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Adults' causal representations integrate information about predictive relations and the possibility of effective intervention; if one event reliably predicts another, adults can represent the possibility that acting to bring about the first event might generate the second. Here we show that although toddlers (mean age: 24 months) readily learn predictive relationships between physically connected events, they do not spontaneously initiate one event to try to generate the second (although older children, mean age: 47 months, do; Experiments 1 and 2). Toddlers succeed only when the events are initiated by a dispositional agent (Experiment 3), when the events involve direct contact between objects (Experiment 4), or when the events are described using causal language (Experiment 5). This suggests that causal language may help children extend their initial causal representations beyond agent-initiated and direct contact events. [ABSTRACT FROM AUTHOR]

The AIDS pandemic will enter its fiftieth year in 2031. Despite much progress, there are thirty-three million infected people worldwide, and 2.3 million adults were newly infected in 2007. Without a change in approach, a major pandemic will still be with us in 2031. Modeling carried out for the AIDS 2031 project suggests that funding required for developing countries to address the pandemic could reach $35 billion annually by 2031-three times the current level. Even then, more than a million people will still be newly infected each year. However, wise policy choices focusing on high-impact prevention and efficient treatment could cut costs by half. Investments in new prevention tools and major behavior-change efforts are needed to spur more rapid advances. Existing donors, middle-income countries with contained epidemics, philanthropists, and innovative financing could help bridge the likely funding gap. [ABSTRACT FROM AUTHOR]

Introduction: Hispanic adolescents are at high risk of engaging in sexual risk-taking behaviors. Parent-child communication protects against such behaviors. Among Hispanic families, it is critical to explore how cultural characteristics influence mothers-daughter communication about sex. The purpose of this qualitative study was to understand how cultural values influence mothers' communication about sex with their early adolescent Hispanic daughters., Methodology: Twenty-one Hispanic mothers of seventh-grade daughters participated in this focus group study. Directed content analysis was used to analyze the data., Results: Four Hispanic cultural values ( familismo, machismo, marianismo , and respeto ) and how each value influences mother-daughter communication about sex were identified. While mothers want to protect their daughters, there are multiple cultural norms that made it challenging for them to have critical conversations., Discussion: The study informs researchers and clinicians how to facilitate parent-child conversations about sex and to equip parents to teach their children how to avoid engaging in sexual risk-taking behaviors.

We used the developmental systems model to deduce a definition of female early adolescent sexual desire. We evaluated a measure of this phenomenon with a secondary analysis of data from a randomized group sexual health intervention trial involving low-income, English-speaking, seventh grade Latinas enrolled in a Miami-Dade County public school ( n =  542). As part of this study, girls completed a four-item early adolescent sexual desire (EASD) measure. Study findings supported internal consistency (Cronbach's alpha = .81 to .82) and stability over a 1-month period ( r = .74). Developmental sensitivity was supported by a decline in stability over 12- ( r = .66) and 24-month periods ( r = .56). Validity was supported by correlations with puberty changes, sexual intentions, sexting, and sexual behavior, and hypothesized mean differences associated with dating and preference for shoes culturally associated with female sexual attractiveness ( p < .01). Research implications include validation work with other ethnic/racial groups and using the EASD as a starting point for a measurement continuum tracking development of sexual desire across adolescence and into adulthood. Directions for future research also include measuring the development of sexual desire in boys and transgendered youth across adolescence and into adulthood.

