Exploring the Experiences of Regional and Rural Revictimized Women in a Group Empowerment Program.

Sexual revictimization can have a negative impact on many facets of women's wellbeing, yet limited evidence exists regarding specific interventions that support healing and the reduction of further revictimization. This paper will explore regional and rural women's experience of a group-based empowerment program, the Shark Cage program, in Victoria, Australia. The "Shark Cage" program aims to address revictimization by empowering women and girls to build personal boundaries and assertiveness within the context of gender equality and human rights. Data were collected via participant observations across the 8-week program, in combination with semi-structured interviews with participants (N = 11) pre and post intervention. All participants had access to therapeutic support outside of the program. Findings indicate that the program fostered connections among women with shared experiences of sexual revictimization, reducing feelings of isolation. Participants detailed the benefit of developing and practicing skills in reducing revictimization, such as assertiveness and boundary setting. Program learning and recovery was embedded within a network of embodied emotions, social connections, cultural norms and place-based relations that influenced how participants recovery could be understood, processed and addressed.

From crisis to capacity: Lessons learned from youth e-mentoring during the COVID-19 pandemic.

The COVID-19 pandemic and associated need for social isolation left in-person youth mentoring programs scrambling to keep mentees and mentors connected, and many programs turned to e-mentoring. To better understand the transition period and to inform e-mentoring practice in a post-COVID world, this study explored the experience of mentoring programs shifting to e-mentoring during the first year of the pandemic. Seven remote focus group discussions were conducted with twenty-three staff members from twenty U.S. youth mentoring organizations that used the iCouldBe e-mentoring platform during Spring/summer 2020 or Fall/Winter 2020-2021. Thematic content analysis was used to uncover insights from the data. E-mentoring was successful overall for keeping mentees and mentors in touch, especially for matches with a strong connection before the pandemic. Zoom and text messaging were the most used virtual communication methods. Programs faced many challenges but also experienced unexpected positives, including a strong interest in future e-mentoring implementation. Participants recommended that programs interested in e-mentoring start small and with intention; they also requested a central website with e-mentoring support and ways to connect with other programs and mentors. Although the literature on e-mentoring remains limited, this study contributes a picture of e-mentoring success even during a global crisis.

A Mobile App to Assist the Mentors of African American Young Men Who Have Sex With Men: Usability Study.

BACKGROUND: Mentoring can promote positive youth development. Owing to social and structural factors, young people in underresourced communities often lack adequate access to mentors, and naturally occurring mentors are more common than formal, programmatic mentors. There is little information on the impact of naturally occurring mentors on youth in general and even less on the role that mentors may play in promoting healthy outcomes in sexual and gender minority youth. African American young men who have sex with men (YMSM) are more likely to reside in communities with limited access to formalized mentorship programs and may benefit from naturally occurring mentoring relationships that address health outcomes, specifically related to HIV. OBJECTIVE: This study is a usability test of a mobile app designed for the mentors of African American YMSM to increase mentors' knowledge of and confidence in talking about HIV prevention and related topics with mentees. METHODS: Following consent, eligible and naturally occurring mentoring pairs involving African American YMSM in Baltimore; Philadelphia; and Washington, District of Columbia, tested the app, UrbanMentorHub, for usability. Participants downloaded the app and used it for 1 month, completed pre- and postintervention surveys, and participated in a follow-up focus group discussion. Participants' sociodemographic characteristics and HIV- and mentorship-related measures were characterized using descriptive statistics. Wilcoxon signed rank tests were used to test for pre- and postintervention differences in knowledge, confidence, and outcome expectancy measures. Focus group discussions were audio recorded and transcribed. Transcripts were thematically coded and analyzed to identify ways that UrbanMentorHub could be improved in the mentoring context. RESULTS: Nine mentorship pairs participated in this usability study (N=18). Mentors obtained high scores on knowledge, confidence, outcome expectancies, skills, and intentions related to HIV and mentoring. No pre- or postintervention changes were observed in these measures. Mentors reported usually initiating conversations around HIV testing and pre-exposure prophylaxis; mentees and mentors equally initiated conversations on sexual practices and same-sex relationships. Mentors reported sexual practices as the most frequently discussed topic in the past month and pre-exposure prophylaxis being the least discussed. Mentees reported high comfort with HIV-related conversations. No pre- or postintervention change was observed regarding HIV knowledge. Most mentees reported having discussed most HIV-related topics with their mentor in the past month. Mentor feedback on the app was mostly neutral, although they reported positive perceptions of the idea of the app, indicating the potential for addressing a need in their communities. Mentors suggested ways to improve the app content and design elements. CONCLUSIONS: Although there was no observed statistical change in measured outcomes, and qualitative feedback was overall neutral, the results of this usability study can inform future work to design and promote interventions and resources that support mentoring relationships for African American YMSM.

