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We review the Pima County (Arizona) Health Department’s efforts to achieve equitable COVID-19 vaccine distribution in a county with a social vulnerability index of 0.88. We expedited vaccine distribution, focusing on equitable distribution, implementing a multi–point of dispensing approach, and using a periurban and rural strategy. Pima County has one of the highest vaccine distribution percentages among the highest social vulnerability index quartiles and is more than 10 percentage points ahead of other large counties in Arizona in vaccine uptake. (Am J Public Health. 2022;112(11):1560–1563. https://doi.org/10.2105/AJPH.2022.307040 )

This introduction explores the theories and themes presented in the articles of this special issue. It considers embodiment, temporality, and coherence as they relate to healing and survival at memory sites dedicated to reckoning with difficult or contentious pasts. This special issue deliberately decenters traditional approaches in memory studies by carving out spaces for the Global South and by considering activist–scholar or activist–artist–scholar interventions. This special issue includes articles on Argentina, Cambodia, Nicaragua, Namibia, Rwanda, Russia, South Africa, South Korea, and the United States.

To explore the near-term and future cost projection of hydrogen production via water electrolysis, Strategic Analysis, Inc. (SA) has developed a bottom-up project cost model for Alkaline, Proton Exchange Membrane (PEM), and Anion Exchange Membrane (AEM) electrolysis technologies. This project cost model incorporates: 1) Stack cost, derived from a Design for Manufacture and Assembly (DFMA) process-based cost model; 2) mechanical balance of plant (BOP) cost; 3) electrical BOP cost; 4) site preparation cost; and 5) construction overhead cost. The SA project cost model results are fed into the Hydrogen Analysis (H2A) model to estimate the Levelized Cost of Hydrogen (LCOH), accounting for electricity and water consumption, in addition to other operating costs. The SA project cost model and the H2A model were used to conceptualize electrolysis system sizes from 100 MW to 1 GW. SA conducted operating point optimization to determine the current density and cell voltage that minimizes LCOH for each system. The expected LCOH for a grid-fed electrolyzer plant is similar for all major low-temperature water electrolysis systems.

This study provides an overview of the relationships between exposure to work-related hand-arm vibration and the occurrence of pre-defined disorders of the hands. We searched Medline, Embase, Web of Science, Cochrane Central, and PsycINFO for cross-sectional and longitudinal studies on the association between work-related vibration exposure and the occurrence of hand-arm vibration syndrome (including vibration-induced white finger), Dupuytren’s contracture, or hypothenar hammer syndrome. We used a 16-item checklist for assessing the risk of bias. We present results narratively, and we conducted random effects meta-analyses if possible. We included 10 studies with more than 24,381 participants. Our results showed statistically significant associations between the exposure to hand-arm vibrations and the occurrence of the selected disorders, with pooled odds ratios ranging between 1.35 (95% CI: 1.28 to 2.80) and 3.43 (95% CI: 2.10 to 5.59). Considerable between-study heterogeneity was observed. Our analyses show that exposure to vibrating tools at work is associated with an increased risk for the occurrence of selected disorders of the hands. Due to the majority of studies being cross-sectional, no firm conclusion is possible regarding causal relationships between vibration exposure and disorder occurrence. Future research should specifically address whether reducing exposure to hand-held vibrating tools at work reduces the incidence of the disorders of the hands investigated in this systematic review.

Patients often report bowel problems after bowel surgery for rectal cancer, the procedure for which is anterior resection and involves the removal of part of the rectum. These symptoms are collectively referred to as low anterior resection syndrome. A recently published definition of this phenomenon describes a range of bowel symptoms and their consequences, as well as the impact they can have on a person’s lifestyle and quality of life. It is useful to have an understanding of the changes that occur after an anterior resection and why they occur, to be able to provide appropriate information to patients preparing for an anterior resection about what to expect and to assist with symptom management after surgery.

