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To date, the history of colonialism has permeated nearly every aspect of our conceptions, structures, and practices of global health; yet, there are no published medical school curricula aimed at promoting decoloniality in global health. We developed a pilot course for medical students to examine the history of colonialism, power, and positionality; promote self-reflection; and teach strategies for dismantling coloniality in global health. This five-part course was offered to students completing a scholarly project in global health with a mixed in-person/virtual format and online pre-session preparation materials. A pre-course survey on prior experiences in global health and self-efficacy was administered, and a reflection piece was analyzed for themes. After completion of the course, the students again completed the self-efficacy questionnaire, a course feedback survey and a semi-structured interview that was analyzed for themes. On average, the students felt that the course was relevant to their global health scholarly project and that the course met their learning objectives. There was a trend toward increased self-efficacy in decoloniality knowledge and skills following the course. In the post-course structured interviews, students raised issues reflected in the course materials including local project leadership; how identity, privilege and positionality influence relationships and the ability to attain mutual trust; project sustainability; and power dynamics. Undergraduate medical education in global health equity and decoloniality can play an important role in teaching future generations to dismantle the colonialism ingrained in global health and reimagine a global health practice based on equitable partnerships, community needs, and local leadership.

The most studied cavefish in the world is Astyanax mexicanus, and the most frequently used specimens in research come from the Pachón cave in Northeast Mexico. A recent study using the capture–mark–recapture technique revealed that the Pachón population size is only in the hundreds of individuals, not in the thousands. This result raises serious concerns about their long-term survival and highlights the need to accurately estimate the population size of other Astyanax caves. In our study, we used a well-established, non-invasive method for estimating population size: the transect sampling method, which counts the abundance of organisms along a line at regular intervals. We used the 310 m long Sabinos Cave’s Pool #1 for measurements and estimated a population of 1142 individuals. Most importantly, we found that cavefish are not distributed uniformly: 68% of the individuals were clustered under a bat roost. To corroborate this observation, we used drones to explore submerged galleries inaccessible to scientists. Results from the Toro/Calera Cave system confirmed that most galleries were essentially void of cavefish, except for in those few areas with high amounts of nutrients. Scientists visiting the most studied Astyanax localities (Pachón, Sabinos, Tinaja, and Chica) experience what appear to be high-density populations of about 10 fish/m2, possibly because the pool they visit happens to be under bat roosts. Our study shows that one cannot extrapolate the density at these localities to the rest of the habitat, where densities might be two orders of magnitude lower. Future studies should consider that the apparent high density at visited sites is overrepresenting the total population size when calculating the number of fish specimens to be captured.

Abstract Background Long-read sequencing platforms offered by Oxford Nanopore Technologies (ONT) allow native DNA containing epigenetic modifications to be directly sequenced, but can be limited by lower per-base accuracies. A key step post-sequencing is basecalling, the process of converting raw electrical signals produced by the sequencing device into nucleotide sequences. This is challenging as current basecallers are primarily based on mixtures of model species for training. Here we utilise both ONT PromethION and higher accuracy PacBio Sequel II HiFi sequencing on two plants, Phebalium stellatum and Xanthorrhoea johnsonii, to train species-specific basecaller models with the aim of improving per-base accuracy. We investigate sequencing accuracies achieved by ONT basecallers and assess accuracy gains by training single-species and species-specific basecaller models. We also evaluate accuracy gains from ONT’s improved flowcells (R10.4, FLO-PRO112) and sequencing kits (SQK-LSK112). For the truth dataset for both model training and accuracy assessment, we developed highly accurate, contiguous diploid reference genomes with PacBio Sequel II HiFi reads. Results Basecalling with ONT Guppy 5 and 6 super-accurate gave almost identical results, attaining read accuracies of 91.96% and 94.15%. Guppy’s plant-specific model gave highly mixed results, attaining read accuracies of 91.47% and 96.18%. Species-specific basecalling models improved read accuracy, attaining 93.24% and 95.16% read accuracies. R10.4 sequencing kits also improve sequencing accuracy, attaining read accuracies of 95.46% (super-accurate) and 96.87% (species-specific). Conclusions The use of a single mixed-species basecaller model, such as ONT Guppy super-accurate, may be reducing the accuracy of nanopore sequencing, due to conflicting genome biology within the training dataset and study species. Training of single-species and genome-specific basecaller models improves read accuracy. Studies that aim to do large-scale long-read genotyping would primarily benefit from training their own basecalling models. Such studies could use sequencing accuracy gains and improving bioinformatics tools to improve study outcomes.

Inflammatory processes are increased by stress and contribute to the pathology of mood disorders. Stress is thought to primarily induce inflammation through peripheral and central noradrenergic neurotransmission. In healthy individuals, these pro-inflammatory effects are countered by glucocorticoid signaling, which is also activated by stress. In chronically stressed individuals, the anti-inflammatory effects of glucocorticoids are impaired, allowing pro-inflammatory effects to go unchecked. Mechanisms underlying this glucocorticoid resistance are well understood, but the precise circuits and molecular mechanisms by which stress increases inflammation are not as well known. In this narrative review, we summarize the mechanisms by which chronic stress increases inflammation and contributes to the onset and development of stress-related mood disorders. We focus on the neural substrates and molecular mechanisms, especially those regulated by noradrenergic signaling, that increase inflammatory processes in stressed individuals. We also discuss key knowledge gaps in our understanding of the communication between nervous and immune systems during stress and considerations for future therapeutic strategies. Here we highlight the mechanisms by which noradrenergic signaling contributes to inflammatory processes during stress and how this inflammation can contribute to the pathology of stress-related mood disorders. Understanding the mechanisms underlying crosstalk between the nervous and immune systems may lead to novel therapeutic strategies for mood disorders and/or provide important considerations for treating immune-related diseases in individuals suffering from stress-related disorders.

