Molten-Salt Electrochemical-Assisted Synthesis of the CeO2-OV@GC Composite-Supported Pt Clusters with a Pt-O-Ce Structure for the Oxygen Reduction Reaction.

Highly active and robust Pt-based electrocatalysts for an oxygen reduction reaction (ORR) are of crucial significance for the development of proton exchange membrane fuel cells (PEMFCs). Herein, the high-loading and well-dispersive Pt clusters on graphitic carbon-supported CeO2 with abundant oxygen vacancies (PtAC/CeO2-OV@GC) were successfully fabricated by a molten-salt electrochemical-assisted method. The bonding of Pt with the highly electronegative O induces charge redistribution through the Pt-O-Ce structure, thus reducing the adsorption energies of oxygen-containing species. Such a PtAC/CeO2-OV@GC electrocatalyst exhibits a greatly enhanced ORR performance with a mass activity of 0.41 ± 0.02 A·mg-1Pt at 0.9 V versus a reversible hydrogen electrode, which is 2.7 times the value of a commercial Pt/C catalyst and shows negligible activity decay after 20000 cycles of accelerated degradation tests. It is anticipated that this work will provide enlightening guidance on the controllable synthesis and rational design of high-performance Pt-based electrocatalysts for PEMFCs.

Symmetric Catalyst Design Employing Ir Nanoparticles on Black WO3- x Nanofiber Support for Boosting Water Electrolysis.

The efficient evolution of gaseous hydrogen and oxygen from water is required to realize sustainable energy conversion systems. To address the sluggish kinetics of the multielectron transfer reaction, bifunctional catalyst materials for both the hydrogen evolution reaction (HER) and the oxygen evolution reaction (OER) should be developed. Herein, a tailored combination of atomically minimized iridium catalysts and highly conductive black WO3- x nanofiber supports are developed for the bifunctional electrolyzer system. Atomic Ir catalysts, particularly those that activate the OER, minimize the utilization of precious metals. The oxygen-deficient black WO3- x NF support, which boosts the HER, offers increased electronic conductivity and favorable nucleation sites for Ir loading. The Ir-black WO3- x NFs exhibit increased double-layer capacitance, a significantly reduced onset potential, lower Tafel slope, and stable cyclability for both the OER and HER, compared to large-sized Ir catalysts loaded on white WO3 nanofibers. This study offers a strategy for developing an optimal catalyst material with suitable supports for high-performance and economical water electrolysis systems for achieving carbon-negative targets.

Chemical Epitaxy of Iridium Oxide on Tin Oxide Enhances Stability of Supported OER Catalyst.

Significantly reducing the iridium content in oxygen evolution reaction (OER) catalysts while maintaining high electrocatalytic activity and stability is a key priority in the development of large-scale proton exchange membrane (PEM) electrolyzers. In practical catalysts, this is usually achieved by depositing thin layers of iridium oxide on a dimensionally stable metal oxide support material that reduces the volumetric packing density of iridium in the electrode assembly. By comparing two support materials with different structure types, it is shown that the chemical nature of the metal oxide support can have a strong influence on the crystallization of the iridium oxide phase and the direction of crystal growth. Epitaxial growth of crystalline IrO2 is achieved on the isostructural support material SnO2, both of which have a rutile structure with very similar lattice constants. Crystallization of amorphous IrOx on an SnO2 substrate results in interconnected, ultrasmall IrO2 crystallites that grow along the surface and are firmly anchored to the substrate. Thereby, the IrO2 phase enables excellent conductivity and remarkable stability of the catalyst at higher overpotentials and current densities at a very low Ir content of only 14 at%. The chemical epitaxy described here opens new horizons for the optimization of conductivity, activity and stability of electrocatalysts and the development of other epitaxial materials systems.

Teachers' Perceptions of the Impact of the COVID-19 Pandemic and Their Implementation of an Evidence-based HIV Prevention Program in the Bahamas.