Aims: To examine the differences between HbA1c and glucose related variables in predicting weight loss and glycaemic changes following 8 weeks of low energy diet (LED) in individuals with overweight and hyperglycaemia. Research design and methods: 2178 individuals with ADA-defined pre-diabetes -impaired fasting glucose (IFG) and/or impaired glucose tolerance (IGT) -who started an 8 week LED weight loss diet, were included in this analysis. Participants were enrolled in the PREVIEW (PREVention of diabetes through lifestyle in-terventions and population studies In Europe and around the World) clinical trial. Multivariable linear mixed effects regression models and generalised additive mixed effect logistic models were used. Results: Only 1 in 3 participants (33%) had HbA1c levels defined as pre-diabetes. Neither baseline HbA1c, IFG or IGT were associated with body weight change at 8 weeks. Higher baseline body weight, baseline fasting insulin and weight loss predicted normalisation of fasting plasma glucose (FPG), whilst higher baseline fasting insulin, C-reactive protein (hsCRP) and older age predicted normalisation of HbA1c. Additionally, male sex and higher baseline BMI, body fat and energy intake were positively associated with weight loss, whereas greater age and higher HDL-cholesterol predicted less weight loss. Conclusions: Whilst neither HbA1c nor fasting glucose predicts short-term weight loss success, both may impact the metabolic response to rapid weight loss. We propose a role of inflammation versus total body adiposity since these variables are independent predictors of the normalisation of HbA1c and fasting glucose, respectively.(c) 2023 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved.

Introduction: Ramadhan fasting increases mental and physical health. The study aims to evaluate the effect of Ramadhan fasting on fatigue, sleepiness, depression and anxiety mood, quality of life (QoL), caloriesconsumed and Brain-derived neurotrophic factor (BDNF) serum level.Methods: Twenty participants are included in the fasting group (FG), and nineteen participants are included in the non-fasting group (NFG). Fatigue severity scales (FSS), fatigue VAS, Epworth sleepiness scale (ESS),hospital depression and anxiety score (HADS), Beck depression inventory (BDI)-II, Short form 12 (SF-12), and BDNF in both groups were assessed at five-time points: one week before Ramadhan (T1), in the middleof Ramadhan (T2), the last days of Ramadhan (T3), one week after Ramadhan fasting (T4) two weeks after Ramadhan (T5).Results: We found no significant differences across the time points between FG and NFG groups in all variables (p>0.05). There is a significant correlation between fatigue VAS with BDNF serum levels (r > rtable), SF-12 PCS (r>r table) with BDNF, SF-12 MCS (r>r table). There is no correlation between fatigue, depression and anxiety intensity, sleepiness, QoL, BDI-II, and BDNF serum levels with calories consumed,BDI-II, and BDNF of fasting group in Ramadhan (r < r table).Conclusions: Ramadhan fasting has positive effects on fatigue and mood. Ramadhan fasting does not have a significant effect on sleepiness, physical exercise, and calories consumed. Fatigue VAS and SF-12 PCScan replace the serum BDNF examinationKeywords: BDNF, depression, fatigue, quality of life, ramadhan fasting

This article presents findings from a case study of a K-12 school in Turkey where teachers shared perceptions of how the International Baccalaureate Learner Profile attributes related to their own practice. While discussing the interdependency of the attributes, teachers considered that being an inquirer is the most valuable attribute for effective International Baccalaureate teachers. Participants at all grade levels believed that being open-minded and r eflective were important attributes. Despite the importance of inquiry, participants shared that they feel most capable of implementing the attribute of being knowledgeable. The conceptual framework developed for this study may be used by schools and teacher educators to develop attributes of teachers who can help students become global citizens with intercultural understandings.

Heterogeneity in the course of posttraumatic stress symptoms (PTSS) following a major life trauma such as childhood sexual abuse (CSA) can be attributed to numerous contextual factors, psychosocial risk, and family/peer support. The present study investigates a comprehensive set of baseline psychosocial risk and protective factors including online behaviors predicting empirically derived PTSS trajectories over time. Females aged 12–16 years (N= 440); 156 with substantiated CSA; 284 matched comparisons with various self-reported potentially traumatic events (PTEs) were assessed at baseline and then annually for 2 subsequent years. Latent growth mixture modeling (LGMM) was used to derive PTSS trajectories, and least absolute shrinkage and selection operator (LASSO) logistic regression was used to investigate psychosocial predictors including online behaviors of trajectories. LGMM revealed four PTSS trajectories: resilient (52.1%), emerging (9.3%), recovering (19.3%), and chronic (19.4%). Of the 23 predictors considered, nine were retained in the LASSO model discriminating resilient versus chronic trajectories including the absence of CSA and other PTEs, low incidences of exposure to sexual content online, minority ethnicity status, and the presence of additional psychosocial protective factors. Results provide insights into possible intervention targets to promote resilience in adolescence following PTEs.

