The racial composition of road users, traffic citations, and police stops.

This paper exploits the potential of Global Positioning System datasets sourced from mobile phones to estimate the racial composition of road users, leveraging data from their respective Census block group. The racial composition data encompasses approximately 46 million trips in the Chicago metropolitan region. The research focuses on the relationship between camera tickets and racial composition of drivers vs. police stops for traffic citations and the racial composition in these locations. Black drivers exhibit a higher likelihood of being ticketed by automated speed cameras and of being stopped for moving violations on roads, irrespective of the proportion of White drivers present. The research observes that this correlation attenuates as the proportion of White drivers on the road increases. The citation rate measured by cameras better matches the racial composition of road users on the links with cameras than do stops by police officers. This study therefore presents an important contribution to understanding racial disparities in moving violation stops, with implications for policy interventions and social justice reforms.

A qualitative study of Chicago gay men and the Mpox outbreak of 2022 in the context of HIV/AIDS, PrEP, and COVID-19.

During the 2022 mpox outbreak, our study conducted 30 interviews with a recruited sample of Chicago gay men (age 18+) during June-September to investigate their experiences of mpox, HIV/AIDS, and COVID-19. Participants were interviewed with a semi-structured guide about gay sexual identity and social experiences; HIV/AIDS, ART, and PrEP; and COVID-19 behaviors and vaccination. All 30 interview respondents had been fully vaccinated for COVID-19 and expressed minimal COVID-19 vaccine hesitancy. All the men living with HIV in our study were on ART with HIV well controlled. A majority of HIV- participants (70%) were on PrEP, with participants universally aware of PrEP benefits. Additionally, most participants had already received at least one shot of the Jynneos mpox vaccine, with many interviewees enduring long lines, sometimes at multiple locations, before vaccination in primarily gay social spaces. These Chicago gay men demonstrated widespread enthusiasm for mpox vaccination as a disease prevention strategy and most of them had already been vaccinated despite significant barriers. The enthusiasm of the participants in our study emerged within a medical landscape shaped by both COVID-19 vaccination and HIV/AIDS-related health interventions including ART and PrEP, which may have helped instill increased medical trust among this population. Our study suggests that out urban gay men may comprise a distinctive minority population with increased medical trust due to specific social, sexual, and historical experiences.

Clinical and histological impact of diffuse inflammation at pouchoscopy.

PURPOSE: The anatomical location of inflammation in and around the ileal pouch affects the pouch survival rate, and diffuse inflammation has poor pouch survival rates. We aimed to clarify the symptoms and histological findings of diffuse inflammation of the pouch. METHODS: We evaluated the symptoms, treatment, and histological findings according to the endoscopic phenotypes of diffuse inflammation, focal inflammation, and normal as the pouch body phenotype and afferent limb involvement, inlet involvement, cuffitis, and fistula as the peripheral findings. RESULTS: Of the 318 pouchoscopies, 47 had diffuse inflammation, 201 had focal inflammation, and 70 were normal. Symptomatic patients had diffuse inflammation more frequently (46.8%) than focal inflammation (13.4%) and normal (14.2%), with no difference between focal inflammation and normal. Antibiotics and steroids were higher rate administered in cases of diffuse inflammation, but not in cases of focal inflammation or in normal cases. Histological inflammation, inflammatory bowel disease (IBD)-specific finding, and colonic metaplasia showed severity in the order of diffuse inflammation > focal inflammation > normal. The number of peripheral inflammatory findings overlapped in the following order: diffuse inflammation > focal inflammation > normal. The number of symptomatic patients increased as the number of peripheral inflammatory findings increased. CONCLUSION: Pouches with diffuse inflammation are more symptomatic, have a higher use of therapeutic agents, and have more severe histological inflammation, IBD-specific finding, and colonic metaplasia accompanying peripheral inflammatory findings than the other groups. The higher the overlap of inflammatory findings in the surrounding tissues, the more symptomatic the patients will appear.

Esophagogastric Junction Outflow Obstruction (EGJOO): A Manometric Phenomenon or Clinically Impactful Problem.