Information on how school-based programs is implemented and sustained during crises is limited. In this study, we assessed the impact of the COVID-19 pandemic on the implementation of a HIV prevention intervention in The Bahamas. Data were collected from 139 Grade 6 teachers in 2021-2022. Teachers attended virtual training and received implementation monitoring from coordinators. On average, teachers taught 26.4 (SD = 9.2) of the 35 core activities, and 7.4 (SD = 2.4) out of 9 sessions. More than half (58.3%) of teachers completed 28 or more core activities; 69.1% covered eight or all nine sessions, which is equivalent to 80% of the HIV intervention curriculum. Almost half of the teachers (43%) reported that the pandemic negatively impacted their ability to teach the program; 72% of teachers maintained that the program remained "very important" during times of crisis. Greater self-efficacy and supports increased implementation fidelity.

The Relationship Between State-Level Earned Income Tax Credits and Violent Crime.

Policies that provide economic support, such as the earned income tax credit (EITC), improve peoples' ability to meet their basic needs and reduce stress, which can reduce violence perpetration. Refundable state-level EITCs have been associated with decreases in multiple forms of violence (e.g., child abuse and neglect); however, it is unknown whether there is an association between the EITC and violent crime as captured by Uniform Crime Reports. Crime and violence remain a pressing concern for many communities across the nation. Using a longitudinal data set, we conducted fixed-effects regression models with year and state specified as fixed effects, to determine whether variations in generosity of state-level EITCs are related to the rate of violent crime. After adjusting for demographic covariates, refundable state-level EITCs remained significantly associated with reductions in criminal homicide compared to states without an EITC. As many states attempt to combat crime and prevent violence in their communities, anti-poverty measures such as the EITC provide a promising strategy for reducing the social and economic costs associated with violence.

Rehabilitation access for individuals with cognitive-communication challenges after traumatic brain injury: A co-design study with persons with lived experience.

BACKGROUND: Adults with traumatic brain injuries (TBI) frequently experience cognitive, emotional, physical and communication deficits that require long-term rehabilitation and community support. Although access to rehabilitation services is linked to positive outcomes, there can be barriers to accessing community rehabilitation related to system navigation, referral processes, funding, resource allocation and communications required to ensure access. AIMS: This study aimed to identify barriers to accessing insurer funding for rehabilitation and healthcare services, for adults with TBI injured in motor vehicle collisions (MVCs). METHODS: We used a co-design approach to collaborate with persons with lived experience to design a survey of adults who sustained a TBI in an MVC. The survey examined access to insurer funding for rehabilitation services and was disseminated through brain injury networks in Ontario, Canada. RESULTS: Respondents (n = 148) identified multiple barriers to accessing rehabilitation services through insurer funding, including delays of more than 2 years (49%), mandatory duplicative assessments (64%) and invasion of privacy (55%). Speech-language therapy and neuropsychological services were denied most frequently. Negative experiences included insurers' poor understanding of TBI symptoms, denials of services despite medical evidence demonstrating need and unsupportive insurer interactions. Although 70% of respondents reported cognitive-communication difficulties, accommodations were rarely provided. Respondents identified supports that would improve insurer and healthcare communications and rehabilitation access. CONCLUSION & IMPLICATIONS: The insurance claims process had many barriers for adults with TBI, limiting their access to rehabilitation services. Barriers were exacerbated by communication deficits. These findings indicate a role for Speech-language therapists in education, advocacy and communication supports during the insurance process specifically as well as rehabilitation access processes in general. WHAT THIS PAPER ADDS: What is already known on this subject There is extensive documentation of the long-term rehabilitation needs of individuals with traumatic brain injury (TBI) and their challenges in accessing rehabilitation services over the long term. It is also well known that many individuals with TBI have cognitive and communication deficits that affect their interactions in the community, including with healthcare providers, and that SLTs can train communication partners to provide communication supports to individuals with TBI in these communication contexts. What this study adds This study adds important information about barriers to accessing rehabilitation, including barriers to accessing SLT services in the community. We asked individuals with TBI about challenges to accessing auto insurance funding for private community services, and their responses illustrate the broader challenges individuals with TBI face in communicating their deficits, conveying service needs, educating and convincing service administrators and self-advocating. The results also highlight the critical role that communication plays in healthcare access interactions, from completing forms to reviewing reports and funding decisions, to managing telephone calls, writing emails and explaining to assessors. What are the clinical implications of this work? This study shows the lived experience of individuals with TBI in overcoming barriers to accessing community rehabilitation. The results show that best practices in intervention should include evaluating rehabilitation access, which is a critical step in patient-centred care. Evaluation of rehabilitation access includes evaluating referral and navigation, resource allocation and healthcare communications, and ensuring accountability at each step, regardless of model of service delivery or funding source. Finally, these findings show the critical role of speech-language therapists in educating, advocating and supporting communications with funding sources, administrators and other healthcare providers.