ObjectivesThe #MeToo social media campaign raised awareness about sexual harassment. The purpose of the current study was to address three unexplored research questions. First, what factors influenced whether a person posted #MeToo? Second, how did posting (or not) influence participants' wellbeing? Finally, what motivated participants' posting (or not) #MeToo?MethodThis mixed-methods study explores how #MeToo was experienced by full-time employees (N = 395) who could have posted #MeToo (i.e., experienced a sexual harassment event), whether or not they did so. Participants completed surveys in July of 2018 assessing social media use, sexual harassment history, relational variables such as relative power and social support, and job and life satisfaction. Participants also responded to open-ended survey questions about the context of and decisions about #MeToo posting.ResultsQuantitative results indicated that sexual harassment history was the most powerful predictor of #MeToo posting, while power and interpersonal contact also contributed. Qualitative analyses (N = 74) using a grounded theory approach indicated themes associated with decisions to disclose, including feeling a responsibility to post, need for support, and affective benefits. Decisions not to disclose were event-related negative affect, posting-related negative affect, timing of the event, fit with the #MeToo movement, privacy concerns, and fear of consequences.ConclusionThis study contributes to the literature on sexual harassment disclosure by focusing on informal means of disclosure and drawing on comparisons to formal reporting and implications for workplaces. Online sexual harassment disclosure, in many ways, reflects the impediments to formal reporting procedures. Given the increased use of social media for purposes of disclosure, these findings suggests that organizations should recognize the legitimacy of sexual harassment reports made online and consider the possible failings of their formal reporting systems as reasons for online disclosure.

High temperature is a limiting factor in the seed germination of most crops. This study evaluated the effects of hydropriming at 6, 12 and 18 h on germination performance and seedling establishment of sunflower seeds under high air temperature. Results showed that germination of unprimed seeds was suppressed at an average elevated temperature of 44.3 °C (range of 39.3 °C to 53.3 °C) for eighteen days indicated by an increased lag time to onset of germination and decreased germination percentage. Conversely, priming seeds for 12 h to 18 h increased the germination percentage, time to 50% seedling emergence (T50), germination index and vigour index. Seedlings emerging from primed seeds exhibited uniform 16-day old seedlings (18 days after sowing), leading to greater seedling dry weight and shoot length as compared to unprimed seeds. Conversely, the total chlorophyll content remain unchanged for all seeds. The significant increase in the shoot parameters suggested a positive association with priming and stress tolerance. The priming duration of 12 h to 18 h showed improvement at elevated air temperature through the reduction of ungerminated seeds and increase in seedling growth characteristics.

Abstract Background P-glycoprotein (P-gp) plays a critical role in protection of the intestinal epithelia by mediating efflux of drugs/xenobiotics from the intestinal mucosa into the gut lumen. Recent studies bring to light that P-gp also confers a critical link in communication between intestinal mucosal barrier function and the innate immune system. Yet, despite knowledge for over 10 years that P-gp plays a central role in gastrointestinal homeostasis, the precise molecular mechanism that controls its functional expression and regulation remains unclear. Here, we assessed how the intestinal microbiome drives P-gp expression and function. Results We have identified a “functional core” microbiome of the intestinal gut community, specifically genera within the Clostridia and Bacilli classes, that is necessary and sufficient for P-gp induction in the intestinal epithelium in mouse models. Metagenomic analysis of this core microbial community revealed that short-chain fatty acid and secondary bile acid production positively associate with P-gp expression. We have further shown these two classes of microbiota-derived metabolites synergistically upregulate P-gp expression and function in vitro and in vivo. Moreover, in patients suffering from ulcerative colitis (UC), we find diminished P-gp expression coupled to the reduction of epithelial-derived anti-inflammatory endocannabinoids and luminal content (e.g., microbes or their metabolites) with a reduced capability to induce P-gp expression. Conclusion Overall, by means of both in vitro and in vivo studies as well as human subject sample analysis, we identify a mechanistic link between cooperative functional outputs of the complex microbial community and modulation of P-gp, an epithelial component, that functions to suppress overactive inflammation to maintain intestinal homeostasis. Hence, our data support a new cross-talk paradigm in microbiome regulation of mucosal inflammation. Video abstract

Abstract Background Low birthweight (LBW) (

Summary: Although optical microscopy has allowed scientists to study the entire brain in early developmental stages, access to the brains of live, adult vertebrates has been limited. Danionella, a genus of miniature, transparent fish closely related to zebrafish has been introduced as a neuroscience model to study the adult vertebrate brain. However, the extent of optically accessible depth in these animals has not been quantitatively characterized. Here, we show that both two- and three-photon microscopy can access the entire depth and rostral-caudal extent of the adult wildtype Danionella dracula brain without any modifications to the animal other than mechanical stabilization. Three-photon microscopy provides higher signal-to-background ratio and optical sectioning of fluorescently labeled vasculature through the deepest part of the brain, the hypothalamus. Hence, we use multiphoton microscopy to penetrate the entire adult brain within the geometry of this genus’ head structures and without the need for pigment removal.

