The importance of developmental assets in HIV prevention behaviors among young black men who have sex with men (MSM).

Developmental assets are critical to the health and wellbeing of youth. The current study examines the influence of developmental assets on PrEP use and HIV testing among YBMSM ages 18-24. Using a cross-sectional survey of YBMSM (N = 225), this study explored the role of external (e.g., family support, other adult support) and internal (e.g., personal responsibility) assets in explaining HIV prevention behaviors. Participants were recruited from Mechanical Turk (M-Turk) internet-based platform, social media sites, and community-based organizations. A path analysis was conducted to investigate the direct/indirect effects of internal and external assets on PrEP use and HIV testing. Family support (ß = 0.40, p < 0.001) and other adult support (ß = 0.22, p = 0.004) were both associated with personal responsibility. Personal Responsibility (ß = 0.15, p = 0.03) and positive identity (ß = 0.28, p < 0.001) were both associated with an increase HIV testing. Personal responsibility was positively associated with increased PrEP use (ß = 0.30, p < 0.001). Our study results indicated that external assets play a role in helping to build internal assets that support increased HIV testing and PrEP use among YBMSM. Our findings suggest the need for strength-based interventions that help YBMSM build assets and increase HIV prevention behaviors.

Coconut leaf midrib skewer as a cause for small bowel obstruction and perforation: A case report.

Foreign body ingestion is an infrequent cause of small bowel obstruction and, rarely, perforation. It is a common occurrence among pediatric patients, mentally impaired and the edentulous elderly population majority of which will pass through the gastrointestinal tract uneventfully. The likelihood of complications such as perforation, bleeding or fistula formation increases markedly particularly for sharp, stiff, and elongated objects (i.e. toothpicks, meat bones, pins, and razor blades). Diagnosis can be difficult as frequently patients are incognizant of the nature and time of ingestion. Imaging is commonly non-specific as well. We present an unusual case of a 65-year-old male who had an ileal perforation secondary to a coconut leaf midrib skewer initially presenting as small bowel obstruction. Intraoperatively, adhesions were seen in the ileum with note of the foreign body perforating two bowel loops that was not identified in preoperative imaging. This case highlights the importance of considering atypical causes of small bowel obstruction even in the background of previous surgery. Finally, early recognition, accurate diagnosis, and timely intervention are essential to improve patient outcomes and decrease mortality in such cases.

Intersectional Mentorship in Academic Medicine: A Conceptual Review.

Academic medical institutions seek to recruit and retain a diverse workforce to foster equitable, supportive environments in which early-stage investigators, especially those who are underrepresented in medicine, can thrive. Intersectionality is a critical theoretical framework rooted in Black feminist activism and scholarship that elucidates how power and privilege are differentially structured for groups at different intersectional sociodemographic positions. As a dynamic method of analyzing multiple axes of power and inequality, intersectionality has the potential to offer a critical lens through which to view the mentor-mentee relationship. In this article, we seek to elaborate upon and extend the concept of intersectional mentoring, elucidate its essential components, and explore its application in the context of mentoring early-stage investigators in academic medicine. We propose that intersectional mentorship requires an orientation toward deep cultural humility, lifetime learning about the impact of systemic oppressions on present-day opportunities and experiences of mentees, and changing systems that perpetuate inequities by centering praxis-the application of principles of intersectionality through action to transform power dynamics in academic culture and institutions. Intersectional mentorship can help build a more equitable and representative workforce to advance intersectionally relevant and innovative approaches to achieving health equity.

A new species of Casearia Jacq. (Salicaceae) from Central Panama and insights into its phylogenetic position within the genus.

