Children's disaster knowledge, risk perceptions, and preparedness: A cross-country comparison in Nepal and Turkey.

While children are one of the groups at risk in disasters, they can also take an active part in disaster management, provided that the opportunity is given. This research examined the effect of disaster experience, disaster education, country, and city socioeconomic status on children's perceived risk and preparedness with a survey of 1335 children between 11 and 14 years old, in Nepal and Turkey. The survey used questionnaires and the pictorial representation of illness and self measure (PRISM) tool. Results showed that (1) children's risk perceptions were in line with their country-specific objective risks; (2) there were differences between the countries in relation to perception of risk for all the hazards except wildfire; (3) socioeconomic status had a statistically significant effect on children's perceptions of risk and preparedness for earthquakes, wildfires, that is, children who live in wealthier places had higher perceived risk and preparedness; (4) children in both countries showed similar trends in their knowledge of the correct protective actions to take in the event of a hazard occurrence. However, there is still room to enhance children's knowledge, in terms of safety behaviors, as the children selected many incorrect protective actions. There are important implications in terms of child-centered disaster management which hopefully will make life safer and help to create more resilience to disaster in society as a whole.

Pintura Mural para Recolectar Datos Sensibilizantes y Fomentar la Participación en la Investigación Entre los Latinos de EE. UU.

Proposito. Describir una intervención de murales implementadas con comunidad envecindarios Latinos para elevar conciencia de barreras delreclutamiento/retención de Latinos en EE. UU. en la investigación clínica,y aumentar acceso de los investigadores a conceptos de sensibilización críticos para el riguroso diseño de estudios. Fondo. Latinos en EE. UU. sufren desproporcionada de varias enfermedadescrónicas, pero son subrepresentados como investigadores y participantesen investigaciones financiadas por Institutos Nacionales de Salud. Faltade representación inhibe conciencia de necesidades Latinas para la saludy obstaculiza esfuerzos para abordar la falta de equidad en comunidadesdiversas. Las intervenciones de arte en comunidades Latinas siguensiendo reconocidas por capacidad a cerrar brechas e incrementar lacalidad y cantidad de asociaciones de investigación entre investigadores y Latinos. Método. Este artículo describe una intervención de murales puesta a prueba endos vecindarios mayormente Latinos entre 2016 y 2020. El método deldiseño fue guiado por prácticas de investigación participativas con lacomunidad enfocadas en Evaluación-Diagnóstico Planificación- Implementación-Evaluación. Resultados. Los murales abordaron muchos desafíos de participación que a menudo se asocian con la subrepresentación de los Latinos en la investigación académica y permitió entrevistas de sensibilización con miembros clave de la comunidad sobre temas de interés para investigación. Conclusión. Los métodos de investigación que reconocen las formas de arte tradicionales, como murales, crean espacio para generar confianza e iniciar interés en la participación en investigaciones, y aumentan acceso.

WNT/ß-catenin modulates the axial identity of embryonic stem cell-derived human neural crest.

WNT/ß-catenin signaling is crucial for neural crest (NC) formation, yet the effects of the magnitude of the WNT signal remain ill-defined. Using a robust model of human NC formation based on human pluripotent stem cells (hPSCs), we expose that the WNT signal modulates the axial identity of NCs in a dose-dependent manner, with low WNT leading to anterior OTX+ HOX- NC and high WNT leading to posterior OTX- HOX+ NC. Differentiation tests of posterior NC confirm expected derivatives, including posterior-specific adrenal derivatives, and display partial capacity to generate anterior ectomesenchymal derivatives. Furthermore, unlike anterior NC, posterior NC exhibits a transient TBXT+/SOX2+ neuromesodermal precursor-like intermediate. Finally, we analyze the contributions of other signaling pathways in posterior NC formation, which suggest a crucial role for FGF in survival/proliferation, and a requirement of BMP for NC maturation. As expected retinoic acid (RA) and FGF are able to modulate HOX expression in the posterior NC. Surprisingly, early RA supplementation prohibits NC formation. This work reveals for the first time that the amplitude of WNT signaling can modulate the axial identity of NC cells in humans.

Mural Painting to Collect Sensitizing Data and Encourage Research Participation Among U.S. Latinos.