Introduction Reproductive injustices such as forced sterilization, preventable maternal morbidity and mortality, restricted access to family planning services, and policy-driven environmental violence undermine reproductive autonomy and health outcomes, with disproportionate impact on historically marginalized communities. However, curricula focused on reproductive justice (RJ) are lacking in medical education. Methods We designed a novel, interactive, case-based RJ curriculum for postclerkship medical students. This curriculum was created using published guidelines on best practices for incorporating RJ in medical education. The session included a prerecorded video on the history of RJ, an article, and four interactive cases. Students engaged in a 2-hour small-group session, discussing key learning points of each case. We evaluated the curriculum's impact with a pre- and postsurvey and focus group. Results Sixty-eight students participated in this RJ curriculum in October 2020 and March 2021. Forty-one percent of them completed the presurvey, and 46% completed the postsurvey. Twenty-two percent completed both surveys. Ninety percent of respondents agreed that RJ was relevant to their future practice, and 87% agreed that participating in this session would impact their clinical practice. Most respondents (81%) agreed that more RJ content is needed. Focus group participants appreciated the case-based, interactive format and the intersectionality within the cases. Discussion This interactive curriculum is an innovative and effective way to teach medical students about RJ and its relevance to clinical practice. Walking alongside patients as they accessed reproductive health care in a case-based curriculum improved students’ comfort and self-reported knowledge on several RJ topics.

Introduction The WHO Nutrition Target aims to reduce the global prevalence of low birth weight by 30% by the year 2025. The Enhancing Nutrition and Antenatal Infection Treatment (ENAT) study will test the impact of packages of pregnancy interventions to enhance maternal nutrition and infection management on birth outcomes in rural Ethiopia.Methods and analysis ENAT is a pragmatic, open-label, 2×2 factorial, randomised clinical effectiveness study implemented in 12 rural health centres in Amhara, Ethiopia. Eligible pregnant women presenting at antenatal care (ANC) visits at

Abstract Background The World Health Organization (WHO) published the WHO Safe Childbirth Checklist in 2015, which included the key evidence-based practices to prevent the major causes of maternal and neonatal morbidity and mortality during childbirth. We assessed the current use of the WHO Safe Childbirth Checklist (SCC) and adaptations regarding the SCC tool and implementation strategies in different contexts from Africa, Southeast Asia, Europe, and North America. Methods This explanatory, sequential mixed methods study—including surveys followed by interviews—of global SCC implementers focused on adaptation and implementation strategies, data collection, and desired improvements to support ongoing SCC use. We analyzed the survey results using descriptive statistics. In a subset of respondents, follow-up virtual semi-structured interviews explored how they adapted, implemented, and evaluated the SCC in their context. We used rapid inductive and deductive thematic analysis for the interviews. Results Of the 483 total potential participants, 65 (13.5%) responded to the survey; 55 completed the survey (11.4%). We analyzed completed responses from those who identified as having SCC implementation experience (n = 29, 52.7%). Twelve interviews were conducted and analyzed. Ninety percent of respondents indicated that they adapted the SCC tool, including adding clinical and operational items. Adaptations to structure included translation into local language, incorporation into a mobile app, and integration into medical records. Respondents reported variation in implementation strategies and data collection. The most common implementation strategies were meeting with stakeholders to secure buy-in, incorporating technical training, and providing supportive supervision or coaching around SCC use. Desired improvements included clarifying the purpose of the SCC, adding guidance on relevant clinical topics, refining items addressing behaviors with low adherence, and integrating contextual factors into decision-making. To improve implementation, participants desired political support to embed SCC into existing policies and ongoing clinical training and coaching. Conclusion Additional adaptation and implementation guidance for the SCC would be helpful for stakeholders to sustain effective implementation.

As solid organ transplantation becomes more prevalent, more individuals are living as members of the immunosuppressed population with an elevated risk for cutaneous squamous cell carcinoma (cSCC). Although great progress has been made in understanding the pathogenesis of cSCC in general, little is known about the drivers of tumorigenesis in immunosuppressed patients and organ-transplant recipients, specifically. This systematic review sought to synthesize information regarding the genetic and epigenetic alterations as well as changes in protein and mRNA expression that place this growing population at risk for cSCC, influence treatment response, and promote tumor aggressiveness. This review will provide investigators with a framework to identify future areas of investigation and clinicians with additional insight into how to best manage these patients.

The COVID-19 pandemic brought abrupt changes to teaching that caused increased stress amid an already difficult time. Whether teaching remote, hybrid, or in-person, university faculty were expected to continue teaching throughout the pandemic, despite personal challenges at home. In addition, there were expectations that faculty show greater levels of compassion towards their students. Multiple articles brought attention to these struggles and questioned whether university faculty might be experiencing compassion fatigue--a state of emotional exhaustion brought on by secondary traumatic stress and characterized by a reduced capacity for empathy. Using data from a larger, longitudinal qualitative study of faculty members' experiences during the pandemic, the present study aims to understand faculty experiences of emotional labor and compassion fatigue during this time. Unsurprisingly, most participants reported an increase in emotional labor during the early pandemic; however, roughly one in four described their emotional labor loads as unchanged or even decreased. In those cases, participants often described active disengagement practices in the workplace, or methods of "guarding one's time." Overall, compassion fatigue was less evident than anticipated, but there were identifiable signs of burnout among participants. This finding alone suggests a need for additional research to better conceptualize and operationalize the two terms.

