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Background: LGBTQ+ youth face myriad adverse health outcomes due to minority stress, creating a need for accessible, mechanism-targeted interventions to mitigate these minority stress-related risk factors. We tested the effectiveness and acceptability of Project RISE, an online single-session intervention designed to ameliorate internalized stigma and improve other outcomes among LGBTQ+ youth. We hypothesized that youth assigned to RISE (versus a control) would report significantly reduced internalized stigma and increased identity pride at post-intervention and at two-week follow-up and would find RISE acceptable. Methods: We recruited adolescents nationally through Instagram advertisements in May 2022 (N = 538; M age = 15.06, SD age = 0.97). Participants were randomly assigned to RISE or an information-only control and completed questionnaires pre-intervention, immediately post-intervention, and two weeks post-intervention. Inclusion criteria included endorsing: (1) LGBTQ+ identity, (2) age 13–16, (3) English fluency (4) Internet access, and (5) subjective negative impact of LGBTQ+ stigma. Results: Relative to participants in the control condition, participants who completed RISE reported significant decreases in internalized stigma (d = −0.49) and increases in identity pride (d = 0.25) from pre- to immediately post-intervention, along with decreased internalized stigma (d = −0.26) from baseline to two-week follow-up. Participants rated both RISE and the information-only control as highly, equivalently acceptable. Conclusions: RISE appears to be an acceptable and useful online SSI for LGBTQ+ adolescents, with potential to reduce internalized stigma in both the short- and longer-term. Future directions include evaluating effects of Project RISE over longer follow-ups and in conjunction with other mental health supports.

In the coal mining districts of the Netherlands, Belgium and Germany, we identified 662 previously unidentified depressions at the land surface using LIDAR data. Their density decreases westwards along with deepening of the Carboniferous coal layers, while not changing in dimensions. The timing of their formation based on historical maps and landowner reports, suggests that they mostly formed during the period 1920–1970, the peak of mining activity. Based on their position, density and age, we link the formation of depressions to the coal-mining activities in South Limburg, Germany and Belgium. Our working hypothesis tentatively explains the origin, mechanism of formation and timing of these local subsidence features.

In the Netherlands land subsidence is a continuously ongoing process. Consequently, an increasing number of people and economic assets are exposed to subsidence, damage costs are soaring, and flood risk and greenhouse gas emissions are increasing. In some areas tipping points have already been reached, where current land-use can no longer be maintained without considerable costs, underlining the urgency to take action. Together with a consortium consisting of universities, research institutes, governmental agencies, public and private partners we have developed a national, multidisciplinary research programme aiming to develop an integrative approach to achieve feasible, legitimate and sustainable solutions for managing the negative societal effects of land subsidence, connecting fundamental research on subsidence processes to socio-economic impact of subsidence and to governance and legal framework design. The program is designed to co-create insights that help to effectively mitigate and adapt to subsidence within the Netherlands by making major improvements in measuring and modeling the processes and consequences of subsidence, identifying, developing and critically evaluating control measures and designing governance and legal approaches that facilitate their implementation. Hereto we will develop (a) new satellite-based technology to measure, attribute and monitor subsidence, (b) solid understanding of the interacting multiple processes contributing to total subsidence, (c) sophisticated physical and economic numerical models to predict human-induced subsidence rates and impacts, and (d) implementation strategies that go beyond technical measures, to strengthen governance and financing capacities as well as legal frameworks. This fully integrated approach deals with all impacts of land subsidence on society and the economy.