PURPOSE: To describe a mural-based intervention that can be implemented in partnership with community members in Latino neighborhoods in order to improve awareness of barriers to recruitment/retention of U.S. Latinos in clinical research, while augmenting researchers' access to sensitizing concepts critical for rigorous study design. BACKGROUND: Latinos in the United States suffer disproportionately from several chronic illnesses but are underrepresented as researchers and participants in National Institutes of Health-funded research. This lack of representation inhibits a nuanced awareness of the health needs of U.S. Latinos and hampers efforts to address a persistent lack of health equity among U.S. Latinos and other communities of color. Art-based interventions implemented in Latino communities are increasingly being recognized for their ability to bridge this gap and positively affect the quality and quantity of research partnerships between clinical researchers and U.S. Latinos. METHOD: This article describes a mural-based intervention piloted in two predominantly Latino neighborhoods between 2016 and 2020. The design of this method was guided by community partnered participatory research practices and involved an Assessment-Diagnosis-Planning-Implementation-Evaluation approach. RESULTS: Mural painting addressed many of the participation challenges often associated with underrepresentation of Latinos in academic research and allowed for sensitizing interviews with key community members surrounding topics of interest to the research team. CONCLUSION: Research methods that acknowledge traditional art forms, such as mural painting, create a space for building trust and spark interest in future research participation, while augmenting researchers' access to sensitizing concepts that may improve the cultural competence of future studies, projects, and interventions.

Deteriorating Patient Training Using Nonimmersive Virtual Reality: A Descriptive Qualitative Study.

Recent nurse education pedagogical strategies are starting to embrace the use of virtual patient simulations in higher education settings. This study evaluated student, simulation technician, and lecturer perspectives on student performance after virtual training for care of a deteriorating diabetic patient. Second year nursing students learned using a virtual patient simulation, which was a follow-up of a randomized controlled trial that took place during the academic year 2017-2018. Group and individual interviews were conducted comprising the 21 staff and students involved in the virtual reality simulation in four individual lecture sessions. Five themes emerged from this study: engagement, immersion, confidence, knowledge, and challenges. Student participants found that the virtual reality exercise aided their understanding of the complex concepts associated with hypoglycemia, provided immediate feedback about their clinical decisions, could be completed multiple times, and provided more opportunities for safe practice, complimenting their ward and clinical skills experiences. Simulation technicians and lecturing staff also recognized these benefits but identified challenges, including time and cost constraints. We recommend further research into potential benefits and challenges, including likely consequences of increased use of virtual reality technologies for nurse education curriculum design.

Validation and Refinement of Noninvasive Methods to Assess Hepatic Fibrosis: Magnetic Resonance Elastography Versus Enhanced Liver Fibrosis Index.

BACKGROUND: Noninvasive fibrosis markers are routinely used in patients with liver disease. Magnetic resonance elastography (MRE) is recognized as a highly accurate methodology, but a reliable blood test for fibrosis would be useful. We examined performance characteristics of the Enhanced Liver Fibrosis (ELF) Index compared to MRE in a cohort including those with HCV, HIV, and HCV/HIV. METHODS: Subjects enrolled in the Miami Adult Studies on HIV (MASH) cohort underwent MRE and blood sampling. The ELF Index was scored and receiver-operator curves constructed to determine optimal cutoff levels relative to performance characteristics. Cytokine testing was performed to identify new markers to enhance noninvasive marker development. RESULTS: The ELF Index was determined in 459 subjects; more than half were male, non-white, and HIV-infected. MRE was obtained on a subset of 283 subjects and the group that had both studies served as the basis of the receiver-operator curve analysis. At an ELF Index of > 10.633, the area under the curve for cirrhosis (Metavir F4, MRE > 4.62 kPa) was 0.986 (95% CI 0.994-0.996; p < 0.001) with a specificity of 100%. For advanced fibrosis (Metavir F3/4), an ELF cutoff of 10 was associated with poor sensitivity but high specificity (98.9%, 95% CI 96.7-99.8%) with an AUC of 0.80 (95% CI 0.749-0.845). ELF Index performance characteristics exceeded FIB-4 performance. HCV and age were associated with increased fibrosis (p < 0.05) in a multivariable model. IP-10 was found to be a promising biomarker for improvement in noninvasive prediction algorithms. CONCLUSIONS: The ELF Index was a highly sensitive and specific marker of cirrhosis, even among HIV-infected individuals, when compared with MRE. IP-10 may be a biomarker that can enhance performance characteristics further, but additional validation is required.

