Promoting Innovation in State and Territorial Maternal and Child Health Policymaking.

INTRODUCTION: The Association of Maternal & Child Health Programs (AMCHP) and the Association of State and Territorial Health Officials (ASTHO) launched the PRISM (Promoting Innovation in State and Territorial MCH Policymaking) Learning Community, funded by the U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB). The goal of PRISM was to build state and territorial health agency program and policy-making capacity to address substance use and mental health in the maternal and child health (MCH) population. Expanding access to care and treatment for perinatal substance use disorders (SUD) emerged as the issue of greatest need for state teams. METHODS: The PRISM Learning Community consisted of three major components: (1) intensive capacity building for cross-agency state teams, which involved action planning, peer-to-peer learning, and technical assistance; (2) programming to inform the MCH field broadly about innovations in perinatal SUD policy and practice; and (3) a program evaluation involving pre-, mid-, and post-assessments and follow-up key informant interviews with state teams. This manuscript is not based on clinical study or patient data, therefore IRB approval was not required. RESULTS: States reported that their knowledge of perinatal SUDs increased and their cross-agency partnerships were strengthened as a result of their participation in PRISM. States identified four key priorities for their continued work: to improve multisector collaborations, to institute equitable SUD screening practices for pregnant people, to strengthen the perinatal behavioral health workforce, and to enhance Medicaid coverage for perinatal SUD prevention and treatment services. The need to respond to urgent demands of COVID-19 and the stigma associated with perinatal SUDs were the most significant barriers to advancing state action plan goals. DISCUSSION: Since 2018, the PRISM project has supported nine jurisdictions across two cohorts. Participation in PRISM advanced state policies and programs to improve perinatal SUD care through capacity building, technical assistance, and virtual programming. Findings and lessons learned from PRISM may inform the activities of other states seeking to address perinatal substance use disorders.

Readability and health literacy level of post-exposure prophylaxis patient education materials offered after sexual assault.

BACKGROUND: The link between readability of patient education materials and patient outcomes has been well established. Patients who experience sexual assault often present to the emergency department in an acute trauma response state. Stress interferes with memory and learning. Patients routinely receive medication to prevent sexually transmitted infections after sexual assault. HIV post-exposure prophylaxis (PEP) success is dependent on completing a 28-day course. Only 24% of sexually assaulted patients complete HIV PEP. METHODS: This descriptive study used three validated tools to assess readability and evaluate the understandability of HIV PEP patient education materials following sexual assault. Patient education materials (n = 21) were collected through a variety of databases, government sources, and secondary reference review. Each researcher independently scored all materials. Inter-rater reliability was assured after robust. DISCUSSION: Final scores were used to determine readability and health literacy levels. RESULTS: All educational materials far exceeded the recommended readability level (Range = 7th grade to college). Those with the highest readability included visual cues. The Patient Education Materials Assessment Tool (PEMAT) understandability scores ranged from 38 to 94%, and actionability scores ranged from 40 to 100%. Using a cut score of 80%, approximately 57% of the educational materials were understandable, while only 14% were actionable. CONCLUSIONS: Expert agencies recommend a sixth-grade or below reading level for patient education reading materials. Our data show that post-exposure patient education materials following sexual assault are difficult to understand. This mismatch between the patient education material's readability and health literacy levels and the recommended standards will likely limit the success of post-exposure prophylaxis course of treatment following sexual assault.

Evaluation of the analytical performance of the novel NS-Prime system and examination of temperature stability of fecal transferrin compared with fecal hemoglobin as biomarkers in a colon cancer screening program.

OBJECTIVE: To examine the analytical aspects of fecal transferrin (Tf) and hemoglobin (Hb) measured on the NS-Prime analyzer for use in a colon cancer screening program. DESIGNS AND METHODS: Method evaluation and temperature stability studies for fecal Tf and Hb were completed. A method comparison was carried out against the NS-Plus system using samples collected from 254 screening program participants. A further 200 samples were analyzed to help determine suitable reference limits for fecal Tf using these systems. RESULTS: The assay for fecal Tf showed acceptable linearity, precision, and recovery, and showed minimal carryover with low potential for impact by the prozone effect. The 95th percentile for fecal Tf obtained for the reference population was 4.9 µg/g feces. The collection device sufficiently maintained fecal Tf and Hb stability for at least 7 days at room temperature, 4 °C, and -20 °C. Fecal Tf and Hb were most stable at 4 °C and -20 °C, but showed considerable loss (20-40%) of both proteins at 37 °C within the first 7 days. Mixing small amounts of blood into diluted fecal samples maintained at 37 °C for various time periods showed >50% loss of both proteins within 1 h of incubation. CONCLUSIONS: The NS-Prime analyzer showed acceptable performance for fecal Tf and Hb. These studies suggest that use of both Tf and Hb together as biomarkers will result in higher positivity rates, but this may not be attributed to greater stability of Tf over Hb in human feces.