Public safety personnel's perceptions of mental health training: an assessment of the Emotional Resilience Skills Training.

Public safety personnel (PSP) work experiences necessitate diverse and frequent exposures to potentially psychologically traumatic events (PPTEs) and other occupational stressors, which may explain the higher prevalence of mental health disorders and suicidal ideation among PSP relative to the general population. Consequently, PSP require emotional coping skills and evidence-informed mental health training to navigate arduous situations. The Emotional Resilience Skills Training (ERST) is a pilot 13-week mental health training program led by a peer and based on the robustly evidenced Unified Protocol for the Transdiagnostic Treatment of Mental Disorders. The study assessed whether PSP: perceived the ERST as improving their mental health or their management of stressors; applied the associated knowledge and skills; and would recommend ESRT to other PSP. Data were collected using a self-report survey and focus groups. A total of 197 PSP (58% male) completed a self-report survey and 72 PSP (33% female) participated in a sector-specific focus group to assess the ERST. The results indicate that PSP perceived ERST as helpful when applied. Almost all participants would recommend the training to other PSP. PSP expressed the ongoing need for mental health skills and knowledge, but also identified mental health training gaps during early-career training and stages.

Medicaid Home and Community-Based Services in the Wake of the COVID-19 Pandemic.

The need to bolster Medicaid home and community-based services (HCBS) became more evident during the COVID-19 pandemic. This recognition stemmed from the challenges of keeping people safe in nursing homes and the acute workforce shortages in the HCBS sector. This article examines two major federal developments and state responses in HCBS options as a result of the pandemic. The first initiative entails a one-year increase of the federal Medicaid matching rate for HCBS included in the American Rescue Plan Act championed by the Biden administration. The second initiative encompasses administrative flexibilities that permitted states to temporarily expand and modify their existing Medicaid HCBS programs. The article concludes that the effects of the pandemic flexibilities and enhanced federal funding on most state HCBS programs will be limited without continued investment and leadership on the part of the federal government, which is a Biden administration priority. States that make the American Rescue Act and COVID-19 flexibilities initiatives permanent are states that have the fiscal resources and political commitment to expanding HCBS benefits that other states lack. States' different approaches to bolstering Medicaid HCBS during the pandemic may contribute to widening disparities in access and quality of HCBS across states and populations who depend on Medicaid HCBS.

Understanding and Navigating the Unique Barriers Rural Primary Care Settings Face when Implementing Collaborative Care for Mental Health.

Rural primary care (RPC) clinics may face unique barriers to implementing the Collaborative Care Model (CoCM). We used mixed methods to explore RPC staff and practice facilitator (PF) perspectives on CoCM implementation. PFs reported on barriers and facilitators experienced after each monthly meeting with clinics (n = 459 surveys across 23 clinics). Data were analyzed descriptively and informed qualitative interviews with a purposive sample (n = 11) of clinic staff and PFs. Interviews were analyzed using Rapid Assessment Process and triangulated with quantitative data. The most prominent barriers experienced were: (1) the COVID-19 pandemic, (2) limited availability of site staff to participate in implementation activities, and (3) hiring of new CoCM staff. Qualitative data further characterized the ways these barriers uniquely influenced RPC settings and promising implementation strategies. RPC settings face unique challenges to CoCM implementation, but several promising implementation strategies - when tailored to RPC contexts - may help.

