Bringing COVID-19 vaccine to medically underserved populations utilizing a community-guided mobile vaccine program.

Between March 23, 2021, and December 31, 2022, the Mobile Vaccine Program (MVP) vaccinated 5044 individuals from medically-underserved communities in Middle Tennessee identified through and guided by a collaboration of local community agencies. The primary objective of the MVP was to vaccinate individuals for COVID-19 who had barriers to traditional mass vaccine strategies through community-guided strategies and partnerships. Three strategies were developed and implemented with community partners and their affiliated community health workers (CHWs). The strategies included pop-up vaccination clinics at community partner events, CHW-guided door-to-door in-home vaccination, and community partner-initiated homebound referrals for vaccination.

Evaluation of training programme uptake in an attempt to reduce obstetric anal sphincter injuries: the SUPPORT programme.

INTRODUCTION AND HYPOTHESIS: The objective was to assess the feedback from a quality improvement training programme to reduce obstetric anal sphincter injuries (OASIS). METHODS: Training sessions were organised that included evidence-based information on OASIS risk factors and training on models to measure perineal body length (PBL), perform episiotomies with standard and 60° fixed angle scissors (EPISCISSORS-60®), and measure post-delivery episiotomy suture angles with protractor transparencies. Feedback forms using a Likert scale (1-4) were completed and analysed. The setting was an evidence-based quality improvement programme (Strategy for Using Practical aids for Prevention of OASIS, Recording episiotomies and clinician Training [SUPPORT]) at two National Health Service (NHS) Hospitals in the UK. The participants were midwives and doctors attending the SUPPORT training programme RESULTS: All of the participants (100 %) would recommend the training programme to a friend or colleague. 92 % felt that the training session improved their knowledge of the impact of PBL and perineal distension and their knowledge of the relationship between episiotomy angle and OASIS "a lot" or "somewhat". CONCLUSION: Based on this feedback, we recommend the addition of the knowledge content of the SUPPORT programme to other centres providing perineal assessment and repair courses.

The incidence of burns among sex-trafficking victims in India.

Sex trafficking remains a flagrant violation of human rights, creating many public health concerns. During the initiation period, these victims experience acts of violence including gang rapes, subjecting them to traumatic injuries that include burns. Furthermore, lack of access to health care, particularly surgical, keeps them from receiving treatment for these functionally debilitating contractures caused by burns. This piece provides an overview of burns among sex-trafficked victims in India and the efforts by Cents of Relief to address the associated surgical burden of disease.

Nutritional value and therapeutic potential of Moringa oleifera: a short overview of current research.

A member of the Moringaceae family, Moringa Oleifera Lam is a perennial deciduous tropical tree known as the 'Miracle Tree' for its medicinal and nutritional benefits. Food and nutrition are crucial aspects of the development and maintenance of healthy health. Moringa oleifera is a multi-purpose herbal bush that is used as both human food and a medical alternative all over the world. Various parts of the tree are used to treat chronic diseases such as hypertension, heart disease, inflammation, oxidative stress, diabetes, and cancer. Moringa is an excellent source of essential nutrients and has been found to have a significant impact on improving nutritional deficiencies in populations with limited access to food. Moringa oleifera contains essential amino acids, carotenoids, minerals, fats, carbohydrates, proteins, phytochemicals, vitamins, and fibre. Moringa offers nutritional and economic advantages, medicinal and therapeutic uses, and future biological potential for human well-being.

Risk perception and information-seeking behavior during emergency: An exploratory study on COVID-19 pandemic in Bangladesh.

With the fluctuating condition of the pandemic, people's perception of COVID-19 is also inconstant. If people perceive a low risk of any health emergency or any other crisis, they won't look for proper information to change their attitude, which might increase their risk. Through the use of two different theories and a mixed-method approach, this study attempted to understand the current perception about COVID-19 and the relationship between risk perception and information-seeking behavior. Survey and in-depth key informant interviews were used as tools for data collection. The results indicated that COVID-19 related risk perception changes following people's demographic and socio-economic characteristics. Also, the study found out a relationship of variation in information-seeking behavior on the basis of factors like demographic characteristics, past experience of any emergency, salience, and belief. Results specified that people seek information differently when they perceive a risk to be of higher order. The study summarized that the information sought about any risk could also amplify or reduce the level of perceived risk. In the end, the study concluded that if people do not perceive the risk of any emergency and don't seek proper information, raising awareness about a pandemic like COVID-19 and managing the emergency will be challenging.