Interest in ecoacoustics has resulted in an influx of acoustic data and novel methodologies to classify and relate landscape sound activity to biodiversity and ecosystem health. However, indicators used to summarize sound and quantify the effects of disturbances on biodiversity can be inconsistent when applied across ecological gradients. This study used an acoustic dataset of 487,148 min from 746 sites collected over 4 years across Sonoma County, California, USA, by citizen scientists. We built a custom labeled dataset of soundscape components and applied a deep learning framework to test our ability to predict these soundscape components: human noise (Anthropophony), wildlife vocalizations (Biophony), weather phenomena (Geophony), Quiet periods, and microphone Interference. These soundscape components allowed us to balance predicting variation in environmental recordings and relative time to build a custom labeled dataset. We used these data to quantify soundscape patterns across space and time that could be useful for environmental planning, ecosystem conservation and restoration, and biodiversity monitoring. We describe a pre-trained convolutional neural network, fine-tuned with our sound reference data, with classification achieving an overall F0.75-score of 0.88, precision of 0.94, and recall of 0.80 across the five target soundscape components. We deployed the model to predict soundscape components for all acoustic data and assess their hourly patterns. We noted an increase in Biophony in the early morning and evening, coinciding with peak animal community vocalization (e.g., dawn chorus). Anthropophony increased during morning/daylight hours and was lowest in the evenings, coinciding with diurnal patterns in human activity. Further, we examined soundscape patterns related to geographic properties at recording sites. Anthropophony decreased with increasing distance to major roads, while Quiet increased. Biophony and Quiet were comparable to Anthropophony at more urban/developed and agriculture/barren sites, while Biophony and Quiet were significantly higher than Anthropophony at less-developed shrubland, oak woodland, and conifer forest sites. These results demonstrate that acoustic classification of broad soundscape components is possible with small datasets, and classifications can be applied to a large acoustic dataset to gain ecological knowledge.

Abstract Background Despite the growing number of patients with limited English proficiency in the United States, not all medical schools offer medical language courses to train future physicians in practicing language-concordant care. Little is known about the long-term use of non-English languages among physicians who took language courses in medical school. We conducted a cross-sectional study to characterize the professional language use of Harvard Medical School (HMS) alumni who took a medical language course at HMS and identify opportunities to improve the HMS Medical Language Program. Methods Between October and November 2019, we sent an electronic survey to 803 HMS alumni who took a medical language course at HMS between 1991 and 2019 and collected responses. The survey had questions about the language courses and language use in the professional setting. We analyzed the data using descriptive statistics and McNemar’s test for comparing proportions with paired data. The study was determined not to constitute human subjects research. Results The response rate was 26% (206/803). More than half of respondents (n = 118, 57%) cited their desire to use the language in their future careers as the motivation for taking the language courses. Twenty-eight (14%) respondents indicated a change from not proficient before taking the course to proficient at the time of survey whereas only one (0.5%) respondent changed from proficient to not proficient (McNemar’s p-value

Abstract Background Child maltreatment (CM) is a major public health problem, affecting many lives, in the short and long term, and costing individuals, families, and society dearly. There is a need for broad implementation of evidence-based preventive interventions, such as the Safe Environment for Every Kid (SEEK) model, developed for pediatric primary care. Primary care offers an excellent opportunity to help address prevalent psychosocial problems (e.g., parental depression) that are risk factors for CM. By addressing such problems, SEEK can strengthen families and support parents; promote children’s health, development, and safety; help prevent CM; and benefit the health of the US population. This study will examine intervention strategies for optimizing SEEK’s adoption, implementation, and sustainment, and its effectiveness in preventing CM. Despite strong evidence from two federally funded randomized controlled trials, SEEK has not been widely adopted. The goal of this study is to examine technology-driven implementation strategies to scale-up SEEK—in pediatric and family medicine primary care settings. The aims are to (1) evaluate the effectiveness of training strategies on SEEK’s implementation in primary care practices, (2) evaluate barriers and facilitators to successful implementation and sustainment of SEEK, and (3) examine the model’s effectiveness in preventing CM and the economic costs of implementing SEEK. Methods This randomized type III hybrid mixed methods design will examine how advances in medical training can bolster SEEK’s adoption and implementation in pediatric and family medicine practices in different regions of the USA. These are independent online training and in-depth structured training via a quality improvement project, approved by the American Boards of Pediatrics and of Family Medicine. We will also evaluate SEEKonline, software that assists primary care practitioners implement the model, and a “Traditional” paper and pencil strategy for their impact on implementation. The study uses the EPIS framework and the Universal Stages of Implementation Completion, quantitative measures, qualitative interviews, and data abstracted from electronic health records. Discussion The knowledge gained should improve pediatric primary care to better address prevalent social determinants of health, benefiting many children and families. The outcomes should enhance the field of implementation science and guide future interventions in primary care. Trial registration NCT03642327 , Clinical Trials, registered August 21, 2018.