The COVID-19 pandemic drastically affected higher education and higher education students around the world, but few studies of college students' experiences during the COVID-19 pandemic have been conducted in Latin America. This study describes the COVID-19-related experiences and perspectives of Peruvian college students. We surveyed 3,427 full-time college students (average age: 23 years) attending a multi-campus Peruvian university in fall 2020. Participants were recruited through the digital platform of the learning management system at their university, email, and social media. We asked participants how they were managing risks related to COVID-19; the continuity of social, educational, and work activities; and the psychological and economic impacts of the pandemic on their lives. Since March 2020, 73.0% of participants reported COVID-19-related symptoms, but only 33.9% were tested for COVID-19. During the national quarantine imposed by the Peruvian government (March 15-June 30, 2020), 64.3% of participants remained in their house. Furthermore, while 44.0% of participants were working in February 2020 (95% CI: [41.7%, 46.4%]), only 23.6% (95% CI: [21.7%, 25.7%]) were working immediately after the pandemic began (i.e., at the end of April 2020). Participants were more stressed about the health and educational implications of COVID-19 for Peruvian society and their families than about themselves. The public health, economic, and educational implications of COVID-19 on college students are continuing to unfold. This study informed Peruvian higher education institutions' continued response to the COVID-19 pandemic, the progressive return to postpandemic activities, as well as other future pandemics and other crises.

The COVID-19 pandemic revealed what educators, policymakers, and researchers have long known--namely, that learning opportunities and outcomes are intimately intertwined with other aspects of children's and families' lives. The list of social forces outside the education sector that can affect learning is endless and includes economic experiences that are inequitably distributed, such as housing security (Gallagher et al., 2020), income (Hoynes & Rothstein, 2019), and wealth (Pfeffer, 2018), as well as social experiences, such as interpersonal and structural racism, (dis)ability, and xenophobia (Anderson-Nathe, 2020; DeMatthews, 2020). Now, it is time to lock in this learning among policymakers, practitioners, and researchers. We posit that the concept of "social determinants of learning" can serve as a powerful reframing tool for promoting educational equity, similar to the conceptual shift and policy impact we have seen in public health as "social determinants of health" has become an accepted and eventually essential concept.

We discuss one of the oldest ambitions in U.S. education: that teachers should treat children as active learners, teaching should be intellectually engaging, teachers should respect students' thinking, and schools should cultivate thoughtful work. These ideas originated when Horace Mann and his allies campaigned for them. We revisit them and take up a key problem in the study of U.S. schooling: can those ambitions be turned into regular work in many classrooms?

Objective: The present study examines sociopolitical stress, coping, and well-being among college students. Participants: Young adult college students (N = 588; ages 18-29; 72% cisgender women) from 10 universities in the USA participated in this study. Methods: Participants completed a 45-minute online survey with closed-ended and open-ended questions, administered via Qualtrics. Results: Election-related sociopolitical stress was high with notable differences across students' demographic backgrounds (e.g., Hispanic/Latinx students, women, and sexual minority students reported high sociopolitical stress). Among those who reported being stressed by the election (N = 448), closed-ended and open-ended data reveal coping strategies including self-care, drugs and alcohol, and further civic action/political participation. Higher sociopolitical stress predicted more depression and many coping strategies were related with flourishing. Conclusions: Young adult college students are experiencing election-related sociopolitical stress and are coping in different ways. More work is needed to understand what coping strategies support well-being. Implications for colleges are discussed.

ObjectivesTo improve healthcare access for rural cisgender women and gender diverse Veterans, we created the “Boost Team,” a clinician-driven telehealth outreach service to connect this population to Veterans Health Administration (VHA) services.MethodsBetween 9/2021 and 2/2022, we conducted a needs assessment in the Veterans Integrated Service Network (VISN) 21 and used those data to develop an outreach intervention. We piloted a clinician-led outreach intervention in 3/2022, and formally deployed an outreach team in 9/2022.ResultsThe needs assessment uncovered opportunities to educate Veterans, staff, and clinicians about available VHA women's health services, and a need for easily-accessible gender-sensitive services. During the pilot, 58% (7/12) rural cisgender women Veterans were successfully contacted, all reported positive experiences with the intervention. The formal outreach team launched in 9/2022 and consists of a nurse practitioner (NP), scheduler, Peer Support Specialist, and medical director. From 9/2022 to 12/2022 the Boost NP called 110 rural cisgender women and gender diverse Veterans and spoke to 65 (59%) of them. Common care needs identified and addressed included care coordination, new referrals, medication management, and diagnostics.DiscussionData from Boost show that clinician-led outreach can engage rural cisgender women and gender diverse Veterans in VHA services, there is a desire for more gender-sensitive services, and there is a need for systems-level improvements to allow for improved care coordination and decreased leakage outside of VHA. Using robust strategies grounded in implementation sciences, we will continue conducting a program evaluation to study the impact of Boost and scale and expand the program.