Climate change and dengue fever knowledge, attitudes and practices in Bangladesh: a social media-based cross-sectional survey.

BACKGROUND: Bangladesh experienced its worst dengue fever (DF) outbreak in 2019. This study investigated the knowledge, attitudes and practices (KAP) among university students in Bangladesh and significant factors associated with their prevention practices related to climate change and DF. METHODS: A social media-based (Facebook) cross-sectional KAP survey was conducted and secondary data of reported DF cases in 2019 extracted. Logistic regression and spatial analysis were run to examine the data. RESULTS: Of 1500 respondents, 76% believed that climate change can affect DF transmission. However, participants reported good climate change knowledge (76.7%), attitudes (87.9%) and practices (39.1%). The corresponding figures for DF were knowledge (47.9%), attitudes (80.3%) and practices (25.9%). Good knowledge and attitudes were significantly associated with good climate change adaptation or mitigation practices (p<0.05). Good knowledge, attitudes and previous DF experiences were also found to be significantly associated with good DF prevention practices (p<0.001). There was no significant positive correlation between climate change and DF KAP scores and the number of DF cases. CONCLUSIONS: Findings from this study provide baseline data that can be used to promote educational campaigns and intervention programs focusing on climate change adaptation and mitigation and effective DF prevention strategies among various communities in Bangladesh and similar dengue-endemic countries.

Incorporation of Hydroxyapatite into Glass Ionomer Cement (GIC) Formulated Based on Alumino-Silicate-Fluoride Glass Ceramics from Waste Materials.

Glass ionomer cement (GIC) is a well-known restorative material applied in dentistry. The present work aims to study the effect of hydroxyapatite (HA) addition into GIC based on physical, mechanical and structural properties. The utilization of waste materials namely clam shell (CS) and soda lime silica (SLS) glass as replacements for the respective CaO and SiO2 sources in the fabrication of alumino-silicate-fluoride (ASF) glass ceramics powder. GIC was formulated based on ASF glass ceramics, polyacrylic acid (PAA) and deionized water, while 1 wt.% of HA powder was added to enhance the properties of the cement samples. The cement samples were subjected to four different ageing times before being analyzed. In this study, the addition of HA caused an increment in density and compressive strength results along with ageing time. Besides, X-ray Diffraction (XRD) revealed the formation of fluorohydroxyapatite (FHA) phase in HA-added GIC samples and it was confirmed by Fourier Transform Infrared (FTIR) analysis which detected OH‒F vibration mode. In addition, needle-like and agglomeration of spherical shapes owned by apatite crystals were observed from Field Emission Scanning Electron Microscopy (FESEM). Based on Energy Dispersive X-ray (EDX) analysis, the detection of chemical elements in the cement samples were originated from chemical compounds used in the preparation of glass ceramics powder and also the polyacid utilized in initiating the reaction of GIC.

Features of schizophrenia following premorbid eating disorders.

OBJECTIVE: Eating disorders (ED) and schizophrenia are frequently comorbid and schizophrenia shares genetic susceptibility with anorexia. Many factors associated with schizophrenia can disrupt eating, but ED can present years before schizophrenia. If premorbid ED distinguishes a particular subtype of schizophrenia, then phenotypic features may differ between schizophrenia cases with and without premorbid ED. METHOD: This secondary analysis used data from an inpatient schizophrenia research study that comprehensively assessed life course psychiatric disorders (DIGS interview), intelligence (WAIS), global assessments of function (GAF) and assessed symptoms during medication-free and fixed dose neuroleptic phases (PANSS). RESULTS: Premorbid ED was identified in 27 of the 288 schizophrenia cases (9.4%). This group had more females than the group without premorbid ED (74.1% vs. 30%); premorbid ED was 5-fold more common in female than male cases (χ2 (17.9, P < .0001). Only the premorbid ED group had gustatory hallucinations. They also demonstrated significantly more severe psychotic and disorganization symptoms during medication-free and fixed dose treatment phases, despite similar negative symptoms and GAF scores, as other cases. The premorbid ED group had significantly better cognition overall, but relatively lower nonverbal than verbal intelligence. DISCUSSION: Premorbid ED may define a specific subtype of schizophrenia that is common in females. Their more severe psychotic symptoms and better IQ, despite similarly impaired function and negative symptoms as other cases, suggests a distinct pathophysiology. Premorbid ED should be considered in evaluating risk states for schizophrenia, and as a relevant phenotype for treatment resistant schizophrenia.