Novel linezolid resistance plasmids in Enterococcus from food animals in the USA.

Objectives: To sequence the genomes and determine the genetic mechanisms for linezolid resistance identified in three strains of Enterococcus isolated from cattle and swine caecal contents as part of the US National Antimicrobial Resistance Monitoring System (NARMS) surveillance programme. Methods: Broth microdilution was used for in vitro antimicrobial susceptibility testing to assess linezolid resistance. Resistance mechanisms and plasmid types were identified from data generated by WGS on Illumina® and PacBio® platforms. Conjugation experiments were performed to determine whether identified mechanisms were transmissible. Results: Linezolid resistance plasmids containing optrA were identified in two Enterococcus faecalis isolates and one Enterococcus faecium. The E. faecium isolate also carried the linezolid resistance gene cfr on the same plasmid as optrA. The linezolid resistance plasmids had various combinations of additional resistance genes conferring resistance to phenicols (fexA), aminoglycosides [spc and aph(3')-III] and macrolides [erm(A) and erm(B)]. One of the plasmids was confirmed to be transmissible by conjugation, resulting in linezolid resistance in the transconjugant. Conclusions: To the best of our knowledge, this is the first identification of linezolid resistance in the USA in bacteria isolated from food animals. The oxazolidinone class of antibiotics is not used in food animals in the USA, but the genes responsible for resistance were identified on plasmids with other resistance markers, indicating that there may be co-selection for these plasmids due to the use of different antimicrobials. The transmissibility of one of the plasmids demonstrated the potential for linezolid resistance to spread horizontally. Additional surveillance is necessary to determine whether similar plasmids are present in human strains of Enterococcus.

Using photography to enhance GP trainees' reflective practice and professional development.

The capacity and the commitment to reflect are integral to the practice of medicine and are core components of most general practitioners (GP) training programmes. Teaching through the humanities is a growing area within medical education, but one which is often considered a voluntary 'add-on' for the interested doctor. This article describes an evaluation of a highly innovative pedagogical project which used photography as a means to enhance GP trainees' reflective capacity, self-awareness and professional development. Photography was used as a tool to develop GP trainees' skills in recognising and articulating the attitudes, feelings and values that might impact on their clinical work and to enhance their confidence in their ability to deal with these concerns/issues. We submit that photography is uniquely well suited for facilitating insight and self-reflection because it provides the ability to record 'at the touch of a button' those scenes and images to which our attention is intuitively drawn without the need for-or the interference of-conscious decisions. This allows us the opportunity to reflect later on the reasons for our intuitive attraction to these scenes. These photography workshops were a compulsory part of the GP training programme and, despite the participants' traditional scientific backgrounds, the results clearly demonstrate the willingness of participants to accept-even embrace-the use of art as a tool for learning. The GP trainees who took part in this project acknowledged it to be beneficial for both their personal and professional development.

The impact of community mobilisation on HIV prevention in middle and low income countries: a systematic review and critique.

While community mobilisation (CM) is increasingly advocated for HIV prevention, its impact on measurable outcomes has not been established. We performed a systematic review of the impact of CM within HIV prevention interventions (N = 20), on biomedical, behavioural and social outcomes. Among most at risk groups (particularly sex workers), the evidence is somewhat consistent, indicating a tendency for positive impact, with stronger results for behavioural and social outcomes than for biomedical ones. Among youth and general communities, the evidence remains inconclusive. Success appears to be enhanced by engaging groups with a strong collective identity and by simultaneously addressing the socio-political context. We suggest that the inconclusiveness of the findings reflects problems with the evidence, rather than indicating that CM is ineffective. We discuss weaknesses in the operationalization of CM, neglect of social context, and incompatibility between context-specific CM processes and the aspiration of review methodologies to provide simple, context-transcending answers.

Associations between ultraprocessed and minimally processed snacks consumption and overweight/obesity among college students in South Florida.