Preventing substance use among urban, African American youth: The potential of mentor-mentee conversations.

BACKGROUND: Early adolescence is a critical time for preventing substance use onset. Mentoring can help protect youth via social influence; however, little is currently known about direct mentor-mentee interactions around substance use. To investigate this topic, interviews were conducted with mentors to explore their comfort with, and perceived barriers and facilitators to, discussions about substance use with youth mentees. METHODS: Interviews were conducted with 26 adults serving as mentors to African American youth ages 12-14 in programs in the Baltimore/Washington, DC area. Themes were identified through qualitative analysis and pertained to comfort and engagement, commonly discussed topics, and barriers and facilitators. RESULTS: Although mentors expressed comfort with the idea of talking about substance use with their mentees, there also was an equally salient theme of having not actually done so beyond relatively cursory conversations. Salient expressed barriers to substance use discussions with mentees included fear of overstepping unclear boundaries in the mentor role and concern about having accurate information. Facilitators included training provided by programs, personal or familial experience with substance use, and concern with disparate legal ramifications for youth of color if caught in possession of, using, or selling drugs. Mentors also were in general agreement that a digital app could serve as a useful resource for discussing substance use with mentees. CONCLUSIONS: These results suggest mentors of urban youth of color may benefit from additional training and support for engaging them in discussions about substance use as well as useful topics to address in this regard.

Injury hazard assessment in schools: Findings from a pilot study in Karachi, Pakistan.

INTRODUCTION: Injuries are a major public health concern and one of the leading causes of death and disability worldwide. Childhood injuries contribute to a major proportion of this burden. OBJECTIVE: To identify injury hazards within school premises and playgrounds in Karachi, Pakistan. METHODS: This observational cross-sectional study took place in 107 public and private schools of Karachi, Pakistan using a self-structured standard injury risk assessment tool. This tool was developed after an extensive literature review, expert consultation, and field visits to a few local schools. Data related to school demographics, administrative data and injury hazards within the school boundaries were collected in schools offering education from nursery to secondary grades (through 10th grade, matriculation). Descriptive analysis were calculated. RESULTS: Out of 107 schools, only 12 were recording school-related injuries. A quarter (25%) of schools had some type of disaster drill exercises and built-in fire exits. Fire alarms were placed in 10 schools (9%), all of which were private. In 16 schools (15%), students had access to rooftop doors. There were multiple injury hazards in the school playgrounds. More than half of the schools had hazardous playground surfaces, such as slippery, concrete and uneven ground. Over 80% of schools were not supervising the children during playtime and did not have a separate play area for children under 6 years old. In 38 schools (22%), there were multiple injury hazards in the play rides, such as broken equipment, rusted parts, and sharp edges. Moreover, nine schools (7%) had loose nuts, bolts, edges, belts, steps, or rails in their play rides. Inside, almost a quarter (24%, n = 76) of schools did not have proper insulation of electric wires. Protruded metal nails, which could be high risk for prick and cut injuries, were observed in 20% of the observed furniture. CONCLUSION: In conclusion, there are multiple injury hazards in the private and public schools of Karachi, Pakistan.