Abstract Background Despite extensive efforts to develop and refine intervention packages, complex interventions often fail to produce the desired health impacts in full-scale evaluations. A recent example of this phenomenon is BetterBirth, a complex intervention designed to implement the World Health Organization’s Safe Childbirth Checklist and improve maternal and neonatal health. Using data from the BetterBirth Program and its associated trial as a case study, we identified lessons to assist in the development and evaluation of future complex interventions. Methods BetterBirth was refined across three sequential development phases prior to being tested in a matched-pair, cluster randomized trial in Uttar Pradesh, India. We reviewed published and internal materials from all three development phases to identify barriers hindering the identification of an optimal intervention package and identified corresponding lessons learned. For each lesson, we describe its importance and provide an example motivated by the BetterBirth Program’s development to illustrate how it could be applied to future studies. Results We identified three lessons: (1) develop a robust theory of change (TOC); (2) define optimization outcomes, which are used to assess the effectiveness of the intervention across development phases, and corresponding criteria for success, which determine whether the intervention has been sufficiently optimized to warrant full-scale evaluation; and (3) create and capture variation in the implementation intensity of components. When applying these lessons to the BetterBirth intervention, we demonstrate how a TOC could have promoted more complete data collection. We propose an optimization outcome and related criteria for success and illustrate how they could have resulted in additional development phases prior to the full-scale trial. Finally, we show how variation in components’ implementation intensities could have been used to identify effective intervention components. Conclusion These lessons learned can be applied during both early and advanced stages of complex intervention development and evaluation. By using examples from a real-world study to demonstrate the relevance of these lessons and illustrating how they can be applied in practice, we hope to encourage future researchers to collect and analyze data in a way that promotes more effective complex intervention development and evaluation. Trial registration ClinicalTrials.gov , NCT02148952; registered on May 29, 2014

Abstract Background The BetterBirth trial tested the effect of a peer coaching program around the WHO Safe Childbirth Checklist for birth attendants in primary-level facilities in Uttar Pradesh, India on a composite measure of perinatal and maternal mortality and maternal morbidity. This study aimed to examine the adherence to essential birth practices between two different cadres of birth attendants—nurses and auxiliary nurse midwives (ANMs)—during and after a peer coaching intervention for the WHO Safe Childbirth Checklist. Methods This is a secondary analysis of birth attendant characteristics, coaching visits, and behavior uptake during the BetterBirth trial through birth attendant surveys, coach observations, and independent observations. Descriptive statistics were calculated overall, and by staffing cadre (staff nurses and ANMs) for demographic characteristics. Logistic regression using the Pearson overdispersion correction (to account for clustering by site) was used to assess differences between staff nurses and ANMs in the intervention group during regular coaching (2-month time point) and 4 months after the coaching program ended (12-month time point). Results Of the 570 birth attendants who responded to the survey in intervention and control arms, 474 were staff nurses (83.2%) and 96 were ANMs (16.8%). In the intervention arm, more staff nurses (240/260, 92.3%) received coaching at all pause points compared to ANMs (40/53, 75.5%). At baseline, adherence to practices was similar between ANMs and staff nurses (~ 30%). Overall percent adherence to essential birth practices among ANMs and nurses was highest at 2 months after intervention initiation, when frequent coaching visits occurred (68.1% and 64.1%, respectively, p = 0.76). Practice adherence tapered to 49.2% among ANMs and 56.1% among staff nurses at 12 months, which was 4 months after coaching had ended (p = 0.68). Conclusions Overall, ANMs and nurses responded similarly to the coaching intervention with the greatest increase in percent adherence to essential birth practices after 2 months of coaching and subsequent decrease in adherence 4 months after coaching ended. While coaching is an effective strategy to support some aspects of birth attendant competency, the structure, content, and frequency of coaching may need to be customized according to the birth attendant training and competency. Trial registration ClinicalTrials.gov: NCT2148952; Universal Trial Number: U1111–1131-5647.

# Background The World Health Organization (WHO) Safe Childbirth Checklist (SCC) was published in 2015 as a patient safety tool to improve facility-based childbirth care through boosting adherence with essential practices around the major causes of maternal and newborn morbidity and mortality. We brought together partners who led implementation of the SCC in India and Rwanda to: (i) contextualize the findings from surveys and interviews about SCC adaptation and implementation around the world (data published separately) with our partners’ implementation experiences in India and Rwanda, and (ii) identify promising practices for SCC implementation. # Methods We identified two partners--one from Tamil Nadu, India and one from Masaka District, Rwanda--to work together in identifying key promising practices regarding the SCC based on their direct experiences and data we collected from other implementers around the world. From June-September 2020, we held 4 virtual design workshops using brainwriting exercises to explore promising practices for adaptation and implementation of the SCC. We consolidated the implementation experiences in India and Rwanda into the WHO SCC Implementation Guide phases of Engage, Launch, and Support, and included two additional phases: Project Design and Evaluation. # Results We present two case studies of SCC implementation that demonstrate improved adherence with essential birth practices after implementation of the SCC. Based on the case studies, we developed promising practices according to five implementation stages: Project Design, Engage, Launch, Support, and Evaluation. Clarifying the purpose and users of the tool, applying human-centered design principles, and developing evaluation plans for the specified purpose were some promising practices that emerged. # Conclusions Our partnership with direct implementers of the SCC yielded important insights about how to adapt, implement, evaluate, and sustain use of the Checklist. Such partnerships are critical in building an evidence base for promising practices regarding SCC implementation around the world.