OBJECTIVE: Evaluate the association between ultraprocessed and minimally processed snack consumption and overweight/obesity among college students. PARTICIPANTS: College students. METHODS: Cross-sectional study. Participants completed an online survey with questions on socio-demographics, beverages and snacks consumption, and weight status. ANCOVA and logistic regression was used; analyses were adjusted for age, sex, race/ethnicity, physical activity, and sleep duration. RESULTS: A total of 435 students completed all questions in the survey. Most students were female (73.3%), Hispanics (61.1%), had a mean age of 24.7-year old and 40% had overweight/obesity. Those with overweight/obesity also had higher odds of consuming soft drinks in higher frequency and quantity than those without overweight/obesity (p < .05). Never consuming unsweetened yogurt/cheese and lower frequency and consumption of fruits were associated with higher odds of overweight/obesity (p < .05). CONCLUSION: Higher frequency and consumption of soft drinks while lower frequency and consumption of unsweetened yogurt/cottage cheese and fruits were associated with overweight/obesity.

Perceived Health and Diet Quality Among Hispanics in South Florida.

There is limited information if perceived health is associated with diet quality in Hispanics. A cross-sectional study was conducted to evaluate is health perception is associated with diet quality among 109 adults in South Florida. Individuals conducting a primary grocery shopping event were asked to complete a survey about their perceived health and to provide a picture of their grocery receipt to estimate diet quality using the Grocery Purchase Quality Index 2016 (GPQI-2016). Data was analyzed using analysis of covariance, adjusting for age, gender, ethnicity, and household size. Mean age was 45.1 ± 13.5 years, 74% were female, 79% were Hispanics, and 36.7% perceived themselves as having 'Good' health. The total average GPQI-2016 score was 40.9 ± 1.0. Perceived health was not significantly associated with total average GPQI-2016 score (p > 0.05). There was no association between perceived health and total diet quality in this sample of Hispanic adults.

Isolation and Identification of Non-O1/Non-O139 Vibrio cholerae in Wild Birds Inhabiting Wetlands in Metropolitan Lima, Peru.

During a survey in wetlands from southern Lima, Peru, two non-O1/non-O139 Vibrio cholerae isolates were obtained from samples collected from an American Oystercatcher (Haematopus palliatus) and a Wren-like Rushbird (Phleocryptes melanops). Vibrio cholerae was identified by amplification and sequencing of 16S rRNA, differentially grown on CHROMagar Vibrio media, and confirmed by ompW amplification. Isolates were confirmed to be non-O1/non-O139 serotypes and to lack the ctxA gene as inferred using PCR. Susceptibility to eight antimicrobial agents was assessed, with one isolate being resistant to azithromycin, doxycycline, tetracycline, and furazolidone. Our results indicate the utility of surveillance for V. cholerae in wetlands in the metropolitan Lima area.

Mowat-Wilson syndrome factor ZEB2 controls early formation of human neural crest through BMP signaling modulation.

Mowat-Wilson syndrome is caused by mutations in ZEB2, with patients exhibiting characteristics indicative of neural crest (NC) defects. We examined the contribution of ZEB2 to human NC formation using a model based on human embryonic stem cells. We found ZEB2 to be one of the earliest factors expressed in prospective human NC, and knockdown revealed a role for ZEB2 in establishing the NC state while repressing pre-placodal and non-neural ectoderm genes. Examination of ZEB2 N-terminal mutant NC cells demonstrates its requirement for the repression of enhancers in the NC gene network and proper NC cell terminal differentiation into osteoblasts and peripheral neurons and neuroglia. This ZEB2 mutation causes early misexpression of BMP signaling ligands, which can be rescued by the attenuation of BMP. Our findings suggest that ZEB2 regulates early human NC specification by modulating proper BMP signaling and further elaborate the molecular defects underlying Mowat-Wilson syndrome.

Diet Quality and Liver Health in People Living with HIV in the MASH Cohort: A Multi-Omic Analysis of the Fecal Microbiome and Metabolome.

