education institutions, and simulation practitioners. It aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally.Key recommendations Advocating for the benefits that simulation provides to patients, staff and organizations is crucial, as well as promoting its adoption and integration into daily learning and practice throughout the healthcare spectrum. Low-cost, high-impact simulation methods should be leveraged to expand global accessibility and integrate into system improvement processes as well as undergraduate and postgraduate curricula. Support at institutional and governmental level is essential, necessitating a unified and concerted approach in terms of political, strategic and financial commitment.It is imperative that simulation is used appropriately, employing evidence-based quality assurance approaches that adhere to recognized standards of best practice. These standards include faculty development, evaluation, accrediting, credentialing, and certification.We must endeavor to provide equitable and sustainable access to high-quality, contextually relevant simulation-based learning opportunities, firmly upholding the principles of equity, diversity and inclusion. This should be complemented with a renewed emphasis on research and scholarship in this field.Call for action We urge policymakers and leaders to formally acknowledge and embrace the benefits of simulation in healthcare practice and education. This includes a commitment to sustained support and a mandate for the application of simulation within education, training, and clinical environments.We advocate for healthcare systems and education institutions to commit themselves to the goal of high-quality healthcare and improved patient outcomes. This commitment should encompass the promotion and resource support of simulation-based learning opportunities for individuals and interprofessional teams throughout all stages and levels of a caregiver's career, in alignment with best practice standards.We call upon simulation practitioners to champion healthcare simulation as an indispensable learning tool, adhere to best practice standards, maintain a commitment to lifelong learning, and persist in their fervent advocacy for patient safety.This statement, the result of an international collaborative effort, aims to establish a consensus on the key priorities for the broad adoption of exemplary simulation practice that benefits patients and healthcare workforces globally.

Partial oxidation of ethane to oxygenates using Fe- and Cu-containing ZSM-5.

Iron and copper containing ZSM-5 catalysts are effective for the partial oxidation of ethane with hydrogen peroxide giving combined oxygenate selectivities and productivities of up to 95.2% and 65 mol kgcat(-1) h(-1), respectively. High conversion of ethane (ca. 56%) to acetic acid (ca. 70% selectivity) can be observed. Detailed studies of this catalytic system reveal a complex reaction network in which the oxidation of ethane gives a range of C2 oxygenates, with sequential C-C bond cleavage generating C1 products. We demonstrate that ethene is also formed and can be subsequently oxidized. Ethanol can be directly produced from ethane, and does not originate from the decomposition of its corresponding alkylperoxy species, ethyl hydroperoxide. In contrast to our previously proposed mechanism for methane oxidation over similar zeolite catalysts, the mechanism of ethane oxidation involves carbon-based radicals, which lead to the high conversions we observe.

Informal settlements and the care of children 0-3 years of age: a qualitative study.

Background: There is a rapid increase in urbanization with a high percentage of people living in poverty in urban informal settlements. These families, including single parents, are requiring accessible and affordable childcare. In Mlolongo, an informal settlement in Machakos County in Nairobi metropolitan area, Kenya, childcare centres, referred to as 'babycares' are increasing in number. They are being provided by local community members without attention to standards or quality control. The study objective was to understand parents', caregivers' and community elders' experiences and perceptions in terms of the quality of babycares in Mlolongo to inform the design and implementation of improved early childcare services. Methods: Using a community-based participatory research philosophy, a qualitative study including focus group discussions with parents, community elders and babycare centre employees/owners (referred to as caregivers) was conducted in Mlolongo. Results: A total of 13 caregivers, 13 parents of children attending babycares, and eight community elders participated in the focus groups. Overall, community elders, parents and caregivers felt that the babycares were not providing an appropriate quality of childcare. The reported issues included lack of training and resources for caregivers, miscommunication between parents and caregivers on expectations and inappropriate child to caregiver ratio. Conclusion: The deficiencies identified by respondents indicate a need for improved quality of affordable childcare to support early child development in these settings. Efforts need to be invested in defining effective models of early childcare that can meet the expectations and needs of parents and caregivers and address the major challenges in childcare quality identified in this study.

Virtual care exercise interventions in multidisciplinary chronic pain clinics: a qualitative study of perspectives of adults living with chronic pain.

PURPOSE: Chronic pain affects 1 in 4 Canadians and is a leading contributor of disability. Although virtual care has become more prevalent, it is unclear how adults living with chronic pain perceive virtual delivery of exercise interventions within multidisciplinary chronic pain clinics (MCPC). This study explores the perspectives of adults living with chronic pain regarding their perceived barriers and facilitators and recommendations when implementing virtual care exercise interventions within MCPCs. METHODS: We conducted an interpretive description qualitative study based on semi-structured interviews with adults (age ≥18 years) living with chronic pain from a MCPC in Toronto, Canada, between March 1 and April 30, 2021. RESULTS: We completed fifteen (N = 15) interviews of adults living with chronic pain. We identified eight themes that addressed the study objectives: 1) virtual care supplements in-person care, 2) virtual care improves accessibility, 3) impact of technology on participation, 4) navigating the home environment, 5) impact of pain on participation, 6) impact of supervision and feedback, 7) the need for tailored care, and 8) the need for preparation and additional support. CONCLUSION: Our results reveal that adults living with chronic pain view virtual care exercise interventions positively however, the implementation of these interventions must be carefully considered within MCPCs. Specifically, virtual care was considered an excellent adjunct to in-person care but should not replace it completely.Implications for RehabilitationChronic pain is a leading contributor of disability.Exercise interventions are recommended component of comprehensive pain management.Virtual delivery of exercise interventions are becoming more prevalent.Adults living with chronic pain view virtual care exercise interventions positively as they can supplement in-person care and improve access to this type of care.

promor: a comprehensive R package for label-free proteomics data analysis and predictive modeling.