Polymer-Supported Heterogeneous Fenton Catalysts for the Environmental Remediation of Wastewater.

Materials based on polymer hydrogels have demonstrated potential as innovative Fenton catalysts for treating water. However, developing these polymer-supported catalysts with robust stability presents a significant challenge. This paper explores the development and application of polymer-supported heterogeneous Fenton catalysts for the environmental remediation of wastewater, emphasizing the enhancement of metal incorporation into catalysts for improved efficiency. The study begins with an introduction to the heterogeneous Fenton process and its relevance to wastewater treatment. It further delves into the specifics of polymer-supported heterogeneous Fenton catalysts, focusing on iron oxide, copper complexes/nanoparticles, and ruthenium as key components. The synthesis methods employed to prepare these catalysts are discussed, highlighting the innovative approaches to achieve substantial metal incorporation. Operational parameters such as catalyst dosage, pollutant concentration, and the effect of pH on the process efficiency are thoroughly examined. The catalytic performance is evaluated, providing insights into the effectiveness of these catalysts in degrading pollutants. Recent developments in the field are reviewed, showcasing advancements in catalyst design and application. The study also addresses the stability and reusability of polymer-supported heterogeneous Fenton catalysts, critical factors for their practical application in environmental remediation. Environmental applications are explored, demonstrating the potential of these catalysts in addressing various pollutants. The Conclusions offers future perspectives, underlining the ongoing challenges and opportunities in the field, and the importance of further research to enhance the efficacy and sustainability of polymer-supported heterogeneous Fenton catalysts for wastewater treatment.

Reflections on a Copenhagen-Minneapolis Axis in Bioorganic Chemistry.

The international peptide community rejoiced when one of its most distinguished members, Morten Meldal of Denmark, shared the 2022 Nobel Prize in Chemistry. In fact, the regiospecific solid-phase "copper(I)-catalyzed 1,3-dipolar cycloaddition of terminal alkynes to azides" (CuACC) reaction-that formed the specific basis for Meldal's recognition-was reported first at the 17th American Peptide Symposium held in San Diego in June 2001. The present perspective outlines intertwining conceptual and experimental threads pursued concurrently in Copenhagen and Minneapolis, sometimes by the same individuals, that provided context for Meldal's breakthrough discovery. Major topics covered include orthogonality in chemistry; the dithiasuccinoyl (Dts) protecting group for amino groups in α-amino acids, carbohydrates, and monomers for peptide nucleic acids (PNA); and poly(ethylene glycol) (PEG)-based solid supports such as PEG-PS, PEGA, and CLEAR [and variations inspired by them] for solid-phase peptide synthesis (SPPS), solid-phase organic synthesis (SPOS), and combinatorial chemistry that can support biological assays in aqueous media.

Distal supports, capabilities, and growth-focused recovery: A comparison of Housing First and the staircase continuum of care.

Adults who have substantial histories of homelessness and complex support needs may feel ambivalent about integrating into their communities and find it difficult to do so. Being familiar to and recognized by others as a resident in a neighborhood or community are sources of "distal support" that provide individuals with feelings of belonging to their community and are important to recovery from homelessness. We hypothesized that individuals engaged with Housing First (HF) programs would report more distal support than individuals engaged with traditional homeless services (treatment as usual, TAU), and that distal support would predict more community integration, growth-related recovery, and achieved capabilities. We analyzed data collected from homeless services users (n = 445) engaged with either HF or TAU in eight European countries. Measures included achieved capabilities, growth-focused recovery, distal supports, and community integration. Serial mediation analyses confirmed our hypothesis that the effects of HF on growth-related recovery and achieved capabilities are indirect, mediated by distal supports and community integration. Findings are discussed in relation to the importance of modeling the effects of HF on social and psychological outcomes as indirect and identifying important mediators that translate the effects of HF components on social and psychological outcomes. We also note the importance of case management activities that encourage clients to develop and sustain distal supports with others who live and work in their neighborhoods.

