Effects of Community-Wide Teen Pregnancy Prevention Initiatives on Local Teen Birth Rates in the United States: A Synthetic Control Approach.

The impact of community-wide teen pregnancy prevention initiatives (CWIs) on local U.S. birth rates among adolescents aged 15 to 19 years was examined using synthetic control methodology within a quasi-experimental design. CWIs were implemented in 10 U.S. communities from 2010 to 2015. Each initiative implemented evidence-based teen pregnancy prevention interventions at local organizations and enhanced best practices in adolescent reproductive health care at local health centers, while engaging diverse community sectors. The synthetic control method was used to estimate the impact of each CWI on overall and race- and ethnicity-specific teen births relative to rates in synthetic control communities. Additionally, we estimated the overall effect of CWIs across communities by pooling results from the 10 synthetic control case studies using the mean percentile rank. Pooled data across all 10 communities indicated an estimated average of 6.6 fewer births per 1000 teens per year overall during the initiative relative to each community's synthetic control (p = .001). By race and ethnicity, there were an estimated average of 6.4 fewer births per 1000 teens per year among Black teens (p = .03), 10.7 fewer births among Hispanic teens (p = .03), and 4.2 fewer births (p = .10) among White teens. Results from individual communities indicated an intervention effect on overall and/or race/ethnicity-specific teen birth rates in five communities. This study demonstrates the value of synthetic control methods in evaluating community-level outcomes of programmatic efforts. Findings indicate the CWIs had a positive impact on teen birth rates and have the potential to address racial and ethnic disparities in those rates.

Bioinspired superhydrophobic surfaces with silver and nitric oxide-releasing capabilities to prevent device-associated infections and thrombosis.

Bacteria-associated infections and thrombus formation are the two major complications plaguing the application of blood-contacting medical devices. Therefore, functionalized surfaces and drug delivery for passive and active antifouling strategies have been employed. Herein, we report the novel integration of bio-inspired superhydrophobicity with nitric oxide release to obtain a functional polymeric material with anti-thrombogenic and antimicrobial characteristics. The nitric oxide release acts as an antimicrobial agent and platelet inhibitor, while the superhydrophobic components prevent non-specific biofouling. Widely used medical-grade silicone rubber (SR) substrates that are known to be susceptible to biofilm and thrombus formation were dip-coated with fluorinated silicon dioxide (SiO2) and silver (Ag) nanoparticles (NPs) using an adhesive polymer as a binder. Thereafter, the resulting superhydrophobic (SH) SR substrates were impregnated with S-nitroso-N-acetylpenicillamine (SNAP, an NO donor) to obtain a superhydrophobic, Ag-bound, NO-releasing (SH-SiAgNO) surface. The SH-SiAgNO surfaces had the lowest amount of viable adhered E. coli (> 99.9 % reduction), S. aureus (> 99.8 % reduction), and platelets (> 96.1 % reduction) as compared to controls while demonstrating no cytotoxic effects on fibroblast cells. Thus, this innovative approach is the first to combine SNAP with an antifouling SH polymer surface that possesses the immense potential to minimize medical device-associated complications without using conventional systemic anticoagulation and antibiotic treatments.

Yarning as a method for building sexual wellbeing among urban Aboriginal young people in Australia.

This paper describes the strategies used by Aboriginal young people to build positive relationships and sexual wellbeing. It does so to counter the risk-focussed narratives present in much existing research and to showcase the resourcefulness of Aboriginal young people. We used peer-interview methods to collect qualitative data from 52 Aboriginal young people living in western Sydney, Australia. Participants reported a strong desire to stay safe and healthy in their sexual relationships and to achieve this they relied heavily on oral communication and yarning strategies. Participants viewed communication as a way to gain or give advice (about bodies, infections, pregnancy, relationships); to assess the acceptability and safety of potential partners; to negotiate consent with partners; to build positive relationships; and to get themselves out of unhealthy relationships. Participants also discussed 'self-talk' as a strategy for building sexual wellbeing, referring to narratives of self-respect and pride in culture as important in establishing Aboriginal young people's positive views of self and as deserving of respectful and safe sexual relationships. These findings suggest that future programmes and interventions based on yarning could be well-regarded, given it is a cultural form of pedagogy and a strategy Aboriginal young people already use to build positive relationships and identities.

The Core Competencies in Hospital Medicine-Clinical Conditions 2023 Update Methodology.