Applying community-based participatory research principles and approaches in clinical trials: forging a new model for cancer clinical research.

Although an estimated 20% of adult cancer patients are medically eligible for a cancer treatment clinical trial (CCT), adult trial participation in the U.S. remains under 3%.- Participation rates are even lower among ethnic and racial minorities and the medically underserved, who tend to have higher cancer mortality rates than the population as a whole.- Given persistent cancer health disparities in these populations, cancer clinical trial participation is increasingly an issue of social justice. Community-based participatory research (CBPR) approaches have been repeatedly recommended as a key strategy for increasing and diversifying cancer clinical trial participation and enhancing their relevance and quality. In 2006, Community-Campus Partnership for Health (CCPH) and the Education Network to Advance Cancer Clinical Trials (ENACCT) received funding from the Agency for Healthcare Research and Quality and the National Cancer Institute (NCI), along with industry and nonprofit partners, to develop the first set of national recommendations to employ CBPR approaches in multisite, phase III cancer clinical trials. The Communities as Partners in Cancer Clinical Trials: Changing Research, Practice and Policy final report, developed through a national advisory committee, two stakeholder meetings and a public vetting process, makes more than fifty detailed recommendations to engage communities in specific and meaningful ways throughout the cancer clinical trial process.1 The report is the first to provide specific guidance as to how and why clinical trials should involve communities affected by cancer-from trial design to implementation to dissemination of results. This paper describes the background and rationale for the initiative, the process used to develop and disseminate the report, and the challenges and opportunities for implementing the report's community-based approaches to cancer clinical research.

The chemistry of escapin: identification and quantification of the components in the complex mixture generated by an L-amino acid oxidase in the defensive secretion of the sea snail Aplysia californica.

Escapin is an L-amino acid oxidase in the ink of a marine snail, the sea hare Aplysia californica, which oxidizes L-lysine (1) to produce a mixture of chemicals which is antipredatory and antimicrobial. The goal of our study was to determine the identity and relative abundance of the constituents of this mixture, using molecules generated enzymatically with escapin and also using products of organic syntheses. We examined this mixture under the natural range of pH values for ink-from approximately 5 at full strength to approximately 8 when fully diluted in sea water. The enzymatic reaction likely forms an equilibrium mixture containing the linear form alpha-keto-epsilon-aminocaproic acid (2), the cyclic imine Delta(1)-piperidine-2-carboxylic acid (3), the cyclic enamine Delta(2)-piperidine-2-carboxylic acid (4), possibly the linear enol 6-amino-2-hydroxy-hex-2-enoic acid (7), the alpha-dihydroxy acid 6-amino-2,2-dihydroxy-hexanoic acid (8), and the cyclic aminol 2-hydroxy-piperidine-2-carboxylic acid (9). Using NMR and mass spectroscopy, we show that 3 is the major component of this enzymatic product at any pH, but at more basic conditions, the equilibrium shifts to produce relatively more 4, and at acidic conditions, the equilibrium shifts to produce relatively more 2, 7, and/or 9. Studies of escapin's enzyme kinetics demonstrate that because of the high concentrations of escapin and L-lysine in the ink secretion, millimolar concentrations of 3, H(2)O(2), and ammonia are produced, and also lower concentrations of 2, 4, 7, and 9 as a result. We also show that reactions of this mixture with H(2)O(2) produce delta-aminovaleric acid (5) and delta-valerolactam (6), with 6 being the dominant component under the naturally acidic conditions of ink. Thus, the product of escapin's action on L-lysine contains an equilibrium mixture that is more complex than previously known for any L-amino acid oxidase.