Increasing self-efficacy reduces visual intrusions to a trauma-film paradigm.

BACKGROUND AND OBJECTIVES: It has been proposed that self-efficacy plays a critical role in the onset and maintenance of Posttraumatic Stress Disorder (PTSD). This study aimed to test if increasing perceptions of self-efficacy using a false feedback technique about coping abilities prior to a trauma-film paradigm lead to a reduction of visual intrusions over the course of 6 days. DESIGN AND METHODS: Healthy participants recruited from the community were randomized to a high self-efficacy (HSE, N = 18), low self-efficacy (LSE, N = 21), or neutral self-efficacy (NSE, N = 23) conditions. RESULTS: Participants in the HSE condition reported higher levels of self-efficacy. In addition, individuals in the HSE conditions reported significantly fewer intrusions over 6 days. Unexpectedly, individuals in the LSE condition reported fewer intrusions on the final day of the study compared to those in the NSE condition. The LSE group was also the only group showing a significant linear decline in intrusion across the 6 days. DISCUSSION: These findings provide further support that perceptions of self-efficacy are modifiable and may contribute to clinically-relevant processes underlying PTSD. Future prospective research with individuals exposed to trauma will help to shed light on the potential role of self-efficacy to buffer the negative impacts of traumatic stress.

Neural circuitry changes associated with increasing self-efficacy in Posttraumatic Stress Disorder.

Cognitive models suggest that posttraumtic stress disorder (PTSD) is maintained, in part, as a result of an individual's maladaptive beliefs about one's ability to cope with current and future stress. These models are consistent with considerable findings showing a link between low levels of self-efficacy and PTSD. A growing body of work has demonstrated that perceptions of self-efficacy can be enhanced experimentally in healthy subjects and participants with PTSD, and increasing levels of self-efficacy improves performance on cognitive, affective, and problem-solving tasks. This study aimed to determine whether increasing perceptions of self-efficacy in participants with PTSD would be associated with changes in neural processing. Combat veterans (N = 34) with PTSD were randomized to either a high self-efficacy (HSE) induction, in which they were asked to recall memories associated with successful coping, or a control condition before undergoing resting state fMRI scanning. Two global network measures in four neural circuits were examined. Participants in the HSE condition showed greater right-lateralized path length and decreased right-lateralized connectivity in the emotional regulation and executive function circuit. In addition, area under receiver operating characteristics curve (AUC) analyses found that average connectivity (.71) and path length (.70) moderately predicted HSE group membership. These findings provide further support for the importance of enhancing perceived control in PTSD, and doing so may engage neural targets that could guide the development of novel interventions.

Expressive flexibility in combat veterans with posttraumatic stress disorder and depression.