As hospital medicine continues to evolve, the Society of Hospital Medicine (SHM) recognizes the importance of periodic re-evaluation and adaptation of The Core Competencies in Hospital Medicine to reflect and guide the continual expansion of hospitalists' scope of practice. Since its first publication in 2006, the Core Competencies were last revised in 2017 to reflect existing practice. The Core Competencies were initially developed to describe hospitalists' roles and expectations and identify growth opportunities. As hospital medicine has expanded, SHM seeks to maintain the Core Competencies as a framework to guide curricular development, enhance practice assessment, improve the quality of care, and cultivate systems-based practices. Additionally, it helps elucidate the clinical and systems-based aspects central to the field. Thus, the new chapters in the 2023 clinical conditions update focus on enhancing individual hospitalist practice in evaluating and managing common clinical conditions. The accompanying article describes the chapter review and revision process and the criteria for new chapter selection.

Aboriginal young people's perspectives and experiences of accessing sexual health services and sex education in Australia: A qualitative study.

Aboriginal and Torres Strait Islander (Aboriginal) young people seek information and access health services for their sexual health needs. This study examined Aboriginal young people's perspectives on sexual health services and sex education in Australia. Overall, 51 Aboriginal people aged 16-26 years were interviewed by peer researchers in Sydney, Australia in 2019-2020. The findings suggest that the internet was used to assess information quickly and confidentially, but Aboriginal young people questioned its reliability and accuracy. Family, Elders and peers were seen as sources of advice because they had real-life experience and highlighted intergenerational learning that occurs in Aboriginal communities. School-based sex education programmes had mixed reviews, with a preference for programmes delivered by external specialists providing anonymity, clear and accurate information about sex and relationships and positive approaches to sex education, including how to gain consent before sex. There was a need identified for school-based programmes to better consider the needs of Aboriginal young people, including those who identified as LGBTQI + . Aboriginal Medical Services were highly valued for providing culturally safe access to services, while sexual health clinics were valued for providing specialised confidential clinical services with low levels of judgement.

Impact of On-Site Hospital Medicine Curriculum on Preceptor Perception of Rotation.

PURPOSE: To assess the feasibility of an on-site, case-based curriculum delivered by preceptors and to assess preceptors' perceptions of the impact of the curriculum on rotation performance and ability to teach. METHODS: Hospital medicine preceptors were surveyed before and after curriculum deployment using a previously developed survey. RESULTS: Preceptors had positive perceptions of the impact of the curriculum. Rotation performance for health care systems topics had the greatest increase. CONCLUSIONS: Curriculum delivery through on-site, case-based teaching might be well received by preceptors. Despite increased demands on preceptor time, preceptor response to the introduction of a structured curriculum during the second-year internal medicine rotation was positive. Use of preceptor-delivered, preprepared, case-based curricular content might be a tool worth testing in further contexts.

High levels of engagement with testing for HIV and sexually transmissible infection among gay Asian men in Sydney and Melbourne: an observational study.

Background Gay and other men who have sex with men of Asian background (GAM) have been identified as a key population in efforts to eradicate HIV in New South Wales. The aims of the present study were to evaluate current levels of engagement with HIV and sexually transmissible infection (STI) testing services, assess knowledge of pre- and post-exposure prophylaxis and to identify factors associated with service engagement in this group. METHODS: A survey of 604 GAM residing in Sydney and Melbourne was undertaken. RESULTS: The data identified that a significant proportion of non-HIV-positive men (i.e. HIV-negative men and men whose HIV status was unknown) surveyed (n = 567; 93.9%) had engaged in frequent HIV testing and comprehensive STI testing in the 12 months prior to the survey (n = 180; 31.7%). There were significant differences (P < 0.05) in sexual practices at the bivariate level between those who reported frequent and comprehensive HIV/STI testing and those who did not. Those who tested regularly were substantially more sexually active, were more likely to have multiple partners (P = 0.001) and were more likely to engage in condomless anal intercourse with both casual (P < 0.001) and regular (P = 0.002) partners. Those who engaged with testing initiatives were more likely to discuss HIV status with both regular (P = 0.008) and casual (P < 0.001) partners, and identified more reasons to test than their counterparts (P < 0.001). The data also highlighted key service venues, with gay men most likely to have used public sexual health clinics (46.9%) as their most recent testing venue. CONCLUSIONS: The data demonstrate an association between high levels of male-to-male sexual activity and engagement in frequent and comprehensive HIV and STI testing. This likely derives from both self-perceived notions of risk and current reliance on established gay community organisations to convey information around testing. Increasing engagement with testing initiatives beyond GAM who self-identify as being at high HIV and STI risk will require the use of novel routes by which to disseminate this information.

Physician Assistant Student Training for the Inpatient Setting: A Needs Assessment.