Purpose: U.S. Hispanic adolescents are at risk for negative health outcomes due to risk-taking behaviors involving sex, drugs, and alcohol. Mother-daughter communication can reduce these risk-taking behaviors and reinforce parents' expectations. The purpose of this study was to explore mothers' descriptions of their communication about risk-taking behaviors with their early adolescent Hispanic daughters., Design and Methods: This qualitative descriptive study involved focus groups with 21 Hispanic mothers of 7th grade (12-14 years old) girls. Conventional content analysis was conducted to identify the strategies they used during these conversations., Results: Strategies mothers used included warning, focusing on negative consequences, creating opportunities to express maternal expectations, and stressing the importance of positive influences. Communication was also influenced by daughters' physical development and social media., Conclusions: The mothers were concerned about their daughters' exposure to risk-taking behaviors but were unsure about how to talk to their daughters about how to avoid them, particularly regarding topics related to sex., Practice Implications: Our study results have implications on how to facilitate parent-child conversations about risk-taking behaviors and to equip mothers and parents to teach their children how to avoid engaging in these behaviors., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Objective: Many low-income and middle-income countries (LMICs) struggle to provide the health services investment required for life-saving congenital heart disease (CHD) surgery. We explored associations between risk-adjusted CHD surgical mortality from 17 LMICs and global development indices to identify patterns that might inform investment strategies., Design: Retrospective analysis: country-specific standardised mortality ratios were graphed against global development indices reflective of wealth and healthcare investment. Spearman correlation coefficients were calculated., Setting and Participants: The International Quality Improvement Collaborative (IQIC) keeps a volunteer registry of outcomes of CHD surgery programmes in low-resource settings. Inclusion in the IQIC is voluntary enrolment by hospital sites. Patients in the registry underwent congenital heart surgery. Sites that actively participated in IQIC in 2013, 2014 or 2015 and passed a 10% data audit were asked for permission to share data for this study. 31 sites in 17 countries are included., Outcome Measures: In-hospital mortality: standardised mortality ratios were calculated. Risk adjustment for in-hospital mortality uses the Risk Adjustment for Congenital Heart Surgery method, a model including surgical risk category, age group, prematurity, presence of a major non-cardiac structural anomaly and multiple congenital heart procedures during admission., Results: The IQIC registry includes 24 917 congenital heart surgeries performed in children<18 years of age. The overall in-hospital mortality rate was 5.0%. Country-level congenital heart surgery standardised mortality ratios were negatively correlated with gross domestic product (GDP) per capita (r=-0.34, p=0.18), and health expenditure per capita (r=-0.23, p=0.37) and positively correlated with under-five mortality (r=0.60, p=0.01) and undernourishment (r=0.39, p=0.17). Countries with lower development had wider variation in mortality. GDP per capita is a driver of the association between some other measures and mortality., Conclusions: Results display a moderate relationship among wealth, healthcare investment and malnutrition, with significant variation, including superior results in many countries with low GDP per capita. These findings provide context and optimism for investment in CHD procedures in low-resource settings., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

The objective of this study was to compare the effectiveness of the topical application of Aloe barbadensis Miller (juice and fresh gel) to skin wounds, in dogs and cats, with that of topically applied silver sulfadiazine cream. The sample included 16 patients with cutaneous wounds (13 dogs and three cats) that were divided into three groups. Aloe vera "juice" and "fresh gel" were applied for groups I and II, respectively, while silver sulfadiazine was applied for the control group III. In order to evaluate the healing of wounds, the following parameters were taken into consideration: the percentage of wound shrinkage, the healing time and the macroscopic appearance of the scarring process. The interpretation of the data relating to the percentage of wound shrinkage showed a faster rate for groups I and II compared to that of group III. However, the wound shrinkage rates between "juice" and "fresh gel" protocols were not significantly different. Aloe vera was more effective than silver sulfadiazine, in accelerating wound shrinkage, reducing healing time and decreasing the severity of the associated injuries., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Objective: To explore the health education needs and learning preferences of female intimate partner violence (IPV) survivors in a social service agency located in South Florida, United States., Design and Sample: An exploratory two-phase sequential mixed-methods study was completed through semistructured interviews with social service providers (n = 10), followed by a survey with predominately female IPV survivors (n = 122, 98.4%)., Measures: Data obtained from interviews with social service providers were analyzed through conventional thematic content analysis. Data from interviews were used in developing a health survey completed by IPV survivors and analyzed utilizing descriptive statistics, chi-square tests and t tests., Results: Three themes emerged from interviews including multidimensional health needs, navigating barriers to health care, and self-improvement specific to survivors of intimate partner violence. Survey results indicated that depression and self-esteem were the health education needs of highest priority. Demographic characteristics, including age and language use, were significantly associated to preferred methods of learning, p < .05., Conclusions: IPV survivors present with various health education needs. Current study findings can inform public health nurses in developing interventions or health-based programs for female IPV survivors in social service agency settings., (© 2017 Wiley Periodicals, Inc.)