We describe here a new species of Casearia from Panama based on both morphological and molecular data. Caseariaisthmicasp. nov. is restricted to the mid-elevation cloud forests of Central Panama and presents morphological similarities with two more widespread species, C.sanchezii from high elevation areas of El Salvador and Mexico and C.tremula from the Caribbean, Central America, and Northern South America. Caseariaisthmica differs in presenting pedunculated and congested inflorescences with up to 20 flowers, as well as flowers with 12 stamens and a pubescent style. Phylogenetic analysis based on selected plastid (petD, trnK-matK, rpl16 and rps4-trnLF) and nuclear (GBSSI and ITS) markers shows that the new species belongs to subclade B3 of Casearia, a lineage that encompasses species from Central America, Mexico and the Caribbean. Results of the morphological and molecular analysis were congruent and allowed a broader understanding of this new taxon, especially regarding its relationships to other Casearia.

Barriers and facilitators to the transplant process among patients living with polycystic kidney disease: a qualitative Approach.

BACKGROUND: Kidney transplant is the gold standard for renal replacement therapy in patients with autosomal dominant polycystic kidney disease (ADPKD), which is the fourth leading cause of kidney failure. Despite the medical and economic benefits of preemptive kidney transplant over dialysis before transplant, only 9-21% of qualifying patients receive preemptive transplants. Given the low rates of preemptive transplant, the aim of this study was to determine perceived facilitators and barriers to preemptive transplant among ADPKD patients using a qualitative approach. METHODS: Data were collected between July 2021 and January 2022 from virtual individual semi-structured interviews of 16 adult participants with ADPKD. Qualitative analysis of the recorded interviews was conducted to generate themes. RESULTS: Our findings revealed two themes specific for facilitators to preemptive transplant (social support and patient agency) and three themes specific to barriers for preemptive transplant (inadequate social support, gaps in knowledge, and institutional and systemic policies). The results also include various subthemes and the application of these themes to the social ecological model. CONCLUSIONS: These findings suggest that increasing social support and patient agency, such as through patient navigator programs and encouraging effective communication between health care providers and patients, can facilitate the transplant process. Increasing dissemination of transplant knowledge from institutions and systems to patients through paired kidney exchange education and live donor outreach can also increase timely access to preemptive kidney transplants for patients with ADPKD. Our findings are limited by our single site study in the US, which may not apply to individuals experiencing different social, cultural, and health access conditions.

Do precipitation anomalies influence short-term mobility in sub-saharan Africa? An observational study from 23 countries.

BACKGROUND: Precipitation anomalies are associated with a number of poor health outcomes. One potential consequence of precipitation extremes is human geographic mobility. We evaluated the associations between precipitation anomalies (droughts and heavy rains) and short-term mobility in 23 sub-Saharan African countries by linking satellite data on precipitation to cross-sectional representative surveys. METHODS: Using data from 23 Demographic and Health Surveys from 2011 to 2017, we estimated the associations between deviations in long-term rainfall trends and short-term mobility among 294,539 women and 136,415 men over 15 years of age. We fit multivariable logistic regression models to assess potential non-linear relationships between rainfall deviations and short-term mobility, adjusting for survey month and socio-demographic covariates, and stratified by participant gender. Furthermore, we assessed whether these associations differed by marital status. RESULTS: Rainfall deviations were associated with short-term mobility among women, but not men. The relationship between rainfall deviations and mobility among women was U-shaped, such that women had increased marginal probabilities of mobility in instances of both lower and heavier precipitation. Differences between married and unmarried women were also revealed: among married women, we found positive associations between both rainfall deviation extremes (drought and heavy rains) and mobility; however, among unmarried women, there was only a positive association for heavy rains. CONCLUSION: Precipitation anomalies were associated with short-term mobility among women, which may be in turn associated with poor health outcomes. More research with longitudinal data is needed to elaborate the associations between weather shocks, mobility, and downstream health impacts.

Understanding the concept of trust and other factors related to COVID-19 vaccine intentions among Black/African American older adults prior to vaccine development.

