Using a Collective Impact Framework to Implement Evidence-Based Strategies for Improving Maternal and Child Health Outcomes.

In 2016, the North Carolina Division of Public Health launched the Improving Community Outcomes for Maternal and Child Health program to invest in evidence-based programs to address three aims: improve birth outcomes, reduce infant mortality, and improve health outcomes for children 0 to 5 years old. Five grantees representing 14 counties were awarded 2 years of funding to implement one evidence-based strategy per aim using a collective impact framework, the principles of implementation science, and a health equity approach. Local health departments served as the backbone organization and provided ongoing support to grantees and helped them form community action teams (CATs) comprising implementation team members, community experts, and relevant stakeholders who met regularly. Focus groups with each grantee's CAT were held during 2017 and 2019 to explore how CATs used a collective impact framework to implement their chosen evidence-based strategies. Results show that grantees made the most progress engaging diverse sectors in implementing a common agenda, continuous communication, and mutually reinforcing activities. Overall, grantees struggled with a shared measurement system but found that a formal tool to assess equity helped use data to drive decision making and program adaptations. Grantees faced logistical challenges holding regular CAT meetings and sustaining community expert engagement. Overtime, CATs cultivated community partnerships and multicounty collaboratives viewed cross-county knowledge sharing as an asset. Future collective impact initiatives should allow grantees more time upfront to form their CAT to plan for sustained community engagement before implementing programs and to incorporate a tool to center equity in their work.

The Use of Health Equity Impact Assessments to Modify Evidence Based Strategies within Local Health Departments in North Carolina.

BACKGROUND: Health equity impact assessments (HEIAs) inform the reduction of health inequities by evaluating programs or policies that affect target populations. Local health departments (LHD) receiving funding through the Improving Community Outcomes for Maternal and Child Health (ICO4MCH) Program conducted HEIAs for evidence-based strategies (EBSs). This paper describes the impact of HEIAs on the implementation of EBSs and highlights lessons learned during implementation of HEIA modifications. METHODS: We conducted a content analysis using data from the HEIA Modification Tracker and focus groups to identify themes and lessons learned. RESULTS: Fifteen HEIAs were conducted by five LHDs between 2016 and 2020. The most common modifications to EBS implementation were 1) increasing education and training for community members and 2) altering messaging mediums and language to reach intended audiences. DISCUSSION: Health equity impact assessments serve as a systematic and tangible way to center health equity, reflect on past processes, and inform improvements.

3D bioprinted scaffolds for diabetic wound-healing applications.

The treatment strategy required for the effective healing of diabetic foot ulcer (DFU) is a complex process that is requiring several combined therapeutic approaches. As a result, there is a significant clinical and economic burden associated in treating DFU. Furthermore, these treatments are often unsuccessful, commonly resulting in lower-limb amputation. The use of drug-loaded scaffolds to treat DFU has previously been investigated using electrospinning and fused deposition modelling (FDM) 3D printing techniques; however, the rapidly evolving field of bioprinting is creating new opportunities for innovation within this research area. In this study, 3D-bioprinted scaffolds with different designs have been fabricated for the delivery of an antibiotic (levoflocixin) to DFU. The scaffolds were fully characterised by a variety of techniques (e.g. SEM, DSC/TGA, FTIR, and mechanical characterisation), demonstrating excellent mechanical properties and providing sustained drug release for 4 weeks. This proof of concept study demonstrates the innovative potential of bioprinting technologies in fabrication of antibiotic scaffolds for the treatment of DFU.

Development of 3D-printed vaginal devices containing metronidazole for alternative bacterial vaginosis treatment.

Bacterial vaginosis (BV) is an abnormal condition caused by the change of microbiota in the vagina. One of the most common bacteria found in the case of BV is Gardnerella vaginalis, which is categorised as anaerobic facultative bacteria. Currently, the available treatment for BV is the use of antibiotics, such as metronidazole (MTZ), in topical and oral dosage forms. The limitation of the currently available treatment is that multiple administration is required and thus, the patient needs to apply the drug frequently to maintain the drug efficacy. To address these limitations, this research proposed prolonged delivery of MTZ in the form of intravaginal devices made from biodegradable and biocompatible polymers. Semi-solid extrusion (SSE) 3D printing was used to prepare the intravaginal devices. The ratio of high and low molecular weight poly(caprolactone) (PCL) was varied to evaluate the effect of polymer composition on the drug release. The versatility of SSE 3D printer was used to print the intravaginal devices into two different shapes (meshes and discs) and containing two different polymer layers made from PCL and a copolymer of methyl vinyl ether and maleic anhydride (Gantrez™-AN119), which provided mucoadhesive properties. Indeed, this layer made from Gantrez™-AN119 increased ca. 5 times the mucoadhesive properties of the final 3D-printed devices (from 0.52 to 2.57 N). Furthermore, MTZ was homogenously dispersed within the polymer matrix as evidenced by scanning electron microscopy analysis. Additionally, in vitro drug release, and antibacterial activity of the MTZ-loaded intravaginal devices were evaluated. Disc formulations were able to sustain the release of MTZ for 72 h for formulations containing 70/30 and 60/40 ratio of high molecular weight/low molecular weight PCL. On the other hand, the discs containing a 50/50 ratio of high molecular weight/low molecular weight PCL showed up to 9 days of release. However, no significant differences in the MTZ release from the MTZ-loaded meshes (60/40 and 50/50 ratio of high molecular weight/low molecular weight PCL) were found after 24 h. The results showed that the different ratios of high and low molecular weight PCL did not significantly affect the MTZ release. However, the shape of the devices did influence the release of MTZ, showing that larger surface area of the meshes provided a faster MTZ release. Moreover, MTZ loaded 3D-printed discs (5% w/w) were capable of inhibiting the growth of Gardnerella vaginalis. These materials showed clear antimicrobial properties, exhibiting a zone of inhibition of 19.0 ± 1.3 mm. Based on these findings, the manufactured represent a valuable alternative approach to the current available treatment, as they were able to provide sustained release of MTZ, reducing the frequency of administration and thus improving patient compliance.