Grounding the Work of Grassroots MCH Leaders in Storytelling.

Our Grassroots Maternal and Child Health (MCH) Initiative works to build the capacity of individuals and organizations in zip codes with persistently high infant mortality rates to bring about systems change that will improve maternal and child health (MCH) outcomes. Foundational to the Initiative is the training and mentoring of local women to become Grassroots MCH Leaders. We greatly honor that these women possess community expertise, essential to the Initiative's success. Our training equips them with strategies they can use to bring about changes in social, economic, political, and/or cultural systems that underlie poor birth outcomes. One impactful strategy they learn is the use of critical narrative intervention (CNI). This approach, grounded in the crafting and sharing of stories, complements statistical, behavioral, and medical approaches to improve MCH outcomes. This article describes the impact of CNI within the Grassroots MCH Initiative. Drawing from 14 Grassroots MCH Leaders' narratives, we present five significant maternal traumas and influential supports in their surrounding contexts. We explore the leaders' reflections on the impact of story development and dissemination. Our findings reveal that situating CNI within the context of a grassroots initiative provides opportunities for leaders to use their stories to advocate for systems change. Personal MCH narratives provide a powerful and respectful approach to public health promotion, as they highlight important systems-level failures that need to be addressed to sustainability improve MCH outcomes.

Formal support and service needs of family caregivers of adults with intellectual and/or developmental disabilities in India.

BACKGROUND: Despite the enactment of disability laws/policies in India, research shows that caregivers of adults with intellectual and/or developmental disabilities experience inadequate formal supports/services due to dissemination barriers and lack of awareness about them. To address discrepancy between caregivers' support needs and the professionals' understanding of their needs, the study proposed to conduct a caregiver needs assessment so that culturally-tailored programs are developed. METHOD: A strengths-based mixed methods needs assessment was conducted with a convenience sample of 100 caregivers in Hyderabad, India. One hundred caregivers completed the survey and 15 caregivers participated in semi-structured interviews. RESULTS: Caregivers needed more and improved formal supports/services, particularly from the government. Caregivers faced systemic and attitudinal barriers, and personal impediments to accessing them. Needs differed by care recipients' intellectual disability level, gender, and intellectual disability related conditions. CONCLUSIONS: Researchers, service providers and policymakers need to adopt innovative strategies to improve formal supports/services access.

Bridging K-12 Student Mental Health Policy to Practice Gaps with a Multi-Component Framework.

K-12 schools are a major sector for efforts to prevent and treat student mental health problems. In the United States, these efforts have led to the emergence of the MultiTiered System of Supports (MTSS) universal prevention, early intervention, and treatment policy framework. With a major focus on behavioral and mental health, MTSS has been adopted by all fifty state education departments. However, multi-level complexities of addressing student mental health within and across organizational structures complicate MTSS and broader policy development, implementation, and evaluation; disconnects between policy writers and practitioners obstruct progress, limiting positive outcomes. To bridge these policy-to-practice gaps, a multi-component solution is needed. The authors propose integrating the following elements: the Massachusetts School Mental Health Consortium's Five Guiding Principles for Building a Coordinated School Mental Health System, the comprehensive school improvement methodology Evolutionary Systems Improvement (ESI); and the ontological framework of BioPsychoSocioTechnical Systems Theory (BPST). Individual application of these components has already yielded systems-level improvements outperforming compliance-driven procedures. Used together, these components offer a multi-level solution for establishing conceptually-guided, measurement-based loops that transcend the restrictions of uninformed policy, supporting stakeholders as they work to systematically eliminate barriers and improve student mental health.

Risk of Hospitalization Associated with Use of Consumer-Directed Attendant Care.