Background: Black/African Americans are receiving COVID-19 vaccines at much lower rates than whites. However, research is still evolving that explains why these vaccination rates are lower. The aim of this study was to examine the effects of the pandemic among older Black/African Americans, with an emphasis on trust and vaccine intention prior to vaccine development. Methods: Data were collected between July and September 2020 from 8 virtual focus groups in Detroit, MI and San Francisco Bay Area, CA with 33 older African Americans and 11 caregivers of older African Americans with cognitive impairment, supplemented by one virtual meeting with the project's Community Advisory Board. Inductive/deductive content analysis was used to identify themes. Results: Five major themes influenced the intention to be vaccinated: uncertainty, systemic abandonment, decrease in trust, resistance to vaccines, and opportunities for vaccination. The last theme, opportunities for vaccination, emerged as a result of interaction with our CAB while collecting project data after the vaccines were available which provided additional insights about potential opportunities that would promote the uptake of COVID-19 vaccination among older Black/African Americans. The results also include application of the themes to a multi-layer framework for understanding precarity and the development of an Integrated Logic Model for a Public Health Crisis. Conclusions: These findings suggest that trust and culturally relevant information need to be addressed immediately to accelerate vaccine uptake among older Black/African Americans. New initiatives are needed to foster trust and address systemic abandonment from all institutions. In addition, culturally relevant public health campaigns about vaccine uptake are needed. Thus, systemic issues need immediate attention to reduce health disparities associated with COVID-19.

Challenges and opportunities for medical referrals at a mobile community health clinic serving sexual and gender minorities in rural South Carolina: a qualitative approach.

BACKGROUND: Sexual and gender minorities (SGM) in the Southern United States face challenges in accessing sexual and gender affirming health care. Alternative care models, like inclusive mobile clinics, help mitigate barriers to care for SGM. There is limited data in the literature on the experience of medical referral processes for SGM individuals accessing services from mobile health clinics. AIMS AND OBJECTIVES: The purpose of this study is to describe the medical referral experiences of SGM clients and their providers at a mobile health clinic in the Southern United States. METHODS: We recruited English-speaking individuals who provided care or received care from the mobile health clinic in South Carolina between June 2019 and August 2020. Participants completed a brief demographic survey and a virtual in-depth, semi-structured individual interview. Data analysis was conducted using an iterative process to generate codes, categories, and themes. Data collection and analysis were terminated once thematic saturation was achieved. RESULTS: The findings from this study indicated that the mobile health clinic had an inconsistent referral process that was largely dependent on providers' knowledge. Furthermore, clients and providers expressed individual barriers to the referral process, such as financial barriers, and opportunities to improve the referral process, such as an opt-in follow-up from the mobile clinic and increased mobile clinic resources. CONCLUSION: The findings in this study underscore the importance of having mobile clinics create a structured referral process that all medical providers are familiar with, and the value of hiring patient navigators that can support and refer clients to care that goes beyond the mobile health clinic setting.

Hydrogel and Effects of Crosslinking Agent on Cellulose-Based Hydrogels: A Review.

Hydrogels are hydrophilic polymer materials that can swell but are insoluble in water. Hydrogels can be synthesized with synthetic or natural polymers, but natural polymers are preferred because they are similar to natural tissues, which can absorb a high water content, are biocompatible, and are biodegradable. The three-dimensional structure of the hydrogel affects its water insolubility and ability to maintain its shape. Cellulose hydrogels are preferred over other polymers because they are highly biocompatible, easily accessible, and affordable. Carboxymethyl cellulose sodium (CMCNa) is an example of a water-soluble cellulose derivative that can be synthesized using natural materials. A crosslinking agent is used to strengthen the properties of the hydrogel. Chemical crosslinking agent is used more often than physical crosslinking agent. In this review, article, different types of crosslinking agents are discussed based on synthetic and natural crosslinking agents. Hydrogels that utilize synthetic crosslinking agent have advantages, such as adjustable mechanical properties and easy control of the chemical composition. However, hydrogels that use natural crosslinking agent have better biocompatibility and less latent toxic effect.