PURPOSE: The number of physician assistants (PAs) practicing hospital medicine is rapidly expanding. Little research has been done to determine which inpatient medicine rotation experiences are most helpful to prepare PA students for a career in inpatient medicine. We aimed to determine those skills that practicing hospitalists believe are most critical for PA students to master and to describe hospitalists' current understanding of PA training. We also sought to evaluate the current performance of our own inpatient medicine rotation for PA students. METHODS: We surveyed 85 practicing hospitalists, including physicians and advanced-practice providers, from 3 hospitals in the Duke University Health System to identify (1) the clinical topics and skills deemed most essential for PA students on an inpatient medicine rotation, (2) the percentage of hospitalists able to correctly answer basic questions about PA training, and (3) current rotation performance. Descriptive statistics were used to summarize responses. RESULTS: Hospitalists identified the clinical conditions and health care systems with the most educational value for PA students. Hospitalists were found to have variable levels of understanding of the PA training pathway, with more than 20% incorrectly answering questions about the training process. According to mean responses, the rotation performed positively for 15 of 19 medical conditions. The majority of survey respondents suggested that a formal curriculum would help faculty teach and improve the learning experience for PA students. CONCLUSIONS: Identifying the most essential content can facilitate curriculum development. Hospitalists have a knowledge gap about the training of PA students. The inpatient medicine rotation was rated positively, but survey responses suggested that a formal curriculum could have a positive effect and would be well received.

Practical Approaches to Evaluating Progress and Outcomes in Community-Wide Teen Pregnancy Prevention Initiatives.

This paper presents an overview of the key evaluation components for a set of community-wide teen pregnancy prevention initiatives. We first describe the performance measures selected to assess progress toward meeting short-term objectives on the reach and quality of implementation of evidence-based teen pregnancy prevention interventions and adolescent reproductive health services. Next, we describe an evaluation that will compare teen birth rates in intervention communities relative to synthetic control communities. Synthetic controls are developed via a data-driven technique that constructs control communities by combining information from a pool of communities that are similar to the intervention community. Finally, we share lessons learned thus far in the evaluation of the project, with a focus on those lessons that may be valuable for local communities evaluating efforts to reduce teen pregnancy.

Injectable polymerized high internal phase emulsions with rapid in situ curing.

Polymerized high internal phase emulsions (polyHIPEs) have been utilized in the creation of injectable scaffolds that cure in situ to fill irregular bone defects and potentially improve tissue healing. Previously, thermally initiated scaffolds required hours to cure, which diminished the potential for clinical translation. Here, a double-barrel syringe system for fabricating redox-initiated polyHIPEs with dramatically shortened cure times upon injection was demonstrated with three methacrylated macromers. The polyHIPE cure time, compressive properties, and pore architecture were investigated with respect to redox initiator chemistry and concentration. Increased concentrations of redox initiators reduced cure times from hours to minutes and increased the compressive modulus and strength without compromising the pore architecture. Additionally, storage of the uncured emulsion at reduced temperatures for 6 months was shown to have minimal effects on the resulting graft properties. These studies indicate that the uncured emulsions can be stored in the clinic until they are needed and then rapidly cured after injection to rigid, high-porosity scaffolds. In summary, we have improved upon current methods of generating injectable polyHIPE grafts to meet translational design goals of long storage times and rapid curing (<15 min) without sacrificing porosity or mechanical properties.

Solvent-free fabrication of polyHIPE microspheres for controlled release of growth factors.

The growth factor bone morphogenetic protein 2 (BMP-2) is utilized in surgical procedures to improve bone regeneration; however, current treatments deliver BMP-2 at amounts greater than 100,000 fold of physiological levels, which increases treatment costs and risk of side effects. Drug-eluting microcarriers developed to improve these therapies have faced significant commercialization challenges including particle size distributions, solvent removal, low encapsulation efficiency, and bioactivity loss. In this study, a solvent-free method is presented for fabrication of uniform polyHIPE microspheres for controlled growth factor release. Emulsion templating principles and fluid dynamics were used to fabricate uniform particles with tunable particle size (200-800 µm) and pore size (10-30 µm). The ability to independently tune particle and pore size is expected to provide excellent control of release kinetics. Overall, this solvent-free method for making porous microspheres displays strong promise for the controlled release of BMP-2 and other growth factors.

Advanced therapies for chronic wounds: NPWT, engineered skin, growth factors, extracellular matrices.

Advanced wound care implies the use of products or procedures that are specialized. Although dermatologists are used to being specialists of the skin, hair, and nails, chronic wound care has evolved such that there are some specific treatment options that are more commonly ordered and performed in wound care clinics. Wound care clinics are staffed by specialists and generalists including dermatologists, but also orthopedic surgeons, vascular surgeons, infectious disease specialists, internists, family practitioners, hyperbaric oxygen-trained physicians from a variety of backgrounds, podiatrists, physician assistants, and nurse practitioners. The care of chronic wounds has almost become its own specialty, with so-called advanced therapies now including the use of growth factors, extracellular matrices, engineered skin, and negative pressure wound therapy. It is critical that the dermatologists understand the treatments such that they can appropriately apply or order them directly, or be involved with the care of their patients receiving these therapies.