The gut-liver axis has been recognized as a potential pathway in which dietary factors may contribute to liver disease in people living with HIV (PLWH). The objective of this study was to explore associations between dietary quality, the fecal microbiome, the metabolome, and liver health in PLWH from the Miami Adult Studies on HIV (MASH) cohort. We performed a cross-sectional analysis of 50 PLWH from the MASH cohort and utilized the USDA Healthy Eating Index (HEI)-2015 to measure diet quality. A Fibrosis-4 Index (FIB-4) score < 1.45 was used as a strong indication that advanced liver fibrosis was not present. Stool samples and fasting blood plasma samples were collected. Bacterial composition was characterized using 16S rRNA sequencing. Metabolomics in plasma were determined using gas and liquid chromatography/mass spectrometry. Statistical analyses included biomarker identification using linear discriminant analysis effect size. Compared to participants with FIB-4 ≥ 1.45, participants with FIB-4 < 1.45 had higher intake of dairy (p = 0.006). Fibrosis-4 Index score was inversely correlated with seafood and plant protein HEI component score (r = -0.320, p = 0.022). The relative abundances of butyrate-producing taxa Ruminococcaceae, Roseburia, and Lachnospiraceae were higher in participants with FIB-4 < 1.45. Participants with FIB-4 < 1.45 also had higher levels of caffeine (p = 0.045) and related metabolites such as trigonelline (p = 0.008) and 1-methylurate (p = 0.023). Dietary components appear to be associated with the fecal microbiome and metabolome, and liver health in PLWH. Future studies should investigate whether targeting specific dietary components may reduce liver-related morbidity and mortality in PLWH.

Deletion of the homeodomain gene Six3 from kisspeptin neurons causes subfertility in female mice.

The homeodomain transcription factor SIX3 is a known regulator of eye, nose, and forebrain development, and has recently been implicated in female reproduction. Germline heterozygosity of SIX3 is sufficient to cause subfertility, but the cell populations that mediate this role are unknown. The neuropeptide kisspeptin is a critical component of the reproductive axis and plays roles in sexual maturation, ovulation, and the maintenance of gonadotropin secretion. We used Cre-Lox technology to remove Six3 specifically from kisspeptin neurons in mice to test the hypothesis that SIX3 in kisspeptin neurons is required for reproduction. We found that loss of Six3 in kisspeptin neurons causes subfertility and estrous cycle irregularities in females, but no effect in males. Overall, we find that SIX3 expression in kisspeptin neurons is an important contributor to female fertility.

Multiomic analysis reveals microbiome-related relationships between cocaine use and metabolites.

OBJECTIVE: Over 19 million individuals globally have a cocaine use disorder, a significant public health crisis. Cocaine has also been associated with a pro-inflammatory state and recently with imbalances in the intestinal microbiota as compared to nonuse. The objective of this pilot study was to characterize the gut microbiota and plasma metabolites in people with HIV (PWH) who use cocaine compared with those who do not. DESIGN: Cross-sectional study. METHODS: A pilot study in PWH was conducted on 25 cocaine users and 25 cocaine nonusers from the Miami Adult Studies on HIV cohort. Stool samples and blood plasma were collected. Bacterial composition was characterized using 16S rRNA sequencing. Metabolomics in plasma were determined using gas and liquid chromatography/mass spectrometry. RESULTS: The relative abundances of the Lachnopspira genus, Oscillospira genus, Bifidobacterium adolescentis species, and Euryarchaeota phylum were significantly higher in the cocaine- using PWH compared to cocaine-nonusing PWH. Cocaine-use was associated with higher levels of several metabolites: products of dopamine catabolism (3-methoxytyrosine and 3-methoxytyramine sulfate), phenylacetate, benzoate, butyrate, and butyrylglycine. CONCLUSIONS: Cocaine use was associated with higher abundances of taxa and metabolites known to be associated with pathogenic states that include gastrointestinal conditions. Understanding key intestinal bacterial functional pathways that are altered due to cocaine use in PWH will provide a better understanding of the relationships between the host intestinal microbiome and potentially provide novel treatments to improve health.

Cocaine use associated gut permeability and microbial translocation in people living with HIV in the Miami Adult Study on HIV (MASH) cohort.