The experimental data collected during the S515 experiment performed by the R3B collaboration at GSI/FAIR represent a great opportunity to investigate nucleon knockout reactions of exotic nuclei in the region of Sn using complete kinematics measurements. These cross sections can be used in the future to investigate the quenching in the knockout of the minority species (neutrons or protons) in nuclei far from stability. Some of the arguments put forward are the underestimation of the knockout of deeply bound nucleons, final state interactions or the role of short-range correlations (SRC). Recently, several works based on inclusive measurements have shown that these SRCs could reduce the single nucleon knockout cross sections by around 50%, depending on the neutron excess (N/Z) of the initial projectile. The S515 data can help us to go further in this investigation because it allows to correlate the knockout cross sections of one, two or more nucleons with the number of protons and neutrons emitted from the target and which can be detected by the CALIFA and NeuLAND detectors, respectively, and perform complete kinematical studies on the nature of the event (SRC, evaporation, emission of clusters, final-state interactions...). Here the results obtained for the charge distribution of reaction residues are presented, which is one of the first steps of the still on-going analysis.

A new experimental fission approach is presented in the context of the R3B (Reactions with Relativistic Radioactive Beams) collaboration, at the GSI/FAIR facility, in which knockout reactions in inverse kinematics are used to induce fission of 238U that will allow to characterise the excitation energy of the fission process and all the fission products. The CALIFA (CALorimeter for In-Flight detection of γ-rays and high energy charged pArticles) calorimeter, a key part of the R3B set-up, is used to reconstruct the momenta of the two protons from the (p, 2p) reactions. Preliminary results show that kinematic variables and first estimates for nucleon-removal cross sections are well reconstructed and in good agreement with other experimental measurements.

Nuclear fission is a complex dynamical process, whose description involves the coupling between intrinsic and collective degrees of freedom, as well as different quantum-mechanical phenomena. For this reason, to this day it still lacks a satisfactory and complete microscopic description. In addition to the importance of describing fission itself, studies of the r-process in astrophysics depend on fission observables to constrain the theoretical models that explain the isotopic abundances in the Universe. To improve on the existing data, fission reactions of heavy nuclei in inverse kinematics are produced in quasi-free (p,2p) scattering reactions, which induce fission through particle-hole excitations that can range from few to tens of MeV. In order to study the evolution of the fission yields with temperature, the excitation energy of the fissioning system must be reconstructed, which is possible by measuring the four-momenta of the two outgoing protons. Performing this kind of experiment requires a complex experimental setup, providing full isotopic identification of both fission fragments and an accurate measurement of the momenta of the two outgoing protons. This was realized recently at the GSI/FAIR facility and some of the results obtained for the charge distributions are presented in this work.

Abstract We live in a world of incredible linguistic diversity; nearly 7000 languages are spoken globally and at least 350 are spoken in the United States. Language-concordant care enhances trust between patients and physicians, optimizes health outcomes, and advances health equity for diverse populations. However, historical and contemporary trauma have impaired trust between communities of color, including immigrants with limited English proficiency, and physicians in the U.S. Threats to informed consent among patients with limited English proficiency persist today. Language concordance has been shown to improve care and serves as a window to broader social determinants of health that disproportionately yield worse health outcomes among patients with limited English proficiency. Language concordance is also relevant for medical students engaged in health care around the world. Global health experiences among medical and dental students have quadrupled in the last 30 years. Yet, language proficiency and skills to address cultural aspects of clinical care, research and education are lacking in pre-departure trainings. We call on medical schools to increase opportunities for medical language courses and integrate them into the curriculum with evidence-based teaching strategies, content about health equity, and standardized language assessments. The languages offered should reflect the needs of the patient population both where the medical school is located and where the school is engaged globally. Key content areas should include how to conduct a history and physical exam; relevant health inequities that commonly affect patients who speak different languages; cultural sensitivity and humility, particularly around beliefs and practices that affect health and wellbeing; and how to work in language-discordant encounters with interpreters and other modalities. Rigorous language assessment is necessary to ensure equity in communication before allowing students or physicians to use their language skills in clinical encounters. Lastly, global health activities in medical schools should assess for language needs and competency prior to departure. By professionalizing language competency in medical schools, we can improve patients’ trust in individual physicians and the profession as a whole; improve patient safety and health outcomes; and advance health equity for those we care for and collaborate with in the U.S. and around the world.

Compared to other Mexican states, Chiapas possessed the lowest rate of contraception use among women 15−49 years old (44.6%) in 2018. This convergent mixed-methods study assessed family planning use, perceptions, and decision-making processes among women and men in rural communities where Compañeros En Salud (CES) works in Chiapas, Mexico. We conducted surveys of reproductive-aged women and semi-structured interviews with reproductive-aged women, men, and physicians completing their social-service year in CES communities from 2016 to 2017. Of the 625 survey respondents, 368 (58.9%) reported using contraception. The most common methods were female sterilization (27.7%), bimonthly injection (10.9%), and the implant (10.9%). Interviews were completed with 27 women, 24 men, and 5 physicians and analyzed through an inductive approach. Common reasons for contraception use were preventing pregnancy, lack of resources for additional children, and birth spacing. Adverse effects, influence of male partners, and perceived lack of need emerged as reasons for non-use. Male partners often made the final decision about contraceptive use, while women often chose what method. Physicians reported adverse effects, misconceptions about methods, and lack of women’s autonomy as barriers to contraception use. Given misconceptions about contraception methods and the dominant role of men in contraception decision-making, our study illustrates the importance of effective counseling and equitable gender dynamics for family planning programming in rural Chiapas.