Motivation: Our overall goal is to develop machine-learning approaches based on genomics and other relevant accessible information for use in predicting how a patient will respond to a given proposed drug or treatment. Given the complexity of this problem, we begin by developing, testing and analyzing learning methods using data from simulated systems, which allows us access to a known ground truth. We examine the benefits of using prior system knowledge and investigate how learning accuracy depends on various system parameters as well as the amount of training data available., Results: The simulations are based on Boolean networks-directed graphs with 0/1 node states and logical node update rules-which are the simplest computational systems that can mimic the dynamic behavior of cellular systems. Boolean networks can be generated and simulated at scale, have complex yet cyclical dynamics and as such provide a useful framework for developing machine-learning algorithms for modular and hierarchical networks such as biological systems in general and cancer in particular. We demonstrate that utilizing prior knowledge (in the form of network connectivity information), without detailed state equations, greatly increases the power of machine-learning algorithms to predict network steady-state node values ('phenotypes') and perturbation responses ('drug effects')., Availability and Implementation: Links to codes and datasets here: https://gray.mgh.harvard.edu/people-directory/71-david-craft-phd., Contact: dcraft@broadinstitute.org., Supplementary Information: Supplementary data are available at Bioinformatics online., (© The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com)

Purpose The purpose of this descriptive qualitative study was to explore cognitive, behavioral, and psychosocial challenges associated with having and/or parenting an adolescent with pediatric type 2 diabetes (T2D) from the perspectives of ethnic minority parents and adolescents. Methods Ethnic minority (79.2% non-Hispanic black, 29.6% Hispanic) adolescents (n = 14, 78.6% female, 14.7 ± 1.9 years) and their parents (n = 13, 100% female) participated in either individual family interviews or multifamily focus group sessions. Sessions were audio recorded, transcribed, and coded by a team of 4 raters. QSR NVivo 10 was used to perform a content analysis and to extract coded adolescent and parent responses. Results Six themes corresponding to 3 broad categories (cognitive, behavioral, and psychosocial challenges) emerged. Regarding cognitive challenges, families described difficulties learning about a new disease and managing youth knowledge deficits and/or superficial knowledge. In terms of behavioral challenges, parents and adolescents discussed ongoing difficulties with making and maintaining positive youth health behavior changes as well as with ensuring regimen adherence. Finally, managing youth emotions related to diabetes and navigating social relationships with peers and other family members around the disclosure of T2D were the primary psychosocial challenges to emerge. Conclusions Directions for future research include developing and evaluating brief family interventions and adolescent psychosocial screening measures. Recommendations for clinical practice include increasing family knowledge of T2D, enhancing parenting skills for managing youth behavior change, and conducting routine psychosocial screening during follow-up clinic visits.

Hispanic females in their late adolescence appear to be disproportionately affected by dating violence, yet the majority of victims never seek out formal services. The purpose of this study was to explore the dating violence and help-seeking experiences of Hispanic females in their late adolescence. Participants were recruited from a social service agency providing wrap-around services to individuals and families affected by abuse in South Florida. Eleven in-depth qualitative interviews were conducted with Hispanic female victims of dating violence in their late adolescence (18 to 24 years of age) in English or Spanish. A thematic analysis of transcripts identified four major themes: (a) conflict, culture, and context influences Hispanic couples; (b) missed opportunities to accessing help; (c) pivotal moments are needed to access formal services; and (d) family matters. Participants of this study believed that dating violence was more normative in Hispanic relationships than "American" relationships. Although participants had opportunities to seek formal services early in their relationships, formal services were only sought after pivotal moments. Families played an important role in supporting or further victimizing the participants. Findings from this study can be used to inform interventions addressing both informal and formal sources of support for Hispanic female victims of dating violence in their late adolescence.