OBJECTIVE: Determine if cocaine use impacts gut permeability, promotes microbial translocation and immune activation in people living with HIV (PLWH) using effective antiretroviral therapy (ART). METHODS: Cross-sectional analysis of 100 PLWH (ART ≥6 months, HIV-RNA <200 copies/mL) from the Miami Adult Studies on HIV (MASH) cohort. Cocaine use was assessed by self-report, urine screen, and blood benzoylecgonine (BE). Blood samples were collected to assess gut permeability (intestinal fatty acid-binding protein, I-FABP), microbial translocation (lipopolysaccharide, LPS), immune activation (sCD14, sCD27, and sCD163) and markers of inflammation (hs-CRP, TNF-α and IL-6). Multiple linear regression models were used to analyze the relationships of cocaine use. RESULTS: A total of 37 cocaine users and 63 cocaine non-users were evaluated. Cocaine users had higher levels of I-FABP (7.92±0.35 vs. 7.69±0.56 pg/mL, P = 0.029) and LPS (0.76±0.24 vs. 0.54±0.27 EU/mL, P<0.001) than cocaine non-users. Cocaine use was also associated with the levels of LPS (P<0.001), I-FABP (P = 0.033), and sCD163 (P = 0.010) after adjusting for covariates. Cocaine users had 5.15 times higher odds to exhibit higher LPS levels than non-users (OR: 5.15 95% CI: 1.89-13.9; P<0.001). Blood levels of BE were directly correlated with LPS (rho = 0.276, P = 0.028), sCD14 (rho = 0.274, P = 0.031), and sCD163 (rho = 0.250, P = 0.049). CONCLUSIONS: Cocaine use was associated with markers of gut permeability, microbial translocation, and immune activation in virally suppressed PLWH. Mitigation of cocaine use may prevent further gastrointestinal damage and immune activation in PLWH.

Kiss1 is differentially regulated in male and female mice by the homeodomain transcription factor VAX1.

Regulation of Kiss1 transcription is crucial to the development and function of the reproductive axis. The homeodomain transcription factor, ventral anterior homeobox 1 (VAX1), has been implicated as a potential regulator of Kiss1 transcription. However, it is unknown whether VAX1 directly mediates transcription within kisspeptin neurons or works indirectly by acting upstream of kisspeptin neuron populations. This study tested the hypothesis that VAX1 within kisspeptin neurons regulates Kiss1 gene expression. We found that VAX1 acts as a repressor of Kiss1 in vitro and within the male arcuate nucleus in vivo. In female mice, we found that the loss of VAX1 caused a reduction in Kiss1 expression and Kiss1-containing neurons in the anteroventral periventricular nucleus at the time of the preovulatory luteinizing hormone surge, but was compensated by an increase in Kiss1-cFos colocalization. Despite changes in Kiss1 transcription, gonadotropin levels were unaffected and there were no impairments to fertility.

Soluble CD163 Identifies Those at Risk for Increased Hepatic Inflammation & Fibrosis.

BACKGROUND: Liver disease remains a significant cause of morbidity and mortality in HIV-infected persons. Soluble CD163 is a marker of Kupffer cell activation that is highly associated with development of hepatic fibrosis. The relative contributions of HIV-associated systemic immune activation vs other etiologies of injury are poorly characterized. METHODS: We utilized subjects in the Miami Adult Studies on HIV (MASH) cohort to evaluate 464 participants including 361 people with HIV (PWH) and 103 hepatitis C virus (HCV)/HIV-uninfected controls. Subjects underwent testing for hepatic fibrosis using both magnetic resonance elastography and the Enhanced Liver Fibrosis Index. Steatosis was evaluated by magnetic resonance imaging-derived proton density fat fraction. Immune activation markers and cytokines were quantitated using Luminex methodologies. RESULTS: Participants with HIV with or without HCV coinfection had higher levels of sCD163 than uninfected controls (P < .05). Soluble sCD163 was highly associated with elevated alanine aminotransferase, a key marker of inflammation/injury and with hepatic fibrosis. Hepatic steatosis was also associated with a cytokine pattern suggestive of Kupffer cell activation but was not associated with an increase in sCD14 or sCD27. CONCLUSIONS: Injury and resultant hepatic fibrosis occur by distinct though overlapping mechanistic pathways. In PWH, sCD163 is highly associated with both injury and fibrosis, suggesting that persistent systemic immune activation is a major contributor to long-term outcomes, adding to damage caused by alcohol, steatosis, and other hepatotoxic drug effects.