Climate Change, Public Health, Health Policy, and Nurses Training.

There are few educational programs in the United States that have a primary focus on preparing nurses to engage in all levels of public health, health policy, and climate change. The United Nations sustainability development goals (SDG) and the Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity (2021) report underscored the importance of key stakeholders, including nurses, engaging in advocacy and policy to promote health equity. We discuss the role of nursing at the intersection of public health, policy, climate change, and the SDG. We also discuss the history and merger of the University of California San Francisco (UCSF) School of Nursing public health and health policy specialties, a significant innovation in our effort to promote health equity. We provide a brief overview of the redesigning of our curriculum that meets the needs of today's learners by including content on climate change, data analytics, and racial, social, and environmental justice. Finally, we emphasize the need to train the next cadre of nurses interested in careers in public health and health policy for us to meet the challenges facing our communities. (Am J Public Health. 2022;112(S3):S321-S327. https://doi.org/10.2105/AJPH.2022.306826).

Primary bilateral inguinal endometriosis: A case report.

INTRODUCTION: Endometriosis is a chronic benign recurrent gynecologic disease commonly affecting 10% of women worldwide wherein endometrial glands implant and mature outside the uterine cavity causing symptoms such as dysmenorrhea, dyspareunia, or abdominal pain. CASE PRESENTATION: Herein we describe a case of a 40-year-old female with primary bilateral inguinal endometriosis presenting with catamenial pain for which surgical excision was performed providing definitive treatment. The patient has been asymptomatic with no recurrence at 6 months of follow-up. DISCUSSION: Most cases of endometriosis occur within the pelvis however, extra-pelvic sites have been reported which include previous surgical scars, bladder, diaphragm, or inguinal area. It is usually classified as primary or secondary but can also be based on location. Oftentimes, these patients can present as a diagnostic dilemma for clinicians and treatment requires surgery and/or medications such as oral contraceptives or hormonal agents. Common diagnoses include hernia, lipoma, lymphadenopathy, or even malignancy. CONCLUSION: We would like to highlight the atypical presentation, pathogenesis, and management of endometriosis in this rare site.

Hepatectomy as a Salvage procedure for blunt abdominal trauma: A case report.

The liver is the organ most commonly injured in blunt abdominal trauma. Significant changes in the management of liver trauma have occurred over the last four decades with non-operative management being the first-line of treatment. Although hepatic resection for trauma is an accepted and established option for definitive treatment, it is rarely performed because of the associated morbidity and mortality, at least historically. Herein we describe a case of a 24-year old male who had blunt abdominal injury for which a right hepatectomy was eventually performed after an initial attempt at damage control surgery. We would like to highlight that early decision by a dedicated team of surgeons coupled with the necessary support from ancillary services as well as coordination between trauma surgeons led to a successful outcome in this case. This case presents an opportunity to revisit the role of hepatic resection in the management of complex liver injuries.

Structure and Properties of Reactively Extruded Opaque Post-Consumer Recycled PET.

The recyclability of opaque PET, which contains TiO2 nanoparticles, has not been as well-studied as that of transparent PET. The objective of this work is to recycle post-consumer opaque PET through reactive extrusion with Joncryl. The effect of the reactive extrusion process on the molecular structure and on the thermal/mechanical/rheological properties of recycling post-consumer opaque PET (r-PET) has been analyzed. A 1% w/w Joncryl addition caused a moderate increase in the molecular weight. A moderate increase in chain length could not explain a decrease in the overall crystallization rate. This result is probably due to the presence of branches interrupting the crystallizable sequences in reactive extruded r-PET (REX-r-PET). A rheological investigation performed by SAOS/LAOS/elongational studies detected important structural modifications in REX-r-PET with respect to linear r-PET or a reference virgin PET. REX-r-PET is characterized by a slow relaxation process with enlarged elastic behaviors that are characteristic of a long-chain branched material. The mechanical properties of REX-r-PET increased because of the addition of the chain extender without a significant loss of elongation at the break. The reactive extrusion process is a suitable way to recycle opaque PET into a material with enhanced rheological properties (thanks to the production of a chain extension and long-chain branches) with mechanical properties that are comparable to those of a typical virgin PET sample.