The purpose of this literature review is to describe the state of the science on teen dating violence (TDV) research identifying support and barriers in accessing services. This review will help identify gaps in dating violence (DV) research and inform secondary and tertiary prevention services, as well as ways that these could be integrated into comprehensive primary prevention efforts. This review was conducted via electronic search through CINAHL, PubMed, and PsychINFO. Results show a serious lack of research in the content area and the importance of increasing research efforts in discovering supports for accessing DV services is emphasized.

Scanning Electron Microscopy (SEM) has long been the standard in imaging the sub-micrometer surface ultrastructure of both hard and soft materials. In the case of biological samples, it has provided great insights into their physical architecture. However, three of the fundamental challenges in the SEM imaging of soft materials are that of limited imaging resolution at high magnification, charging caused by the insulating properties of most biological samples and the loss of subtle surface features by heavy metal coating. These challenges have recently been overcome with the development of the Helium Ion Microscope (HIM), which boasts advances in charge reduction, minimized sample damage, high surface contrast without the need for metal coating, increased depth of field, and 5 angstrom imaging resolution. We demonstrate the advantages of HIM for imaging biological surfaces as well as compare and contrast the effects of sample preparation techniques and their consequences on sub-nanometer ultrastructure.

Countries have reached universal health coverage by different paths and with varying health systems. Nonetheless, the trajectory toward universal health coverage regularly has three common features. The first is a political process driven by a variety of social forces to create public programmes or regulations that expand access to care, improve equity, and pool financial risks. The second is a growth in incomes and a concomitant rise in health spending, which buys more health services for more people. The third is an increase in the share of health spending that is pooled rather than paid out-of-pocket by households. This pooled share is sometimes mobilised as taxes and channelled through governments that provide or subsidise care--in other cases it is mobilised in the form of contributions to mandatory insurance schemes. The predominance of pooled spending is a necessary condition (but not sufficient) for achieving universal health coverage. This paper describes common patterns in countries that have successfully provided universal access to health care and considers how economic growth, demographics, technology, politics, and health spending have intersected to bring about this major development in public health., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

At present, there exists no widely agreed upon set of study-design selection criteria for systematic reviews of health systems research, except for those proposed by the Cochrane Collaboration's Effective Practice and Organisation of Care (EPOC) review group (which comprises randomized controlled trials, controlled clinical trials, controlled before-after studies, and interrupted time series). We conducted a meta-review of the study-design selection criteria used in systematic reviews available in the McMaster University's Health Systems Evidence or the EPOC database. Of 414 systematic reviews, 13% did not indicate any study-design selection criteria. Of the 359 studies that described such criteria, 50% limited their synthesis to controlled trials and 68% to some or all of the designs defined by the EPOC criteria. Seven out of eight reviews identified at least one controlled trial that was relevant for the review topic. Seven percent of the reviews included either no or only one relevant primary study. Our meta-review reveals reviewers' preferences for restricting synthesis to controlled experiments or study designs that comply with the EPOC criteria. We discuss the advantages and disadvantages of the current practices regarding study-design selection in systematic reviews of health systems research as well as alternative approaches., (Copyright © 2012. Published by Elsevier Ireland Ltd.)

Existing techniques for electron- and ion-beam lithography, routinely employed for nanoscale device fabrication and mask/mold prototyping, do not simultaneously achieve efficient (low fluence) exposure and high resolution. We report lithography using neon ions with fluence <1 ion/nm(2), ∼1000× more efficient than using 30 keV electrons, and resolution down to 7 nm half-pitch. This combination of resolution and exposure efficiency is expected to impact a wide array of fields that are dependent on beam-based lithography.