BACKGROUND: A growing body of evidence suggests that the ability to flexibly express and suppress emotions ("expressive flexibility") supports successful adaptation to trauma and loss. However, studies have yet to examine whether individuals that meet criteria for posttraumatic stress disorder (PTSD) or depression exhibit alterations in expressive flexibility. The present study aims to test whether lower levels of expressive flexibility are associated with PTSD and depression in combat-exposed veterans. METHODS: Fifty-nine combat veterans with and without PTSD completed self-report measures assessing symptoms of depression, PTSD, and combat exposure. Participants also completed an expressive flexibility task in which they were asked to either enhance or suppress their expressions of emotion while viewing affective images on a computer screen. Expressive flexibility was assessed by both expressive enhancement ability and expressive suppression ability. RESULTS: Repeated measures ANOVA's showed that both PTSD and depression were associated with lower levels of emotional enhancement ability. In addition, a series of linear regressions demonstrated that lower levels of emotional enhancement ability were associated with greater symptom severity of PTSD and depression. The ability to suppress emotional responses did not differ among individuals with and without PTSD or depression. LIMITATIONS: of the study include a cross-sectional design, precluding causality; the lack of a non-trauma exposed group and predominantly male participants limit the generalizability to other populations. CONCLUSIONS: Alterations in expressive flexibility is a previously unrecognized affective mechanism associated with PTSD and depression. Clinical strategies aimed at enhancing emotional expression may aid in the treatment of these disorders.

Neuropsychological Predictors of Trauma Centrality in OIF/OEF Veterans.

This study examined whether reduced performance on two neuropsychological tasks, cognitive flexibility and working memory, were associated with higher levels of trauma centrality. A growing body of research has shown that trauma centrality, the extent to which a person believes a potentially traumatic event has become central to their self-identity and life story, is associated with post-traumatic stress disorder (PTSD). Furthermore, PTSD is often associated with alterations in neuropsychological functioning. The relationship between neuropsychological processes and trauma centrality, however, has yet to be explored. OEF/OIF combat veterans (N = 41) completed the Post-traumatic Diagnostic Scale (PDS), the Beck Depression Inventory-II (BDI-II), the Centrality of Event Scale (CES), and on-line measures of cognitive flexibility and working memory assessed via WebNeuro. Bivariate Pearson correlations showed that CES scores were positively correlated with PDS and BDI scores, and negatively correlated with cognitive flexibility and working memory. Linear regressions revealed that working memory significantly predicted CES when controlling for depression and PTSD severity while cognitive flexibility approached significance when controlling for these same variables. This study employed a cross-sectional design, precluding causality. The small sample size, entirely male sample, and use of an online neuropsychological assessment warrant follow-up research. Although numerous studies have found an association between CES and PTSD, this is the first to suggest that neuropsychological processes underlie the construct of trauma centrality. Given the importance of maladaptive cognitive processes underlying the pathogenesis of PTSD, these data suggest that future studies aimed at examining the link between neuropsychological processes and maladaptive cognitive processes, such as trauma centrality, may help to characterize and treat PTSD.

Optimal PMU placement using topology transformation method in power systems.

Optimal phasor measurement units (PMUs) placement involves the process of minimizing the number of PMUs needed while ensuring the entire power system completely observable. A power system is identified observable when the voltages of all buses in the power system are known. This paper proposes selection rules for topology transformation method that involves a merging process of zero-injection bus with one of its neighbors. The result from the merging process is influenced by the selection of bus selected to merge with the zero-injection bus. The proposed method will determine the best candidate bus to merge with zero-injection bus according to the three rules created in order to determine the minimum number of PMUs required for full observability of the power system. In addition, this paper also considered the case of power flow measurements. The problem is formulated as integer linear programming (ILP). The simulation for the proposed method is tested by using MATLAB for different IEEE bus systems. The explanation of the proposed method is demonstrated by using IEEE 14-bus system. The results obtained in this paper proved the effectiveness of the proposed method since the number of PMUs obtained is comparable with other available techniques.

Enhancing self-efficacy improves episodic future thinking and social-decision making in combat veterans with posttraumatic stress disorder.

Posttraumatic Stress Disorder (PTSD) is associated with maladaptive changes in self-identity, including impoverished perceived self-efficacy. This study examined if enhancing perceptions of self-efficacy in combat veterans with and without symptoms of PTSD promotes cognitive strategies associated with positive mental health outcomes. Prior to completing a future thinking and social problem-solving task, sixty-two OEF/OIF veterans with and without symptoms of PTSD were randomized to either a high self-efficacy (HSE) induction in which they were asked to recall three autobiographical memories demonstrating self-efficacy or a control condition in which they recalled any three autobiographical events. An interaction between HSE and PTSD revealed that individuals with symptoms of PTSD in the HSE condition generated future events with more self-efficacious statements than those with PTSD in the control condition, whereas those without PTSD did not differ in self-efficacy content across the conditions. In addition, individuals in the HSE condition exhibited better social problem solving than those in the control condition. Increasing perceptions of self-efficacy may promote future thinking and problem solving in ways that are relevant to overcoming trauma and adversity.