PURPOSE OF REVIEW: Esophagogastric junction outflow obstruction (EGJOO), defined manometrically by impaired esophagogastric junction relaxation (EGJ) with preserved peristalsis, can be artifactual, due to secondary etiologies (mechanical, medication-induced), or a true motility disorder. The purpose of this review is to go over the evolving approach to diagnosing and treating clinically relevant EGJOO. RECENT FINDINGS: Timed barium esophagram (TBE) and the functional lumen imaging probe (FLIP) are useful to identify clinically relevant EGJOO that merits lower esophageal sphincter (LES) directed therapies. There are no randomized controlled trials evaluating EJGOO treatment. Uncontrolled trials show effectiveness for pneumatic dilation and peroral endoscopic myotomy to treat confirmed EGJOO; Botox and Heller myotomy may also be considered but data for confirmed EGJOO is more limited. Diagnosis of clinically relevant idiopathic EGJOO requires symptoms, exclusion of mechanical and medication-related etiologies, and confirmation of EGJ obstruction by TBE or FLIP. Botox LES injection has limited durability, it can be used in patients who are not candidates for other treatments. PD and POEM are effective in confirmed EGJOO, Heller myotomy may also be considered but data for confirmed EGJOO is limited. Randomized controlled trials are needed to clarify optimal management of EGJOO.

A case report of youth-onset lipoprotein glomerulopathy with APOE Chicago mutation.

BACKGROUND: This article reports an extremely rare case of lipoprotein glomerulopathy (LPG) with apolipoprotein E gene (APOE) Chicago mutation in a young Chinese male. Only five cases or families with APOE Chicago mutations have been reported in the literature. CASE PRESENTATION: The young male patient is manifested with nephrotic syndrome, accompanied by hyperlipidemia with a preferable increase in triglycerides and elevated ApoE level. Renal biopsy of the patient showed highly dilated glomerular capillaries filled with vacuolar lipids, segmentally fused podocyte foot processes, vacuolar degeneration of renal tubular epithelial cells and absence of electron-dense material, which indicates the diagnosis of LPG. Whole-exome gene sequencing identified the heterozygous mutation of NM_000041.4:c.494G > C (p.Arg165Pro), which is in the exon 4 of the APOE gene and also known as APOE Chicago mutation, a rare mutation of LPG. Further family pedigree gene analysis clarified that the mutation was inherited from the patient's mother, who does not have high ApoE levels or renal manifestations. This is also consistent with the incomplete penetrance of APOE gene mutations in LPG. Under lipid-lowering treatments, including a low-fat diet and fenofibrate, the patient's urinary protein was partially controlled, and the albumin level was recovered. CONCLUSION: Patients with nephrotic syndrome and elevated ApoE levels should be prompted into renal biopsy to avoid delay of appropriate treatment and unnecessary use of glucocorticoids. This case of LPG was diagnosed by renal biopsy and further verified with genetic sequencing. The timely diagnosis and treatment improved the patient's symptoms. This case is one of only six reported LPG cases or families with APOE Chicago mutation in the world.

Are the Chicago 3.0 manometric diagnostics consistent with Chicago 4.0?

There is little information on the degree of concordance between the results obtained using the Chicago 3.0 (CCv3.0) and Chicago 4.0 (CCv4.0) protocols to interpret high-resolution manometry (HRM) seeking to determine the value provided by the new swallowing maneuvers included in the last protocol. This is a study of diagnostic tests, evaluating concordance by consistency between the results obtained by the CCv3.0 and CCv4.0 protocols, in patients undergoing HRM. Concordance was assessed with the kappa test. Bland-Altman scatter plots, and Lin's correlation-concordance coefficient (CCC) were used to assess the agreement between IRP measured with swallows in the supine and seated position or with solid swallows. One hundred thirty-two patients were included (65% women, age 53 ± 17 years). The most frequent HRM indication was dysphagia (46.1%). Type I was the most common type of gastroesophageal junction. The most frequent CCv4.0 diagnoses were normal esophageal motility (68.9%), achalasia (15.5%), and ineffective esophageal motility (IEM; 5.3%). The agreement between the results was substantial (Kappa 0.77 ± 0.05), with a total agreement of 87.9%. Diagnostic reclassification occurred in 12.1%, from IEM in CCv3.0 to normal esophageal motility in CCv4.0. Similarly, there was a high level of agreement between the IRP measured in the supine compared to the seated position (CCC0.92) and with solid swallows (CCC0.96). In conclusion, the CCv4.0 protocol presents a high concordance compared to CCv3.0. In the majority of manometric diagnoses there is no reclassification of patients with provocation tests. However, the more restrictive criteria of CCv4.0 achieve a better reclassification of patients with IEM.