Older people with disabilities living independently often use attendant care, also known as Personal Assistive Services (PAS). The aides providing care can come from a home health agency contracted by the state Medicaid authority, known as agency-directed PAS, or the Medicaid recipient can receive a monthly budget and arrange their own care, known as consumer-directed care. Consumer-directed care is hypothesized to have some possible benefits but could also potentially lead to health hazards. This study examined whether people receiving consumer-directed PAS versus people receiving agency-directed PAS faced a higher risk of hospitalization. The data for this study came from Pennsylvania Medicaid claims, enrollment files, standardized assessments, and hospitalization claims from Medicare and Medicaid. The analysis used two-stage least square regression, with the percentage of people in a county using consumer-directed care as an instrument for the type of PAS. People using consumer-directed care did not have a statistically significant difference in risk for hospitalization compared to people using agency-directed PAS (p = .976). Risk of hospitalization was not different for people using consumer-directed care compared to people using agency-directed care.

Leveraging Existing Datasets to Advance Family Caregiving Research: Opportunities to Measure What Matters.

More than 17.7 million people in the U.S. care for older adults. Analyzing population datasets can increase our understanding of the needs of family caregivers of older adults. We reviewed 14 U.S. population-based datasets (2003-2023) including older adults' and caregivers' data to assess inclusion and measurement of 8 caregiving science domains, with a focus on whether measures were validated and/or unique variables were used. Challenges exist related to survey design, sampling, and measurement. Findings highlight the need for consistent data collection by researchers, state, tribal, local, and federal programs, for improved utility of population-based datasets for caregiving and aging research.

Provision of Home & Community Based Services to Veterans by Race, Rurality, and Neighborhood Deprivation Index.

Home and community-based services (HCBS) enable frail patients to remain at home. We examined whether there were neighborhood-deprivation, racial, or rural disparities in HCBS utilization provided to Veterans by the Department of Veterans Affairs (VA) or Medicare by comparing the adjusted utilization rate of a historically disadvantaged group with the predicted utilization rate had it been treated as the historically dominant group. Among the 2.7 million VA patients over 66 years old in 2019, 11.0% were Black, 39.2% lived in rural settings, 15.3%/29.2%/30.9%/24.7% lived in least/mild/moderate/most-deprived neighborhoods. On average, 11.2% received VA or Medicare HCBS. Veterans residing in more deprived neighborhoods had 0.11-0.95% higher adjusted probability of receiving HCBS than expected had they resided in the least deprived neighborhoods. Veterans residing in rural areas had 0-0.7% lower HCBS rates than expected had they been treated like urban Veterans. Black Veterans were 0.8-1.2% more likely to receive HCBS than expected had they been treated like White Veterans. Findings indicate that VA resources were equitably employed, aligning with probable HCBS needs, suggesting that VA's substantial and long-standing investment in HCBS for care of frail Veterans could serve as a model for other payers and providers in the U.S.

Leveraging Health Services Research to Address Aging Health Equity.

To achieve optimal, equitable health outcomes for all older adults, the United States desperately needs equity in access to, quality of, and cost of aging care. To illustrate these needs, we discuss the current inequitable state of frailty care. Frailty disproportionately affects marginalized populations, yet these populations struggle to access high-quality geriatrics care and long-term care services and supports (LTSS) that mitigate frailty, leading to accelerated frailty trajectories. Health services research can provide the data needed to document, elucidate, and address health inequities in frailty care, including early identification and referral of frail adults to specialized care and financing LTSS.

Metal-Organic Frameworks Derived Carbon-Supported Metal Electrocatalysts for Energy-Related Reduction Reactions.

Electrochemical reduction reactions, as cathodic processes in many energy-related devices, significantly impact the overall efficiency determined mainly by the performance of electrocatalysts. Metal-organic frameworks (MOFs) derived carbon-supported metal materials have become one of star electrocatalysts due to their tunable structure and composition through ligand design and metal screening. However, for different electroreduction reactions, the required active metal species vary in phase component, electronic state, and catalytic center configuration, hence requiring effective customization. From this perspective, this review comprehensively analyzes the structural design principles, metal loading strategies, practical electroreduction performance, and complex catalytic mechanisms, thereby providing insights and guidance for the future rational design of such electroreduction catalysts.