Comparison of obstetric anal sphincter injuries in nulliparous women before and after introduction of the EPISCISSORS-60(®) at two hospitals in the United Kingdom.

AIM: To assess whether the introduction of episiotomy scissors specially designed to achieve a cutting angle of 60°, EPISCISSORS-60(®), in two hospitals in the UK would result in a reduction in obstetric anal sphincter injuries (OASIS) in nulliparous women. METHODS: A structured training program for all doctors and midwives provided a theoretical framework around OASIS including risk factors and the role of episiotomies and a practical hands-on training element to use EPISCISSORS-60(®) correctly and to measure perineal body length and post-suturing angles. Data for perineal body length, post-suturing angles, user feedback, episiotomy use, and incidence of OASIS were collected through specifically designed forms and the general hospital data collection system. RESULTS: Data were available for 838 nulliparous vaginal deliveries. Mean perineal body length was 37 mm in spontaneous vaginal delivery group (standard deviation [SD] =8.3, 95% confidence interval [CI] =34-39) and 38 mm in the operative vaginal delivery group (SD=8, 95% CI=35-40). Post-suturing episiotomy angles were 53° (SD=6.5, 95% CI=50.7-55.8) in spontaneous vaginal deliveries and 52° (SD=9.6, 95% CI=49-54) in operative vaginal deliveries. EPISCISSORS-60(®) were rated as "good" to "very good" by 84% of users. There was a 47% increase in the number of episiotomies in nulliparous spontaneous vaginal deliveries at Poole (P=0.007) and a 16.5% increase in the number of episiotomies in nulliparous operative vaginal deliveries in Hinchingbrooke (P=0.003). There was an overall 11% increase in episiotomy numbers in nulliparous vaginal deliveries (P=0.08). There was a statistically significant OASIS reduction of 84% in nulliparous spontaneous vaginal deliveries in women who received an episiotomy (P=0.003). CONCLUSION: Initial results after introduction of EPISCISSORS-60(®) show that the majority of health care professionals achieve post-suturing episiotomy angles between 40° and 60°. The results also show a significant increase in the use of episiotomies in the delivery of nulliparous women. There has been a statistically significant reduction in OASIS in nulliparous spontaneous vaginal deliveries.

Challenges in diagnosing tuberculosis in children.

INTRODUCTION: Clinical investigations of childhood tuberculosis (TB) are challenged by the paucibacillary nature of the disease and the difficulties in obtaining specimens. We investigated the challenges in diagnosing TB in children in a low-incidence country. MATERIAL AND METHODS: The data were retrieved retrospectively from the paediatric departments at Danish university hospitals from April 2004 to March 2009 using the diagnosis code A15.0-A19.9 in children below the age of 15 years. RESULTS: A total of 54 children were identified of whom 13 were native Danes. The remaining immigrants were from a range of countries, the majority from Somalia. In all, 44 children had pulmonary TB and the proportion of extrapulmonary TB was higher among immigrants than among Danes. The cardinal symptoms were fever, weight loss and cough. In 41 cases (76%), a combination of a positive tuberculin skin test, an abnormal chest X-ray and the clinical presentation led to initiation of treatment. TB diagnosis was confirmed later by culture in 29 cases. The median number of days from contact to the healthcare system to treatment initiation was two days for 23 children who were part of contact tracing and seven days for the remaining children. All children but one completed treatment, and three patients were retreated due to relapse. Side effects to treatment were observed in 20 cases. None of the patients died. CONCLUSION: The majority of the children affected with TB were foreign-born with a higher proportion of extrapulmonary TB. The microbiological confirmation was low. A rapid onset of treatment was closely related to known, recent exposure.