Perceptions, barriers, and strategies regarding helmet use by female pillion riders in Pakistan: A qualitative study.

INTRODUCTION: Despite the existence of a national motorcycle helmet law that applies to both riders and pillion riders, the use of helmets among female pillion riders is low in Pakistan. This study aimed to explore perceptions, barriers, and strategies related to helmet use by female pillion riders. METHODS: Data was collected from nine focus group discussions held with female pillion riders and male riders working at the Aga Khan University. Focus group discussions were transcribed verbatim and checked for accuracy before being imported into NVivo2. Transcriptions were analyzed using a thematic analysis approach. RESULTS: Four overarching themes emerged, including: (1) motorcycle as mode of transportation, (2) law on helmet use and its enforcement, (3) barriers to helmet use among female pillion riders, and (4) strategies to improve helmet use among female pillion riders. Female participants never wore a helmet or considered wearing it even though "safety" was the most important benefit of helmet usage expressed. The motorcycle is an economical mode of transportation for families, particularly those in the middle and lower socioeconomic groups. Helmet laws are not strictly enforced for pillion riders, including females. Possible barriers to helmet use among female pillion riders included discomfort in wearing a helmet, uninvited attention from others, concerns about physical appearance, and substandard quality and design of helmets. Suggested strategies for implementing helmet use among female pillion riders encompassed awareness generation through media, complementary distribution of helmets, strict law enforcement in the form of fines, and the influence of religious leaders regarding social norms and cultural barriers. CONCLUSION: Motorcycles are a risky mode of transport, and there are several social and cultural barriers regarding helmet use by female pillion riders. Enforcing helmet laws for female pillion riders, raising awareness about helmet laws, and making helmet use among pillion riders a norm are some essential steps to take to promote helmet use among female pillion riders in Pakistan.

Clinical Oncology Society of Australia Position Statement: 2022 update to the safe handling of monoclonal antibodies in healthcare settings.

AIM: The aims were to (a) review the scientific literature on occupational risk, including exposure mechanisms and risk assessment, with regards to handling monoclonal antibodies (mABs) in healthcare settings; and (b) update the recommendations in the Clinical Oncology Society of Australia (COSA) safe handling of monoclonal antibodies in healthcare settings position statement, published in 2013. METHODS: A literature search was conducted between April 24, 2022, and July 3, 2022, to identify evidence relating to occupational exposure and handling of mABs in healthcare settings. Evidence in the literature was compared to the Position Statement published in 2013, and any potential additions, deletions, or revisions were discussed by the authors, and then agreed changes were made. RESULTS: Thirty-nine references were included in this update, comprising of the 2013 Position Statement itself and 10 of its references, as well as 28 new references. The risks to healthcare workers in the preparation and administration of mABs arise from four distinct exposure mechanisms: dermal, mucosal, inhalation, and oral. Updates included recommendations on using protective eyewear during the preparation and administration of mABs, developing a local institutional risk assessment tool and handling recommendations, considerations for using closed system transfer devices, and to have awareness of the nomenclature change from 2021 for new mABs. CONCLUSION: Practitioners should follow the 14 recommendations to lower occupational risk when handling mABs. Another Position Statement update should occur in 5-10 years to ensure the currency of recommendations.

Attending to cardiovascular disease risk factors after incarceration: A study of empowerment and structural barriers to care.

Incarceration in the United States is associated with high rates of cardiovascular disease (CVD) risk factors and elevated CVD risk continues into the immediate period following release from prison. One reason may be that people who are released from incarceration experience difficulties accessing healthcare and navigating the healthcare system. We use empowerment theory to describe the experiences of people after release from incarceration who have been diagnosed with or affected by risk factors for CVD, specifically focusing on ways in which they overcome barriers within the United States' medical system. We conducted a secondary analysis of qualitative data collected in Baltimore, MD in 2019. Qualitative data were collected through interviews and interactive discussion forums with 98 people who were previously incarcerated and 19 key informants. Data were analysed using qualitative thematic analysis guided by the theoretical constructs of powerlessness and empowerment. Individuals who were formerly incarcerated described feeling empowered primarily through personal motivation, maintaining a positive mindset and receiving support from within the system. They also listed a number of structural barriers they faced and repeatedly suggested a desire for improved access to healthcare and a greater understanding of the healthcare system. Efforts to develop a straightforward and easily accessible support system can promote empowerment and encourage a successful return to society and should be prioritised.