This study investigates the extent of implementation of blended learning in senior high school (SHS) science education as to the content, communication, technology, pedagogy, and assessment vis-à-vis students' academic achievement. In this analytical research design, data were gathered from 182 students and 12 science teachers using stratified random sampling. Gathered data were systematically treated and analyzed utilizing descriptive and inferential statistics such as frequency, percentage count, mean, standard deviation, one-way analysis of variance (ANOVA), and Pearson Product-Moment Correlation. Findings revealed the extent of implementation of blended learning in SHS science education as moderately implemented as perceived by the students and teachers. As to the students' profiles, there was a significant relationship between technology and the parent's monthly income. There was no significant difference in the extent of implementation of blended learning across all variables as perceived by the teachers. After implementing blended learning, the student's academic achievement in science was outstanding, and this put forward a significant relationship between content and assessment in their academic achievement. The study concluded that several things should be considered in implementing blended learning in the new normal education. Students' and teachers' involvement in the implementation is essential for improving the modality and the school administrators may consider undertaking specific plans and activities such as the need for teachers to attend training, seminars, and workshops related to blended learning implementation.

Background: Millions of children are affected by disasters every year. Children need not be passive victims, however, but instead may contribute to disaster risk reduction activities. Objective: This paper provides a theoretical foundation for children’s involvement in disaster risk reduction activities. Method: The paper reviews and analyses the literature on children’s participation, on their developmental capacity to participate, and on disaster risk reduction activities involving children. Results: Participation yields numerous potential benefits for children, including enhanced personal development and skills, self-efficacy, and interpersonal relationships, and for communities through improved social connections and networks and disaster preparedness. Conclusions: Children are resources to be cultivated and mobilized for disaster preparedness, response, recovery, and resilience. Attention is needed to identify approaches to appropriately enlist, engage, and involve children in disaster risk reduction activities; to promote these efforts; and to evaluate these approaches.

Drug allergies, also termed adverse drug reactions (ADRs), are a problem for individuals of all ages, from paediatric to geriatric, and in all medical settings. They may be a predictable reaction to a specific drug (termed Type A) or particular to the individual (termed Type B). Health professionals, especially those caring for patients at the point of entry into the medical system, have a very important role in determining if and when a patient is having an ADR. The purpose of this article is to review the pathophysiology of ADRs, describe the signs and symptoms of different classifications of ADRs, and present the medical and wound treatment for patients with systemic and cutaneous reactions to drug allergies.

ABSTRACT Enteroaggregative Escherichia coli (EAEC) causes diarrhea and intestinal inflammation worldwide. EAEC strains are characterized by the presence of aggregative adherence fimbriae (AAF), which play a key role in pathogenesis by mediating attachment to the intestinal mucosa and by triggering host inflammatory responses. Here, we identify the epithelial transmembrane mucin MUC1 as an intestinal host cell receptor for EAEC, demonstrating that AAF-mediated interactions between EAEC and MUC1 facilitate enhanced bacterial adhesion. We further demonstrate that EAEC infection also causes elevated expression of MUC1 in inflamed human intestinal tissues. Moreover, we find that MUC1 facilitates AAF-dependent migration of neutrophils across the epithelium in response to EAEC infection. Thus, we show for the first time a proinflammatory role for MUC1 in the host response to an intestinal pathogen. IMPORTANCE EAEC is a clinically important intestinal pathogen that triggers intestinal inflammation and diarrheal illness via mechanisms that are not yet fully understood. Our findings provide new insight into how EAEC triggers host inflammation and underscores the pivotal role of AAFs—the principal adhesins of EAEC—in driving EAEC-associated disease. Most importantly, our findings add a new dimension to the signaling properties of the transmembrane mucin MUC1. Mostly studied for its role in various forms of cancer, MUC1 is widely regarded as playing an anti-inflammatory role in response to infection with bacterial pathogens in various tissues. However, the role of MUC1 during intestinal infections has not been previously explored, and our results describe the first report of MUC1 as a proinflammatory factor following intestinal infection.

BackgroundUnderstanding the experience of Hispanic parents of children diagnosed with asthma can be useful in the delivery of effective and meaningful asthma education. In order to assess the needs of Hispanic families with asthmatic children in South Texas, investigators utilized a combination of qualitative and quantitative research methods.ObjectivesThis study aimed (1) to assess the impact of asthma in the quality of life of Hispanic children and their families and (2) to identify barriers and challenges to asthma management as perceived by parents of children diagnosed with asthma.MethodsA mixed-methods study included a quality-of-life survey and focus group discussions. The Children’s Health Survey for Asthma (CHSA) was completed by 90 parents of children with asthma. Three focus groups were conducted with 15 low-income, Hispanic parents of asthmatic children to assess their needs and experience in managing the disease.ResultsResults from the CHSA showed that asthma significantly affects the quality of life of children with asthma and their families, particularly the emotional dimensions and the child’s physical health. Fifty-three percent of the children had visited the emergency room, and 51% had been hospitalized due to asthma. One out of five parents had missed work, and 27% of children had missed school in the past 2 weeks due to the child’s asthma. In the focus group discussions, the key themes emerging included lack of asthma knowledge, the burden of disease for asthmatic children and their families, and the importance of asthma education and self-management behaviors for asthma control.ConclusionOne of the main challenges faced by Hispanic families with asthmatic children is the lack of asthma-related knowledge to help understand and control their children’s disease. Lack of knowledge and self-management skills lead to significant stress and anxiety among children with asthma and their parents. Results highlight that while asthma has an effect on the quality of life of children and their families, particularly on the emotional health domain, a wide dissemination of asthma management education in different settings might help prevent asthma attacks and improve symptom control among those suffering from this disease along the US–Mexico border.