Context Peatlands in the Australian Alps are important ecologically and recognised in national environmental legislation. Increasing fire frequency over the past 40 years has put the community at greater risk of degradation. Aims Using published studies of fire effects in peatlands and new data, we investigate general responses of peatlands to fire so that risk can be evaluated and appropriate management adopted. Methods We present four case studies that employ repeated measures of floristic composition or chronosequences to assess fire-related changes. Key results Cover of frequently-occurring species declined after fire but most had returned to pre-fire cover after 10 years. Recovery of the obligate seeder shrub Dracophyllum continentis (B.L.Burtt) S.Venter and the dominant moss Sphagnum cristatum Hampe was much slower, but variable for the latter, apparently depending on fire intensity and post-fire moisture availability; both species favoured less frequently burnt peatlands with high soil moisture. Some herbs (including non-native species) benefitted from fire, briefly becoming abundant soon afterwards. Overall species richness and diversity were unaffected by fire. Conclusions Peatlands in the Australian Alps tend to be resilient to single fires with effects on species composition being short-lived. However, species cover (especially Sphagnum cristatum) requires perhaps 20 years between fires for full recovery. Fire can cause localised community extinction and this is likely to be exacerbated by other pressures such as trampling and drought. Implications Fire will be difficult to manage in peatlands but resilience might be built by removing other pressures such as trampling by feral animals.

Purpose: The purpose of this study is to determine whether and how learning American Sign Language (ASL) is associated with spoken English skills in a sample of ASL–English bilingual deaf and hard of hearing (DHH) children. Method: This cross-sectional study of vocabulary size included 56 DHH children between 8 and 60 months of age who were learning both ASL and spoken English and had hearing parents. English and ASL vocabulary were independently assessed via parent report checklists. Results: ASL vocabulary size positively correlated with spoken English vocabulary size. Spoken English vocabulary sizes in the ASL–English bilingual DHH children in the present sample were comparable to those in previous reports of monolingual DHH children who were learning only English. ASL–English bilingual DHH children had total vocabularies (combining ASL and English) that were equivalent to same-age hearing monolingual children. Children with large ASL vocabularies were more likely to have spoken English vocabularies in the average range based on norms for hearing monolingual children. Conclusions: Contrary to predictions often cited in the literature, acquisition of sign language does not harm spoken vocabulary acquisition. This retrospective, correlational study cannot determine whether there is a causal relationship between sign language and spoken language vocabulary acquisition, but if a causal relationship exists, the evidence here suggests that the effect would be positive. Bilingual DHH children have age-expected vocabularies when considering the entirety of their language skills. We found no evidence to support recommendations that families with DHH children avoid learning sign language. Rather, our findings show that children with early ASL exposure can develop age-appropriate vocabulary skills in both ASL and spoken English.

Decades of research suggests that supportive faculty communication improves student retention and progression; however, most communication interventions occurred at on-site universities and were implemented briefly in one or several courses. In this article, we describe the outcomes of a consistent, personalized student outreach program implemented in every course and for students’ entire tenure at a fully online university. In 2019, Western Governors University launched a student support program called Learner-Centered Faculty (LCF)—a paradigm that focuses on just-in-time, personalized, student-centered faculty support at scale. We evaluated the impact of LCF on student retention and course completion rates and found that LCF-based intervention improved retention and course completion generally and was particularly beneficial for certain groups of students. In the future, we will examine the mechanisms underlying LCF’s success.

A Wireless Body Area Network (WBAN) is a network that may be worn on the human body or implanted in the human body to transmit data, audio, and video in real-time to assess how vital organs are performing. A WBAN may be either an inter-WBAN or an intra-WBAN network. Intra-WBAN communication occurs when the various body sensors can share information. This is known as inter-WBAN communication, which occurs when two or more WBANs can exchange data with one another. One difficulty involves getting data traffic from wireless sensor nodes to the gateway with as little wasted energy, dropped packets, and downtime as possible. In this paper, the WBAN protocols have been compared with WBAN under Particle Swarm Optimization (PSO), and the performance of various parameters has been analysed for different simulation areas. The WBAN under the PSO protocol reduces the energy consumption by 43.2% against the SIMPLE protocoldue to the effective selection of forwarding nodes based on PSO optimization. In addition to that the experimental WBAN testbed is conducted in indoor environment to study the performance of the routing metrics towards energy and packet reception..