Sociopolitical stress arises in reaction to awareness of, exposure to, and/or involvement in political events. Among a longitudinal cohort of 628 college students from 10 universities across the U.S., we explored trajectories of sociopolitical stress during the 2020 United States presidential election season and examined relationships to psychological well-being. Growth mixture modeling classified our sample into four subgroups each with distinct trajectories of sociopolitical stress: High and Decreasing, Moderate and Increasing, Consistently Low, and High-to-Low. Participants with lower levels of sociopolitical stress expressed higher psychological well-being (high flourishing, high optimism, low anxiety symptoms, low depressive symptoms). The High and Decreasing subgroup was associated with the highest levels of civic action. Participants in the High and Decreasing trajectory were 20 times more likely to identify as LGBQ+, and 4 times more likely to be a woman or a transgender/gender diverse student, compared to participants in the Consistently Low subgroup.

Introduction: Emotional and behavioral problems are growing among children ages birth to five, and racial/ethnic and socioeconomic disparities exist. Comprehensive, culturally responsive, family-driven systems of care, such as the one operated by California’s diverse, urban Alameda County, offer one potential intervention. Methods: We used client-level service data (n = 496 children) to calculate descriptive statistics and regression analyses (including multilevel models to account for observations for the same client at multiple points in time). We estimated the prevalence of mental health issues and assessed the association between the length of time using services and emotional and behavioral functioning. Results: Comprehensive mental health services and supports were associated with improved emotional and behavioral functioning outcomes for children over time, even after controlling for other risk factors. Discussion: Systems of care appear to support the multidimensional functioning of children and their families.

Pandemic restrictions aiming to curb the spread of COVID-19 in the U.S. impacted the quality, quantity and tenor of adolescents’ social relationships and shifted the context in which sensitive social learning is occurring. We conducted in-depth semi-structured interviews with 47 adolescents (ages 10–24) from December 2020–February 2021, coded them using ATLAS.ti, and employed qualitative, grounded theory methodology to explore the impact of COVID-19 pandemic restrictions on adolescents’ social relationships with peers and family members. Overall, the impact of the pandemic restrictions on young people’s social relationships was multidimensional and complex. Many participants experienced benefits to relationships with family members. In contrast, their relationships with peers were more negatively impacted by severe social distancing measures. Young people who underwent significant social transitions and those who identified as people of color or LGBTQ+ described more negative effects on their social relationships.

Background. Heart failure affects nearly 65 million people globally, resulting in recurrent hospital admissions and substantial healthcare expenditure. The use of morphine in the management of acute pulmonary oedema remains controversial, with conflicting guidance and significant variation in practice. Synthesised evidence is needed to inform standard treatment guidelines and clinical practice. Objective. To determine whether morphine should be used in the treatment of acute pulmonary oedema (APE) in adults. Methods. A rapid review of systematic reviews of randomised controlled trials or observational studies, and then randomised controlled trials, was conducted searching three electronic databases (PubMed, Embase, Cochrane Library) and one clinical trial registry on 12 February 2022. We used a prespecified protocol following Cochrane rapid review methods and aligned to the National Standard Treatment Guidelines and Essential Medicines List methodology. We first considered relevant high-quality systematic reviews of randomised controlled trials or observational studies, then (if required) randomised controlled trials to inform time-sensitive or urgent evidence requests, clinical practice, policy, or standard treatment guidelines. Results. We identified four systematic reviews of observational studies. The two most relevant, up-to-date, and highest-quality reviews were used to inform evidence for critical outcomes. Morphine may increase in-hospital mortality (odds ratio (OR) 1.78; 95% confidence interval (CI) 1.01 - 3.13; low certainty of evidence; six observational studies, n=151 735 participants), resulting in 15 more per 1 000 hospital deaths, ranging from 0 to 40 more hospital deaths. Morphine may result in a large increase in invasive mechanical ventilation (OR 2.72; 95% CI 1.09 - 6.80; low certainty of evidence; four observational studies, n=167 847 participants), resulting in 45 more per 1 000 ventilations, ranging from 2 more to 136 more. Adverse events and hospital length of stay were not measured across reviews or trials. Conclusion. Based on the most recent, relevant and best-available quality evidence, morphine use in adults with APE may increase in-hospital and all-cause mortality and may result in a large increase in the need for invasive mechanical ventilation compared to not using morphine. Recommending against the use of morphine in pulmonary oedema may improve patient outcomes. Disinvesting in morphine for this indication may result in cost savings, noting the possible accrued benefits of fewer patients requiring invasive ventilation and management of morphine-related side-effects.