The Relationship between Indoor and Outdoor Fine Particulate Matter in a High-Rise Building in Chicago Monitored by PurpleAir Sensors.

In urban areas like Chicago, daily life extends above ground level due to the prevalence of high-rise buildings where residents and commuters live and work. This study examines the variation in fine particulate matter (PM2.5) concentrations across building stories. PM2.5 levels were measured using PurpleAir sensors, installed between 8 April and 7 May 2023, on floors one, four, six, and nine of an office building in Chicago. Additionally, data were collected from a public outdoor PurpleAir sensor on the fourteenth floor of a condominium located 800 m away. The results show that outdoor PM2.5 concentrations peak at 14 m height, and then decline by 0.11 µg/m3 per meter elevation, especially noticeable from midnight to 8 a.m. under stable atmospheric conditions. Indoor PM2.5 concentrations increase steadily by 0.02 µg/m3 per meter elevation, particularly during peak work hours, likely caused by greater infiltration rates at higher floors. Both outdoor and indoor concentrations peak around noon. We find that indoor and outdoor PM2.5 are positively correlated, with indoor levels consistently remaining lower than outside levels. These findings align with previous research suggesting decreasing outdoor air pollution concentrations with increasing height. The study informs decision-making by community members and policymakers regarding air pollution exposure in urban settings.

Work-related factors of mental health among Chicago residents two years into the COVID-19 pandemic.

The COVID-19 pandemic led to widespread consequences for economic, social, and general wellbeing with rates of anxiety and depression increasing across the population and disproportionately for some workers. This study explored which factors were the most salient contributors to mental health through a cross-sectional 68-item questionnaire that addressed topics related to the pandemic. Data were collected through an address-based sampling frame over the two months from April 2022 to June 2022. A total of 2,049 completed surveys were collected throughout Chicago's 77 Community Areas. Descriptive statistics including frequency and percentages were generated to describe workplace characteristics, work-related stress, and sample demographics and their relationship to psychological distress. Independent participant and workplace factors associated with the outcomes were identified using multivariable logistic regression. The weighted prevalence of persons experiencing some form of psychological distress from mild to serious was 32%. After adjusting for potential confounding factors, certain marginalized communities experienced psychological distress more than others including females, adults over the age of 25 years of age, and people with higher income levels. Those who had been laid off, lost pay, or had reduced hours had increased odds of psychological distress (aOR = 1.71, CI95% 1.14-2.56; p = 0.009) as did people that reported that their work-related stress was somewhat or much worse as compared to before the COVID-19 pandemic (aOR = 2.22, CI95% 1.02-4.82; p = 0.04, aOR = 11.0, CI95% 4.65-26.1; p < 0.001, respectively). These results warrant further investigation and consideration in developing workplace and mental health interventions.

Brief guidelines for beginners on how to perform and analyze esophageal high-resolution manometry.

High-resolution manometry (HRM) is a diagnostic tool for surgeons, gastroenterologists and other healthcare professionals to evaluate esophageal physiology. The Chicago Classification (CC) system is based on a consensus of worldwide experts to minimize ambiguity in HRM data acquisition and diagnosis of esophageal motility disorders. The most updated version, CCv4.0, was published in 2021; however, it does not provide step-by-step guidelines (i.e., for beginners) on how to assess the most important HRM metrics. This paper aims to summarize the basic guidelines for conducting a high-quality HRM study including data acquisition and interpretation, based on CCv4.0, using Manoview ESO analysis software, version 3.3 (Medtronic, Minneapolis, MN).

Embedding a Parenting Skills Program in Public PreK: Outcomes of a Quasi-experimental Mixed Methods Study.

This sequential mixed methods study evaluated the impact of the Chicago Parent Program (CPP) in 12 Baltimore Title I PreK programs on parent engagement and student outcomes from kindergarten through 2nd grade. Phase 1 (quasi-experiment; N = 11,996) compared PreK students whose parents enrolled in CPP with those whose parents did not enroll in CPP on measures of kindergarten readiness, chronic absenteeism, suspensions/expulsions, and grade retention. Phase 2 (qualitative; n = 20) explored the perceptions of school-based staff, principals, and district and community leaders on CPP's impact on parents, students, and parent engagement, and why they sought to continue CPP in the schools. Research Findings: No effects on student outcomes were found using administrative data. However, all of those interviewed described observed improvements in parent and student behavior and parent engagement and all schools have continued implementing CPP. Practice or Policy: Qualitative results highlight the importance of stakeholder perspectives and the limitations of administrative data for evaluating brief interventions serving families with complex needs.