Nurses working within any aspect of gastrointestinal nursing could benefit from a review of the anatomy and physiology of the gastrointestinal tract. This article aims to provide a refresher on the topic, enabling nurses to better recognise the cause of bowel changes and provide more effective care for people with bowel conditions

There are three main output stomas—colostomy, ileostomy and urostomy. Each of these requires a different stoma appliance to collect and contain the stoma output. This article discusses stoma product selection, things to consider before choosing a product, as well as caring for the stoma.

Penicillin allergy records are often incorrect and may result in harm. We aimed to systematically review the effectiveness and safety of non-allergist healthcare worker delivery of penicillin allergy de-labelling (PADL).We searched EMBASE/ MEDLINE/ CINAHL (Ovid), PsycInfo, Web of Science and Cochrane CENTRAL from inception to 21/01/22, and unpublished studies and the grey literature. The proportion of penicillin allergic patients de-labelled and harmed was calculated using random effects models.Overall, 5019 patients were de-labelled. Using allergy history alone, 14% (95% CI, 9.0-21%) of 4350 assessed patients were de-labelled without reported harm. Direct drug provocation testing resulted in de-labelling 27%; (95% CI, 18-37%) of 4207 assessed patients. Of 1373 tested, 98% were de-labelled (95% CI, 97-99%), harm, none serious, was reported in 1% (95% CI, 0-2%). Using skin testing followed by drug provocation testing de-labelled 41% (95% CI, 24-59%) of 2890 assessed patients. Of 1294 tested patients 95.0% (95% CI, 90%-99%) were de-labelled, reported harm was low.(0%; (95% CI 0%-1%).PADL by non-allergists is efficacious and safe. The proportion of assessed patients who can be de-labelled increases with complexity of testing method, but substantial numbers can be de-labelled without skin testing.Source of funding: NIHR300542. Funder had no further role in the study.

Clinical trial participants do not reflect the racial and ethnic diversity of people with cancer. ASCO and the Association of Community Cancer Centers collaborated on a quality improvement study to enhance racial and ethnic equity, diversity, and inclusion (EDI) in cancer clinical trials. The groups conducted a pilot study to examine the feasibility, utility, and face validity of a two-part clinical trial site self-assessment to enable diverse types of research sites in the United States to (1) review internal data to assess racial and ethnic disparities in screening and enrollment and (2) review their policies, programs, procedures to identify opportunities and strategies to improve EDI. Overall, 81% of 62 participating sites were satisfied with the assessment; 82% identified opportunities for improvement; and 63% identified specific strategies and 74% thought the assessment had potential to help their site increase EDI. The assessment increased awareness about performance (82%) and helped identify specific strategies (63%) to increase EDI in trials. Although most sites (65%) were able to provide some data on the number of patients that consented, only two sites were able to provide all requested trial screening, offering, and enrollment data by race and ethnicity. Documenting and evaluating such data are critical steps toward improving EDI and are key to identifying and addressing disparities more broadly. ASCO and Association of Community Cancer Centers will partner with sites to better understand their processes and the feasibility of collecting screening, offering, and enrollment data in systematic and automated ways.

Mathematics has a lot of negative stigma in society caused by the delivery of less interactive learning materials that makes many people not interested in studying mathematics. Educational games can be an option to create an interactive learning media. This study aimed to develop a mobile visual novel game for mathematics subjects, especially definite integral in order to increase interest in learning mathematics. Visual novel is used as a media to emphasise interactivity by delivering a story inside a game. This research investigates the level of immersion and behavioural intention to use using Hedonic-Motivation System Adoption Model (HMSAM). Evaluation was conducted using questionnaires with 46 students as respondents. The results showed that the application was able to increase students’ interest in learning mathematics. This is indicated by the level of behavioural intention to use of 84.28% which states that students strongly agree that the game is able to increase the reusability of the application. In addition, the game obtained 82.09% for the immersion aspect, showing that students alsostrongly agree that the game is able to make the players get carried away.