Improvement in trauma care for road traffic injuries: an assessment of the effect on mortality in low-income and middle-income countries.

Over 90% of the annual 1·35 million worldwide deaths due to road traffic injuries (RTIs) occur in low-income and middle-income countries (LMICs). For this Series paper, our aim was two-fold. Firstly, to review evidence on effective interventions for victims of RTIs; and secondly, to estimate the potential number of lives saved by effective trauma care systems and clinical interventions in LMICs. We reviewed all the literature on trauma-related health systems and clinical interventions published during the past 20 years using MEDLINE, Embase, and Web of Science. We included studies in which mortality was the primary outcome and excluded studies in which trauma other than RTIs was the predominant injury. We used data from the Global Status Report on Road Safety 2018 and a Monte Carlo simulation technique to estimate the potential annual attributable number of lives saved in LMICs. Of the 1921 studies identified for our review of the literature, 62 (3·2%) met the inclusion criteria. Only 28 (1·5%) had data to calculate relative risk. We found that more than 200 000 lives per year can be saved globally with the implementation of a complete trauma system with 100% coverage in LMICs. Partial system improvements such as establishing trauma centres (>145 000 lives saved) and instituting and improving trauma teams (>115 000) were also effective. Emergency medical services had a wide range of effects on mortality, from increasing mortality to saving lives (>200 000 excess deaths to >200 000 lives saved per year). For clinical interventions, damage control resuscitation (>60 000 lives saved per year) and institution of interventional radiology (>50 000 lives saved per year) were the most effective interventions. On the basis of the scarce evidence available, a few key interventions have been identified to provide guidance to policy makers and clinicians on evidence-based interventions that can reduce deaths due to RTIs in LMICs. We also highlight important gaps in knowledge on the effects of other interventions.

Perioperative Mobile Telehealth Program for Post-Prostatectomy Incontinence: A Randomized Clinical Trial.

PURPOSE: Perioperative pelvic floor muscle training can hasten recovery of bladder control and reduce severity of urinary incontinence following radical prostatectomy. Nevertheless, most men undergoing prostatectomy do not receive this training. The purpose of this trial was to test the effectiveness of interactive mobile telehealth (mHealth) to deliver an evidence-based perioperative behavioral training program for post-prostatectomy incontinence. MATERIALS AND METHODS: This was a 3-site, 2-arm, randomized trial (2014-2019). Men with prostate cancer scheduled to undergo radical prostatectomy were randomized to a perioperative behavioral program (education, pelvic floor muscle training, progressive exercises, bladder control techniques) or a general prostate cancer education control condition, both delivered by mHealth for 1-4 weeks preoperatively and 8 weeks postoperatively. The primary outcome was time to continence following surgery measured by the ICIQ (International Consultation on Incontinence Questionnaire) Short-Form. Secondary outcomes measured at 6, 9 and 12 months included Urinary Incontinence Subscale of Expanded Prostate Cancer Index Composite; pad use; International Prostate Symptom Score QoL Question and Global Perception of Improvement. RESULTS: A total of 245 men (ages 42-78 years; mean=61.7) were randomized. Survival analysis using the Kaplan-Meier estimate showed no statistically significant between-group differences in time to continence. Analyses at 6 months indicated no statistically significant between-group differences in ICIQ scores (mean=7.1 vs 7.0, p=0.7) or other secondary outcomes. CONCLUSIONS: mHealth delivery of a perioperative program to reduce post-prostatectomy incontinence was not more effective than an mHealth education program. More research is needed to assess whether perioperative mHealth programs can be a helpful addition to standard prostate cancer care.