Developmental models of psychopathology posit that exposure to social stressors may confer risk for depression in adolescent girls by disrupting neural reward circuitry. The current study tested this hypothesis by examining the relationship between early adolescent social stressors and later neural reward processing and depressive symptoms. Participants were 120 girls from an ongoing longitudinal study of precursors to depression across adolescent development. Low parental warmth, peer victimization, and depressive symptoms were assessed when the girls were 11 and 12 years old, and participants completed a monetary reward guessing fMRI task and assessment of depressive symptoms at age 16. Results indicate that low parental warmth was associated with increased response to potential rewards in the medial prefrontal cortex (mPFC), striatum, and amygdala, whereas peer victimization was associated with decreased response to potential rewards in the mPFC. Furthermore, concurrent depressive symptoms were associated with increased reward anticipation response in mPFC and striatal regions that were also associated with early adolescent psychosocial stressors, with mPFC and striatal response mediating the association between social stressors and depressive symptoms. These findings are consistent with developmental models that emphasize the adverse impact of early psychosocial stressors on neural reward processing and risk for depression in adolescence.

Mycoplasma genitalium is a facultative anaerobic organism and a recognized cause of nongonococcal urethritis in men. In women, M. genitalium has been associated with cervicitis, endometritis, pelvic inflammatory disease (PID), infertility, susceptibility to human immunodeficiency virus (HIV), and adverse birth outcomes, indicating a consistent relationship with female genital tract pathology. The global prevalence of M. genitalium among symptomatic and asymptomatic sexually active women ranges between 1 and 6.4%. M. genitalium may play a role in pathogenesis as an independent sexually transmitted pathogen or by facilitating coinfection with another pathogen. The long-term reproductive consequences of M. genitalium infection in asymptomatic individuals need to be investigated further. Though screening for this pathogen is not currently recommended, it should be considered in high-risk populations. Recent guidelines from the Centers for Disease Control regarding first-line treatment for PID do not cover M. genitalium but recommend considering treatment in patients without improvement on standard PID regimens. Prospective studies on the prevalence, pathophysiology, and long-term reproductive consequences of M. genitalium infection in the general population are needed to determine if screening protocols are necessary. New treatment regimens need to be investigated due to increasing drug resistance.

In 2000, the UC Statewide Integrated Pest Management Program (UC IPM) conducted a comprehensive survey of pest management decision-making and pest control practices of cotton growers in the 11 major cotton-producing counties of California. The results indicate progress in growers' knowledge and implementation of IPM principles and techniques, although the use of certain aspects, such as treatment thresholds for insects, often fell short of researchers' recommendations. The survey also confirmed the central role of pest control advisers (PCAs) in IPM decision-making. Although independent PCAs communicate more with growers than do PCAs who are affiliated with product suppliers, PCA affiliation did not affect most on-the-ground pest treatment actions measured by this survey. The results indicate a need to expand IPM adoption surveys to include PCAs and to develop more effective ways of measuring IPM decision-making beyond counting the techniques used or not used.

Data are the foundation of empirical research, yet all too often the datasets underlying published papers are unavailable, incorrect, or poorly curated. This is a serious issue, because future researchers are then unable to validate published results or reuse data to explore new ideas and hypotheses. Even if data files are securely stored and accessible, they must also be accompanied by accurate labels and identifiers. To assess how often problems with metadata or data curation affect the reproducibility of published results, we attempted to reproduce Discriminant Function Analyses (DFAs) from the field of organismal biology. DFA is a commonly used statistical analysis that has changed little since its inception almost eight decades ago, and therefore provides an opportunity to test reproducibility among datasets of varying ages. Out of 100 papers we initially surveyed, fourteen were excluded because they did not present the common types of quantitative result from their DFA or gave insufficient details of their DFA. Of the remaining 86 datasets, there were 15 cases for which we were unable to confidently relate the dataset we received to the one used in the published analysis. The reasons ranged from incomprehensible or absent variable labels, the DFA being performed on an unspecified subset of the data, or the dataset we received being incomplete. We focused on reproducing three common summary statistics from DFAs: the percent variance explained, the percentage correctly assigned and the largest discriminant function coefficient. The reproducibility of the first two was fairly high (20 of 26, and 44 of 60 datasets, respectively), whereas our success rate with the discriminant function coefficients was lower (15 of 26 datasets). When considering all three summary statistics, we were able to completely reproduce 46 (65%) of 71 datasets. While our results show that a majority of studies are reproducible, they highlight the fact that many studies still are not the carefully curated research that the scientific community and public expects.

Interplanting grasses into alfalfa effectively uses grass competition to reduce the amount of weeds in alfalfa hay. The increased production offsets a lower price for the hay content, making the alfalfa-grass hay equally profitable to alfalfa hay sprayed with herbicide. This technique avoids plant-back restrictions from use of some herbicides. Alfalfa weevil populations can be reduced below threshold levels, providing additional benefit from the technique. The percentage of growers interplanting did not change but nearly half of the 24% of growers using interplanting are new users of the technique. Cooperative Extension was viewed as the most useful source for interplanting information by 64% of farmers surveyed.