Psychiatric epidemiology and the Chicago School of Sociology.

This article explores the Chicago School of Sociology's influence on psychiatric epidemiology. While the Chicago School text usually associated with psychiatric epidemiology is the 1939 book by Faris and Dunham, it is important to acknowledge the influence of earlier Chicago School projects during the 1920s. These projects, tackling everything from homelessness and delinquency to the ghetto and suicide, provided models not only for Faris and Dunham, but also for numerous methodological and theoretical insights for the social psychiatry projects that would emerge after World War II. The social sciences and the humanities still have important roles to play in informing contemporary approaches to psychiatric epidemiology and deriving ways to tackle the socio-economic problems that contribute to mental illness.

SARS-CoV-2 Reinfection Risk in Persons with HIV, Chicago, Illinois, USA, 2020-2022.

Understanding if persons with HIV (PWH) have a higher risk for SARS-CoV-2 reinfection may help tailor future COVID-19 public health guidance. To determine whether HIV infection was associated with increased risk for SARS-CoV-2 reinfection, we followed adult residents of Chicago, Illinois, USA, with SARS-CoV-2 longitudinally from their first reported infection through May 31, 2022. We matched SARS-CoV-2 laboratory data and COVID-19 vaccine administration data to Chicago's Enhanced HIV/AIDS Reporting System. Among 453,587 Chicago residents with SARS-CoV-2, a total of 5% experienced a SARS-CoV-2 reinfection, including 192/2,886 (7%) PWH and 23,642/450,701 (5%) persons without HIV. We observed higher SARS-CoV-2 reinfection incidence rates among PWH (66 [95% CI 57-77] cases/1,000 person-years) than PWOH (50 [95% CI 49-51] cases/1,000 person-years). PWH had a higher adjusted rate of SARS-CoV-2 reinfection (1.46, 95% CI 1.27-1.68) than those without HIV. PWH should follow the recommended COVID-19 vaccine schedule, including booster doses.

Diagnosis, treatment and disclosure: A qualitative exploration of participant challenges in a Monogenic Diabetes Registry.

PURPOSE: Maturity-onset diabetes of the young (MODY) represents a heterogenous group of monogenic diabetes. Despite its autosomal dominant inheritance, many MODY participants in the University of Chicago Monogenic Diabetes Registry have no family members enrolled. We aimed to gather data on the Registry participants' experiences in (1) receipt of an accurate diagnosis, (2) decisions regarding disclosure of their MODY genetic test results with biological relatives, and (3) recommendations toward our Registry's processes and outreach. METHODS: We conducted 20 one-on-one semistructured interviews with adult Registry participants. RESULTS: All participants found navigating the health care system challenging because of the providers' unfamiliarity with MODY and dismissal of its importance post diagnosis. All had shared their results with at least 1 relative, however many found their relatives resistant to engaging with their providers. Participants wanted to receive targeted information on their condition and connect with other participants who have faced similar diagnostic and treatment challenges. CONCLUSION: Our results demonstrate that our probands faced resistance to reclassification of their diabetes from both health care providers and relatives. In an effort to improve cascade testing, the Registry is designing a portal to facilitate participant-research team communication and provide additional supports for participants to involve family members in testing.

COVID-19, Retention in HIV Care, and Access to Ancillary Services for Young Black Men Living with HIV in Chicago.

This study conducted 28 semi-structured, in-depth interviews with Young Black Men who have Sex with Men in Chicago to investigate the impact of COVID-19 on their HIV care and ancillary service access. The qualitative analysis identified both negative and positive effects. The negative effects included: (l) mixed disruptions in linkage to and receipt of HIV care and ancillary services, and (2) heightened concerns about police and racial tensions in Chicago following the murder of George Floyd, contributing to possible disruption of retention in care. The positive effects included: (1) the ability to reflect and socially connect, contributing to heightened self-care and retention in care, and (2) some improvements in receipt of medical care. These findings suggest that while COVID-19 disruptions in care reduced in-person use of HIV care, the expansion of telemedicine allowed more administrative tasks to be handled online and focused in-person interactions on more substantive interactions.