Mentoring in the Time of COVID-19: An Analysis of Online Focus Groups with Mentors to Youth.

This study explored the experiences of mentors to youth during the early months of the COVID-19 pandemic. The study aims were to examine (1) the role of the pandemic on mentor-mentee interactions and relationships and (2) the ways in which mentors could be supported during the health crisis to better meet youth needs. Six online focus groups were conducted with 39 mentors. Mentor participants included 26 females and 11 males (two did not disclose gender), and 51% identified as white. Any mentor currently in a mentoring relationship, regardless of type, was eligible. Using Facebook groups, moderators posted questions and prompts, and mentor participants responded using textual comments. The text from each group was recorded, extracted, and coded and analyzed using thematic analysis. As mentors transitioned to a primarily online format, text and video chat became the most common communication methods. Mentees' access to technology and privacy were the biggest challenges faced. Mentor concerns for their mentees varied, including mental health, school, family finances, and access to instrumental support and food. Mentor help involved routinely connecting with mentees and providing academic support. Mentors requested ideas and resources for connecting with mentees and an online mentor support group. During the early weeks of the pandemic, mentors continued to engage with mentees, offering valuable support during a confusing and scary time. Mentoring programs can broaden their approach, intentionally integrating online connecting in an effort to provide safe, appropriate, and continued support to both mentors and mentees.

Simultaneous release of Fe and As during the reductive dissolution of Pb-As jarosite by Shewanella putrefaciens CN32.

Jarosites are produced during metallurgical processing, on oxidized sulfide deposits, and in acid mine drainage environments. Despite the environmental relevance of jarosites, few studies have examined their biogeochemical stability. This study demonstrates the simultaneous reduction of structural Fe(III) and aqueous As(V) during the dissolution of synthetic Pb-As jarosite (PbFe(3)(SO(4),AsO(4))(2)(OH)(6)) by Shewanella putrefaciens using batch experiments under anaerobic circumneutral conditions. Fe(III) reduction occurred immediately in inoculated samples while As(V) reduction was observed after 72 h. XANES spectra showed As(III) (14.7%) in the solid phase at 168 h coincident with decreased aqueous As(V). At 336 h, XANES spectra and aqueous speciation analysis demonstrated 20.2% and 3.0% of total As was present as As(III) in the solid and aqueous phase, respectively. In contrast, 12.4% of total Fe was present as aqueous Fe(II) and was below the detection limits of XANES in the solid phase. TEM-EDS analysis at 336 h showed secondary precipitates enriched in Fe and O with minor amounts of As and Pb. Based on experimental data and thermodynamic modeling, we suggest that structural Fe(III) reduction was thermodynamically driven while aqueous As(V) reduction was triggered by detoxification induced to offset the high As(V) (328 µM) concentrations released during dissolution.

A public health academic-practice partnership to develop capacity for exercise evaluation and improvement planning.

In December 2006, Congress passed the Pandemic and All-Hazards Preparedness Act to improve the nation's public health preparedness and response capabilities. It includes the role of Centers for Public Health Preparedness (CPHPs) to establish a competency-based core curriculum and perform evaluation of impact on newly developed materials. The Heartland Center for Public Health Preparedness (HCPHP) at the Saint Louis University School of Public Health is part of the Centers for Disease Control and Prevention national CPHP network and is engaged with state and regional partners in workforce development, preparedness planning, evaluation, and multi-year exercise and training cycles. This includes development, implementation, and evaluation of the HCPHP Exercise Evaluation Training Program to improve the competence and capacity for exercise evaluation and improvement planning. This program is designed to enhance quality improvement and performance measurement capabilities to identify increase of workforce competence over time (maturity).

Mobile diagnosis: Hamman's crunch in a primary spontaneous pneumothorax.