My participation in the conference was a studio visit of sorts (my own version of Marcel Duchamp’s Boîte-en-valise— if you are familiar with that work— Atelier-en-valise. my studio in a suitcase). It is a peek into the development of a series in progress “Silenced” from 2018 onward. The series was inspired by a one-off installation I created for the 2013 Contain It! exhibit at the Dunedin Fine Art Center in Florida, Do You Know Where Your Guns Are? featuring “Missing Gun” posters based on reports of guns stolen from private homes and vehicles. I moved on to other projects, but the headlines kept coming. More mass shootings, more stolen guns, more incidents of domestic gun violence. “Community members shocked over rare murder-suicide.” “Domestic Shooting Leaves Woman Dead in Shreveport.” Headlines led me to statistical research in an attempt to gain insight into actual numbers of deaths and injuries, and what patterns emerge. The Centers for Disease Control and Prevention report one set of statistics and advocacy groups promoting or opposing gun control measures offer different sets, but few offer a comprehensive look beyond numbers. The non-profit Gun Violence Archive attempts to fill this void, collecting news and police reports in real time for free online public access. While the spreadsheets, charts, and maps are useful, it is the incident reports that provide the most detail with locations, participants, notes, and source links. For the Silenced: Records Series, I use the Gun Violence Archive information to create temporal data portraits in a series of mixed-media drawings. The Records Series are not just data visualization but also performative drawings—experiencing the loss and suffering in a ritualistic practice. In 2019, I returned to the headlines to dissect and interrogate how news media and government agencies tell the stories of gun-related domestic violence incidents. Silenced: Domestic Report (this is an isolated incident with no threat to the public) is a new series that pairs the data of domestic gun violence incidents with a critical eye toward the images and language used in such reports. Much of the language is either clinical, naïve and/or irresponsible, and reinforces social, racial, and economic inequalities even though domestic violence crosses all demographics. I am interested in how these reports help or hinder our understanding of the statistics and the issues, one example being domestic violence assaults involving a gun are twelve times more likely to result in death. The Silenced series is evolving as I consider digital formats along with traditional print formats in the spirit of a “cultural jamming” artistic practice to critique and subvert the dominant media messages. I am currently experimenting with interventions utilizing mass marketing forms (posters, cards, brochures, etc) that would be situated in public spaces— bathrooms, lounges, dining areas— and would encourage social media interaction. I am also developing ideas to expand the performative rituals into collaborative projects with the community. The Silenced series intends to start conversations, show how intimately we are impacted by gun violence, and generate momentum for action.

Objective: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) hospital outbreaks have been common and devastating during the coronavirus disease 2019 (COVID-19) pandemic. Understanding SARS-CoV-2 transmission in these environments is critical for preventing and managing outbreaks. Design: Outbreak investigation through epidemiological mapping and whole-genome sequencing phylogeny. Setting: Hospital in-patient medical unit outbreak in Toronto, Canada, from November 2020 to January 2021. Participants: The outbreak involved 8 patients and 10 staff and was associated with 3 patient deaths. Results: Patients being cared for in geriatric chairs at the nursing station were at high risk for both acquiring and transmitting SARS-CoV-2 to other patients and staff. Furthermore, given the informal nature of these transmissions, they were not initially recognized, which led to further transmission and missing the opportunity for preventative COVID-19 therapies. Conclusions: During outbreak prevention and management, the risk of informal patient care settings, such as geriatric chairs, should be considered. During high-risk periods or during outbreaks, efforts should be made to care for patients in their rooms when possible.

Data primitives are the fundamental measurements or variables that capture the process under investigation. In this study annual data for small areas were collated and used to identify and characterise gentrification. Such data-driven approaches are possible because of the increased availability of data over small areas for fine spatial and temporal resolutions. They overcome limitations of traditional approaches to quantifying geodemographic change. This study uses annual data for 2010–2019 of House Price, Professional Occupation, Residential Mobility (in and out flows) and Ethnicity over small areas, Lower Super Output Areas (LSOAs). Areas of potential gentrification were identified from directional changes found in all of these variables, across combinations of start and end time periods. The initial set of areas were further processed and filtered to select robust gentrification cycles with minimum duration, and to determine start, peak and end years. Some 123 neighbourhoods in a regional case study area were found to have undergone some form of potential gentrification. These were examined further to characterise their spatial context and nature of the gentrification present, and specific types of gentrification were found to have specific periodicities. For example short-length durations (three to four years) were typically located in rural and suburban areas, associated with transit-induced cycles of gentrification, and greenification. Seven neighbourhoods were validated in detail, confirming the gentrification process and its type and their multivariate change vectors were examined. These showed that vector angle reflects the main data primitive driving the cycle of gentrification, which could aid with future prediction of gentrification cycles. A number of areas of further work are discussed.