Violent Crime, Physical Inactivity, and Obesity: Examining Spatial Relationships by Racial/Ethnic Composition of Community Residents.

Violence is a public health issue that disproportionately affects communities of color in urban centers. There is limited understanding of how violent crime is associated with adult physical inactivity and obesity prevalence given the racial/ethnic composition of community residents. This research aimed to address this gap by examining census tract-level data in Chicago, IL. Ecological data gathered from a variety of sources were analyzed in 2020. Violent crime rate represented the number of police-reported incidents of homicide, aggravated assault, and armed robbery per 1,000 residents. Spatial error and ordinary least square regression models were evaluated to determine if violent crime rate was significant associated with prevalence (%) of adult physical inactivity and obesity among all Chicago census tracts (N = 798), majority non-Hispanic (NH) White tracts (n = 240), majority NH Black tracts (n = 280), majority Hispanic tracts (n = 169), and racially diverse tracts (n = 109). Majority was defined as ≥ 50% representation. After adjusting for socioeconomic and environmental measures (e.g., median income, grocery store availability, walkability index), violent crime rate was associated with % physical inactivity and % obesity at the census tract level in Chicago, IL (both p < 0.001). Associations were statistically significant among majority NH Black and Hispanic tracts, but not majority NH White and racially diverse tracts. Future studies should evaluate the structural drivers of violence and the influence these drivers have on adult physical inactivity and obesity risk, particularly in communities of color.

Esophageal high-resolution manometry demands visual interpretation in addition to mathematical software-based analysis.

PURPOSE: Esophageal high-resolution manometry (HRM) revolutionized esophageal function testing due to the intuitive colorful and agreeable-to-the-eyes plots (Clouse plots). HRM execution and interpretation is guided by the Chicago Classification. The well-established metrics for interpretation allows a reliable automatic software analysis. Analysis based on these mathematical parameters, however, ignores the valuable visual interpretation unique to human eyes and based on expertise. METHODS: We compiled some situations where visual interpretation added useful information for HRM interpretation. RESULTS: Visual interpretation may be useful in cases of hypomotility, premature waves, artifacts, segmental abnormalities of peristalsis, and extra-luminal non-contractile findings. CONCLUSION: These extra findings can be reported apart from the conventional parameters.

Long-term outcomes of peroral endoscopic myotomy for Chicago classification type I vs type III achalasia in treatment-naive patients.

The efficacy of peroral endoscopic myotomy (POEM) for achalasia has potential associations with Chicago classification by high-resolution manometry (HRM). Type II achalasia demonstrates the best response to POEM of all subtypes, while there remain controversies between type I and type III. Moreover, previous treatment history might cause discrepancy in direct comparison. We aimed to compare the clinical outcome of POEM for type I vs type III in treatment-naive patients. In total, 82 patients with type I or type III achalasia (45 type I, 37 type III) from February 2015 to December 2018 were enrolled and POEM was carried out as the initial treatment. Clinical success, change of Eckardt scores and HRM parameters were analyzed and compared between type I and type III group. About, 43 (95.6%) patients and 34 (91.9%) patients in type I and type III group acquired the clinical success (P = 0.821). Eckardt score and HRM results after POEM treatment decreased significantly in either group (P<0.01). Compared to type III group, higher reduction rates of Eckardt score (type I vs type III, 78.6 vs 66.9%, P = 0.034) and basal LES pressure (type I vs type III, 58.9 vs 40.4%, P = 0.040) were observed in type I group. Type I achalasia patients showed better response to POEM with more favorable clinical remission in Eckardt score and HRM outcomes than type III.

A Short History of High-Resolution Esophageal Manometry.