Pharmacognostic Evaluation of Ten Species of Medicinal Importance of Cecropia: Current Knowledge and Therapeutic Perspectives.

This work covers a systematic review of literature about the genus Cecropia from 1978 to 2020, emphasizing the analysis of 10 of the most relevant species and their associated biological activities. Cecropia is a neotropical genus, which comprises about 61 native species in the American continent where it is known to be part of the traditional medicine of numerous countries. Secondary metabolites described for this genus showed an elevated structural and functional diversity, where polyphenols have been the most abundant. Based on this diversity, Cecropia phytochemicals represent an important source of potential therapeutic agents yet to be exploited. This review also highlights the effectiveness of combining chemometrics and ultra-performance liquid chromatography-tandem mass spectrometry as a novel approach to successfully single out Cecropia species phytochemicals. While the medicinal use of Cecropia species is officially recognized in National Pharmacopoeias and Formularies of several Latin American countries, it is important to recognize that these phytomedicines are complex mixtures requiring a thorough understanding of their chemical composition and their correlation with biological activities to guarantee their quality, safety, and efficacy.

"Little Red Flags": Barriers to Accessing Health Care as a Sexual or Gender Minority Individual in the Rural Southern United States-A Qualitative Intersectional Approach.

ABSTRACT: Sexual and gender minorities (SGMs) experience unique challenges when accessing sexuality and gender-affirming, safe health care services in the rural, southern United States. An identified gap in the literature is an intersectional, community-based approach to assessing the obstacles SGM individuals with intersecting identities experience when navigating comprehensive health services in rural southern communities in the United States; therefore, the present study used qualitative inquiry with an intersectional lens to describe these obstacles. The authors analyzed qualitative data from in-depth, semi-structured individual interviews with SGM individuals (N = 12). Common themes emerged that highlighted the compounding effects of the sociopolitical climate of the geographical area, religious attitudes toward SGMs, and the experience of racism. Findings of this study can inform health professions' academic curriculum, provider and support staff training, and implementation of policy that focuses on creating a diverse and inclusive health care delivery experience.

Food Insufficiency and Mental Health in the U.S. During the COVID-19 Pandemic.

INTRODUCTION: During the COVID-19 pandemic, the rates of food insecurity and mental illness have been projected to increase in the U.S. owing to significant social and economic disruption. This study aims to estimate the prevalence of food insufficiency (often the most extreme form of food insecurity), the correlates of food insufficiency, and the associations between food insufficiency and symptoms of poor mental health in the U.S. during the COVID-19 pandemic. METHODS: Cross-sectional data from 63,674 participants of the U.S. Census Household Pulse Survey were collected and analyzed in 2020. Multiple Poisson regression models were used to estimate associations with food insufficiency. RESULTS: Food insufficiency rose from 8.1% to 10.0% from March to June 2020. Factors associated with food insufficiency included lower age, Black/African American or Latinx race/ethnicity, being unmarried, larger household size, recent employment loss, income below the federal poverty line, and lower education (all p<0.001). Food insufficiency was independently associated with all symptoms of poor mental health, adjusting for socioeconomic and demographic factors (adjusted RRs ranged from 1.16 to 1.42, all p<0.001). The association between food insufficiency and poor mental health was attenuated among people who received free groceries or meals. CONCLUSIONS: Food insufficiency has increased during the COVID-19 pandemic and affects vulnerable populations, placing individuals at higher risk for symptoms of poor mental health. Particularly in the current crisis, clinicians should regularly screen patients for food insufficiency and mental health outcomes as well as provide support in accessing appropriate resources.