Attention-deficit hyperactivity disorder reduces automatic attention in young adults.

Previous ERP studies have provided mixed information about ADHD, especially in adults and when conscious attention to stimuli is not required. We used the auditory N1 to assess automatic attention in adults with and without ADHD. While participants watched a silent video, trains of 5 tones (400-ms onset-to-onset time) were presented with intertrain intervals (ITIs) of 1 or 5 s. The P1, N1, P2, and N2 were analyzed. Compared to controls, participants with ADHD had relatively little N1 attenuation after the 5-s ITI, which was driven by uniformly small N1s to all tones. However, after the 1-s ITI, the ADHD group had relatively large N2s to all 5 tones in the train. The reduced N1 in adults with ADHD indicated reduced automatic attention to salient sound stimuli, which may be due to reduced function of brain-stem arousal mechanisms. However, the increased N2 in these participants suggests they had developed certain compensatory mechanisms.

The Sensory Gating Inventory as a potential diagnostic tool for attention-deficit hyperactivity disorder.

Diagnoses of attention-deficit hyperactivity disorder (ADHD) are often made rapidly in physicians' offices without thorough assessment. We examined whether adults diagnosed with ADHD would score differently from controls on a modified Sensory Gating Inventory (SGI: Hetrick et al. in Schizophr Bull 38:178-191, 2012; Kisley et al. in Psychophysiol 41:604-612, 2004), which would facilitate rapid and easy preliminary assessment of ADHD status. The modified SGI was administered to 22 controls and 22 adults with physician diagnoses of ADHD. Analysis was performed on the 17 SGI items and the three categories to which they belong (Perceptual Modulation, Distractibility, and Over-Inclusion). The Distractibility category, and its individual items, showed large group differences. In spite of a relatively small sample size, we found large effect sizes between those with and without ADHD diagnoses. The SGI is a simple, quick, paper/pencil method that may be used to facilitate accurate diagnosis of individuals experiencing ADHD symptoms, which may be especially useful when evaluations are made in settings such as physicians' offices.

Antiviral activity of arbidol, a broad-spectrum drug for use against respiratory viruses, varies according to test conditions.

The therapeutic activity of arbidol was investigated against representatives of seven different virus families. Its 50% median effective concentration (EC(50) ) was 0.22-11.8 µg/ml (0.41-22 nM). Therapeutic indices of 91 were obtained for type 1 poliovirus and 1.9-8.5 for influenza A and B, human paramyxo-3, avian infectious bronchitis-, and Marek's disease viruses. Arbidol was more inhibitory for influenza A/Aichi/2/68 (H3N2) virus than rimantadine or amantadine (EC(50) 10 vs. >15 and >31.6 µg/ml); greater inhibition occurred when end-points were expressed as TCID(50) s. For respiratory syncytial virus (RSV), a reduction in plaque size but not number was observed. However, when the drug was added to infected cultures (≥5 µg/ml), a 3-log reduction in titer occurred. Arbidol did not inhibit directly influenza A/Aichi/2/68 hemagglutinin (HA) or neuraminidase (NA) activity, but inhibition of fusion between the viral envelope and chicken red blood cells occurred when added at 0.1 µg/ml prior to infection. Arbidol induced changes to viral mRNA synthesis of the PB2, PA, NP, NA, and NS genes in MDCK cultures infected with influenza A/PR/8/34. There was no indirect evidence of enhancement of interferon-α by arbidol following infection with A/Aichi/2/68. Arbidol neither reduced lung viral titers nor caused a significant reduction of lung consolidation in BALB/c mice after administration by the oral and intraperitoneal (i.p.) routes and intranasal challenge with influenza A/Aichi/2/68. A small reduction in lung consolidation, but not viral titer, occurred after i.p. administration and subsequent challenge with RSV. The results indicate the potential of arbidol as a broad-spectrum respiratory antiviral drug.

Self-audit as part of a research governance framework for health research.

Clinical research is an area of increasing activity for hospitals, universities and research institutions, which requires formal governance and oversight to manage risks. Monitoring research practice should be a part of research governance activities. However, formal audits have proved time consuming for researchers and auditors. To increase attention to good research practice and screen for poor practice, the Department of Epidemiology and Preventive Medicine at Monash University and the Alfred Research and Ethics Unit in Melbourne have developed a brief self-audit tool for researchers. We evaluated the self-audit using a questionnaire for researchers. The results were positive, with most respondents believing that it promoted good research practice.