Summary: We present promor, a comprehensive, user-friendly R package that streamlines label-free quantification proteomics data analysis and building machine learning-based predictive models with top protein candidates. Availability and implementation: promor is freely available as an open source R package on the Comprehensive R Archive Network (CRAN) (https://CRAN.R-project.org/package=promor) and distributed under the Lesser General Public License (version 2.1 or later). Development version of promor is maintained on GitHub (https://github.com/caranathunge/promor) and additional documentation and tutorials are provided on the package website (https://caranathunge.github.io/promor/). Supplementary information: Supplementary data are available at Bioinformatics Advances online.

Medical education and population health-A framework in the design of a new undergraduate program.

Health sciences curricular planners are challenged to add new content to established education programs. There is increasing pressure for content in public health, health systems, global health, and planetary health. These important areas often compete for curricular time. What is needed is a convergence model that builds a common framework within which students can integrate areas and better align this knowledge to the individual client or patient who they have responsibility to support. A population health framework is proposed for health sciences education programs that supports a common conceptual understanding of population health. The framework links five thematic areas that have influence on health and wellbeing and a sixth element that defines the range of methodologies essential to understanding health and wellbeing, from the individual to the population. The five areas providing convergence are: (1) the biopsychosocial development of the individual, (2) the socioeconomic factors that influence health and wellbeing, (3) the physical natural and built environment including climate, (4) the continuum of public health and health care systems, and (5) the nation state and global relationships. Using this framework, students are encouraged to think and understand individual health and wellbeing in context to the population and to utilize the appropriate methodological tools to explore these relationships. Planning for a new undergraduate medicine program illustrates the curricular elements that will be used to support student learning with foundation knowledge applied and tracked throughout the program. The proposed framework has application across health sciences disciplines and serves to build a common understanding that supports cross professional communication and collaboration.

Child disability and family-centred care in East Africa: Perspectives from a workshop with stakeholders and health practitioners.

Background: Our understanding of child disability has undergone major changes over the last three decades transforming our approach to assessment and management. Globally there are significant gaps in the application of these 21st century models of care. There is recognition that economic, cultural, and social factors influence transitions in care and there is need to consider contextual factors. Objectives: A two-day workshop brought together key stakeholders to discuss current models of care and their application in the East African context. This article summarises workshop proceedings and identifies a broadly supported set of recommendations that serve to set a direction for health professionals, families, family-based disability organisations, communities and government. Method: Presentations followed by facilitated round-table sessions explored specific themes with participants reporting their responses communally. Future actions were agreed upon by relevant stakeholders. Results: Many barriers exist to care for children with disabilities in East Africa, including stigma and a lack of human and infrastructural resources. In addition, significant disparities exist with regard to access to medication and specialist care. The International Classification of Functioning framework needs to be translated to clinical practice within East Africa, with due recognition of the importance of family-centred care and emphasis on the life course theory for disability care. Family-centred care, educational initiatives, advocacy on the part of stakeholders and involvement of government policymakers are important avenues to improve outcomes. Conclusion: Further education and data are needed to inform family-centred care and multidisciplinary team implementation across East African care contexts for children with disabilities.

Five Influential Factors for Clinical Team Performance in Urgent, Emergency Care Contexts.

INTRODUCTION: In deployed contexts, military medical care is provided through the coordinated efforts of multiple interdisciplinary teams that work across and between a continuum of widely distributed role theaters. The forms these teams take, and functional demands, vary by roles of care, location, and mission requirements. Understanding the requirements for optimal performance of these teams to provide emergency, urgent, and trauma care for multiple patients simultaneously is critical. A team's collective ability to function is dependent on the clinical expertise (knowledge and skills), authority, experience, and affective management capabilities of the team members. Identifying the relative impacts of multiple performance factors on the accuracy of care provided by interdisciplinary clinical teams will inform targeted development requirements. MATERIALS AND METHODS: A regression study design determined the extent to which factors known to influence team performance impacted the effectiveness of small, six to eight people, interdisciplinary teams tasked with concurrently caring for multiple patients with urgent, emergency care needs. Linear regression analysis was used to distinguish which of the 11 identified predictors individually and collectively contributed to the clinical accuracy of team performance in simulated emergency care contexts. RESULTS: All data met the assumptions for regression analyses. Stepwise linear regression analysis of the 11 predictors on team performance yielded a model of five predictors accounting for 82.30% of the variance. The five predictors of team performance include (1) clinical skills, (2) team size, (3) authority profile, (4) clinical knowledge, and (5) familiarity with team members. The analysis of variance confirmed a significant linear relationship between team performance and the five predictors, F(5, 240) = 218.34, P < .001. CONCLUSIONS: The outcomes of this study demonstrate that the collective knowledge, skills, and abilities within an urgent, emergency care team must be developed to the extent that each team member is able to competently perform their role functions and that smaller teams benefit by being composed of clinical authorities who are familiar with each other. Ideally, smaller, forward-deployed military teams will be an expert team of individual experts, with the collective expertise and abilities required for their patients. This expertise and familiarity are advantageous for collective consideration of significant clinical details, potential alternatives for treatment, decision-making, and effective implementation of clinical skills during patient care. Identifying the most influential team performance factors narrows the focus of team development strategies to precisely what is needed for a team to optimally perform.