Mobile phone technology is gaining popularity in healthcare systems, particularly in providing clinical care to patients. A novel use of a mobile phone by a patient to record praecordial sounds (Hamman's crunch) is described which helped in the diagnosis of his condition.

Hypoxia inducible factors regulate pluripotency and proliferation in human embryonic stem cells cultured at reduced oxygen tensions.

Human embryonic stem (hES) cells are routinely cultured under atmospheric, 20% oxygen tensions but are derived from embryos which reside in a 3-5% oxygen (hypoxic) environment. Maintenance of oxygen homeostasis is critical to ensure sufficient levels for oxygen-dependent processes. This study investigates the importance of specific hypoxia inducible factors (HIFs) in regulating the hypoxic responses of hES cells. We report that culture at 20% oxygen decreased hES cell proliferation and resulted in a significantly reduced expression of SOX2, NANOG and POU5F1 (OCT4) mRNA as well as POU5F1 protein compared with hypoxic conditions. HIF1A protein was not expressed at 20% oxygen and displayed only a transient, nuclear localisation at 5% oxygen. HIF2A (EPAS1) and HIF3A displayed a cytoplasmic localisation during initial hypoxic culture but translocated to the nucleus following long-term culture at 5% oxygen and were significantly upregulated compared with cells cultured at 20% oxygen. Silencing of HIF2A resulted in a significant decrease in both hES cell proliferation and POU5F1, SOX2 and NANOG protein expression while the early differentiation marker, SSEA1, was concomitantly increased. HIF3A upregulated HIF2A and prevented HIF1A expression with the knockdown of HIF3A resulting in the reappearance of HIF1A protein. In summary, these data demonstrate that a low oxygen tension is preferential for the maintenance of a highly proliferative, pluripotent population of hES cells. While HIF3A was found to regulate the expression of both HIF1A and HIF2A, it is HIF2A which regulates hES cell pluripotency as well as proliferation under hypoxic conditions.

Demonstrating excellence in the scholarship of practice-based service for public health.

Practice-based scholarship in public health addresses community health issues. The accredited schools of public health (SPHs) have played a significant role in defining and implementing the multidisciplinary, interprofessional, ecological approach to improving the health and safety of communities through academic public health practice. These schools have addressed the challenges raised by the Institute of Medicine for enhancing academic-practice linkages. The Association of Schools of Public Health (ASPH) established the Council of Public Health Practice Coordinators (Practice Council), whose members are delegates from each of the SPHs accredited by the Council on Education for Public Health (CEPH); there were 40 as of 2008. The Practice Council's priorities are to (1) promote greater commitment to scholarship in public health practice-based research, teaching, and service within SPHs, and (2) facilitate recognition and reward for practice-based scholarship in academic institutions. Extensive alignment of efforts by the Practice Council, SPHs, federal agencies, private institutions, and the practice sector have invigorated scholarship in academic public health practice.

Interleukin-6 is crucial for recall of influenza-specific memory CD4 T cells.

Currently, our understanding of mechanisms underlying cell-mediated immunity and particularly of mechanisms that promote robust T cell memory to respiratory viruses is incomplete. Interleukin (IL)-6 has recently re-emerged as an important regulator of T cell proliferation and survival. Since IL-6 is abundant following infection with influenza virus, we analyzed virus-specific T cell activity in both wild type and IL-6 deficient mice. Studies outlined herein highlight a novel role for IL-6 in the development of T cell memory to influenza virus. Specifically, we find that CD4+ but not CD8+ T cell memory is critically dependent upon IL-6. This effect of IL-6 includes its ability to suppress CD4+CD25+ regulatory T cells (Treg). We demonstrate that influenza-induced IL-6 limits the activity of virus-specific Tregs, thereby facilitating the activity of virus-specific memory CD4+ T cells. These experiments reveal a critical role for IL-6 in ensuring, within the timeframe of an acute infection with a cytopathic virus, that antigen-specific Tregs have no opportunity to down-modulate the immune response, thereby favoring pathogen clearance and survival of the host.