As the miniaturization of semiconductor devices continues, characterization of dopant distribution within the structures becomes increasingly challenging. One potential solution is the use of the secondary electron signal produced in scanning electron (SEMs) or helium ion microscopes (HeIMs) to image the changes in electrical potential caused by the dopant atoms. In this article, the contrast mechanisms and resolution limits of secondary electron dopant contrast are explored. It is shown that the resolution of the technique is dependent on the extent of electrical potential present at a junction and that the resolution of dopant contrast can be improved in the HeIM after an in-situ plasma cleaning routine, which causes an oxide to form on the surface altering the contrast mechanism from electrical potential to material contrast.

As the global HIV/AIDS pandemic nears the end of its third decade, the challenges of efficient mobilisation of funds and management of resources are increasingly prominent. The aids2031 project modelled long-term funding needs for HIV/AIDS in developing countries with a range of scenarios and substantial variation in costs: ranging from US$397 to $722 billion globally between 2009 and 2031, depending on policy choices adopted by governments and donors. We examine what these figures mean for individual developing countries, and estimate the proportion of HIV/AIDS funding that they and donors will provide. Scenarios for expanded HIV/AIDS prevention, treatment, and mitigation were analysed for 15 representative countries. We suggest that countries will move in increasingly divergent directions over the next 20 years; middle-income countries with a low burden of HIV/AIDS will gradually be able to take on the modest costs of their HIV/AIDS response, whereas low-income countries with a high burden of disease will remain reliant upon external support for their rapidly expanding costs. A small but important group of middle-income countries with a high prevalence of HIV/AIDS (eg, South Africa) form a third category, in which rapid scale-up in the short term, matched by outside funds, could be phased down within 10 years assuming strategic investments are made for prevention and efficiency gains are made in treatment., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

China's current strategy to improve how health services are paid for is headed in the right direction, but much more remains to be done. The problems to be resolved, reflecting the setbacks of recent decades, are substantial: high levels of out-of-pocket payments and cost escalation, stalled progress in providing adequate health insurance for all, widespread inefficiencies in health facilities, uneven quality, extensive inequality, and perverse incentives for hospitals and doctors. China's leadership is taking bold steps to accelerate improvement, including increasing government spending on health and committing to reaching 100% insurance coverage by 2010. China's efforts are part of a worldwide transformation in the financing of health care that will dominate global health in the 21st century. The prospects that China will complete this transformation successfully in the next two decades are good, although success is not guaranteed. The real test, as other countries have experienced, will come when tougher reforms have to be introduced.

Medical and biochemical analysis were performed on 58 patients with chronic alcoholism. In accordance with medical characterisation, patients were divided in three groups: A (patients having only hepatopathy), B (patients with hepatopathy and neuropathy) and C (patients having only alcoholic neuropathy). Simultaneously, several parameters related to heme biosynthesis were examined. Urinary delta-aminolevulic acid (ALA), porphobilinogen (PBG) and porphyrins and fecal porphyrins measurements did not show significant difference among all studied groups. The activities of ALA-dehydratase (ALA-D), uroporphyrinogen-I-synthase (URO-I-S) and uroporphyrinogen-III-synthase (URO-III-S) were monitored in peripheral erythrocytes. From the enzymes measured, only ALA-D levels in groups B and C were significantly depressed (p < 0.002) compared with normal subjects. The decrease in ALA-D correlated with the degree of neuropathy.

There is a vast gap between methodology and practice in the analysis and assessment of health programs. This presents an acute problem in developing countries where resource allocation decisions at the tight budgetary margin have important practical consequences. The prospects for improving this primitive situation depend critically on progress in analysis of the affordability and effectiveness of health programs. The analysis of affordability--especially on the recurrent cost side--is a necessary condition which can help ensure that proposed programs are unlikely to be vulnerable to implementation delays or underfinancing of operating costs which may seriously compromise the benefits expected from new investments. Improved analysis of effectiveness is also essential in order to help planners choose the best pattern of resource use from among the various combinations of programs that are affordable. To do this will require the devotion of substantial analytical effort to fill the great void of organized empirical knowledge available to those seeking to assess the effectiveness of health interventions. In particular there must be a shift in focus from single interventions directed at communicable diseases in children to a broader concern with multi-purpose interventions, including those directed against the emerging problems of non-communicable disease in adults.