Curcumin nanocrystals-in-nanofibres as a promising platform for the management of periodontal disease.

It is estimated that nearly a half of the world's population over 30 years old suffer from some kind of periodontal disease (PD). Although preventable, PD can pose a significant health burden to patients, causing from pain and discomfort to disfigurement and death. The management of PD often requires surgical procedures accompanied of systemic antibiotic and anti-inflammatory treatments. Curcumin (CUR), a potent anti-inflammatory and antimicrobial active, has shown great promise in the management of PD; however, its effects are often limited by its low bioavailability. In this work, we report the development of electrospun nanofibres (NFs) loaded with CUR nanocrystals (NCs) for the management of PD. NCs of 100 nm were obtained by media milling and loaded into dissolving polyvinyl alcohol NFs using electrospinning. The resultant NCs-in-NFs dissolved in water spontaneously, releasing NCs with a particle size of âˆ¼120 nm. The physiochemical characterisation of the systems indicated the absence of chemical interactions between drug and polymer, and nanofibres with an amorphous nature. In vitro release profiles demonstrated that the NCs had a significantly higher dissolution rate (∼100 % at day 40) than the control group (approximately 6 % at day 40), which consisted of NFs containing a physical mixture of the drug and stabiliser. Finally, mucosal deposition studies demonstrated a 10-fold higher capacity of the novel NCs-in-NFs system to deposit CUR ex vivo using excised neonatal porcine mucosal tissue, when compared to the control group.

Non-invasive, 3D printed, colourimetric, early wound-infection indicator.

A simple, non-invasive, colour-based carbon dioxide (CO2) indicator is described. The indicator provides an indirect response to the rapid, aerobic microbial colonisation of an underlying wound when used in conjunction with an occlusive (i.e. sealed) dressing. The indicator has potential as an early warning indicator of infection in chronic wounds.

Young Mothers' and Fathers' Perceptions of Relationship Violence: A Focus Group Study.

Teens and young adults who are pregnant or parenting are important targets for efforts to prevent intimate partner violence (IPV). To intervene appropriately and effectively, we need to fully understand the unique issues and contexts for IPV in this population. This focus group study examined young parents' ( N = 28) perceptions of their relationships, stressors and sources of conflict, forms of IPV, and help-seeking behaviors. We examined data using template, content, thematic, and framework analyses. Findings about relationships and violence between young parents provide valuable insights for future intervention programs designed to prevent or address IPV among teen parents.

Starting the Conversation: Are Campus Sexual Assault Policies Related to the Prevalence of Campus Sexual Assault?

One goal of university campus sexual assault (CSA) policies is to help prevent CSA. Federal guidance in the 2014 White House Task Force to Protect Students From Sexual Assault Checklist for Campus Sexual Misconduct Policies suggests 10 elements for inclusion in CSA policies (e.g., Policy Introduction, Grievance/Adjudication), and outlines policy topics to be included within each element (Policy Introduction includes two topics: statement of prohibition against sex discrimination including sexual misconduct and statement of commitment to address sexual misconduct). However, no research has examined whether CSA policies impact CSA prevalence. To begin addressing this gap, we studied 24 universities participating in the 2015 Association of American Universities Campus Climate Survey on Sexual Assault and Sexual Misconduct. We linked 2014-2015 data from these universities' CSA policies and their CSA prevalence findings from the 2015 Association of American Universities (AAU) survey. To test whether the comprehensiveness of schools' CSA policies was related to schools' CSA prevalence, we examined the degree to which the CSA policies included recommended policy content from the aforementioned Checklist. Policies were characterized as more comprehensive if they included greater numbers of Checklist topics. We then correlated the number of topics within the policies with school-level CSA prevalence. We also explored whether there was lower CSA prevalence among schools with policies containing particular topics. Results suggested that greater comprehensiveness of schools' entire CSA policies was negatively correlated with CSA prevalence; however, these findings did not approach statistical significance. The number of negative correlations observed between schools' CSA policy elements and CSA prevalence among undergraduate women was greater than expected by chance alone, suggesting a possible connection between comprehensive CSA policies and CSA prevalence. Schools with policies that included a topic on their sexual assault response team had the lowest CSA prevalence for both women and men, and schools that included topics describing grievance/adjudication procedures had lower CSA prevalence. This study provides a novel examination of CSA and could inform needed research related to the impact of CSA policies on CSA.