The COVID-19 pandemic drew public attention to the essential work and vulnerability of low-income Latina immigrants. Less recognized were the ways immigrant community organizations mobilized under exceptional conditions to provide immediate support to their communities while continuing to work toward durable systematic change. This paper analyzes the approach of Mujeres Unidas y Activas (MUA) in the San Francisco Bay Area. Over three decades, MUA developed an organizing model that builds transformative relationships among peers and provides direct services and leadership development for civic engagement. MUA has a long history of research collaborations and self-study aligned with critical community-engaged research methods and values. In 2019, MUA formed a research team of its leaders and academics to analyze the impact of their model. Since data collection occurred between March 2020 and December 2022, the research also documented the organization’s response to COVID-19. This paper argues that specific organizational values and practices of liderazgo, apoyo, and confianza (leadership, support, and trust) proved to be particularly powerful resources for sustaining individuals and community work through the pandemic, enabling women who have experienced multiple forms of structural violence to perceive themselves as capable of healing themselves and their communities while working to address root causes of trauma and inequity.

Background. Data measured as key performance indicators (KPIs) are used internationally in emergency medicine to measure and monitor quality of care. The Department of Health in the Western Cape Province, South Africa, introduced time-based KPIs for emergency centres (ECs) in 2012.Objectives. To describe the most recently processed results of the audits conducted in Western Cape ECs between 2013 and 2014.Methods. A retrospective, descriptive study was conducted on data collected in the 6-monthly Western Cape EC triage and waiting time audits for 2013 - 2014. Time variables were analysed overall and per triage category. ECs in hospitals were compared with ECs in community health centres (CHCs). A descriptive analysis of the sample was undertaken. Proportions for categorical data are presented throughout. The continuous variable time was described using means and standard deviations. The χ2 test and Fisher’s exact test were used to describe associations. The level of significance was p

Background. Warfarin is the most commonly used anticoagulant for both primary and secondary prevention of thromboembolism. For anticoagulation efficacy, the international normalised ratio (INR) needs to be within the therapeutic range for at least 65% of time on warfarin.Objectives. To describe INR control in patients on long-term warfarin and identified predictors of good INR control at two dedicated warfarin follow-up clinics in Cape Town, South Africa (SA).Methods. We reviewed clinical records of patients in care at the INR clinics at Mitchell’s Plain Community Health Centre and Groote Schuur Hospital. We included patients who had been on warfarin therapy for at least 27 months and excluded patients with 70-day gap between INR tests in the calculation period, and if >25% of follow-up time was at an alternative site. The time in therapeutic range (TTR) over 180 days using the Rosendaal method was calculated, and we categorised INR control as good if the TTR was ≥65%. We constructed a multivariate logistic regression model to identify associations with good INR control.Results. We included 363 patients, with a median age of 55 years (interquartile range (IQR) 44 - 64), of whom 65.6% were women. The most common indications for warfarin were valvular heart disease (45.7%) and atrial fibrillation (25.1%). The mean TTR was 47%, with only 91/363 patients having good INR control. In a multivariate model adjusted for age, sex, clinic and target INR, patients aged ≥55 years were more likely to have good INR control than younger patients (adjusted odds ratio 1.69, 95% confidence interval 1.03 - 2.79). Poorly controlled patients had more frequent INR monitoring than those with good INR control, with a median of 8 INRs (IQR 6 - 10) v. 6 INRs (IQR 5 - 8) in the 180-day period (p