High-resolution esophageal manometry (HRM) utilizes sufficient pressure sensors such that intraluminal pressure is monitored as a continuum along luminal length, similar to time viewed as a continuum on polygraph tracings in 'conventional' manometry. When HRM is coupled with pressure topography plotting, and pressure amplitude is transformed into spectral colors with isobaric areas indicated by same-colored regions, "Clouse plots" are generated. HRM has several advantages compared to the technology that it replaced: (1) the contractility of the entire esophagus can be viewed simultaneously in a uniform standardized format, (2) standardized objective metrics of peristaltic and sphincter function can be systematically applied for interpretation, and (3) topographic patterns of contractility are more easily recognized with greater reproducibility. Leveraging these advantages led to the current standard for the interpretation of clinical esophageal HRM studies, the Chicago Classification (CC), now in its fourth iteration. Compared to conventional manometry, HRM has vastly improved the sensitivity for detecting achalasia, largely due to the objectivity and accuracy of identification of impaired esophagogastric junction (EGJ) relaxation. Additionally, it has led to the subcategorization of achalasia into three clinically relevant subtypes, differentiated by the contractile function of the esophageal body, and identified an additional disorder of EGJ outflow obstruction wherein esophageal peristalsis is preserved. Headway has also been made in understanding hypocontractile and hypercontractile conditions. In summary, HRM and the CC process have revolutionized our understanding of esophageal motility and motility disorders. Moving forward, there will always be remaining challenges, but we now have the tools to meet them.

Chicago Classification Version 4.0 Improves Stratification of Ineffective Esophageal Motility Patients into Clinically Meaningful Subtypes: A Two-Center International Study.

The 4th iteration of the Chicago Classification (CC v4.0) for esophageal motility disorders offers more restrictive criteria for the diagnosis of Ineffective Esophageal Motility (IEM) compared to version 3.0 (CC v3.0). In light of the updated criteria for IEM, we aimed to characterize and compare the patients who retained their IEM diagnosis to those who were reclassified as normal motility, and to evaluate the clinical impact of the newly introduced CC v4.0. We performed a retrospective case-control study. We included all individuals who underwent a high-resolution manometry (HRM) between 2020 and 2021 at two centers. Consecutive studies reported as IEM according to the CC v3.0 were reanalyzed according to the CC v4.0. We compared demographics, clinical, manometry, and pH-monitoring parameters. Out of 452 manometry studies, 154 (34%) met criteria for IEM as per the CC v3.0 (CC v3.0 IEM group). Of those, 39 (25%) studies were reclassified as normal studies according to the CC v4.0 (CC v4.0 normal group), while the remaining 115 studies (25% of the overall cohort) retained an IEM diagnosis (CC v4.0 IEM group). The CC v4.0 normal group had more recovered contractions during solid swallows (p = 0.01), less ineffective swallows (p = 0.04), and lower acid exposure time (p = 0.02) compared to the CC4.0 IEM group. Under CC v4.0 criteria, fewer patients are diagnosed with IEM. Those diagnosed with IEM had worse esophageal function and higher acid burden. Though further studies are needed to confirm these findings, our results indicate that CC v4.0 criteria restrict the IEM diagnosis to a more clinically meaningful population.

Actualising power sharing in community-led initiatives: Insights from community-based organisation leaders in Chicago, USA.

There is an increasing call for a governmental organisations such as local health departments and federal health and human service agencies to partner with community based organisations (CBOs) for health promotion. There is a large body of literature suggesting that CBOs need capacity building or empowerment to do this work, but less literature about the necessary culture shift at governmental organisations who fund public health work. This study aimed to examine the knowledge, attitudes, and beliefs of CBO leadership who do not want to partner with state funders, and understand which structures and practices demonstrate power-sharing in a community-led approach. We conducted six interviews with community-based organisation leaders and conducted a thematic analysis and a secondary, inductive discourse analysis of the transcripts to analyse why organisations chose not to apply for a government funded initiative and how they talked about power-sharing for community-led public health. Themes about the decision for CBOs to apply to the public health funding initiative: how it related to the CBO's scope of work, meeting the needs of the community, having the technical capacity, and cross-cutting themes of putting the community first and having a long-term positive impact. Organisations rejected the opportunity for this funding due to poor fit, even if they could fulfil the scope of work. A community-led approach was described as one that includes the government giving up control, creating spaces for meaningful participation and power-sharing, and systems demonstrating trust in CBOs. These findings reiterate that in order for public health to be community-led, there needs to be system-wide transformation and intentional investment that supports an infrastructure for community-led public health. State funders can learn from practices in trust-based philanthropy, such as flexible funding and reporting requirements. The results of this study can support the wider participation of CBOs in collaboration with state actors, maximising the transformative potential of collaboration, ultimately transforming power structures and advancing health equity.